Controlled impact evaluation of a birth registration ...

Bull World Health Organ 201997259ndash269 | doi httpdxdoiorg102471BLT18221705

Research

259

IntroductionCivil registration records the occurrence and characteristics of vital events providing individuals with legal proof of identity and family relationships and protecting children from exploi-tation1ndash6 Having a birth registration grants legal protection and fundamental rights especially for the most vulnerable children such as those belonging to ethnic minorities or who have been orphaned7 The registration facilitates the production of vital statistics the measurement of fertility and mortality the monitoring of population movements89 and the development of data-driven policies and interventions56 Studies have shown that a direct correlation exists between the presence of a well-functioning civil registration and vital statistics system within a country and the health outcomes of its population810ndash12 Fur-ther timely registration (defined in Burkina Faso law as within 60 days of birth) is a prerequisite for tracing and recording neo-natal and infant deaths513 Civil registration is also more accurate and costndasheffective than other statistical sources14ndash16 Although analysis based on data from Demographic and Health Surveys or Multiple Indicator Cluster Surveys1117ndash19 and cross-sectional studies can determine the proportion of registered individu-als20ndash24 such surveys and studies cannot identify interventions to improve this proportion

In the sub-Saharan country of Burkina Faso each munici-pality has a principal civil registration centre and vital events can only be recorded in the municipality in which the event occurred The mayor is permitted to establish secondary civil registration centres in villages and health centres but these are rare Births and deaths can be registered for free within 60 days of their occurrence Event registration after this period is only possible in principal registration centres after a judi-cial procedure and payment of a fine of about 4 United States dollars2526 Despite these penalties the registrations of births in Burkina Faso and in most sub-Saharan African countries are predominantly late227 by examining a sample of registers we identified that about 80 of birth registrations during a 4-month period in 2014 took place more than 60 days after birth (Martelli E et al SantrsquoEgidio unpublished data 2014)

To promote civil registration SantrsquoEgidio an international faith-based organization launched the Birth Registration for All Versus Oblivion (BRAVO) programme in 2008 The programme is currently active in Burkina Faso Malawi and Mozambique7

28 In Burkina Faso SantrsquoEgidio birth registration programme advised and supported the national registration campaign in 2009 During the campaign teams of civil servants visited all villages and offered free registrations In 2010 just before the end of this campaign 523 (769114 704) of children aged

Objective To evaluate the impact of the introduction of secondary civil registration centres on birth registrations within 60 days of birth in Burkina FasoMethods The faith-based organization SantrsquoEgidio supported the inauguration of secondary birth registration centres within seven health centres in Reacuteo from July 2015 and four health centres in Godyr from February 2015 at which delivery and vaccination services were available We calculated the number of timely registrations per 1000 population before and after the launch of the intervention in both the intervention and control municipalities We used a logistic regression model to evaluate the probability of non-registration as a function of the health centre services used and various demographic and health characteristics obtained through health registers data and interviewsFindings Compared with the previous 12 months the number of timely birth registrations in Reacuteo and Godyr rose from 502 to 2094 (3171) and from 267 to 793 (1970) during the first 12 months of the intervention In the two control municipalities the numbers were unchanged Infants whose mothers attended health centres for delivery but did not return for vaccinations had the lowest proportions of birth registration (690 294426 in Reacuteo and 702 4057 in Godyr) Infants of mothers who were not interviewed were more likely to not having a timely birth registration (in Reacuteo odds ratio OR 625 95 confidence interval CI 410ndash952 and in Godyr OR 2564 95 CI 431ndash16667)Conclusion Introduction of secondary registration centres within health centres increased timely birth registrations

a Birth Registration for All Versus Oblivion (BRAVO) Community of SantrsquoEgidio Piazza di S Egidio 3a 00153 Rome Italyb Department of Statistical Sciences Padua University Padua Italyc Department of Biomedicine and Prevention Tor Vergata University of Rome Rome Italyd Birth Registration for All Versus Oblivion (BRAVO) Community of SantrsquoEgidio Ouagadougou Burkina Fasoe Ministry of Justice Human Rights and Civic Promotion Ouagadougou Burkina Fasof Office for Demographic Structure and Dynamics Italian National Institute of Statistics Rome Italyg Department of Social Policies Municipality of Rome Rome Italyh Department of Human Sciences Libera Universitagrave Maria SS Assunta University Rome ItalyCorrespondence to Evelina Martelli (email infobravoprogram-santegidioorg)(Submitted 2 August 2018 ndash Revised version received 10 January 2019 ndash Accepted 16 January 2019 ndash Published online 25 February 2019 )

Controlled impact evaluation of a birth registration intervention Burkina FasoEvelina Martellia Maria Castiglionib Gianpiero Dalla-Zuannab Leonardo Emberti Gialloretic Colette Guiebred Honorine Medah Dabirete Adriana Gulottaa Angela Silvestrinif Francesco Di Domenicantoniog Palmira Gianturcoa amp Maria Cristina Marazzih

260 Bull World Health Organ 201997259ndash269| doi httpdxdoiorg102471BLT18221705

ResearchTimely birth registrations Burkina Faso Evelina Martelli et al

0ndash4 years had a birth certificate18 In 2014 this proportion had increased to 599 (779113 006)17

To further promote the timely civil registration of births the SantrsquoEgidio birth registration programme cooperated with the local authorities to set up sec-ondary civil registration centres in health centres at which deliveries and vaccina-tions take place Here we present the results of a 2-year impact evaluation of this intervention by estimating the num-ber of timely birth registrations and by considering several possible factors that may facilitate or hamper registrations

MethodsStudy setting

The Centre-Ouest region of Burkina Faso was selected for the location of the intervention for its below-average proportion of registered births In 2010 the proportion of children younger than 5 years whose birth had been registered was 624 (7251162 national 769 11 30714 704)18 The average number of children per woman in this region was 66 (national 60) and infant mortality rate was 87 deaths per 1000 live births (na-tional 65 deaths per 1000 live births)18 We analysed data from the urban munici-pality of Reacuteo and the rural municipality of Godyr in which birth registration was previously only available in principal registration centres The SantrsquoEgidio birth registration programme conceived and realized the activation of secondary registration centres at the seven health centres of Reacuteo and the four health cen-tres of Godyr Civil registrars one per health centre operated these secondary registration centres 5 days per week from February 2015 in Godyr and July 2015 in Reacuteo We investigated the impact on the proportion of timely registrations until April 2017 in both municipalities

We also obtained data on the num-bers of births registered within 60 days from two comparable control municipali-ties (Yako and Gomponsom) located in the Nord region where registration is only available in principal registration centres This allowed us to assess any potential external variables that may influence birth registration trends for ex-ample the time of year or the occurrence of political and administrative changes

Registrar training

With the assistance of the ministries of Justice and Territorial Administration the

SantrsquoEgidio birth registration programme provided a 3-day training course for all registrars The course included training on civil registration and procedures the importance of raising awareness of civil registration and on interviewing consenting mothers and recording their personal data At health centres registrars approached mothers and informed of the availability of the registration office and invited the mothers to be interviewed However some mothers left the health centres without meeting registrars due to closed register or short visit During the interviews registrars recorded on paper whether a mother was a French speaker

Data sources

The numbers of timely birth registrations at principal and secondary registration centres were collected during January 2014ndashApril 2017 for the study municipal-ities of Reacuteo and Godyr and for the period January 2014ndashJune 2016 for the control municipalities of Yako and Gomponsom Delivery and vaccination data from the health centres hosting secondary reg-istration centres were acquired for the study municipalities for the approximate 2-year period until April 2017

We digitalized and integrated pa-per-based data from the civil and health registers and from the interviews We eliminated obvious recording errors such as improbable birth dates by manually linking records at the indi-vidual level with deliveries and vacci-nations retrieved from health registers we did not use any software to correct for missing or false data In the event of data discrepancies we considered civil registers to be the most accurate source

We considered all children recorded in the civil or health registers to be eligible for the impact evaluation except for 779 records in Reacuteo and 1026 in Godyr (Fig 1)

Data from the control munici-palities sometimes included incomplete registrations referred to as ldquobirth dec-larations with no birth recordrdquo In these cases birth certificates were given to the parents and the corresponding pages of the registers were left blank an attached note reported the birth declaration Both birth records and birth declarations were included in the comparisons between study and control municipalities

Data processing

To determine the impact of our inter-vention we compared the numbers of

timely birth registrations before and after the introduction of the secondary registration centres To compare munic-ipalities with different population sizes we calculated the number of timely birth registrations per 1000 population (no registered births times 1000population) To consider seasonality we analysed data from the 12 months leading to the start of the intervention and the first 12 months of the intervention

We estimated the populations of Reacuteo and Godyr in 2015 the middle year of the study by applying the an-nual growth rates for Burkina Faso to the 2006 census data29 which reported that Reacuteo had 62 208 inhabitants and Godyr 19 320 From average annual population growth rates provided by the United Na-tions Population Division30 for Burkina Faso of 301 and 298 for the periods 2005ndash2010 and 2010ndash2015 respectively the populations of Reacuteo and Godyr in 2015 were estimated at 81 120 and 25 194

To calculate the proportion of birth registration we first divided the number of timely birth registrations by the number of newborns To estimate the crude number of newborns we calculated the expected number of births applying the birth rate of 412 births per 1000 inhabitants at regional level according to 2010 Demographic and Health Surveys18 to the estimated popula-tion for 2015 resulting in 3342 expected births in Reacuteo and 1038 in Godyr How-ever this crude estimation introduced too much uncertainty We therefore estimated a more accurate number of children born in the two municipalities by obtaining data on all newborns attending health centres since only 729 (67949324) of newborns in the health district of Reacuteo and Godyr were delivered at a health centre31 Almost all newborns were brought to a health centre for pentavalent vaccina-tion31 We therefore defined proportions of civil registered children as the number of registered births divided by the number of eligible infants

Statistical analyses

We anonymized all data before conduct-ing statistical analyses We performed comparisons between timely registered births in the study and control municipali-ties as appropriate with the two-sample t-test and the Pearson χ2-test We used a logistic regression model to study the association between the probability of a birth not being registered within 60 days and demographic and health characteris-tics of the mother and child The binary

261Bull World Health Organ 201997259ndash269| doi httpdxdoiorg102471BLT18221705

ResearchTimely birth registrations Burkina FasoEvelina Martelli et al

outcome variable was birth registration (no 1 yes 0) As predictors we included which health centre services had been used (delivery vaccination delivery and vaccination or only birth registration) motherrsquos characteristics (age ethnicity and if a French speaker) birth characteristics (sex and month of birth) and the distance between the health centre and usual resi-dence We used the Wald χ2-test and the likelihood-ratio test to assess the partial effect of predictors and the goodness of fit

We only included parity weight of mother (classified as underweight normal weight or overweight by calculating body mass index) and any problems at delivery in the models for Godyr Such data were either unreliable (in the case of parity) or had only been partially recorded in the registers of the Reacuteo health centres (moth-errsquos weight status and whether problems at delivery were not recorded for 984 and 977 of mothers respectively) Parity information was obtained either during the interview with the mother or extracted

from the register for delivery Whether any delivery problems were experienced was considered as a binary variable either no problems (0) or a preterm birth resusci-tated child or perinatal death (1)

P-values of less than 005 were con-sidered statistically significant Statisti-cal analyses were performed using SAS software 93 (SAS Institute Cary United States of America)

Ethics

The Comiteacute drsquoethique pour la recherche en santeacute of Burkina Faso and our insti-tutional review boards all approved our study procedures32 Mothers who con-sented to be interviewed signed a dec-laration allowing the processing of their personal data for research purposes

ResultsOf the 7512 deliveries and vaccinations recorded in the health registers of Reacuteo 779 (104) were not eligible for the

impact evaluation of the 4354 recorded in the health registers of Godyr 1026 (236) did not meet the eligibility crite-ria (Fig 1) During the first 12 months of the intervention 2094 out of 2433 eligible births were registered within 60 days in Reacuteo (861) and 793 out of 829 in Godyr (957 Table 1)

Changes in registration

Comparisons between the first 12 months of the intervention and the previous 12 months in Reacuteo and Godyr indicate an increase in the number of timely registra-tions from 502 to 2094 in Reacuteo (3171) and from 267 to 793 in Godyr (1970) After the introduction of secondary reg-istration centres birth registrations in Reacuteo (from July 2015) and Godyr (from February 2015) followed similar seasonal trends (Fig 2) both were characterized by low points that coincided with severe weather conditions the Harmattan wind (February) and intense rainfalls (JunendashJuly) followed by registration peaks

Fig 1 Numbers of birth registrations deliveries vaccinations and eligible children in the study and control municipalities

Reacuteo and GodyrJanuary 2014 - April 2017

timely birth registrations (le60 days)

Civil registry study municipalities

Yako and GomponsomJanuary 2014 - June 2016

timely birth registrations (le60 days)

Civil registry control municipalities

Reacuteo July 2015 - April 2017Godyr February 2015 - April 2017

Health data study municipalities

Birth recordsReacuteo 4479 Godyr 2007

Birth recordsYako 550 Gomponsom 405

Birth declarations with no birth recordsYako 3386 Gomponsom 90

DeliveriesReacuteo 3622 Godyr 2043

VaccinationsReacuteo 3890 Godyr 2311

Eligible birth registrationsReacuteo 4479 Godyr 2007 Yako 3936 Gomponsom 495

Eligible health eventsReacuteo 6733 Godyr 3328

Eligible children

Health centre service used Reacuteo (5026) Godyr (2129) Yako (3936) Gomponsom (495)

Before intervention

Birth registration only 502 267 2029 236

During intervention

Delivery only 934 162

Vaccination only 450 84

Both delivery and vaccination 2851 1580

Birth registration only 289 36 1907 259

Ineligible health events

Reason Reacuteo (779) Godyr (1026)

Motherrsquos name omitted at delivery 8 35

Motherrsquos name omitted at vaccination 19 12

Date of birth omitted 32 44

Place of birth omitted 267 243

Child older than 60 days 55 16

Not born in municipality 398 676

Note birth records births recorded in the official register of the municipality birth declarations births attested by a paper note in the registration office and a birth certificate released to the person but not recorded in the official register due to administrative shortcomings and birth registrations total of birth records + birth declarations

262 Bull World Health Organ 201997259ndash269| doi httpdxdoiorg102471BLT18221705

ResearchTimely birth registrations Burkina Faso Evelina Martelli et al

Table 1 Numbers of timely birth registrations according to demographic and health characteristics of mothers and infants in Burkina Faso for a 12-month period from February 2015 (Godyr) and July 2015 (Reacuteo)

Covariate Reacuteo Godyr

No of births ()a Registered births of eligible

infants ()b

No of births ()a Registered births of eligible

infants ()b

Eligible (n = 2433)

Registered (n = 2094)

Eligible (n = 829)

Registered (n = 793)

Health centre service usedDelivery only 426 (175) 294 (140) 690 57 (69) 40 (50) 702Vaccination only 227 (93) 212 (101) 934 41 (49) 34 (43) 829Both delivery and vaccination

1665 (684) 1473 (703) 885 725 (875) 713 (899) 983

Birth registration only 115 (47) 115 (55) 1000 6 (07) 6 (08) 1000Month of birthJanuary 205 (84) 157 (75) 766 89 (107) 83 (105) 933February 146 (60) 121 (58) 829 88 (106) 80 (101) 909March 154 (63) 141 (67) 916 62 (75) 60 (76) 968April 196 (81) 189 (90) 964 64 (77) 63 (79) 984May 219 (90) 206 (98) 941 60 (72) 58 (73) 967June 223 (92) 197 (94) 883 63 (76) 59 (74) 937July 151(62) 128 (61) 848 54 (65) 52 (66) 963August 218 (90) 179 (85) 821 74 (89) 72 (91) 973September 252 (104) 207 (99) 821 69 (83) 66 (83) 957October 251 (103) 195 (93) 777 65 (78) 63 (79) 969November 218 (90) 196 (94) 899 81 (98) 79 (100) 975December 200 (82) 178 (85) 890 60 (72) 58 (73) 967Sex of babyMale 1217 (500) 1053 (503) 865 408 (492) 392 (494) 961Female 1207 (496) 1041 (497) 862 421 (508) 401 (506) 952Not recorded 9 (04) 0 (00) 00 0 (00) 0 (00) 00 Motherrsquos age yearslt 18 46 (19) 45 (21) 978 40 (48) 39 (49) 97518ndash19 137 (56) 136 (65) 993 46 (55) 45 (57) 97820ndash24 419 (172) 413 (197) 986 134 (162) 132 (166) 98525ndash29 397 (163) 391 (187) 985 153 (185) 151 (190) 98730ndash34 332 (136) 331 (158) 997 124 (150) 122 (154) 98435ndash39 206 (85) 203 (97) 985 68 (82) 67 (84) 985ge 40 104 (43) 102 (49) 981 45 (54) 44 (56) 978Not recorded 792 (326) 473 (226) 597 219 (264) 193 (243) 881Parityc

1 1650 (678) 1330 (635) 806 221 (267) 208 (262) 9412 275 (113) 266 (127) 967 122 (147) 117 (148) 9593 165 (68) 162 (77) 982 109 (131) 108 (136) 9914 157 (65) 154 (74) 981 121 (146) 119 (150) 9835 83 (34) 82 (39) 988 96 (116) 93 (117) 9696 54 (22) 54 (26) 1000 67 (81) 67 (84) 10007 37 (15) 34 (16) 919 46 (55) 39 (49) 848ge 8 12 (05) 12 (06) 1000 47 (57) 42 (53) 894Motherrsquos ethnicityGourounsi 2145 (882) 1915 (915) 893 624 (753) 604 (762) 968Mossi 116 (48) 97 (46) 836 157 (189) 155 (195) 987Other 20 (08) 20 (10) 1000 26 (31) 26 (33) 1000Not recorded 152 (62) 62 (30) 408 22 (27) 8 (10) 364Mother a French speakerYes 434 (178) 422 (202) 972 133 (160) 131 (165) 985No 1220 (502) 1179 (563) 966 610 (736) 596 (752) 977

(continues )

263Bull World Health Organ 201997259ndash269| doi httpdxdoiorg102471BLT18221705

ResearchTimely birth registrations Burkina FasoEvelina Martelli et al

However no significant fluctuations were observed in connection with major political upheavals namely the insurrec-tion and deposition of the president and the subsequent removal of all mayors (October to December 2014) a coup at-tempt and political elections (September

to November 2015) and administrative elections (May 2016)

Comparing the trends in timely birth registration showed that before the intervention the numbers of birth regis-trations per 1000 population were lower in Reacuteo than in the control municipality

Yako however these increased in Reacuteo after opening secondary registration centres (Fig 3) The level of birth registrations in Godyr and Gomponsom were similar before the intervention and increased in Godyr after the implementation of the intervention (Fig 4) Further all birth

Covariate Reacuteo Godyr

No of births ()a Registered births of eligible

infants ()b

No of births ()a Registered births of eligible

infants ()b

Eligible (n = 2433)

Registered (n = 2094)

Eligible (n = 829)

Registered (n = 793)

Not recorded 779 (320) 493 (235) 633 86 (104) 66 (83) 767Mother interviewedYes 1845 (758) 1763 (842) 956 800 (965) 782 (986) 977No 416 (171) 224 (107) 538 26 (31) 10 (13) 385Not recorded 172 (71) 107 (51) 622 3 (04) 1 (01) 333Usual residenceOutside the municipality

248 (102) 157 (75) 633 227 (274) 217 (274) 956

gt 10 km 29 (12) 24 (11) 828 27 (33) 25 (31) 9265ndash10 km 0 (00) 0 (00) ndash 233 (281) 219 (276) 940lt 5 km 2156 (886) 1913 (914) 887 342 (413) 332 (419) 971Motherrsquos weight statusd

Underweight 3 (01) 3 (01) 1000 15 (18) 15 (19) 1000Normal weight 19 (08) 19 (09) 1000 453 (546) 439 (554) 969Overweight 16 (07) 16 (08) 1000 97 (117) 91 (115) 938Not recorded 2395 (984) 2056 (982) 858 264 (318) 248 (313) 939Problems at deliveryYes 9 (04) 1 (01) 111 24 (29) 14 (18) 583No 46 (19) 45 (21) 978 646 (779) 631 (796) 977Not recorded 2378 (977) 2048 (978) 861 159 (192) 148 (187) 931

a Percentages do not always add up to 1000 due to rounding errorsb Number of timely registered births as a percentage of the number of eligible birthsc Registration of most recently-borne child only d Motherrsquos weight was classified by calculating body mass index from measured weight and height

( continued)

Fig 2 Number of birth registrations per 1000 population in the study municipalities of Reacuteo and Godyr Burkina Faso January 2014ndashApril 2017

No o

f birt

h re

gist

ratio

ns p

er 1

000

popu

latio

n 5

4

3

2

1

0

Opening of secondary registration centres

Janndash2014 Apr ndash2014 Jul ndash2014 Oct ndash2014 Jan ndash2015 Apr ndash2015 Jul ndash2015 Oct ndash2015 Jan ndash2016 Apr ndash2016 Jul ndash2016 Oct ndash2016 Jan ndash2017 Apr ndash2017

ReacuteoGodyr

Month year

264 Bull World Health Organ 201997259ndash269| doi httpdxdoiorg102471BLT18221705

ResearchTimely birth registrations Burkina Faso Evelina Martelli et al

declarations in Reacuteo and Godyr matched the official birth records while 860 (33863936) of declarations in Yako and 182 (90495) in Gomponsom were not converted into valid birth records (Fig 1)

Before the intervention the mean period between birth and registra-tion was 195 plusmn 153 days in Reacuteo and 253 plusmn 185 days in Godyr During the intervention this period was sig-nificantly reduced to 108 plusmn 144 days (P lt 0 0001) and 7 3 plusmn 11 3 days (P lt 00001) respectively

Over the same interval the mean period between birth and registration did not change significantly in control

municipalities from 273 plusmn 186 days to 248 plusmn 160 days in Yako (P = 0339) and from 232 plusmn 557 days to 213 plusmn 183 days in Gomponsom (P = 0745)

Overall 196 of the children in Reacuteo (4102094) and 315 in Godyr (250793) were registered on the day of delivery or the day of vaccination

Factors affecting registration

During the first year of the intervention 684 (16652433) of newborns in Reacuteo and 875 (725829) in Godyr were de-livered and vaccinated in a health centre among these infants the percentages of timely civil registrations were 885

(14731665) and 983 (713725) re-spectively Considering newborns who received vaccinations only the births of 934 (212227) in Reacuteo and 829 (3441) in Godyr were formally registered within 60 days Of newborns delivered in health centres but who did not receive vaccina-tions the births of 690 (294426) in Reacuteo and 702 (4057) in Godyr were formally registered (Table 1) No signifi-cant differences in the proportion of birth registrations were observed in relation to motherrsquos ethnicity age parity and whether a normal weight or a French speaker

We developed two basic logistic models for Reacuteo and Godyr to test for the

Fig 3 Number of birth registrations per 1000 population in the urban municipalities of Reacuteo (study) and Yako (control) Burkina Faso January 2014ndashJune 2016

No o

f birt

h re

gist

ratio

ns p

er 1

000

popu

latio

n

4

3

2

1

0

Opening of secondary registration centres

Janndash2014 Apr ndash2014 Jul ndash2014 Oct ndash2014 Jan ndash2015 Apr ndash2015 Jul ndash2015 Oct ndash2015 Jan ndash2016 Apr ndash2016

ReacuteoYako (total)

Month yearYako (birth declarations with no birth record)

Note In 2015 the estimated population was 81 120 in Reacuteo and 105 529 in Yako

Fig 4 Number of birth registrations per 1000 population in the rural municipalities of Godyr (study) and Gomponsom (control) Burkina Faso January 2014ndashJune 2016

No o

f birt

h re

gist

ratio

ns p

er 1

000

popu

latio

n 4

3

2

1

0

Opening of secondary registration centres

Janndash2014 Apr ndash2014 Jul ndash2014 Oct ndash2014 Jan ndash2015 Apr ndash2015 Jul ndash2015 Oct ndash2015 Jan ndash2016 Apr ndash2016

GodyrGomponsom (total)

Month yearGomponson (birth declarations with no birth records)

Note In 2015 the estimated population was 25 194 in Godyr and 23 822 in Gomponsom

265Bull World Health Organ 201997259ndash269| doi httpdxdoiorg102471BLT18221705

ResearchTimely birth registrations Burkina FasoEvelina Martelli et al

probability of a birth being registered within 60 days during the intervention (Table 2) In both municipalities the in-fants of mothers attending health centres only for delivery had a higher probability of not being formally registered than those attending for vaccination or for delivery and vaccination In both municipalities the infants of mothers who were not interviewed had a higher probability of not being formally registered Distance between usual residence and the health centre service used influenced whether the birth was registered in Reacuteo but not in Godyr The month of birth appeared to be statistically significant in Reacuteo but not in Godyr however this result was probably due to the smaller population size in Godyr

For Godyr we developed an ex-panded logistic model by incorporating the health conditions of the mother and child which might have affected birth registration None of these covariates had a statistically significant association with timely registration (Table 2) To validate the inability of these variables to describe differences in the probability of timely registration we used a likelihood-ratio test to compare the basic model with the expanded model The difference between the minus2 log-likelihood functions was 8887 (148629ndash139742) and the χ2 statistic was not statistically significant (P = 0261)

DiscussionCompared with the number of birth registrations during the year before the start of our intervention we observed an increase in timely registrations of more than threefold in Reacuteo and an almost two-fold increase in Godyr no major changes were observed in the control municipali-ties This increase could be explained by the provision of registration offices in health centres habitually used by families staffed by dedicated personnel Several reported factors for registration (eg sex of baby and motherrsquos age ethnicity and marital status)1921ndash233334 were not associ-ated with the increase of timely registered births in the study municipalities

Of all the services provided by health centres birth registration proportions were lowest among mothers who at-tended for delivery but did not return for vaccination This lower performance might be due to poor access to health centres after birth early infant mortality or high mobility Poor access does not seem likely however given the high vac-

cination rates in the area31 Early infant mortality is a possibility and records of (non-registered) perinatal deaths were noted in health registers for delivery (31 deaths in Reacuteo and 16 in Godyr) and reported by mothers during interviews (53 in Reacuteo and 28 in Godyr) Future regulations could allow health and ad-ministrative staff as well as traditional and religious authorities to offer a cleri-cal civil declaration of an unregistered event Mobility is also a possible cause being high in the Centre-Ouest region of Burkina Faso29 In fact the reason that so many children vaccinated in the study municipalities were not eligible for the impact evaluation was that they were born elsewhere The mobility barrier could be addressed through amendments that allow for a declaration of birth in municipalities other than the birthplace

We noted that mothers who at-tended a health centre and were not interviewed by registrars demonstrated the lowest probability of registering their children We also observed monthly fluctuations in registration trends which could not be fully explained by adverse climate conditions Further possible rea-sons must be investigated (eg whether a result of temporary organizational prob-lems within particular health centres or whether a consequence of local events)

Our study has several limitations First we recorded all deliveries andor vaccinated children at health centres this covered the large majority of newborns but not the whole infant population of the area Our municipal birth rates implied from the number of eligible infants (30 243381 120 for Reacuteo and 33 82925 194 for Godyr) are lower than the national birth rates provided by the United Nations Population Divi-sion (41)30 highlighting how some newborns who were not immunized or born to families who migrated may have been excluded from the number of eligible newborns Second the large volume of data not reported for some health variables (eg whether a mother had a normal weight or experienced problems at delivery) might have led to a non-random selection and consequently the misinterpretation of the role of some predictors Third we could not divide the population into wealth quintiles either from the registers or from interviews Lastly although several neonatal deaths were observed none of these were reg-istered by the parents either at birth or death this confirms previous studies

which have reported that neonatal deaths often go unregistered1322ndash2435

We argue that a widespread regis-tration system based in health centres already used by mothers for delivery and vaccination with dedicated registry per-sonnel could considerably improve the proportion of births which are formally registered The strengthening of civil status services during our intervention reinforced the administrative structure of the study municipalities guarantee-ing registration continuity during the political upheavals between 2014 and 2016 In contrast control municipalities experienced operating problems due to political and administrative hardships as shown by the high numbers of birth certificates with no birth records Un-like studies that suggest the use of health personnel to register births2036 we believe that a civil registrar dedicated exclusively to sensitization recording and digitiza-tion is essential to increase the registra-tion of births considering the registry expertise needed the time required for computerization and the lack of health-care personnel Although interval from birth to registration was reduced in both study municipalities registrations mainly occurred on a different day from birth or vaccination it may therefore be adequate for the registrar to attend the centre for a limited number of days per week

We believe that our system of intro-ducing secondary registration centres also lends itself to meeting the challenge of recording deaths laying the foundations for reliable civil registration systems

AcknowledgmentsWe thank Cleacutement Pendwenge Sawado-go the former Minister for Security of Burkina Faso and the ministries of Ter-ritorial Administration Justice Health Education Social Action and Foreign Affairs We thank Maxime Bouda Gen-eral Director of Modernisation de lrsquoeacutetat civil (DGMEC) and its first General Di-rector Aimeacute Geacuterard Yameogo We thank Philippe Zongo of the Community of SantrsquoEgidio and all the staff of Birth Registration for All Versus Oblivion in Burkina Faso

Funding This study was funded by Kin-dermissionswerksbquo ldquoDie Sternsingerrdquo

Competing interests EM and CG were supported by Kindermissionswerksbquo ldquoDie Sternsingerrdquo All other authors declare no competing interests

266 Bull World Health Organ 201997259ndash269| doi httpdxdoiorg102471BLT18221705

ResearchTimely birth registrations Burkina Faso Evelina Martelli et al

Table 2 Risk of birth not being registered within 60 days according to demographic and health characteristics of mothers and infants in Burkina Faso for a 12-month period from February 2015 (Godyr) and July 2015 (Reacuteo)

Covariate OR (95 CI)

Reacuteo Godyr

Basic model Basic model Basic model incorporating health characteristics of mother and infant

Health centre service usedDelivery only 283 (182ndash441) 3448 (971ndash12500) 1818 (451ndash7692)Vaccination only delivery and vaccination or birth registration only

100 100 100

Month of birthJanuary 568 (232ndash1409) 112 (010ndash1250) 114 (008ndash1587)February 291 (113ndash752) 386 (037ndash4000) 418 (034ndash5000)March 143 (050ndash407) 287 (016ndash5263) 353 (017ndash7143)April 068 (021ndash217) 044 (002ndash1250) 066 (002ndash2041)May 158 (056ndash444) 254 (018ndash3704) 402 (023ndash7143)June 422 (169ndash1053) 274 (018ndash4167) 226 (010ndash5263)July 265 (099ndash704) 162 (010ndash2703) 154 (007ndash3226)August 228 (092ndash565) 029 (001ndash610) 035 (002ndash807)September 283 (117ndash685) 170 (009ndash3226) 320 (014ndash7692)October 400 (166ndash962) 474 (032ndash7143) 516 (029ndash9091)November 072 (029ndash177) 209 (014ndash3125) 174 (010ndash2941)December 100 100 100Sex of babyFemale 099 (067ndash145) 107 (041ndash282) 109 (039ndash304)Male 100 100 100Motherrsquos age yearslt 18 286 (031ndash2632) 175 (013ndash2326) 079 (004ndash1493)18ndash19 038 (004ndash344) 238 (020ndash2857) 178 (014ndash2222)20ndash24 100 100 10025ndash29 131 (040ndash435) 020 (002ndash180) 033 (003ndash346)30ndash34 027 (003ndash235) 074 (010ndash568) 116 (012ndash1124)35ndash39 074 (017ndash328) 145 (024ndash885) 087 (009ndash901)ge 40 172 (029ndash1031)Not recorded 3448 (1429ndash8333) 433 (090ndash2083) 332 (062ndash1754)Paritya

1ndash2 NA NA 1003ndash4 NA NA 056 (011ndash279)5ndash6 NA NA 033 (003ndash362)ge 7 NA NA 271 (045ndash1639)Motherrsquos ethnicityGourounsi 100 100 100Mossi and other 155 (071ndash339) 016 (002ndash111) 026 (004ndash190)Not recorded 225 (125ndash403) 787 (081ndash7692) 1031 (096ndash11111)Mother a French speakerYes 100 100 100No 045 (021ndash100) 129 (023ndash719) 153 (023ndash1000)Not recorded 392 (185ndash833) 962 (141ndash6667) 1266 (146ndash11111)Mother interviewedYes 100 100 100No 625 (410ndash952) 2564 (431ndash16667) 2222 (336ndash14286)Usual residenceOutside the municipality 263 (158ndash439) 016 (002ndash138) 015 (002ndash142)gt 10 km 088 (016ndash481) 1031 (089ndash12500) 571 (037ndash9091)5ndash10 km NA 279 (096ndash813) 205 (065ndash645)lt 5 km 100 100 100

(continues )

267Bull World Health Organ 201997259ndash269| doi httpdxdoiorg102471BLT18221705

ResearchTimely birth registrations Burkina FasoEvelina Martelli et al

摘要布基纳法索对出生登记干预的控制影响评估目的 旨在评估在布基纳法索设立二级民事登记中心对及时（出生后 60 天内）出生登记的影响方法 以 信 仰 为 基 础 的 非 营 利 组 织 圣 艾 智 德 团 体从 2015 年 7 月起在雷奥县的七个健康中心设立二级出生登记中心以及从 2015 年 2 月起在 Godyr 县的四个健康中心设立二级出生登记中心以提供分娩和疫苗接种服务我们计算了干预和控制城市在发起干预前后每 1000 人中进行及时登记的人数我们使用逻辑回归模型来评估未登记的概率根据所使用的健康中心服务以及健康登记数据和访谈获得的各种人口统计和健康特征的函数

结果 与 前 12 个 月 相 比 雷 奥 县 和 Godyr 县 的及 时 出 生 登 记 人 数 分 别 从 干 预 前 的 502 人 增 加到 2094 人 (3171 ) 和从 267 增加到 793 人 (1970 )在两个控制城市中人数没有发生变化母亲在健康中心进行分娩但未接种疫苗的婴儿出生登记比例最低（雷奥县为 690 294426 Godyr 县为 702 4057）其母亲未接受访谈的婴儿更有可能没有及时进行出生登记（雷奥县的优势率OR 625 95 置信区间CI 410ndash952 以及 Godyr 县的 OR 256495 CI 431-16667）结论 在健康中心内设立二级登记中心可以增加及时出生登记的人数

ملخصتقييم التأثير المنضبط لتدخل تسجيل الولادة بوركينا فاصوعلى الثانوية المدني التسجيل مراكز افتتاح أثر تقييم الغرض تسجيل المواليد في بوركينا فاصو في الوقت المناسب (في غضون 60

يوما من الولادة)مراكز افتتاح SantrsquoEgidio الدينية المنظمة دعمت الطريقة ريو من تموز تسجيل المواليد الثانوية في سبعة مراكز صحية في يوليو 2015 وأربعة مراكز صحية في جودير ابتداء من شباط

قمنا لقد والتطعيم الولادة خدمات تتوفر حيث 2015 فبراير باحتساب عدد التسجيلات في الوقت المناسب لكل 1000 نسمة التدخل بلديات من كل في التدخل بدء وبعد قبل السكان من احتمال لتقييم اللوجيستي التحوف نموذج استخدمنا والتحكم المستخدمة الصحي المركز لخدمات كوظيفة التسجيل عدم الحصول تم التي والصحية الديموغرافية الخصائص ومختلف عليها من خلال بيانات السجلات الصحية والمقابلات الشخصيةارتفع عدد تسجيلات السابقة 12 الـ النتائج مقارنة مع الأشهر المواليد في الوقت المناسب في ريو وجودير من 502 إلى 2094

(3171) ومن 267 إلى 793 (1970) خلال الأشهر الـ 12 الأولى من التدخل في كل من البلديتين اللتين خضعتا للضبط كانت الأرقام دون تغيير وكان الرضع الذين حضرت أمهاتهم في التطعيمات على للحصول يعدن لم ولكن للولادة صحية مراكز (690 للمواليد تسجيل نسب أدنى لديهم للتطعيم كان و426294 في ريو و702 5740 في جودير) الرضع الذين لم تحضر أمهاتهم مقابلات شخصية كانوا أكثر عرضة لعدم ريو في الاحتمالات (نسبة المناسب الوقت في المواليد تسجيل في 952 إلى 410 95 الثقة فاصل 625 أرجحية بنسبة جودير بنسبة أرجحية 2564 بنسبة أرجحية 95 431 إلى

(16667الاستنتاج أدى افتتاح مراكز التسجيل الثانوية داخل المراكز الصحية

إلى زيادة تسجيل المواليد في الوقت المناسب

Covariate OR (95 CI)

Reacuteo Godyr

Basic model Basic model Basic model incorporating health characteristics of mother and infant

Motherrsquos weight statusb

Underweight and normal weight NA NA 100Overweight NA NA 061 (011ndash334)Not recorded NA NA 065 (011ndash394)Problems at deliveryYes NA NA 581 (080ndash4167)No NA NA 100Not recorded NA NA 100 (014ndash694)

CI confidence interval NA not applicable OR odds ratioa Registration of most recently-borne child only b Motherrsquos weight was classified by calculating body mass index from measured weight and height

( continued)

268 Bull World Health Organ 201997259ndash269| doi httpdxdoiorg102471BLT18221705

ResearchTimely birth registrations Burkina Faso Evelina Martelli et al

Reacutesumeacute

Eacutevaluation controcircleacutee de lincidence dune intervention en matiegravere denregistrement des naissances ndash Burkina FasoObjectif Eacutevaluer lincidence de lintroduction de centres secondaires denregistrement des deacuteclarations deacutetat civil sur lenregistrement des naissances en temps voulu (dans les 60 jours apregraves la naissance) au Burkina FasoMeacutethodes Lorganisation religieuse SantrsquoEgidio a soutenu linauguration de centres secondaires denregistrement des naissances au sein de sept centres de santeacute agrave Reacuteo en juillet 2015 et au sein de quatre centres de santeacute agrave Godyr en feacutevrier 2015 des centres qui proposaient des services daccouchement et de vaccination Nous avons calculeacute le nombre denregistrements reacutealiseacutes en temps voulu pour 1 000 habitants avant et apregraves le lancement de cette initiative tant dans les municipaliteacutes cibleacutees par lintervention que dans des municipaliteacutes teacutemoins Nous avons utiliseacute un modegravele de reacutegression logistique pour eacutevaluer la probabiliteacute dun non-enregistrement de la naissance en fonction des services utiliseacutes dans les centres de santeacute et de diverses caracteacuteristiques deacutemographiques et de santeacute agrave partir des donneacutees obtenues dans les registres meacutedicaux et au cours dentretiens

Reacutesultats Comparativement aux 12 mois anteacuterieurs agrave Reacuteo et agrave Godyr le nombre denregistrements en temps voulu des naissances a augmenteacute durant les 12 premiers mois de lintervention en passant de 502 agrave 2 094 (3171) et de 267 agrave 793 (1970) respectivement Dans les deux municipaliteacutes teacutemoins les chiffres nont pas eacutevolueacute Les plus faibles proportions denregistrement ont correspondu aux enfants neacutes de megraveres seacutetant rendues dans les centres de santeacute pour accoucher mais sans y revenir pour des services de vaccination (agrave Reacuteo 690 294426 et agrave Godyr 702 4057) Les naissances denfants neacutes de megraveres nayant pas eacuteteacute vues en entretien ont eacuteteacute plus susceptibles de ne pas ecirctre enregistreacutees en temps voulu (agrave Reacuteo rapport des cotes (RC) 625 intervalle de confiance (IC) de 95 410ndash952 et agrave Godyr RC 2564 IC 95 431-16667)Conclusion Lintroduction de centres secondaires deacutetat civil au sein des centres de santeacute a permis daugmenter le nombre denregistrements des naissances reacutealiseacutes en temps voulu

Резюме

Оценка контролируемого воздействия мероприятий по регистрации рождений в Буркина-ФасоЦель Оценка эффекта внедрения вспомогательных центров регистрации актов гражданского состояния на своевременную (до 60 дней с момента рождения) регистрацию новорожденных в Буркина-ФасоМетоды Религиозное сообщество laquoСантЭгидиоraquo (SantrsquoEgidio) поддержало внедрение вспомогательных центров регистрации рождений в семи центрах здравоохранения в Рео с июля 2015 года и в четырех центрах здравоохранения в Годыре с февраля 2015 года предоставляющих услуги по родовспоможению и вакцинации Авторы рассчитали количество своевременных регистраций на 1000 человек населения до и после принятия данных мер в охваченных ими муниципалитетах и в контрольных муниципалитетах Использовалась модель логистической регрессии для оценки вероятности отсутствия регистрации как функции использованных услуг центров здравоохранения а также разнообразных демографических показателей и показателей

здоровья полученных через органы здравоохранения и путем опросовРезультаты В сравнении с предыдущими 12 месяцами количество своевременно зарегистрированных рождений в Рео и Годыре выросло с 502 до 2094 (3171) и с 267 до 793 (1970) за первые 12 месяцев осуществления мероприятий В двух контрольных муниципалитетах цифры остались без изменений Дети чьи матери пользовались услугами медицинских центров для родов но не вернулись для вакцинации имели самую низкую долю регистрации рождений (690 или 294426 в Рео и 702 или 4057 в Годыре) Дети матерей не участвовавших в опросе с большей вероятностью не были зарегистрированы своевременно (отношение шансов для Рео составило 625 95-й ДИ 410ndash952 а для Годыра 2564 95-й ДИ 431ndash16667)Вывод Ввод в действие дополнительных центров регистрации в медицинских центрах увеличил процент своевременной регистрации новорожденных

Resumen

Evaluacioacuten del impacto controlado de una intervencioacuten del registro de nacimientos Burkina FasoObjetivo Evaluar el impacto de la introduccioacuten de centros secundarios de registro civil para la inscripcioacuten oportuna (en los 60 diacuteas siguientes al nacimiento) de los nacimientos en Burkina FasoMeacutetodos La organizacioacuten religiosa SantrsquoEgidio apoyoacute la inauguracioacuten de centros secundarios de registro de nacimientos en siete centros de salud en Reacuteo desde julio de 2015 y cuatro centros de salud en Godyr desde febrero de 2015 en los que se disponiacutean de servicios de parto y vacunacioacuten Se ha calculado el nuacutemero de registros oportunos por cada 1000 habitantes antes y despueacutes del lanzamiento de la intervencioacuten tanto en los municipios intervenidos como los de control Se ha seguido un modelo de regresioacuten logiacutestica para evaluar la probabilidad del no registro como una funcioacuten de los servicios de los centros de salud utilizados y diferentes caracteriacutesticas demograacuteficas y de salud obtenidas a traveacutes de los registros de datos de salud y entrevistasResultados Comparados con los 12 meses anteriores el nuacutemero de registros de nacimientos oportunos en Reacuteo y Godyr aumentoacute de 502

a 2094 (3171 ) y de 267 a 793 (1970 ) durante los primeros 12 meses de la intervencioacuten Las cifras no cambiaron en los dos municipios de control Los bebeacutes cuyas madres asistieron a los centros de salud para el parto pero no regresaron para recibir las vacunas tuvieron las proporciones maacutes bajas de registros de nacimientos (690 294426 en Reacuteo y 702 4057 en Godyr) Los bebeacutes de madres que no fueron entrevistadas tuvieron maacutes probabilidades de no ser inscritos oportunamente en el registro de nacimientos (en la razoacuten de probabilidades de Reacuteo RP 625 intervalo de confianza del 95 IC 410-952 y en Godyr RP 2564 IC del 95 431-16667)Conclusioacuten La introduccioacuten de centros secundarios de registro en los centros de salud aumentoacute los registros de nacimientos oportunos

269Bull World Health Organ 201997259ndash269| doi httpdxdoiorg102471BLT18221705

ResearchTimely birth registrations Burkina FasoEvelina Martelli et al

References1 Resolution 4425 Convention on the rights of the child In Forty-fourth General

Assembly New York 20 Nov 1989 New York United Nations 1989 Available from httpstreatiesunorgPagesViewDetailsaspxsrc=TREATYampmtdsg_no=IV-11ampchapter=4amplang=en [cited 2019 Jan 24]

2 Every childrsquos birth right inequities and trends in birth registration New York United Nations Childrenrsquos Fund 2013 Available from httpwwwunorgruleoflawfilesEmbargoed_11_Dec_Birth_Registration_report_low_respdf [cited 2019 Jan 24]

3 AHRC2722 Birth registration and the right of everyone to recognition everywhere as a person before the law - report of the Office of the United Nations High Commissioner for Human Rights Twenty-seventh session of the Human Rights Council Geneva 2014 Jun 17 Geneva United Nations Human Rights Council 2014 Available from httpwwwohchrorgENHRBodiesHRCRegularSessionsSession27PagesListReportsaspx [cited 2019 Jan 24]

4 A passport to protection a guide to birth registration programming New York United Nations Childrenrsquos Fund 2013 Available from httpwwwrefworldorgpdfid52b2e2bd4pdf [cited 2019 Jan 24]

5 Principles and recommendations for a vital statistics system Revision 3 New York United Nations Statistics Division 2014

6 Global civil registration and vital statistics scaling up investment plan 2015ndash2024 Washington DC The World Bank 2014 Available from httpdocumentsworldbankorgcurateden457271468148160984Global-civil-registration-and-vital-statistics-scaling-up-investment-plan-2015-2024 [cited 2019 Jan 24]

7 Gulotta A Alla scuola della pace Educare i bambini in un mondo globale Milano San Paolo 2017 Italian

8 Setel PW Macfarlane SB Szreter S Mikkelsen L Jha P Stout S et al Monitoring of Vital Events A scandal of invisibility making everyone count by counting everyone Lancet 2007 Nov 3370(9598)1569ndash77 doi httpdxdoiorg101016S0140-6736(07)61307-5 PMID 17992727

9 Kyegera B The emerging data revolution in Africa strengthening the statistics policy and decision making chain Stellenbosch SUN MeDIA 2015 Available from httpwwwafricansunmediacozaPortals0filesextracts9781920689568_extractpdf [cited 2019 Jan 24]

10 Phillips DE AbouZahr C Lopez AD Mikkelsen L de Savigny D Lozano R et al Are well functioning civil registration and vital statistics systems associated with better health outcomes Lancet 2015 Oct 3386(10001)1386ndash94 doi httpdxdoiorg101016S0140-6736(15)60172-6 PMID 25971222

11 Comandini O Cabras S Marini E Birth registration and child undernutrition in sub-Saharan Africa Public Health Nutr 2016 0719(10)1757ndash67 doi httpdxdoiorg101017S136898001500333X PMID 26669828

12 Boekle-Giufrida B Harbitz M Democratic governance citizenship and legal identity linking theoretical discussion and operational reality Working Paper Washington DC Inter-American Development Bank 2009 Available from httpspublicationsiadborgenpublication16498democratic-governance-citizenship-and-legal-identity-linking-theoretical [cited 2019 Jan 24]

13 Oza S Cousens SN Lawn JE 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 2014 Nov2(11)e635ndash44 doi httpdxdoiorg101016S2214-109X(14)70309-2 PMID 25442688

14 AbouZahr C de Savigny D Mikkelsen L Setel PW Lozano R Lopez AD Towards universal civil registration and vital statistics systems the time is now Lancet 2015 Oct 3386(10001)1407ndash18 doi httpdxdoiorg101016S0140-6736(15)60170-2 PMID 25971217

15 Lohleacute-Tart L Franccedilois M Eacutetat civil et recensements en Afrique francophone Pour une collecte administrative de donneacutees deacutemographiques Paris Centre franccedilais sur la population et le deacuteveloppement 1999 French Available from httpwwwcepedorgcdromintegral_publication_1988_2002manuelspdfmanuels_cpd_10pdf [cited 2019 Jan 24]

16 UNECE Register-based statistics in the Nordic countries review of best practices with focus on population and social statistics Geneva United Nations Economic Commission for Europe 2019 Available from httpwwwuneceorgindexphpid=17470 [cited 2019 Jan 24]

17 Enquecircte multisectorielle continue (EMC) 2014 Caracteacuteristiques sociodeacutemographiques de la population Novembre 2015 Ouagadougou Institut National de la Statistique et de la Deacutemographie 2015 French Available from httpwwwinsdbfncontenuenquetes_recensementsEnq_EMCCaracte9ristiques_sociodemographiques_de_la_populationpdf [cited 2019 Jan 24]

18 Enquecircte deacutemographique et de santeacute et agrave indicateurs multiples du Burkina Faso 2010 Calverton INSD et ICF International 2012 French

19 Giang KB Oh J Kien VD Hoat LN Choi S Lee CO et al Changes and inequalities in early birth registration and childhood care and education in Vietnam findings from the Multiple Indicator Cluster Surveys 2006 and 2011 Glob Health Action 2016 02 299(1)29470 doi httpdxdoiorg103402ghav929470 PMID 26950564

20 Fagernaumls S Odame J Birth registration and access to health care an assessment of Ghanarsquos campaign success Bull World Health Organ 2013 Jun 191(6)459ndash64 doi httpdxdoiorg102471BLT12111351 PMID 24052683

21 Garenne M Collinson MA Kabudula CW Goacutemez-Oliveacute FX Kahn K Tollman S Completeness of birth and death registration in a rural area of South Africa the Agincourt health and demographic surveillance 1992-2014 Glob Health Action 2016 10 249(1)32795 doi httpdxdoiorg103402ghav932795 PMID 27782873

22 Mathenge GW Lehola PJ Makokha AO Wanzala P Factors associated with low levels of birth amp death registration in Kieni East District of the Central Province of Kenya Afr J Health Sci 201326(4)272ndash90

23 Tobin EA Obi AI Isah EC Status of birth and death registration and associated factors in the South-south region of Nigeria Annals of Nigerian Medicine 20137(1)3ndash7 doi httpdxdoiorg1041030331-3131119979

24 Sachdeva S Nagar M Tyagi A Sachdeva R Kumar V Early birth registration at a center in rural India J Family Med Prim Care 2013 Jul2(3)234ndash7 doi httpdxdoiorg1041032249-4863120722 PMID 24479089

25 Zatu no An VII 0013FPPRES du 16 novembre 1989 portant institution et application du Code des personnes et de la famille Geneva International Labour Organization 2014 French Available from httpswwwiloorgdynnatlexnatlex4detailp_lang=enampp_isn=43834ampp_country=BFAampp_count=582 [cited 2019 Jan 24]

26 LOI ndeg055-2004AN du 21 deacutecembre 2004 portant Code geacuteneacuteral des collectiviteacutes territoriales au Burkina Faso Ouagadougou Burkina24 2004 French Available from httpsburkina24comwp-contentuploads201309LOI-ndeg055-2004-AN-du-21-deacutecembre-2004pdf [cited 2019 Jan 24]

27 Makinde OA Olapeju B Ogbuoji O Babalola S Trends in the completeness of birth registration in Nigeria 2002ndash2010 Demogr Res 201635315ndash38 doi httpdxdoiorg104054DemRes20163512

28 Mikkelsen L Phillips DE AbouZahr C Setel PW de Savigny D Lozano R et al A global assessment of civil registration and vital statistics systems monitoring data quality and progress Lancet 2015 Oct 3386(10001)1395ndash406 doi httpdxdoiorg101016S0140-6736(15)60171-4 PMID 25971218

29 Recensement geacuteneacuteral de la population et de lrsquohabitation (RGPH) 2006 Ouagadougou Institut National de la Statistique et de la Deacutemographie Ministegravere de lrsquoEconomie et des Finances 2009 French Available from httpwwwinsdbfncontenuenquetes_recensementsrgph-bfthemes_en_demographieTheme2-Etat_et_structure_de_la_populationpdfhttpwwwinsdbfncontenuenquetes_recensementsrgph-bfthemes_en_demographieTheme2-Etat_et_structure_de_la_populationpdf [cited 2019 Feb 6]

30 World Population Prospects 2017 New York United Nations DesaPopulation Division 2017 Available from httpsesaunorgunpdwppDownloadSpecialAggregatesEcological [cited 2019 Jan 24]

31 Annuaire statistique 2017 Ouagadougou Ministegravere de la Santeacute 2018 French Available from httpcnsbfIMGpdfannuaire_ms_2017pdf [cited 2019 Feb 6]

32 The Burkina Faso Ethics Committee approves the BRAVO research on civil registration in Sanguieacute district Rome Community of SantEgidio 2016 Available from httpwwwinvisiblechildreninfo201605the-burkina-faso-ethics-committeehtml [cited 2019 Jan 24]

33 Bennouna C Feldman B Usman R Adiputra R Kusumaningrum S Stark L Using the three delays model to examine civil registration barriers in Indonesia PLoS One 2016 12 1911(12)e0168405 doi httpdxdoiorg101371journalpone0168405 PMID 27992515

34 Gibberd AJ Simpson JM Eades SJ No official identity a data linkage study of birth registration of Aboriginal children in Western Australia Aust N Z J Public Health 2016 Aug40(4)388ndash94 doi httpdxdoiorg1011111753-640512548 PMID 27372965

35 Gupta M Rao C Lakshmi PVM Prinja S Kumar R Estimating mortality using data from civil registration a cross-sectional study in India Bull World Health Organ 2016 Jan 194(1)10ndash21 doi httpdxdoiorg102471BLT15153585 PMID 26769992

36 Good practices in integrating birth registration into health systems (2000ndash2009) Case studies Bangladesh Brazil the Gambia and Delhi India New York United Nations Childrenrsquos Fund 2009