Abstract
BackgroundStillbirth rates are high and represent a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC). In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented cause of stillbirths or the trends in rate of stillbirth over time.MethodsWe undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, Democratic Republic of Congo, India, Pakistan, and Guatemala). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Cause of stillbirth was assigned by algorithm.ResultsFrom 2010 through 2018, 573,148 women were enrolled with delivery data obtained. Of the 552,547 births that reached 500 g or 20 weeks gestation, 15,604 were stillbirths; a rate of 28.2 stillbirths per 1000 births. The stillbirth rates were 19.3 in the Guatemala site, 23.8 in the African sites, and 33.3 in the Asian sites. Specifically, stillbirth rates were highest in the Pakistan site, which also documented a substantial decrease in stillbirth rates over the study period, from 56.0 per 1000 (95% CI 51.0, 61.0) in 2010 to 44.4 per 1000 (95% CI 39.1, 49.7) in 2018. The Nagpur, India site also documented a substantial decrease in stillbirths from 32.5 (95% CI 29.0, 36.1) to 16.9 (95% CI 13.9, 19.9) per 1000 in 2018; however, other sites had only small declines in stillbirth over the same period. Women who were less educated and older as well as those with less access to antenatal care and with vaginal assisted delivery were at increased risk of stillbirth. The major fetal causes of stillbirth were birth asphyxia (44.0% of stillbirths) and infectious causes (22.2%). The maternal conditions that were observed among those with stillbirth were obstructed or prolonged labor, antepartum hemorrhage and maternal infections.ConclusionsOver the study period, stillbirth rates have remained relatively high across all sites. With the exceptions of the Pakistan and Nagpur sites, Global Network sites did not observe substantial changes in their stillbirth rates. Women who were less educated and had less access to antenatal and obstetric care remained at the highest burden of stillbirth.Study registrationClinicaltrials.gov (ID# NCT01073475).
Highlights
Stillbirth rates are high and represent a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC)
Over the study period, stillbirth rates have remained relatively high across all sites
Women who were less educated and had less access to antenatal and obstetric care remained at the highest burden of stillbirth
Summary
Stillbirth rates are high and represent a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC). In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented cause of stillbirths or the trends in rate of stillbirth over time. An estimated 2.1 million third trimester stillbirths (95% CI 1.8, 2.5) occurred in 2015, representing a decrease of nearly 50% since 1990 [1] While this reduction is considerable, the overall rate of decrease in stillbirth lags well behind the rate of reductions that have occurred in under-5 mortality. We have reported on stillbirth rates from a population-based study in LMIC in the Global Network for Women’s and Children’s Health Research and found stillbirth rates ranging from 18 per 1000 births in Kenya to 44 per 1000 births in Pakistan [4, 5]. Estimates from the Global Network and AMANHI have suggested that more than half of stillbirths may occur in the intrapartum period and are generally considered preventable [4, 5]
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