Development and utility of tools to identify preventable perinatal deaths: Results from a community-based interventional study in two districts of Karnataka State, India

Background: The presently used perinatal death certificate devised by the World Health Organization is incomplete and does not help in identifying 'preventability.' Objective: To develop tools that can help identify (1) preventable perinatal death and (2) preventable and/or avoidable cause for perinatal deaths. Materials and Methods: As a prerequisite for conduct of a community-based interventional study in two different districts of Karnataka state, two information tools, Perinatal death reporting form (PeNDReF) and perinatal death audit report (PeNDAR), were designed. The process involved series of preparatory and review meetings, before and after the field work to list facilities available, categorize facilities, identify causality, assess risk factors, and assert preventability of a perinatal death. The process was repeated over a period of 6 months and the information tools, PeNDReF and PeNDAR, were finalized. Doctors and paramedical personnel of both the districts were trained to fill the tools, which were analyzed to ascertain contributing risk factors and identify preventable perinatal death. Results: The use of PeNDAR led to identification of 5.7% of perinatal deaths as 'preventable' and 19% as 'possibly preventable.' The use of PeNDReF helped in the identification of risk factors (maternal anemia 49.6%, age of marriage <20 years 18.7%, and maternal weight <50 kg 9.1%), avoidable/preventable factors related to quality of care, transport, and referral. Conclusions: These tools are useful for identifying 'preventable' perinatal deaths and avoidable/preventable factors.