Stillbirth rates in low-middle income countries 2010 - 2013: a population-based, multi-country study from the Global Network

Public Deposited
Analytics

Downloadable Content

Download PDF
Request Version for Screen Reader
Creator
  • McClure, Elizabeth M
    • Other Affiliation: RTI International, Durham, USA
  • Saleem, Sarah
    • Other Affiliation: Aga Khan University, Karachi, Pakistan
  • Goudar, Shivaprasad S
    • Other Affiliation: KLE University’s Jawaharlal Nehru Medical College, Belgaum, India
  • Moore, Janet L
    • Other Affiliation: RTI International, Durham, USA
  • Garces, Ana
    • Other Affiliation: Fundación para la Alimentación y Nutrición de Centro América y Panamá, Guatemala City, Guatemala
  • Esamai, Fabian
    • Other Affiliation: Moi University School of Medicine, Eldoret, Kenya
  • Patel, Archana
    • Other Affiliation: Lata Medical Research Foundation, Nagpur, India
  • Chomba, Elwyn
    • Other Affiliation: University Teaching Hospital, Lusaka, Zambia
  • Althabe, Fernando
    • Other Affiliation: Institute for Clinical Effectiveness and Health Policy, University of Buenos Aires, Argentina
  • Pasha, Omrana
    • Other Affiliation: Aga Khan University, Karachi, Pakistan
  • Kodkany, Bhalachandra S
    • Other Affiliation: KLE University’s Jawaharlal Nehru Medical College, Belgaum, India
  • Bose, Carl
    • Affiliation: University of North Carolina at Chapel Hill
  • Berreuta, Mabel
    • Other Affiliation: Institute for Clinical Effectiveness and Health Policy, University of Buenos Aires, Argentina
  • Liechty, Edward A
    • Other Affiliation: School of Medicine, University of Indiana, Indianapolis, USA
  • Hambidge, K M
    • Other Affiliation: University of Denver School of Medicine, Denver, USA
  • Krebs, Nancy F
    • Other Affiliation: University of Denver School of Medicine, Denver, USA
  • Derman, Richard J
    • Other Affiliation: Christiana Care Health Services, Newark, USA
  • Hibberd, Patricia L
    • Other Affiliation: Massachusetts General Hospital, Boston, USA
  • Buekens, Pierre
    • Other Affiliation: Tulane School of Public Health and Tropical Medicine, New Orleans, USA
  • Manasyan, Albert
    • Other Affiliation: University of Alabama at Birmingham, Birmingham, USA
  • Carlo, Waldemar A
    • Other Affiliation: University of Alabama at Birmingham, Birmingham, USA
  • Wallace, Dennis D
    • Other Affiliation: RTI International, Durham, USA
  • Koso-Thomas, Marion
    • Other Affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA
  • Goldenberg, Robert L
    • Other Affiliation: Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, USA
Abstract
  • Background Stillbirth rates remain nearly ten times higher in low-middle income countries (LMIC) than high income countries. In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented characteristics or care for mothers with stillbirths. Non-macerated stillbirths, those occurring around delivery, are generally considered preventable with appropriate obstetric care. Methods We undertook a prospective, population-based observational study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Results From 2010 through 2013, 269,614 enrolled women had 272,089 births, including 7,865 stillbirths. The overall stillbirth rate was 28.9/1000 births, ranging from 13.6/1000 births in Argentina to 56.5/1000 births in Pakistan. Stillbirth rates were stable or declined in 6 of the 7 sites from 2010-2013, only increasing in Pakistan. Less educated, older and women with less access to antenatal care were at increased risk of stillbirth. Furthermore, women not delivered by a skilled attendant were more likely to have a stillbirth (RR 2.8, 95% CI 2.2, 3.5). Compared to live births, stillbirths were more likely to be preterm (RR 12.4, 95% CI 11.2, 13.6). Infants with major congenital anomalies were at increased risk of stillbirth (RR 9.1, 95% CI 7.3, 11.4), as were multiple gestations (RR 2.8, 95% CI 2.4, 3.2) and breech (RR 3.0, 95% CI 2.6, 3.5). Altogether, 67.4% of the stillbirths were non-macerated. 7.6% of women with stillbirths had cesarean sections, with obstructed labor the primary indication (36.9%). Conclusions Stillbirth rates were high, but with reductions in most sites during the study period. Disadvantaged women, those with less antenatal care and those delivered without a skilled birth attendant were at increased risk of delivering a stillbirth. More than two-thirds of all stillbirths were non-macerated, suggesting potentially preventable stillbirth. Additionally, 8% of women with stillbirths were delivered by cesarean section. The relatively high rate of cesarean section among those with stillbirths suggested that this care was too late or not of quality to prevent the stillbirth; however, further research is needed to evaluate the quality of obstetric care, including cesarean section, on stillbirth in these low resource settings. Study registration Clinicaltrials.gov (ID# NCT01073475)
Date of publication
DOI
Identifier
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • McClure et al; licensee BioMed Central Ltd.
Journal title
  • Reproductive Health
Journal volume
  • 12
Journal issue
  • 1
Page start
  • S7
Language
  • English
Bibliographic citation
  • Reproductive Health. 2015 Jun 08;12(Suppl 2):S7
Publisher
  • BioMed Central

Relations

Parents:

This work has no parents.

Items

Thumbnail Title Date Uploaded Visibility Actions
file details 12978_2015_article_391.pdf 2019-05-06 Public Download
file details 12978_2015_391_moesm1_esm.pdf 2019-05-06 Public Download