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Birth and Neonatal Death Registrations
in Jordan
Yousef S. Khader, Mohammad Alyahya, and Anwar Batieha
Contents
Introduction ....................................................................................... 2
Limitations in Mortality Data: Underreporting .. ................................................ 3
Registration of Births and Deaths in Jordan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 5
Registration of Births in Jordan .............................................................. 5
Registration of Deaths in Jordan .............................................................. 6
Problems in Registration of Births and Deaths in Jordan ....................................... 6
Completeness of Neonatal Death Registration ................................................... 7
Conclusions ....................................................................................... 8
Recommendations to Improve the Process of Birth Registration . . .. . . . . . . . . .. . . . . . . . . . . .. . . . . . 10
Recommendations to Improve the Process of Death Registration . . . . .......................... 10
References .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . 11
Abstract
Assessing the magnitude and etiologies of perinatal deaths and their risk factors
begins with accurately defining and reporting these deaths. This chapter examines
to what extent births and neonatal deaths are underreported and discusses the
challenges facing the current registration system in Jordan. Irrespective of where
the event occurs, reporting a birth or death in Jordan to the Civil Status and
Passports Department is initiated by a family member. Stillbirths in Jordan are not
routinely registered. Moreover, the majority of neonatal deaths are underreported,
and the causes of neonatal death are very likely recorded inaccurately. There are
Y. S. Khader · A. Batieha (*)
Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine,
Jordan University of Science & Technology, Irbid, Jordan
e-mail: yskhader@just.edu.jo;batieha@just.edu.jo
M. Alyahya
Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science
and Technology, Irbid, Jordan
e-mail: msalyahya@just.edu.jo
© Springer Nature Switzerland AG 2019
I. Laher (ed.), Handbook of Healthcare in the Arab World,
https://doi.org/10.1007/978-3-319-74365-3_116-1
1
several reasons for this, but avoidable reasons center around the death notifica-
tion, including the causes of death, which is not usually completed by the
attending physician as physicians are not well trained on assigning causes of
death; they are often not aware of the definitions of and distinctions between
direct causes, underlying causes, and contributing causes of death.
The majority of neonatal deaths in Jordan and all stillbirths go unreported
and are not registered in Jordan. The underreporting is mainly attributable to
a dysfunctional reporting system and the fact that families, not the health system,
are responsible for registering births and deaths. Greater investment of resources
is needed to improve vital registration and the health information system in
Jordan. Timely actions are required at two levels: at the institutional level
immediately after a stillbirth or an infant death has occurred and at a national
level from data received from institutional levels. Since a high proportion of
deaths occur in, or have been in contact with, the health system, investments in its
ability to report neonatal deaths are therefore warranted. Clear policies and
guidelines are required to ensure data collection activity is accurate, timely,
comprehensive, and accessible to policy makers.
Keywords
Neonatal deaths · Stillbirths · Registration · Underreporting · Causes of perinatal
deaths
Introduction
Perinatal death rate is widely recognized as a key indicator of population health
status. It is a broad definition which combines neonatal deaths and stillbirths during a
given year per 1000 births (Lawn et al. 2011; World Health Organization 2016a).
Assessing the magnitude and etiologies of these important events and predicting its
risk factors begin with accurately defining and reporting perinatal deaths (Barfield
2016). Although generally accepted by the larger medical community, WHO defi-
nitions are not the basis for perinatal data collection in many countries. Countries
may have their own legal definitions of live births, stillbirths, or infant deaths, which
differ from those recommended by WHO (World Health Organization 2016a; AIHW
et al. 2016; Manning et al. 2014). The criteria for registering these important events
also vary, and the time within which an event must be registered varies between
events and among countries. The reporting of stillbirths, which is an alternative
outcome to live birth, is frequently not explicitly defined or included in national
statistical data; perinatal data is often collected as a by-product of administrative or
legal processes. Timing of registration is usually longer for live births and stillbirths
compared to registration of deaths of live-born infants and adults. As a consequence,
stillbirths and neonatal deaths are not reported accurately because births may not be
recorded prior to early death (World Health Organization 2016b).
Neonatal mortality improvement requires improvement so as to build a trustwor-
thy official reporting system for births and deaths. Tackling underreporting and
2 Y. S. Khader et al.
evaluating the profiles of unregistered deaths will reduce the decision-making based
on invalid information. In doing so, the challenges in neonatal health can be
recognized, and resources may be distributed according to real needs instead of
overly optimistic indicators. In this chapter, we analyze to what extent births and
neonatal deaths are underreported and discuss the challenges of the current registra-
tion system in Jordan.
Limitations in Mortality Data: Underreporting
Reliability of data depends on accurate reporting and recording of births and
deaths, and failure to report the birth of a baby who dies soon afterward leads to
underestimated mortality rates. Underreporting and misclassification are common,
originating both with the parent and with the recording process. Misclassification of
live births and deaths can also occur; there may be a misunderstanding of the
definition of live birth and fetal death or a misunderstanding of the purpose of
reporting. Live births are more likely to be reported compared to fetal or early
neonatal deaths, and a nonviable fetus may systematically be reported as a stillbirth
(World Health Organization 2016b; Atlas 2013; Deb-Rinker et al. 2015).
Countries around the world are increasingly interested in collecting data on
perinatal deaths because of the burden of 2.6 million stillbirths and 2.61 million
neonatal deaths that are estimated to occur every year (UNICEF 2015; United
Nations Inter-agency Group for Child Mortality Estimation (UN IGME) 2017).
In most countries, however, especially those that continue to have high perinatal
mortality rates, there are no effective civil registration and vital statistics systems for
capturing all births and deaths and assigning causes of death. Half of the world’s
children do not receive a birth certificate; and almost all stillbirths and half of all
neonatal deaths are not currently registered. Developing national systems for
reporting births and perinatal deaths is a matter of human rights and a prerequisite
for improving stillbirths and neonatal mortality rates (World Health Organization
2016a; Lawn et al. 2014; Målqvist et al. 2008).
It has been argued that the potential of reporting the infant as being alive may be
associated with the perception of the infant’s survivability (Oza et al. 2014); a young
gestational age and low birth weight reduce survival rates and also reporting death.
Vital statistics, which are derived from birth and death certificates, are available for
more than half of the world countries, but only about 50% of those datasets (mostly
from the wealthiest countries) are reliable (Oza et al. 2014; Oestergaard et al. 2011).
Comparison between vital statistics and surveys carried in different countries,
especially in developing ones, showed that significant numbers of infant and early
deaths remain undocumented. For example, a recent study used the Ethiopian Mini
Demographic and Health Survey (EMDHS) data and found that the rate of stillbirths
was 85 per 1000 total births. This rate was significantly higher than what has been
previously reported (26 stillbirths per 1000) (Lakew et al. 2017; Cousens et al.
2011). Another prospective study carried out in a Nepali district found that the
perinatal mortality rate was 60 per 1000 births and the neonatal mortality rate was
Birth and Neonatal Death Registrations in Jordan 3
38 per 1000 live births (Manandhar et al. 2010). Yet, at the time of the study, the
most recent official estimates of perinatal deaths and neonatal deaths were 45/1000
births and 33/1000 live births, respectively (Population Division 2007). This reflects
a discrepancy between reporting of vital events and the findings of community
survey studies; vital statistics underestimate the true magnitude of perinatal mortality
rates. Furthermore, incomplete reporting or misreporting of vital registration data is
not uncommon even in developed countries (Farquhar et al. 2015; Seske et al. 2017).
Results from a study aimed to recognize the limitations of combining fetal and
neonatal death records and to find opportunities for improving fetal death registra-
tion in New York City showed that fetal death records frequently lack important
information including demographic, medical, and cause of death (Lee et al. 2014).
The results confirmed the findings of previous studies concerning completeness
of fetal death registration (Lee et al. 2014; Duke et al. 2008). Another US retrospec-
tive cohort study was conducted to evaluate the reliability of infant death certificate
information regarding cause of death in comparison with related autopsy data and
confirmed a considerable disconnect between infant cause of death data derived from
vital records and autopsy data (Seske et al. 2017).
According to the WHO, perhaps 40% or more of early neonatal deaths and
stillbirths may go unreported in official data. Underreporting is also a problem in
birth registration. There may be various reasons for why children are registered late
or not at all. In some countries the responsibility to register newborns is put on the
families, who often have a poor understanding of the necessity of registration. Many
parents simply do not see an urgent need for the procedure and, particularly in
remote areas, simply do not have easy access to registrars. According to a UNICEF
study, less than half of the families in Vietnam had registered their child within the
legally prescribed time period (UNICEF 2000). If the responsibility to report births
and deaths was instead placed on the institutions where these events occurred, more
reliable statistics could be produced.
Inconsistency between various terminologies used to evaluate pregnancy could
also lead to underreporting at several levels. In this sense, livebirth, perinatal death,
neonatal death, stillbirth, fetal death, and abortion terms have definitions which may
overlap based on the country or the health facility. For example, the WHO recom-
mends reporting of livebirths weighing at least 500 g or born after 22 weeks
of gestation (World Health Organization 2016b). Another well-recognized difficulty
in the registration of neonatal deaths is the matter of defining early neonatal deaths
from stillbirths. To distinguish whether a baby dies intrapartum or shows signs of life
immediately after delivery can be difficult, and establishing the boundary can be
a source of confusion. In some countries where neonatal survivability is uncertain,
the baby remains unnamed and unreported, and if death occurs early in neonatal life,
it will not be registered as a live birth. Similarly, due to variations in the timing of
the death during the neonatal period and national reporting standards, a live birth
with less than 28 weeks of gestation will be recorded as an abortion case rather than
a live birth (Pathirana et al. 2016).
To avoid this, perinatal mortality has often been used as a measure that combines
the stillbirth rate with the early neonatal mortality rate. Especially in a setting with
4 Y. S. Khader et al.
a large proportion of home deliveries, perinatal mortality has been widely used as an
indicator especially where there is a large proportion of home deliveries, thereby
avoiding the trouble of definition. However, considering the differences in etiology
between stillbirths and neonatal deaths, and the subsequent possible preventive
interventions, there is an argument for stratifying them (Kramer et al. 2002).
Underreporting of births and deaths may have severe consequences for policy
formulation, health planning, research, and resource allocation at all levels in the
pursuit of improved neonatal survival. Without statistics based on local data, it will
be difficult to target interventions to reach those in greatest need. Pregnant women
will not take adequate precautions before delivery since pregnancy may be perceived
as a normal part of life and not as a potentially hazardous situation (Mesko et al.
2003). Initiatives by local actors or NGOs will not be backed up by statistics, and
local authorities will not act to solve problems that they perceive not to have. On the
contrary, local health authorities might even encourage underreporting in order to
gain approval and rewards from central authorities.
To register the death of a newborn is, however, not only a matter of statistics
but also a matter of human rights. The right to birth registration is part of the UN
Convention on the Rights of the Child (Pais 2002), but despite this fact, newborns
not reported to have died are often not even registered as being born. The imple-
mentation and enforcement of human rights depend on civil registration, something
that is not well known or recognized in many parts of the world (Jewkes and Wood
1998). Acknowledging and reporting a neonatal death strengthens the position and
rights of the living by acknowledging that every child is a human being from the
moment of birth. The UN Millennium Project states that in order to improve
the situation of women’s and children’s health in the world, human rights need to
be highlighted and enforced (Freedman and Millénaire 2005). Pursuing a true
representation of child survival is an integral part of this effort (Filippi et al. 2006).
Registration of Births and Deaths in Jordan
Birth registration as defined by UNICEF is the continuous, permanent, and universal
reporting process, within the civil registry system, of the incidence and main
characteristics of births based on the legal requirements of a country. In Jordan,
99% of live births are registered through the civil registration system which is
a centralized system (UNICEF 2013). The Department of Civil Status and Passport
(under the Ministry of Interior) is responsible for all civil registrations in the country.
There are 74 suboffices spread around the country, and offices within the Department
of Civil Status and Passport are linked to a computer network, operated by the
network management center.
Registration of Births in Jordan
Usually the notification of a birth is prepared by a health institution and in a limited
number of cases by a local government official such as a village chief (i.e.,
Birth and Neonatal Death Registrations in Jordan 5
Al-Mukhtar). To document the birth of a baby (issuing a birth certification), the
notification should be submitted to the registrar of the Department of Civil Status and
Passport. The notification report has no legal value other than being informative
(Department of Civil Status and Passport 2018).
Current legislation on birth registration requires that all births occurring in Jordan
(including to foreign citizens) should be reported to the civil registration administra-
tion within 30 days of birth. For the registration of births occurring in the country, the
family member, family book (or passport for foreigners), and proof from the hospital
have to be presented. The government imposes a fine for late registration. Birth
certificates for births reported after 30 days but within 1 year are fined 10 Jordanian
Dinars (JD), equivalent to about US $14. Births reported after 1 year requires a court
decision to be registered, and a 10 JD fine should be paid. While this fine enforces and
encourages parents to register their babies on time, it can also put a burden on families
that find it difficult to register, such as those living in remote areas that are poorly
served by government services. For Jordanians born outside the country, a similar
process is followed, but the time periods described earlier are extended to 90 days
instead of 30 days and to 2 years instead of 1 year. A birth certificate from the country
in which the baby was born can be exchanged with a Jordanian birth certificate
irrespective of the time elapsed. Reporting of births is carried out by the baby’s family
member or a family member (Department of Civil Status and Passport 2018).
Once a birth certificate is issued, each child is given a unique and unchangeable
national identification number (NID). This unique official number is used in
government transactions. Moreover, the NID is also used to securely access
a patient’s centric health record which can be retrieved from any automated health
institution –through the Hakeem program –across the country. The Hakeem
program was launched in 2009 to facilitate efficient, high-quality healthcare services
through the nationwide implementation of an electronic health record solution
(HER) (Solution EH 2018).
Registration of Deaths in Jordan
The death registration process is similar to the process of birth registration. Deaths
occurring within the country have to be reported with the following documents: the
presence of a qualified family member, family book and NID for Jordanians who
die within Jordan (or passport for foreigners), and proof from the hospital or other
eligible agencies. Deaths should be reported within 1 week of death; death certifi-
cates for deaths reported after 7 days but within 1 year are fined 10 JD. A court
decision is needed to register deaths reported after 1 year.
Problems in Registration of Births and Deaths in Jordan
Irrespective of where the event occurs, the reporting of a birth or death to the Civil
Status and Passports Department is initiated by a family member. Families report
births to preserve the baby’s privileges, such as health insurance, vaccination,
6 Y. S. Khader et al.
admission to school, inheritance, and so on. However, if the baby dies shortly after
birth, then families may have no interest in reporting the birth or the death. Similarly,
deaths of people who have no property are unlikely to be reported. According to the
latest analytical study conducted in 2015, the infant mortality rate for males and
females were 18.4 and 15.8 infant deaths per 1000 live births (Statistcs Do 2016).
While the infant mortality rate (per 1000 live births) was reported at 15.0 for the
same year according to the 2016 UNICEF report (UNICEF 2016). These conflicting
figures reflect the fact that the death registration system in Jordan does not cover all
events. The problem of underreporting is also magnified because people are largely
unaware of the need for early reporting, and the fine for late reporting is too small to
deter people.
The cause/s of death are likely to be recorded inaccurately. There are several
reasons for this, but important, avoidable reasons include:
(a) The death notification, including the causes of death, is not usually completed by
the attending physician.
(b) Physicians are not well trained on how to assign causes of death; they are often
not aware of the definitions of and distinctions between direct causes, underlying
causes, and contributing causes of death.
A new registration system was launched in March 2018. Each individual birth
and death will be recorded so that trends can be identified. The dataset of the new
system will enable multivariable analysis to produce an initial report on perinatal
mortality and therefore make necessary changes to prevent future losses. The goal of
such a system is not only to accurately report perinatal deaths but also to collaborate
with the wider maternity community and enhance maternal healthcare services in
Jordan.
Completeness of Neonatal Death Registration
Under-registration of births and deaths in Jordan may have a substantial impact on
reported neonatal and infant death rates and distort international mortality compar-
isons. There is a need for valid health statistics and data reporting on child births and
deaths as such official figures are important for policy formation, planning,
and allocation of funds. They are also necessary for the design and monitoring
of interventions aimed at improving child survival. According to a workshop report
by the Civil Administration in 2005, about 1.5% of births were not registered
because the babies died early, and a further 80% of infant deaths were not recorded.
A tendency to under-register female deaths was also observed since registered
female deaths accounted for only 40% of all registered deaths.
There is currently little data available on stillbirths in Jordan. According to the
WHO estimation in 2000, the stillbirth rate was 13 per 1000. With a neonatal
mortality rate reaching 17 per 1000, the perinatal mortality rate was estimated as
26 per 1000 live births. In 2002, a survey conducted in the Deir-Alla district of
Birth and Neonatal Death Registrations in Jordan 7
Jordan found that 72.2% of child deaths including stillbirths were not registered
(Al Rabee and Al Kafajei 2006).
The Jordan Neonatal Mortality Study (Batieha et al. 2016) is a national prospec-
tive study in which a total of 21,928 women who gave birth (a total 22,591 births) in
18 selected hospitals during the study period were followed up for 28 days to verify
the status of their newborns (dead or alive) and to identify causes and predictors of
neonatal death. The study provided a unique opportunity to assess the completeness
of registration of stillbirths and neonatal deaths by the Department of Civil Status
and Passport. To analyze the extent to which neonatal deaths were unregistered,
268 out of 327 neonatal deaths identified during the study period were cross-checked
with the Department of Civil Status and Passport registry to determine how many
were captured. The baby’s national number was used for cross-checking, and when it
was unavailable, the name of the mother and other information such as residency,
father’s name, and hospital of child birth were used for cross-checking. The neonatal
deaths were cross-checked 2–8 months after the babies’deaths, with the vast
majority being checked 6–7 months after death. The same procedure was used to
cross-check for stillbirths.
No stillbirth was registered in the Department of Civil Status and Passport
registry. Of the total 268 neonatal deaths identified in the prospective study,
207 (77.2%) neonatal deaths were not registered, 22 (8.2%) were still registered as
alive, and 39 (14.6%) neonatal deaths were accurately registered as dead. Overall,
the rate of under-registration of neonatal deaths was 85.4% (95% CI: 81.2–89.6%).
The rate of under-registration of neonatal deaths according to different variables
including region, type of hospital, timing of death, gender of the baby, gestational
age, birth weight, mother’s employment status and education, and father’s education
is shown in Table 1. The rate of under-registration of neonatal deaths varied
significantly according to gestational age (p-value =0.021) and father’s level of
education (p-value =0.006). The rate of under-registration of neonatal deaths was
the highest (90.4%) for preterm babies (31 gestational weeks). The corresponding
rates were 84.0% for older preterm babies (32–36 gestational weeks) and 76.4% for
full-term babies (37 gestational weeks). Neonatal deaths in babies born to fathers
with 12 years of education were more likely to be unregistered compared to
neonatal deaths of babies born to fathers with >12 years of education (88.4%
vs. 73.6%). On the other hand, the data does not support the claim that female deaths
are more likely to go unregistered compared to male deaths. The rate of under-
registration of female neonatal deaths (83.3%) was not significantly different from
the rate of under-registration of male neonatal deaths (86.9%). The registered cause
of neonatal deaths was appropriately recorded for only 3 of the 39 registered deaths.
Conclusions
The majority of neonatal deaths in Jordan and all stillbirths go unreported and are not
registered in Jordan. The underreporting is mainly attributable to a dysfunctional
reporting system and the fact that families, not the health system, are responsible for
8 Y. S. Khader et al.
Table 1 Rates of under-registration of neonatal deaths in the Department of Civil Status and
Passport registry, Jordan
Not registered as dead
(N=229) N (%)
Registered as dead (N=39)
N (%)
P-
value
Region 0.478
North 83 (88.3) 11 (11.7)
Middle 129 (83.2) 26 (16.8)
South 17 (89.5) 2 (10.5)
Type of hospital 0.062
Private 13 (76.5) 4 (23.5)
Public 131 (88.5) 17 (11.5)
Military 73 (85.9) 12 (14.1)
Teaching 12 (66.7) 6 (33.3)
Mother’s education
(years)
0.089
12 171 (87.7) 24 (12.3)
>12 58 (79.5) 15 (20.5)
Father’s education
(years)
0.006
12 190 (88.4) 25 (11.6)
>12 39 (73.6) 14 (26.4)
Mother’s occupation 0.365
Housewife 207 (84.8) 37 (15.2)
Employed 22 (91.7) 2 (8.3)
Gender of baby 0.420
Male 139 (86.9) 21 (13.1)
Female 90 (83.3) 18 (16.7)
Timing of neonatal
death
0.411
Early neonatal
death
194 (86.2) 31 (13.8)
Late neonatal
death
35 (81.4) 8 (18.6)
Birth weight (g) 0.059
<1000 62 (89.9) 7 (10.1)
1000 to <1500 56 (88.9) 7 (11.1)
1500 to <2500 67 (87.0) 10 (13.0)
2500 44 (74.6) 15 (25.4)
Gestational age
(weeks)
0.021
31 132 (90.4) 14 (9.6)
32–36 42 (84.0) 8 (16.0)
37 55 (76.4) 17 (23.6)
Birth and Neonatal Death Registrations in Jordan 9
registering births and deaths. Greater investment of resources is needed to make
systemic improvements in vital registration data and for the collection of routine
information in Jordan. Timely actions are required at two levels: at the institutional
level immediately after a stillbirth or an infant death has occurred and at the national
level as a result of data received from the institutional level. Since a high proportion
of deaths occur in babies born in (or have been in contact with) the health system,
investments in its ability to report neonatal deaths are warranted. Clear policies and
guidelines are required to ensure data collection is timely, accurate, comprehensive,
and customized for the purposes required.
Recommendations to Improve the Process of Birth Registration
The following are recommendations to improve the process of birth registration:
•There is a need for legislation that obliges hospitals and other places where
deliveries occur to directly report births to the Department of Civil Status and
Passport in a timely manner. Knowing that about 99% of all deliveries occur in
hospitals, such legislation, if properly implemented, would boost the complete-
ness and timely coverage of births in Jordan. An electronic system automatically
connecting the Department of Civil Status and Passport with hospitals would be
ideal for the registration process
•Community awareness programs are needed to capture the remaining roughly 1%
of births that are unreported. Implementation of public awareness programs on
the importance of birth registration and an accurate system of vital records should
be initiated at the national and local levels.
•Requiring the national identification number (NID) as a prerequisite for receiving
healthcare, vaccinations in health facilities, and other benefits can also
help improve birth registration. To avoid denying essential health services to
the baby, the health facility can take the opportunity to report the birth to the
Department of Civil Status and Passport while simultaneously providing the
services.
•Birth registration should be carried out free of charge. Fees may be charged for
issuance of a birth certificate.
Recommendations to Improve the Process of Death Registration
To improve the process of death registration, the following changes are
recommended:
•The legislation and electronic system proposed above to improve birth registra-
tion should be extended to cover registration of deaths.
•Introduce reporting requirements for fetal demise or stillbirth.
10 Y. S. Khader et al.
•Strict adherence to obtaining a burial permit should be enforced by
municipalities.
•In order to consider preventable factors, there is a need for a classification system
to identify the most important factors or health conditions which might lead to or
cause the death of an infant. Moreover, physicians should be trained on how to
identify the correct causes of death.
•Institutionalize basic training regarding concepts of death certification practices in
medical school and postgraduate training curricula.
•Conduct training for both healthcare providers involved in certifying births and
death and the coders responsible for assigning the International Classification of
Diseases-10th revision (ICD-10) codes.
References
AIHW, Monk A, Harris K, Donnolley N, Hilder L, Humphrey M, Gordon A, Chambers GM (2016)
Perinatal deaths in Australia, 1993–2012, Perinatal deaths series no. 1. Cat. no. PER 86. AIHW,
Canberra
Al Rabee K, Al Kafajei A (2006) Evaluation of child deaths registration in a Jordanian community.
East Meditrr Health J 12(1–2):23–34
Atlas SW (2013) In excellent health: setting the record straight on America’s Health Care. Hoover
Press, California, USA
Barfield WD (2016) Standard terminology for fetal, infant, and perinatal deaths. Pediatrics 137(5):
e20160551
Batieha AM, Khader YS, Berdzuli N, Chua-Oon C, Badran EF, Al-sheyab NA et al (2016) Level,
causes and risk factors of neonatal mortality, in Jordan: results of a national prospective study.
Matern Child Health J 20(5):1061–1071
Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L et al (2011) National, regional,
and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis.
Lancet 377(9774):1319–1330
Deb-Rinker P, León JA, Gilbert NL, Rouleau J, Andersen A-MN, Bjarnadóttir RI et al (2015)
Differences in perinatal and infant mortality in high-income countries: artifacts of birth regis-
tration or evidence of true differences? BMC Pediatr 15:112
Department of Civil Status and Passport (2018) Birth regestration in Jordan: Department of Civil
Status and Passport. http://www.cspd.gov.jo/SubDefault.aspx?PageId=186&MenuId=114
Duke W, Williams L, Correa A (2008) Using active birth defects surveillance programs to
supplement data on fetal death reports: improving surveillance data on stillbirths. Birth Defects
Res A Clin Mol Teratol 82(11):799–804
Farquhar C, Armstrong S, Kim B, Masson V, Sadler L (2015) Underreporting of maternal and
perinatal adverse events in New Zealand. BMJ Open 5(7):e007970
Filippi V, Ronsmans C, Campbell OMR, Graham WJ, Mills A, Borghi J et al (2006) Maternal health
in poor countries: the broader context and a call for action. Lancet 368(9546):1535–1541
Freedman LP, Millénaire POD (2005) Who’s got the power? Transforming health systems for
women and children. Earthscan, London
Jewkes R, Wood K (1998) Competing discourses of vital registration and personhood: perspectives
from rural South Africa. Soc Sci Med 46(8):1043–1056
Kramer MS, Liu S, Luo Z, Yuan H, Platt RW, Joseph KS, Fetal and Infant Health Study Group of
the Canadian Perinatal Surveillance System (2002) Analysis of perinatal mortality and its
components: time for a change? Am J Epidemiol 156(6):493–497
Lakew D, Tesfaye D, Mekonnen H (2017) Determinants of stillbirth among women deliveries at
Amhara region, Ethiopia. BMC Pregnancy Childbirth 17(1):375
Birth and Neonatal Death Registrations in Jordan 11
Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I et al (2011) Stillbirths: Where?
When? Why? How to make the data count? Lancet 377(9775):1448–1463
Lawn JE, Blencowe H, Oza S, You D, Lee AC, Waiswa P et al (2014) Every Newborn: progress,
priorities, and potential beyond survival. Lancet 384(9938):189–205
Lee EJ, Gambatese M, Begier E, Soto A, Das T, Madsen A (2014) Understanding perinatal death:
a systematic analysis of New York City fetal and neonatal death vital record data and implica-
tions for improvement, 2007–2011. Matern Child Health J 18(8):1945–1954
Målqvist M, Eriksson L, Nga NT, Fagerland LI, Hoa DP, Wallin L et al (2008) Unreported births
and deaths, a severe obstacle for improved neonatal survival in low-income countries;
a population based study. BMC Int Health Hum Rights 8(1):4
Manandhar SR, Ojha A, Manandhar DS, Shrestha B, Shrestha D, Saville N et al (2010) Causes of
stillbirths and neonatal deaths in Dhanusha district, Nepal: a verbal autopsy study. Kathmandu
Univ Med J 8(29):62–72
Manning E, Corcoran P, Meaney S, Greene RA, on behalf of the Perinatal Mortality Group (2014)
Perinatal mortality in Ireland annual report 2012. National Perinatal Epidemiology Centre, Cork
Mesko N, Osrin D, Tamang S, Shrestha BP, Manandhar DS, Manandhar M et al (2003) Care for
perinatal illness in rural Nepal: a descriptive study with cross-sectional and qualitative compo-
nents. BMC Int Health Hum Rights 3(1):3
Ministry of Health and Population (MOHP) [Nepal], New ERA, and Macro International Inc. 2007.
Nepal Demographic and Health Survey 2006. Kathmandu, Nepal: Ministry of Health and
Population, New ERA, and Macro International Inc
Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, Cousens S et al (2011) Neonatal
mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of
progress, projections, and priorities. PLoS Med 8(8):e1001080
Oza S, Cousens SN, Lawn JE (2014) Estimation of daily risk of neonatal death, including the day of
birth, in 186 countries in 2013: a vital-registration and modelling-based study. Lancet Glob
Health 2(11):e635–ee44
Pais MS (2002) Birth registration: right from the start. UNICEF Innocenti Dig 2(1):1–32
Pathirana J, Muñoz FM, Abbing-Karahagopian V, Bhat N, Harris T, Kapoor A et al (2016) Neonatal
death: case definition & guidelines for data collection, analysis, and presentation of immuniza-
tion safety data. Vaccine 34(49):6027–6037
Seske LM, Muglia LJ, Hall ES, Bove KE, Greenberg JM (2017) Infant mortality, cause of death,
and vital records reporting in Ohio, United States. Matern Child Health J 21(4):727–733
Solution EH (2018) KAKEEM: EHS. https://ehs.com.jo/
Statistcs Do (2016) Deaths in Jordan: maternity and adult mortality. In: Statistcs Do (ed)
UNICEF (2000) Birth registration in Viet Nam: securing children’s right to an identity. UNICEF,
California, USA
UNICEF (2013) Every child’s birth right: inequities and trends in birth registration. UNICEF,
New York
UNICEF (2015) Child mortality estimates. United Nations Children’s Fund, New York. http://www.
childmortality.org/index.php?r=site/index
UNICEF (2016) The State of the World’s Children 2016: A fair chance for every child. UNICEF,
New York
United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) (2017) ‘Levels &
trends in child mortality: report 2017. Estimates Developed by the UN Inter-agency Group for
Child Mortality Estimation’, United Nations Children’s Fund, New York
World Health Organization (2016a) Making every baby count: audit and review of stillbirths and
neonatal deaths. http://www.who.int/maternal_child_adolescent/documents/stillbirth-neonatal-
death-review/en/
World Health Organization (2016b) Neonatal and perinatal mortality: country, regional and global
estimates. World Health Organization, Geneva
12 Y. S. Khader et al.
