Perinatal Death Surveillance and Response

Reducing Stillbirths and Neonatal Deaths

In many areas of the world, newborns die from preventable causes. An important step in reducing high rates of perinatal mortality (deaths of infants around the time of birth) is to understand its prevalence and causes.

A Perinatal Death Surveillance and Response system:

• Provides information on the causes of newborn death.
• Makes recommendations to prevent future deaths from those causes.
• Serves as an official data resource in places where there is a high risk of perinatal death and less data.

Investigating and Reducing Perinatal Deaths

Many stillbirths and newborn deaths can be prevented when:

• High-risk births are identified early.
• The mother receives skilled birth care.
• The newborn receives help with breathing immediately after birth (resuscitation care).

However, in low resource countries this medical care may be lacking. In addition, these countries may not have complete reporting, surveillance, and death registration systems.

A Perinatal Death Surveillance and Response (PDSR) system can help public health officials to collect information on stillbirths and newborn deaths and to better understand the causes of those deaths. Once the causes are understood, recommendations can be made to improve care and prevent future deaths from those causes.

PDSR follows the same framework as the Maternal Death Surveillance and Response (MDSR). As with MDSR, CDC has collaborated with the World Health Organization (WHO) to develop PDSR guidance for countries to adapt and use.

CDC Provides Assistance With PDSR

CDC provides technical assistance to public health officials in some countries to set up or improve systems that identify, report, and review stillbirths and neonatal deaths in health facilities and in communities with high mortality.

CDC has worked in several countries, evaluating their existing death surveillance systems and helping them to:

• Monitor all pregnancy outcomes (live births, stillbirths, newborn deaths) and the care received, and document all stillbirth and newborn deaths.
  • Example: CDC assisted with surveillance of all stillbirths and newborn deaths in health facilities in Kigoma Region, Tanzania from 2013 through 2023.

• Adapt PDSR guidelines to fit the local setting.
  • Example: CDC assisted Uganda and Cameroon in developing national surveillance guidelines and improving perinatal death reporting.

• Assess and interpret the PDSR data to guide improvements in surveillance and medical care.
  • Example: CDC evaluated the surveillance system set up in Uganda as part of the Saving Mothers, Giving Life initiative (SMGL), and trained staff to improve the system's efficiency. This included introducing a verbal and social autopsy developed in collaboration with WHO.

• Strengthen the system of perinatal reviews to include all stillbirths and pre-discharge newborn deaths.
  • Example: CDC trained staff in Zambia to conduct perinatal death surveillance, including conducting cause-of-death analyses.

PDSR Guidance and Tools

CDC has collaborated with the World Health Organization (WHO) and other global partners to develop and strengthen PDSR guidance and tools, including the following:

• Maternal and perinatal death and surveillance and response: materials to support implementation
• Making Every Baby Count
• Verbal Autopsy for stillbirth and neonatal deaths (Annex 10, page 105)