Epidemiology of stillbirth in low-middle income countries: a Global Network Study.

Academic Article

Abstract

  • OBJECTIVE: To determine population-based stillbirth rates and to determine whether the timing and maturity of the stillbirths suggest a high proportion of potentially preventable deaths. DESIGN: Prospective observational study. SETTING: Communities in six low-income countries (Democratic Republic of Congo, Kenya, Zambia, Guatemala, India, and Pakistan) and one site in a mid-income country (Argentina). POPULATION: Pregnant women residing in the study communities. METHODS: Over a five-year period, in selected catchment areas, using multiple methodologies, trained study staff obtained pregnancy outcomes on each delivery in their area. MAIN OUTCOME MEASURES: Pregnancy outcome, stillbirth characteristics. RESULTS: Outcomes of 195,400 deliveries were included. Stillbirth rates ranged from 32 per 1,000 in Pakistan to 8 per 1,000 births in Argentina. Three-fourths (76%) of stillbirth offspring were not macerated, 63% were ≥ 37 weeks and 48% weighed 2,500 g or more. Across all sites, women with no education, of high and low parity, of older age, and without access to antenatal care were at significantly greater risk for stillbirth (p<0.001). Compared to those delivered by a physician, women delivered by nurses and traditional birth attendants had a lower risk of stillbirth. CONCLUSIONS: In these low-middle income countries, most stillbirth offspring were not macerated, were reported as ≥ 37 weeks' gestation, and almost half weighed at least 2,500 g. With access to better medical care, especially in the intrapartum period, many of these stillbirths could likely be prevented.
  • Keywords

  • Adult, Delivery, Obstetric, Developing Countries, Female, Humans, Income, Maternal Age, Midwifery, Pregnancy, Prenatal Care, Prospective Studies, Risk Factors, Stillbirth, Young Adult
  • Digital Object Identifier (doi)

    Author List

  • McClure EM; Pasha O; Goudar SS; Chomba E; Garces A; Tshefu A; Althabe F; Esamai F; Patel A; Wright LL
  • Start Page

  • 1379
  • End Page

  • 1385
  • Volume

  • 90
  • Issue

  • 12