Stillbirth rates in 20 countries of Latin America: an ecological study

Pingray, Verónica; Althabe, Fernando; Vazquez, Paula; Correa, Malena; Pajuelo, Mónica; Jm, Belizán

doi:10.1111/1471-0528.15294

Cited by 14 publications

(29 citation statements)

References 23 publications

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“…Contrary to the general assumptions of social determinants of health, we did not find significant associations between stillbirth rate, and urban residence, lifestyle factors (alcohol and tobacco consumption) and income disparity. With exception to urban residence, a similar conclusion was reached from an ecological cross sectional study of 20 Latin American countries 45 . Furthermore, our study did not observe significant association between diabetes among female adults and stillbirth.…”

Section: Discussionsupporting

confidence: 69%

Evidence of health inequity in child survival: spatial and Bayesian network analyses of stillbirth rates in 194 countries

Adeyinka

Olakunde

Muhajarine

2019

Sci Rep

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Estimated at 2.6 million annually, stillbirths worldwide have stayed alarmingly high, in contrast to neonatal and under-five mortality rates. It is a neglected public health challenge globally, with less attention to its social determinants. We examined spatial patterns of country-level stillbirth rates and determined the influence of social determinants of health on spatial patterns of stillbirth rates. We also estimated probabilistic relationships between stillbirth rates and significant determinants from the spatial analysis. Using country-level aggregated data from the United Nations databases, it employed ecological spatial analysis and artificial intelligence modeling based on Bayesian network among 194 World Health Organization member countries. From the spatial analysis, thirty-seven countries formed a cluster of high values (hot-spots) for stillbirth and 13 countries formed a cluster of low values (cold-spots). In the multivariate regression, gender inequality and anaemia in pregnancy were significantly associated with spatial patterns of higher stillbirth rates, while higher antenatal care (ANC) coverage and skilled birth attendants during delivery were associated with clusters of lower stillbirth rates. The Bayesian network model suggests strong dependencies between stillbirth rate and gender inequality index, geographic regions and skilled birth attendants during delivery. The Bayesian network predicted that the probability of low stillbirth rate increased from 56% to 100% when the percentage of countries with high skilled birth attendants during delivery increased from 70% to 88%, high ANC coverage increased from 55% to 70%, high prevalence of anaemia in pregnancy decreased from 27% to 11% and high gender inequality index decreased from 43% to 21%. Recognizing the urgency in reducing stillbirths globally, multi-pronged strategies should be designed to promote gender equality and strengthen the reproductive and maternal health services in Africa, Eastern Mediterranean, South Eastern Asia, and other countries with disproportionately high stillbirth rates.

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Section: Discussionsupporting

confidence: 69%

Evidence of health inequity in child survival: spatial and Bayesian network analyses of stillbirth rates in 194 countries

Adeyinka

Olakunde

Muhajarine

2019

Sci Rep

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“…This study is the first to apply the WHO ICD-PM tool on stillbirths in the Americas. Stillbirths have not previously been studied in Suriname, and the SBR of 14.4 per 1000 births found in this study is higher than in most other LMIC in Latin America and the Caribbean [11]. Women of African descent were at higher risk of a stillbirth compared to women of all other ethnicities.…”

Section: Main Findingscontrasting

confidence: 61%

“…Small for gestational age was defined as weight under the 10th percentile according to INTERGROWTH 21 st charts [22]. A macerated foetus was defined as a stillbirth with skin and soft tissue changes such as redness, peeling and skin discolouration [9,11]. Congenital malformations were determined by reported macroscopic abnormalities.…”

Section: Variablesmentioning

confidence: 99%

“…A previous nationwide study on perinatal outcomes in Suriname, South America, in 2016 and 2017 reported an SBR of 14.8 per 1000. This ranked Suriname with the second-highest SBR of Latin America and the Caribbean [11,12]. The reason for Suriname's high SBR is unknown.…”

Section: Introductionmentioning

confidence: 96%

“…The reason for Suriname's high SBR is unknown. Similar to many other LMIC, no stillbirth registry or classification system is in place, and no perinatal death audits are performed [4,5,11]. To develop an adequate stillbirth reduction strategy, in-depth investigation into stillbirths is necessary to identify risk factors, causes and contributing factors.…”

Section: Introductionmentioning

confidence: 99%

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Investigation of stillbirth causes in Suriname: application of the WHO ICD-PM tool to national-level hospital data

Prüst

Verschueren

Bhikha-Kori

et al. 2020

Global Health Action

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Background: Suriname has one of the highest stillbirth rates in Latin America and the Caribbean. To facilitate data comparison of perinatal deaths, the World Health Organization developed the International Classification of Diseases-10 Perinatal Mortality (ICD-PM). Objective: We aimed to (1) assess characteristics and risk indicators of women with a stillbirth, (2) determine the timing and causes of stillbirths according to the ICD-PM with critical evaluation of its application and (3) propose recommendations for the reduction of stillbirths in Suriname. Methods: A hospital-based, nationwide , cross-sectional study was conducted in all hospitals within Suriname during one-year (2017). The medical files of stillbirths (gestation ≥28 weeks/ birth weight ≥1000 grams) were reviewed and classified using ICD-PM. We used descriptive statistics and multiple logistic regression analyses. Results: The stillbirth rate in Suriname was 14.4/1000 births (n=131 stillbirths, n=9089 total births). Medical files were available for 86% (n=113/131) of stillbirths. Women of African descent had the highest stillbirth rate and two times the odds of stillbirth (OR 2.1, 95%CI 1.4-3.1) compared to women of other ethnicities. One third (33%, n=37/113) of stillbirths occurred after hospital admission. The timing was antepartum in 85% (n=96/113), intrapartum in 11% (n=12/113) and unknown in 4% (n=5/113). Antepartum stillbirths were caused by hypoxia in 46% (n=44/96). In 41% (n=39/96) the cause was unspecified. Maternal medical and surgical conditions were present in 50% (n=57/113), mostly hypertensive disorders. Conclusion: Stillbirth reduction strategies in Suriname call for targeting ethnic disparities, improving antenatal services, implementing perinatal death audits and improving diagnostic post-mortem investigations. ICD-PM limited the formulation of recommendations due to many stillbirths of 'unspecified' causes. Based on our study findings, we also recommend addressing some challenges with applying the ICD-PM.

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Performance of the INTERGROWTH‐21^st and World Health Organization fetal growth charts for the detection of small‐for‐gestational age neonates in Latin America

Miranda

Maestre

Paternina-Caicedo

et al. 2023

Intl J Gynecology & Obste

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Objective To evaluate the performance of INTERGROWTH‐21st (IG‐21st) and World Health Organization (WHO) fetal growth charts to identify small‐for‐gestational‐age (SGA) and fetal growth restriction (FGR) neonates, as well as their specific risks for adverse neonatal outcomes. Methods Multicenter cross‐sectional study including 67 968 live births from 10 maternity units across four Latin American countries. According to each standard, neonates were classified as SGA and FGR (birth weight <10th and less than third centiles, respectively). The relative risk (RR) and diagnostic performance for a low APGAR score and low ponderal index were calculated for each standard. Results WHO charts identified more neonates as SGA than IG‐21st (13.9% vs 7%, respectively). Neonates classified as having FGR by both standards had the highest RR for a low APGAR (RR, 5.57 [95% confidence interval (CI), 3.99–7.78]), followed by those who were SGA by both curves (RR, 3.27 [95% CI, 2.52–4.24]), while neonates with SGA identified by WHO alone did not have an additional risk (RR, 0.87 [95% CI, 0.55–1.39]). Furthermore, the diagnostic odds ratio for a low APGAR was higher when IG‐21st was used. Conclusion In a population from Latin America, the WHO charts seem to identify more SGA neonates, but the diagnostic performance of the IG‐21st charts for low APGAR score and low ponderal index is better.

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Stillbirth rates in 20 countries of Latin America: an ecological study

Abstract: Stillbirth rates decreased in Latin America but remain relatively high, with wide variations among countries.

Cited by 14 publications

References 23 publications

Evidence of health inequity in child survival: spatial and Bayesian network analyses of stillbirth rates in 194 countries

Evidence of health inequity in child survival: spatial and Bayesian network analyses of stillbirth rates in 194 countries

Investigation of stillbirth causes in Suriname: application of the WHO ICD-PM tool to national-level hospital data

Performance of the INTERGROWTH‐21^st and World Health Organization fetal growth charts for the detection of small‐for‐gestational age neonates in Latin America

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Stillbirth rates in 20 countries of Latin America: an ecological study

Abstract: Stillbirth rates decreased in Latin America but remain relatively high, with wide variations among countries.

Cited by 14 publications

References 23 publications

Evidence of health inequity in child survival: spatial and Bayesian network analyses of stillbirth rates in 194 countries

Evidence of health inequity in child survival: spatial and Bayesian network analyses of stillbirth rates in 194 countries

Investigation of stillbirth causes in Suriname: application of the WHO ICD-PM tool to national-level hospital data

Performance of the INTERGROWTH‐21st and World Health Organization fetal growth charts for the detection of small‐for‐gestational age neonates in Latin America

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Performance of the INTERGROWTH‐21^st and World Health Organization fetal growth charts for the detection of small‐for‐gestational age neonates in Latin America