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

Elizabeth M. McClure, Omrana Pasha, Shivaprasad S. Goudar, Elwyn Chomba, Ana Garces, Antoinette Tshefu, Fernando Althabe, Fabian Esamai, Archana Patel, Linda L. Wright, Janet Moore, Bhalchandra S. Kodkany, Jose M. Belizan, Sarah Saleem, Richard J. Derman, Waldemar A. Carlo, K. Michael Hambidge, Pierre Buekens, Edward A. Liechty, Carl BoseMarion Koso-Thomas, Alan H. Jobe, Robert L. Goldenberg

Research output: Contribution to journalArticle

48 Citations (Scopus)

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 500g 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 500g. With access to better medical care, especially in the intrapartum period, many of these stillbirths could likely be prevented.

Original languageEnglish
Pages (from-to)1379-1385
Number of pages7
JournalActa Obstetricia et Gynecologica Scandinavica
Volume90
Issue number12
DOIs
StatePublished - Dec 2011

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Stillbirth
Epidemiology
Pakistan
Argentina
Pregnancy Outcome
Women Physicians
Guatemala
Zambia
Democratic Republic of the Congo
Prenatal Care
Kenya
Midwifery
Parity
Population
Observational Studies
Pregnant Women
India
Nurses
Outcome Assessment (Health Care)
Parturition

Keywords

  • Developing countries
  • intrapartum stillbirth
  • stillbirth

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

McClure, E. M., Pasha, O., Goudar, S. S., Chomba, E., Garces, A., Tshefu, A., ... Goldenberg, R. L. (2011). Epidemiology of stillbirth in low-middle income countries: A Global Network Study. Acta Obstetricia et Gynecologica Scandinavica, 90(12), 1379-1385. https://doi.org/10.1111/j.1600-0412.2011.01275.x

Epidemiology of stillbirth in low-middle income countries : A Global Network Study. / McClure, Elizabeth M.; Pasha, Omrana; Goudar, Shivaprasad S.; Chomba, Elwyn; Garces, Ana; Tshefu, Antoinette; Althabe, Fernando; Esamai, Fabian; Patel, Archana; Wright, Linda L.; Moore, Janet; Kodkany, Bhalchandra S.; Belizan, Jose M.; Saleem, Sarah; Derman, Richard J.; Carlo, Waldemar A.; Hambidge, K. Michael; Buekens, Pierre; Liechty, Edward A.; Bose, Carl; Koso-Thomas, Marion; Jobe, Alan H.; Goldenberg, Robert L.

In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 90, No. 12, 12.2011, p. 1379-1385.

Research output: Contribution to journalArticle

McClure, EM, Pasha, O, Goudar, SS, Chomba, E, Garces, A, Tshefu, A, Althabe, F, Esamai, F, Patel, A, Wright, LL, Moore, J, Kodkany, BS, Belizan, JM, Saleem, S, Derman, RJ, Carlo, WA, Hambidge, KM, Buekens, P, Liechty, EA, Bose, C, Koso-Thomas, M, Jobe, AH & Goldenberg, RL 2011, 'Epidemiology of stillbirth in low-middle income countries: A Global Network Study', Acta Obstetricia et Gynecologica Scandinavica, vol. 90, no. 12, pp. 1379-1385. https://doi.org/10.1111/j.1600-0412.2011.01275.x
McClure, Elizabeth M. ; Pasha, Omrana ; Goudar, Shivaprasad S. ; Chomba, Elwyn ; Garces, Ana ; Tshefu, Antoinette ; Althabe, Fernando ; Esamai, Fabian ; Patel, Archana ; Wright, Linda L. ; Moore, Janet ; Kodkany, Bhalchandra S. ; Belizan, Jose M. ; Saleem, Sarah ; Derman, Richard J. ; Carlo, Waldemar A. ; Hambidge, K. Michael ; Buekens, Pierre ; Liechty, Edward A. ; Bose, Carl ; Koso-Thomas, Marion ; Jobe, Alan H. ; Goldenberg, Robert L. / Epidemiology of stillbirth in low-middle income countries : A Global Network Study. In: Acta Obstetricia et Gynecologica Scandinavica. 2011 ; Vol. 90, No. 12. pp. 1379-1385.
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AU - McClure, Elizabeth M.

AU - Pasha, Omrana

AU - Goudar, Shivaprasad S.

AU - Chomba, Elwyn

AU - Garces, Ana

AU - Tshefu, Antoinette

AU - Althabe, Fernando

AU - Esamai, Fabian

AU - Patel, Archana

AU - Wright, Linda L.

AU - Moore, Janet

AU - Kodkany, Bhalchandra S.

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AU - Saleem, Sarah

AU - Derman, Richard J.

AU - Carlo, Waldemar A.

AU - Hambidge, K. Michael

AU - Buekens, Pierre

AU - Liechty, Edward A.

AU - Bose, Carl

AU - Koso-Thomas, Marion

AU - Jobe, Alan H.

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N2 - 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 500g 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 500g. With access to better medical care, especially in the intrapartum period, many of these stillbirths could likely be prevented.

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KW - Developing countries

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KW - stillbirth

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