Trends and determinants of stillbirth in developing countries: results from the Global Network’s Population-Based Birth Registry

Abstract

BackgroundStillbirth rates remain high, especially in low and middle-income countries, where rates are 25 per 1000, ten-fold higher than in high-income countries. The United Nations’ Every Newborn Action Plan has set a goal of 12 stillbirths per 1000 births by 2030 for all countries.MethodsFrom a population-based pregnancy outcome registry, including data from 2010 to 2016 from two sites each in Africa (Zambia and Kenya) and India (Nagpur and Belagavi), as well as sites in Pakistan and Guatemala, we evaluated the stillbirth rates and rates of annual decline as well as risk factors for 427,111 births of which 12,181 were stillbirths.ResultsThe mean stillbirth rates for the sites were 21.3 per 1000 births for Africa, 25.3 per 1000 births for India, 56.9 per 1000 births for Pakistan and 19.9 per 1000 births for Guatemala. From 2010 to 2016, across all sites, the mean stillbirth rate declined from 31.7 per 1000 births to 26.4 per 1000 births for an average annual decline of 3.0%. Risk factors for stillbirth were similar across the sites and included maternal age < 20 years and age > 35 years. Compared to parity 1–2, zero parity and parity > 3 were both associated with increased stillbirth risk and compared to women with any prenatal care, women with no prenatal care had significantly increased risk of stillbirth in all sites.ConclusionsAt the current rates of decline, stillbirth rates in these sites will not reach the Every Newborn Action Plan goal of 12 per 1000 births by 2030. More attention to the risk factors and treating the causes of stillbirths will be required to reach the Every Newborn Action Plan goal of stillbirth reduction.Trial registrationNCT01073475.

Association Between Obstetric and Medical Risk Factors With Stillbirths in 4 Tertiary Hospitals in a Low Income Country

“…There was a positive association between increasing parity and risk of stillbirth. This is in keeping with observations by Aliyu et al, 2005 (19) but in contrast with other studies (7,24). Advanced gravidity has been associated with a concept termed 'maternal depletion syndrome' that stipulates that short intergestational intervals and high parity depletes maternal nutritional reserves leading to a poor nutritional state for the subsequent pregnancies and a high likelihood of an adverse pregnancy outcome including stillbirth (25).…”

Burden of stillbirths and associated factors in Yirgalem Hospital, Southern Ethiopia: a facility based cross-sectional study

“…Thus, aforementioned studies were conducted in referral hospitals which have better obstetric care facilities and skilled health workforce; whereas our study setting was a general hospital with fewer obstetricians and majority of cases were referred from peripheral primary health care units with poor facilities, which provide obstetric services for a predominantly rural population. The proportion of stillbirths in our nding was also higher than the global estimates of stillbirth for Ethiopia (25,26), and other studies from developing countries such as Bangladeshi (27) and India (28). This variation could be partly explained by differences in study settings and methods because the present study was a hospital based study unlike other community based studies from developing countries.…”

Enhancing routine surveillance to improve stillbirth data

“…In AMANHI, stillbirth rates were reported of 35·1 per 1000 births at a south Asia site and 17·1 per 1000 births at sub-Saharan African sites; 8 in the Global Network, stillbirth rates were reported from 21·3 per 1000 births for African sites to 56·9 per 1000 for Pakistani sites. 9 In another study, Anwar and colleagues 10 reported that the stillbirth rate in Pakistan was 50 per 1000 births using an enhanced surveillance system versus 29 per 1000 births with the traditional DHS approach (p<0·0001). Studies such as these point to the substantial gap in reporting of stillbirths in routine reporting systems such as the DHS programme, even with enhancements.…”

“…7 Although the FPH approach seemed to improve stillbirth reporting, substantial gaps remain. Alternatives for more accurate stillbirth data are prospective population-based studies, eg, AMANHI 8 and Global Network, 9 which enrolled women in early pregnancy with follow-up to delivery. In AMANHI, stillbirth rates were reported of 35·1 per 1000 births at a south Asia site and 17·1 per 1000 births at sub-Saharan African sites; 8 in the Global Network, stillbirth rates were reported from 21·3 per 1000 births for African sites to 56·9 per 1000 for Pakistani sites.…”