| dc.description.abstract |
Background: 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.
Methods: We 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.
Results: From 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. |
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