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Stillbirth surveillance and review in rural districts in Bangladesh

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Halim, Abdul, Aminu, Mamuda ORCID: https://orcid.org/0000-0002-2335-7147, Dewez, Juan, Biswas, Animesh, Rahman, A. K. M. Fazlur and van den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2018) 'Stillbirth surveillance and review in rural districts in Bangladesh'. BMC Pregnancy and Childbirth, Vol 18, Issue 1.

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Abstract

Background
An estimated 2.6 million stillbirths occur every year, with the majority occurring in low- and middle-income countries. Understanding the cause of and factors associated with stillbirth is important to help inform the design and implementation of interventions aimed at reducing preventable stillbirths.

Methods
Population-based surveillance with identification of all stillbirths that occurred either at home or in a health facility was introduced in four districts in Bangladesh. Verbal autopsy was conducted for every fifth stillbirth using a structured questionnaire. A hierarchical model was used to assign likely cause of stillbirth.

Results
Six thousand three hundred thirty-three stillbirths were identified for which 1327 verbal autopsies were conducted. 63.9% were intrapartum stillbirths. The population-based stillbirth rate obtained was 20.4 per 1000 births; 53.9% of all stillbirths occurred at home. 69.6% of mothers had accessed health care in the period leading up to the stillbirth. 48.1% had received care from a highly trained healthcare provider. The three most frequent causes of stillbirth were maternal hypertension or eclampsia (15.2%), antepartum haemorrhage (13.7%) and maternal infections (8.9%). Up to 11.3% of intrapartum stillbirths were caused by hypoxia. However, it was not possible to identify a cause of death with reasonable certainty using information obtained via verbal autopsy in 51.9% of stillbirths.

Conclusions
Introducing surveillance for stillbirths at community level is possible. However, verbal autopsy yields limited data, and the questionnaire used for this needs to be revised and/or combined with information obtained through case note review.
Most women accessed and received care from a qualified healthcare provider. To reduce the number of preventable stillbirths, the quality of antenatal and intrapartum care needs to be improved.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WQ Obstetrics > Childbirth. Prenatal Care > WQ 175 Prenatal care
WQ Obstetrics > Pregnancy Complications > WQ 240 Pregnancy complications (General)
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12884-018-1866-2
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 18 Jun 2018 15:26
Last Modified: 21 Jun 2018 14:50
URI: http://archive.lstmed.ac.uk/id/eprint/8785

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