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. 2020 Nov 24;10(11):e038859.
doi: 10.1136/bmjopen-2020-038859.

Informing prevention of stillbirth and preterm birth in Malawi: development of a minimum dataset for health facilities participating in the DIPLOMATIC collaboration

Beatrix von Wissmann  1   2 , Elizabeth Wastnedge  3 , Donald Waters  3 , Luis A Gadama  4 , Queen Dube  5 , Clemens Masesa  6 , Elizabeth Chodzaza  7 , Sarah Jane Stock  8 , Rebecca M Reynolds  9 , John Norrie  10 , Enita Makwakwa  11 , Bridget Freyne  5   12 , Harry Campbell  13 , Jane E Norman  14 , Rachael Wood  15   16 ; DIPLOMATIC collaboration
Collaborators, Affiliations

Informing prevention of stillbirth and preterm birth in Malawi: development of a minimum dataset for health facilities participating in the DIPLOMATIC collaboration

Beatrix von Wissmann et al. BMJ Open. .

Abstract

Objective: The global research group, DIPLOMATIC (Using eviDence, Implementation science, and a clinical trial PLatform to Optimise MATernal and newborn health in low Income Countries), aims to reduce stillbirths and preterm births and optimise outcomes for babies born preterm. Minimum datasets for routine data collection in healthcare facilities participating in DIPLOMATIC (initially in Malawi) were designed to assist understanding of baseline maternal and neonatal care processes and outcomes, and facilitate evaluation of improvement interventions and pragmatic clinical trials.

Design: Published and grey literature was reviewed alongside extensive in-country consultation to define relevant clinical best practice guidance, and the existing local data and reporting infrastructure, to identify requirements for the minimum datasets. Data elements were subjected to iterative rounds of consultation with topic experts in Malawi and Scotland, the relevant Malawian professional bodies and the Ministry of Health in Malawi to ensure relevance, validity and feasibility.

Setting: Antenatal, maternity and specialist neonatal care in Malawi.

Results: The resulting three minimum datasets cover the maternal and neonatal healthcare journey for antenatal, maternity and specialist neonatal care, with provision for effective linkage of records for mother/baby pairs. They can facilitate consistent, precise recording of relevant outcomes (stillbirths, preterm births, neonatal deaths), risk factors and key care processes.

Conclusions: Poor quality routine data on care processes and outcomes constrain healthcare system improvement. The datasets developed for implementation in DIPLOMATIC partner facilities reflect, and hence support delivery of, internationally agreed best practice for maternal and newborn care in low-income settings. Informed by extensive consultation, they are designed to integrate with existing local data infrastructure and reporting as well as meeting research data needs. This work provides a transferable example of strengthening data infrastructure to underpin a learning healthcare system approach in low-income settings.DIPLOMATIC is funded by the UK National Institute for Health Research.

Keywords: information management; international health services; neonatology; obstetrics; quality in health care.

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Conflict of interest statement

Competing interests: SJS reports grants from NIHR HTA, non-financial support from HOLOGIC, non-financial support from PARSAGEN, non-financial support from MEDIX BIOCHEMICA, during the conduct of the study; and SJS declares being a member of the HTA general committee. JN reports membership of the following NIHR boards: Commissioning Priority Review decision-making committee (2015); Health Technology Assessment (HTA) Commissioning Board (2010–2016); HTA Commissioning Sub-Board (Expression of Interest) (2014); HTA Funding Boards Policy Group (2016–2019); HTA General Board (2016–2019); HTA Post-Board funding teleconference (2016–2019); NIHR Clinical Trials Unit Standing Advisory Committee (2018–present); NIHR HTA and Efficacy and Mechanism Evaluation Editorial Board (2014–2019); Pre-exposure Prophylaxis Impact Review Panel (2017). JEN reports being named as Principal Investigator on government and charitable research grants to her institution which aim to improve pregnancy outcome. In the last 3 years, she has provided consultancy to Pharma companies GSK and Dilafor: her institution was remunerated for this. Her institution has received travel and subsistence expenses from Merck to facilitate her speaking at a Merck-sponsored symposium on metformin. She is on Subpanel A1 for REF, and on a Wellcome Trust Science interview panel, and receive personal remuneration for each.

Figures

Figure 1
Figure 1
Flowchart summarising the datasets’ design process. ANC, antenatal care; DIPLOMATIC, Using eviDence, Implementation science, and a clinical trial PLatform to Optimise MATernal and newborn health in low Income Countries; ID, identifier.
Figure 2
Figure 2
DIPLOMATIC datasets structure (horizontal lines between the three ID/demography elements highlight that these facilitate the linkage of the different datasets for the same individual and/or mother/baby pairings; different shading within the maternal discharge and the specialist neonatal care datasets show the retrospective summary sections). DIPLOMATIC, Using eviDence, Implementation science, and a clinical trial PLatform to Optimise MATernal and newborn health in low Income Countries; EDD, estimated date of delivery; ID, identifier.
See this image and copyright information in PMC

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