EXECUTIVE SUMMARY
Infant mortality rate (IMR) is a key public health indicator, reflecting not only the overall health of the population but also the social, economic, and environmental conditions under which children and their communities live. Stillbirth rate (SR) is also an important indicator, however stillbirth reporting is sparse and is not prioritized or appropriately financed under policies and programs. The following is the first study on the completeness and accuracy of the Primary Health Care Community Health Department (PHC CHD) database in the West Bank (WB) and PHC Death Registry in the Gaza Strip (GS) for infant deaths and stillbirths based on data from 2019. This audit was conducted in partnership with the Ministry of Health (MoH).
Different sources of data were used in the West Bank (paper forms) and Gaza (electronic forms). Once data was extracted, the number of notified cases at the PHC level was compared with those at the Primary Health Information Center (PHIC) to examine completeness of the PHC registries. Descriptive statistics were used to examine the completeness of administrative and clinical data. The accuracy of reporting for underlying cause of death was examined by a trained pediatrician based on the available clinical data.
For deaths that occur outside hospitals, a certified doctor issues a death notification form (DNF) and provides copies to the parents. For deaths inside the hospital, the attending physician fills in the DNF and provides two copies to the parents. In the West Bank, there are two systems used for death registration, Oracle at PHIC and DHIS2 for the PHC Death Registry. As a result, there is often duplication in data entry and coding the underlying cause of death. Parents must give one copy of the DNF to the PHC Directorate, where a statistician is responsible for entering the data from the administrative part of the form into the DHIS2 system. Another focal point from the PHC Directorate fills in the underlying cause of death and assigns the ICD10 code. The statistician then sends a copy of the DNF to PHIC where it is entered and coded again in the Oracle system. In addition to filling DNFs, obstetric and pediatric/neonatal departments in hospitals are asked to fill out investigation forms for all cases of infant death and stillbirth. The PHC Mother and Child Section/CHD in each district collects investigation forms from all hospitals in that district and sends them to the PHC CHD to be reviewed and entered into an Excel sheet that is used for analysis.
In the Gaza Strip, hospitals fill the DNF and enter the main data. Hospital databases can be accessed through the PHC Death Registry. Parents take two copies of the DNF from the hospital and send one copy to the Ministry of Interior (MoI) and the other copy to the PHC Directorate where a focal point completes missing data based on the hospital’s electronic system, and reviews the administrative portion of the form. PHIC has access to this data, and a focal point is responsible for reviewing and coding the underlying cause of death.
Among the 357 forms found in the PHC CHD database, 11 were DNFs, and the rest were investigation forms. While all cases of infant mortality and stillbirth in the PHIC death registry were found in the PHC Death Registry in the Gaza Strip, less than one-third of infant mortality 4 and stillbirth cases reported by PHIC were found in the PHC CHD infant death and stillbirth database in the West Bank.
