Stillbirths and newborn deaths in slum settlements in Mumbai, India: a prospective verbal autopsy study

Bapat, Ujwala; Alcock, Glyn; More, Neena Shah; Das, Sushmita; Joshi, Wasundhara; Osrin, David

doi:10.1186/1471-2393-12-39

Cited by 45 publications

(59 citation statements)

References 48 publications

(52 reference statements)

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“…These social stigma-related factors affecting the timing of presentation to skilled care before or during labour were also found in earlier studies carried out in low- and middle-income countries [22, 32, 33]. …”

Section: Discussionsupporting

confidence: 77%

Case review of perinatal deaths at hospitals in Kigali, Rwanda: perinatal audit with application of a three-delays analysis

Musafili

Persson

Baribwira

et al. 2017

BMC Pregnancy Childbirth

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BackgroundPerinatal audit and the three-delays model are increasingly being employed to analyse barriers to perinatal health, at both community and facility level. Using these approaches, our aim was to assess factors that could contribute to perinatal mortality and potentially avoidable deaths at Rwandan hospitals.MethodsPerinatal audits were carried out at two main urban hospitals, one at district level and the other at tertiary level, in Kigali, Rwanda, from July 2012 to May 2013. Stillbirths and early neonatal deaths occurring after 22 completed weeks of gestation or more, or weighing at least 500 g, were included in the study. Factors contributing to mortality and potentially avoidable deaths, considering the local resources and feasibility, were identified using a three-delays model.ResultsOut of 8424 births, there were 269 perinatal deaths (106 macerated stillbirths, 63 fresh stillbirths, 100 early neonatal deaths) corresponding to a stillbirth rate of 20/1000 births and a perinatal mortality rate of 32/1000 births. In total, 250 perinatal deaths were available for audit. Factors contributing to mortality were ascertained for 79% of deaths. Delay in care-seeking was identified in 39% of deaths, delay in arriving at the health facility in 10%, and provision of suboptimal care at the health facility in 37%. Delay in seeking adequate care was commonly characterized by difficulties in recognising or reporting pregnancy-related danger signs. Lack of money was the major cause of delay in reaching a health facility. Delay in referrals, diagnosis and management of emergency obstetric cases were the most prominent contributors affecting the provision of appropriate and timely care by healthcare providers. Half of the perinatal deaths were judged to be potentially avoidable and 70% of these were fresh stillbirths and early neonatal deaths.ConclusionsFactors contributing to delays underlying perinatal mortality were identified in more than three-quarters of deaths. Half of the perinatal deaths were considered likely to be preventable and mainly related to modifiable maternal inadequate health-seeking behaviours and intrapartum suboptimal care. Strengthening the current roadmap strategy for accelerating the reduction of maternal and neonatal morbidity and mortality is needed for improved perinatal survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1269-9) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 77%

Case review of perinatal deaths at hospitals in Kigali, Rwanda: perinatal audit with application of a three-delays analysis

Musafili

Persson

Baribwira

et al. 2017

BMC Pregnancy Childbirth

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“…Twenty‐one clinical classification systems were used in 41 of the 85 reports (LIC, 15 reports covering 30% of stillbirths; MIC, 6 reports covering 5% of stillbirths; HIC, 20 reports covering 27% of stillbirths). The ICD was used more frequently in HIC (14 reports covering 72% of stillbirths) and MIC (7 reports covering 94% of stillbirths) than LIC (3 reports covering 2% of stillbirths) (Table ).…”

Section: Resultsmentioning

confidence: 99%

Making stillbirths visible: a systematic review of globally reported causes of stillbirth

Reinebrant

Leisher

Coory

et al. 2017

BJOG

142

138

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Background Stillbirth is a global health problem. The World Health Organization (WHO) application of the International Classification of Diseases for perinatal mortality (ICD‐PM) aims to improve data on stillbirth to enable prevention. Objectives To identify globally reported causes of stillbirth, classification systems, and alignment with the ICD‐PM. Search strategy We searched CINAHL, EMBASE, Medline, Global Health, and Pubmed from 2009 to 2016. Selection criteria Reports of stillbirth causes in unselective cohorts. Data collection and analysis Pooled estimates of causes were derived for country representative reports. Systems and causes were assessed for alignment with the ICD‐PM. Data are presented by income setting (low, middle, and high income countries; LIC, MIC, HIC). Main results Eighty‐five reports from 50 countries (489 089 stillbirths) were included. The most frequent categories were Unexplained, Antepartum haemorrhage, and Other (all settings); Infection and Hypoxic peripartum (LIC), and Placental (MIC, HIC). Overall report quality was low. Only one classification system fully aligned with ICD‐PM. All stillbirth causes mapped to ICD‐PM. In a subset from HIC, mapping obscured major causes. Conclusions There is a paucity of quality information on causes of stillbirth globally. Improving investigation of stillbirths and standardisation of audit and classification is urgently needed and should be achievable in all well‐resourced settings. Implementation of the WHO Perinatal Mortality Audit and Review guide is needed, particularly across high burden settings. Funding HR, SH, SHL, and AW were supported by an NHMRC‐CRE grant (APP1116640). VF was funded by an NHMRC‐CDF (APP1123611). Tweetable abstract Urgent need to improve data on causes of stillbirths across all settings to meet global targets. Plain Language Summary Background and methodsNearly three million babies are stillborn every year. These deaths have deep and long‐lasting effects on parents, healthcare providers, and the society. One of the major challenges to preventing stillbirths is the lack of information about why they happen. In this study, we collected reports on the causes of stillbirth from high‐, middle‐, and low‐income countries to: (1) Understand the causes of stillbirth, and (2) Understand how to improve reporting of stillbirths. FindingsWe found 85 reports from 50 different countries. The information available from the reports was inconsistent and often of poor quality, so it was hard to get a clear picture about what are the causes of stillbirth across the world. Many different definitions of stillbirth were used. There was also wide variation in what investigations of the mother and baby were undertaken to identify the cause of stillbirth. Stillbirths in all income settings (low‐, middle‐, and high‐income countries) were most frequently reported as Unexplained, Other, and Haemorrhage (bleeding). Unexplained and Other are not helpful in understanding why a baby was stillborn. In low‐income countries, stillbirths were often attribute...

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“…Studies from Nigeria constituted 9.2% of all papers included in this review, all of which were hospital‐based. Similarly, 10.6% of the articles were from India and all but one were hospital‐based …”

Section: Resultsmentioning

confidence: 99%

Causes of and factors associated with stillbirth in low‐ and middle‐income countries: a systematic literature review

Aminu

Unkels

Mdegela

et al. 2014

BJOG

231

215

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Background Annually, 2.6 million stillbirths occur worldwide, 98% in developing countries. It is crucial that we understand causes and contributing factors. Methods We conducted a systematic review of studies reporting factors associated with and cause(s) of stillbirth in low‐ and middle‐income countries (2000–13). Narrative synthesis to compare similarities and differences between studies with similar outcome categories. Main results A total of 142 studies with 2.1% from low‐income settings were investigated; most report on stillbirths occurring at health facility level. Definition of stillbirth varied; 10.6% of studies (mainly upper middle‐income countries) used a cut‐off point of ≥22 weeks of gestation and 32.4% (mainly lower income countries) used ≥28 weeks of gestation. Factors reported to be associated with stillbirth include poverty and lack of education, maternal age (>35 or <20 years), parity (1, ≥5), lack of antenatal care, prematurity, low birthweight, and previous stillbirth. The most frequently reported cause of stillbirth was maternal factors (8–50%) including syphilis, positive HIV status with low CD4 count, malaria and diabetes. Congenital anomalies are reported to account for 2.1–33.3% of stillbirths, placental causes (7.4–42%), asphyxia and birth trauma (3.1–25%), umbilical problems (2.9–33.3%), and amniotic and uterine factors (6.5–10.7%). Seven different classification systems were identified but applied in only 22% of studies that could have used a classification system. A high percentage of stillbirths remain ‘unclassified’ (3.8–57.4%). Conclusion To build capacity for perinatal death audit, clear guidelines and a suitable classification system to assign cause of death must be developed. Existing classification systems may need to be adapted. Better data and more data are urgently needed.

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Stillbirths and newborn deaths in slum settlements in Mumbai, India: a prospective verbal autopsy study

Cited by 45 publications

References 48 publications

Case review of perinatal deaths at hospitals in Kigali, Rwanda: perinatal audit with application of a three-delays analysis

Case review of perinatal deaths at hospitals in Kigali, Rwanda: perinatal audit with application of a three-delays analysis

Making stillbirths visible: a systematic review of globally reported causes of stillbirth

Causes of and factors associated with stillbirth in low‐ and middle‐income countries: a systematic literature review

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