title: eRegistries: indicators for the WHO Essential Interventions for reproductive, maternal, newborn and child health.
abstract: Electronic health registries - eRegistries - can systematically collect relevant information at the point of care for reproductive, maternal, newborn and child health (RMNCH). However, a suite of process and outcome indicators is needed for RMNCH to monitor care and to ensure comparability between settings. Here we report on the assessment of current global indicators and the development of a suite of indicators for the WHO Essential Interventions for use at various levels of health care systems nationally and globally.
  
  
  
  Currently available indicators from both household and facility surveys were collated through publicly available global databases and respective survey instruments. We then developed a suite of potential indicators and associated data points for the 45 WHO Essential Interventions spanning preconception to newborn care. Four types of performance indicators were identified (where applicable): process (i.e. coverage) and outcome (i.e. impact) indicators for both screening and treatment/prevention. Indicators were evaluated by an international expert panel against the eRegistries indicator evaluation criteria and further refined based on feedback by the eRegistries technical team.
  
  
  
  Of the 45 WHO Essential Interventions, only 16 were addressed in any of the household survey data available. A set of 216 potential indicators was developed. These indicators were generally evaluated favourably by the panel, but difficulties in data ascertainment, including for outcome measures of cause-specific morbidity and mortality, were frequently reported as barriers to the feasibility of indicators. Indicators were refined based on feedback, culminating in the final list of 193 total unique indicators: 93 for preconception and antenatal care; 53 for childbirth and postpartum care; and 47 for newborn and small and ill baby care.
  
  
  
  Large gaps exist in the availability of information currently collected to support the implementation of the WHO Essential Interventions. The development of this suite of indicators can be used to support the implementation of eRegistries and other data platforms, to ensure that data are utilised to support evidence-based practice, facilitate measurement and accountability, and improve maternal and child health outcomes.
authors.affiliation: Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia. vicki.flenady@mater.uq.edu.au.|International Stillbirth Alliance, Bristol, UK. vicki.flenady@mater.uq.edu.au.
authors.forename: Vicki
authors.initials: V
authors.lastname: Flenady
authors.affiliation: Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.|International Stillbirth Alliance, Bristol, UK.
authors.forename: Aleena M
authors.initials: AM
authors.lastname: Wojcieszek
authors.affiliation: Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Ingvild
authors.initials: I
authors.lastname: Fjeldheim
authors.affiliation: Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Ingrid K
authors.initials: IK
authors.lastname: Friberg
authors.affiliation: Department of Epidemiology and Biostatics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.|Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International health, University of Bergen, Bergen, Norway.
authors.forename: Victoria
authors.initials: V
authors.lastname: Nankabirwa
authors.affiliation: Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.|Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International health, University of Bergen, Bergen, Norway.
authors.forename: Jagrati V
authors.initials: JV
authors.lastname: Jani
authors.affiliation: Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Sonja
authors.initials: S
authors.lastname: Myhre
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.
authors.forename: Philippa
authors.initials: P
authors.lastname: Middleton
authors.affiliation: South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.|Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Caroline
authors.initials: C
authors.lastname: Crowther
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Griffith University & Gold Coast University Hospital, Gold Coast, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Ellwood
authors.affiliation: Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Tudehope
authors.affiliation: Medical Research Council, University of Pretoria, Pretoria, South Africa.
authors.forename: Robert
authors.initials: R
authors.lastname: Pattinson
authors.affiliation: Penang Medical College and Penang Hospital, Penang, Malaysia.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Ho
authors.affiliation: Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Jiji
authors.initials: J
authors.lastname: Matthews
authors.affiliation: The Australian Nurse Family Partnership Program National Program Centre, Abt Australia, Brisbane, Australia.
authors.forename: Aurora
authors.initials: A
authors.lastname: Bermudez Ortega
authors.affiliation: Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.|Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International health, University of Bergen, Bergen, Norway.
authors.forename: Mahima
authors.initials: M
authors.lastname: Venkateswaran
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Doris
authors.initials: D
authors.lastname: Chou
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Lale
authors.initials: L
authors.lastname: Say
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Garret
authors.initials: G
authors.lastname: Mehl
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.|Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International health, University of Bergen, Bergen, Norway.
authors.forename: J Frederik
authors.initials: JF
authors.lastname: Frøen
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000706:statistics & numerical data; D007231:Infant, Newborn; D000068101:Maternal-Child Health Services / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D036801:Parturition; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data*; D014944:World Health Organization; D055815:Young Adult
keywords: Intervention coverage; Maternal health; Newborn health; Outcome indicators; Performance indicators; Perinatal health; Process indicators; Registries; ehealth