Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa

Aminu, Mamuda ORCID: https://orcid.org/0000-0002-2335-7147, Bar-Zeev, Sarah, White, Sarah ORCID: https://orcid.org/0000-0001-5535-8075, Mathai, Matthews ORCID: https://orcid.org/0000-0002-7352-9330 and van den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2019) 'Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa'. BMC Pregnancy and Childbirth, Vol 19, Issue 1, e470.

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Abstract

Background
Every year, an estimated 2.6 million stillbirths occur worldwide, with up to 98% occurring in low- and middle-income countries (LMIC). There is a paucity of primary data on cause of stillbirth from LMIC, and particularly from sub-Saharan Africa to inform effective interventions. This study aimed to identify the cause of stillbirths in low- and middle-income settings and compare methods of assessment.
Methods
This was a prospective, observational study in 12 hospitals in Kenya, Malawi, Sierra Leone and Zimbabwe. Stillbirths (28 weeks or more) were reviewed to assign the cause of death by healthcare providers, an expert panel and by using computer-based algorithms. Agreement between the three methods was compared using Kappa (κ) analysis. Cause of stillbirth and level of agreement between the methods used to assign cause of death.
Results
One thousand five hundred sixty-three stillbirths were studied. The stillbirth rate (per 1000 births) was 20.3 in Malawi, 34.7 in Zimbabwe, 38.8 in Kenya and 118.1 in Sierra Leone. Half (50.7%) of all stillbirths occurred during the intrapartum period.
Cause of death (range) overall varied by method of assessment and included: asphyxia (18.5–37.4%), placental disorders (8.4–15.1%), maternal hypertensive disorders (5.1–13.6%), infections (4.3–9.0%), cord problems (3.3–6.5%), and ruptured uterus due to obstructed labour (2.6–6.1%). Cause of stillbirth was unknown in 17.9–26.0% of cases.
Moderate agreement was observed for cause of stillbirth as assigned by the expert panel and by hospital-based healthcare providers who conducted perinatal death review (κ = 0.69; p < 0.0005). There was only minimal agreement between expert panel review or healthcare provider review and computer-based algorithms (κ = 0.34; 0.31 respectively p < 0.0005).
Conclusions
For the majority of stillbirths, an underlying likely cause of death could be determined despite limited diagnostic capacity. In these settings, more diagnostic information is, however, needed to establish a more specific cause of death for the majority of stillbirths. Existing computer-based algorithms used to assign cause of death require revision.

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 > Pregnancy Complications > WQ 225 Spontaneous abortion. Fetal death
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1186/s12884-019-2626-7
Depositing User:	Rachel Dominguez
Date Deposited:	16 Dec 2019 11:53
Last Modified:	08 Sep 2020 09:44
URI:	https://archive.lstmed.ac.uk/id/eprint/13325

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