DOI: 10.7272/q69s1p7k
title: Migori County Referral Hospital_Gestational Age Data_Nov15-April16

description: Background: Preterm birth is the leading cause of neonatal mortality
 worldwide and specifically in Kenya. Preterm birth is defined by
 gestational age (GA) less than 37 weeks, but GA estimates are questionable
 in the absence of the gold standard of early ultrasound. In Migori County,
 where the majority of women seek care at government facilities and do not
 receive ultrasound dating, the accuracy of the GA estimates, and therefore
 the preterm birth rates, is unknown. Methods: We conducted a retrospective
 chart review of 455 preterm births from Migori County Referral Hospital, a
 level-four government hospital in Western Kenya. Preterm birth was defined
 in this context as all babies less than 2500g and babies greater than
 2500g with a last menstrual period (LMP) calculated GA of less than 37
 weeks. GA estimates from both the maternity register and the individual
 inpatient chart were evaluated for data quality, agreement between
 measurements, and accuracy when compared to the INTERGROWTH-21st
 International Newborn Birthweight Standards as a benchmark. Results:
  Data completeness ranged from 35.3% for recorded GA in the
 inpatient chart to 97.8% for birth weight in the maternity register. LMP
 and recorded GA agreed in 16.8% of cases in the maternity register and
 19.2% of cases in the inpatient chart, while symphysis fundal height
 agreed in 37.1% and 50.5% of cases, respectively. Of the four GA measures
 evaluated, the maternity register recorded GA was accurate in 69.4% of
 cases, maternity register LMP-calculated GA in 57.9% of cases, the
 inpatient recorded GA in 68.8% of cases, and the inpatient LMP-calculated
 GA in 56.0% of cases. Preterm birth rates calculated from the four GA
 measures ranged from 7.5% to 18.8%. Conclusion: Non-ultrasound methods of
 estimating GA result in a wide range of results, with up to five different
 estimates per woman. With such conflicting data, clinical decision making
 is compromised and preterm birth facility estimates are likely inaccurate.
 Widespread access to early ultrasound, new technologies, and/or new
 methods of thinking about GA are urgently needed to improve clinical care
 for the mother-infant dyad, and to better understand the preterm birth
 burden in low-resource settings.
description: The dataset evaluated was
 compiled from two routine data sources at MCRH. The first was the
 maternity register, a large book kept in the maternity ward where
 providers record demographic and clinical data for every birth at the
 facility. The second was the maternity unit inpatient record, the
 individual patient medical chart of each woman admitted to MCRH for labor
 and delivery. Both the maternity register and the inpatient record are
 standardized forms from the Ministry of Health and completed by the
 clinical staff. Data from both sources were entered into a Research
 Electronic Data Capture (REDCap) tool, an online data collection mechanism
 hosted on a secure server at the University of California, San Francisco
 (UCSF) and created in advance by the investigators.
 During the study period, there were 2070 total births at MCRH of
 which 455 were identified as cases from the maternity register by either
 having a birth weight &lt;2500g or having a birth weight &gt;2500g
 and an LMP-calculated GA of &lt;37 weeks. Inpatient records were found
 for 289 (63.5%) of the cases with the remaining 166 missing, mislabeled,
 or otherwise inaccessible. The five GA estimates analyzed were recorded GA
 and calculated GA from the maternity register and recorded GA, calculated
 GA, and SFH from the inpatient chart. 
description: Anybody using this data must credit the authors and the East
 Africa Preterm Birth Initiative.