Labour and delivery ward register data availability, quality, and utility - Every Newborn - birth indicators research tracking in hospitals (EN-BIRTH) study baseline analysis in three countries
Authors: Day Louise Tina , Gore-Langton Georgia R. , Rahman Ahmed Ehsanur , Basnet Omkar , Shabani Josephine , Tahsina Tazeen , Poudel Asmita , Shirima Kizito , Ameen Shafiqul , K.C. Ashish , Salim Nahya , Zaman Sojib Bin , Shamba Donat , Blencowe Hannah , Ruysen Harriet , El Arifeen Shams , Boggs Dorothy , Gordeev Vladimir S. , Rahman Qazi Sadeq-ur , Hossain Tanvir , Joshi Elisha , Thapa Sabu , Poudel Rajendra Prasad , Poudel Durga , Chaudhary Priyanka , Karki Rabina , Chitrakar Bibek , Mkopi Namala , Wisiko Anna , Kitende Alodear Patrick , Shirati Marystella Revocatus , Chingalo Christostomus , Semhando Amina Omari , Mtei Cleopatra , Mwenisongole Victoria , Bakuza John Mathias , Kombo Japhet , Mbaruku Godfrey , Lawn Joy E. 
Published: August 2020

Abstract
Background
Countries with the highest burden of maternal and newborn deaths and stillbirths often have little information on these deaths. Since over 81% of births worldwide now occur in facilities, using routine facility data could reduce this data gap. We assessed the availability, quality, and utility of routine labour and delivery ward register data in five hospitals in Bangladesh, Nepal, and Tanzania. This paper forms the baseline register assessment for the Every Newborn-Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study.

Methods
We extracted 21 data elements from routine hospital labour ward registers, useful to calculate selected maternal and newborn health (MNH) indicators. The study sites were five public hospitals during a one-year period (2016–17). We measured 1) availability: completeness of data elements by register design, 2) data quality: implausibility, internal consistency, and heaping of birthweight and explored 3) utility by calculating selected MNH indicators using the available data.

Results
Data were extracted for 20,075 births. Register design was different between the five hospitals with 10–17 of the 21 selected MNH data elements available. More data were available for health outcomes than interventions. Nearly all available data elements were > 95% complete in four of the five hospitals and implausible values were rare. Data elements captured in specific columns were 85.2% highly complete compared to 25.0% captured in non-specific columns. Birthweight data were less complete for stillbirths than live births at two hospitals, and significant heaping was found in all sites, especially at 2500g and 3000g. All five hospitals recorded count data required to calculate impact indicators including; stillbirth rate, low birthweight rate, Caesarean section rate, and mortality rates.

Conclusions
Data needed to calculate MNH indicators are mostly available and highly complete in EN-BIRTH study hospital routine labour ward registers in Bangladesh, Nepal and Tanzania. Register designs need to include interventions for coverage measurement. There is potential to improve data quality if Health Management Information Systems utilization with feedback loops can be strengthened. Routine health facility data could contribute to reduce the coverage and impact data gap around the time of birth.