Stillbirth maternity care measurement and associated factors in population-based surveys: EN-INDEPTH study.


Collaborators: Byass P, Tollman S, Godefay H, Lawn JE, Waiswa P, Blencowe H, Yargawa J, Akuze J, Fisker AB, Martins JSD, Rodrigues A, Thysen SM, Biks GA, Abebe SM, Ayele TA, Bisetegn TA, Delele TG, Gelaye KA, Geremew BM, Gezie LD, Melese T, Mengistu MY, Tesega AK, Yitayew TA, Kasasa S, Galiwango E, Gyezaho C, Kaija J, Kajungu D, Nareeba T, Natukwatsa D, Tusubira V, Enuameh YAK, Asante KP, Dzabeng F, Etego SA, Manu AA, Manu G, Nettey OE, Newton SK, Owusu-Agyei S, Tawiah C, Zandoh C, Alam N, Delwar N, Haider MM, Imam A, Mahmu K, Baschieri A, Cousens S, Gordeev VS, Hardy VP, Kwesiga D, Machiyama K.
Author information:
(1)Maternal, Adolescent, Reproductive & Child Health
(MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
(2)Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
(3)Centre of Excellence for Maternal Newborn and Child Health Research, Makerere University, Kampala, Uganda.
(4)Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.
(5)IgangaMayuge Health and Demographic Surveillance System, Makerere University Centre for Health and Population Research, Makerere, Uganda.
(6)Kintampo Health Research Centre, Kintampo, Ghana.
(7)Bandim Health Project, Bissau, Guinea-Bissau.
(8)Research Centre for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark.
(9)Department of Clinical Research, Open Patient data Explorative Network
(OPEN), University of Southern Denmark, Odense, Denmark.
(10)Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
(11)Maternal, Adolescent, Reproductive & Child Health
(MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK. [Email]
(12)Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
(#)Contributed equally


BACKGROUND: Household surveys remain important sources of maternal and child health data, but until now, standard surveys such as Demographic and Health Surveys (DHS) have not collected information on maternity care for women who have experienced a stillbirth. Thus, nationally representative data are lacking to inform programmes to address the millions of stillbirths which occur annually. METHODS: The EN-INDEPTH population-based survey of women of reproductive age was undertaken in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017-2018). All women answered a full birth history with additional questions on pregnancy losses (FBH+) or full pregnancy history (FPH). A sub-sample, including all women reporting a recent stillbirth or neonatal death, was asked additional maternity care questions. These were evaluated using descriptive measures. Associations between stillbirth and maternal socio-demographic characteristics, babies' characteristics and maternity care use were assessed using a weighted logistic regression model for women in the FBH+ group. RESULTS: A total of 15,591 women reporting a birth since 1 January 2012 answered maternity care questions. Completeness was very high (> 99%), with similar proportions of responses for both live and stillbirths. Amongst the 14,991 births in the FBH+ group, poorer wealth status, higher parity, large perceived baby size-at-birth, preterm or post-term birth, birth in a government hospital compared to other locations and vaginal birth were associated with increased risk of stillbirth after adjusting for potential confounding factors. Regarding association with reported postnatal care, women with a stillbirth were more likely to report hospital stays of > 1 day. However, women with a stillbirth were less likely to report having received a postnatal check compared to those with a live birth. CONCLUSIONS: Women who had experienced stillbirth were able to respond to questions about pregnancy and birth, and we found no reason to omit questions to these women in household surveys. Our analysis identified several potentially modifiable factors associated with stillbirth, adding to the evidence-base for policy and action in low- and middle-income contexts. Including these questions in DHS-8 would lead to increased availability of population-level data to inform action to end preventable stillbirths.