Stillbirth and newborn data quality and use and related input and process factors: findings of the IMPULSE study in Ethiopia

Background: High quality data is mandatory when shaping action-oriented policies aimed at reducing preventable neonatal deaths. Ethiopia has a high a neonatal mortality rate, but there has been limited assessment of the quality and use of newborn data, and its contributing factors. Methods: We conducted a cross-sectional study in Ethiopia from November 2022 to September 2023 in 35 sites: 24 facilities, 10 subnational data offices, and the Ministry of Health. We collected data using Every Newborn - Measurement Improvement for Newborn & Stillbirth Indicators tools and analysed them per the Performance of Routine Information System Management User's Kit. Results: The major strengths identified in our analysis included governance at subnational data offices (80-90%), use of quality improvement standards (100%), supervision quality (100%) in data offices, sites with internet access (92-100%), routine health information system (RHIS) designated staff (100%), data management in data offices (62-100%), data availability and completeness (91-98%) for denominator elements (total births, live births), and use of data to produce reports in data offices (100%). Regarding key gaps, data accuracy (registers vs. District Health Information Software 2) was low on all 10 newborn indicators (11-67%), while data use for performance review was suboptimal (≤90%) at both in facilities (12-66%) and data offices (21-90%). Key weaknesses in input and process factors included only 40% of data offices having a long-term financial plan for supporting RHIS, 8% of data offices and 16% of facilities having the minimum item bundle in working conditions, few sites having supplies of recording/reporting tools (15-68%, depending on the item), and supervision quality (58-62%), staff skills to perform RHIS tasks (16-40%), and data management (46-75%) being particularly low in facilities. An average of 57% of end users reported a need for improvement in the quality and use of newborn data, as well as in the studied enabling factors. Conclusions: Our findings highlight the specific strengths and weaknesses that need to be addressed to improve data quality and use in the assessed sample in Ethiopia.