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. 2021 Feb 8;19(Suppl 1):13.
doi: 10.1186/s12963-020-00239-8.

Stillbirth outcome capture and classification in population-based surveys: EN-INDEPTH study

Hannah Blencowe  1 , Matteo Bottecchia  2 , Doris Kwesiga  3   4   5 , Joseph Akuze  2   3   4 , M Moinuddin Haider  6 , Edward Galiwango  7 , Francis Dzabeng  8 , Ane B Fisker  9   10   11 , Yeetey Akpe Kwesi Enuameh  8   12 , Bisrat Misganaw Geremew  13 , Tryphena Nareeba  7 , Susannah Woodd  2 , Alexandra Beedle  2 , Kimberly Peven  2 , Simon Cousens  2 , Peter Waiswa #  3   4   14 , Joy E Lawn #  2 ; Every Newborn-INDEPTH Study Collaborative Group
Collaborators, Affiliations

Stillbirth outcome capture and classification in population-based surveys: EN-INDEPTH study

Hannah Blencowe et al. Popul Health Metr. .

Abstract

Background: Household surveys remain important sources of stillbirth data, but omission and misclassification are common. Classifying adverse pregnancy outcomes as stillbirths requires accurate reporting of vital status at birth and gestational age or birthweight for every pregnancy. Further categorisation, e.g. by sex, or timing (intrapartum/antepartum) improves data to understand and prevent stillbirth.

Methods: We undertook a cross-sectional population-based survey of women of reproductive age 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 pregnancy loss questions (FBH+) or a full pregnancy history (FPH). A sub-sample across both groups were asked additional stillbirth questions. Questions were evaluated using descriptive measures. Using an interpretative paradigm and phenomenology methodology, focus group discussions with women exploring barriers to reporting birthweight for stillbirths were conducted. Thematic analysis was guided by an a priori codebook.

Results: Overall 69,176 women reported 98,483 livebirths (FBH+) and 102,873 pregnancies (FPH). Additional questions were asked for 1453 stillbirths, 1528 neonatal deaths and 12,620 surviving children born in the 5 years prior to the survey. Completeness was high (> 99%) for existing FBH+/FPH questions on signs of life at birth and gestational age (months). Discordant responses in signs of life at birth between different questions were common; nearly one-quarter classified as stillbirths on FBH+/FPH were reported born alive on additional questions. Availability of information on gestational age (weeks) (58.1%) and birthweight (13.2%) was low amongst stillbirths, and heaping was common. Most women (93.9%) were able to report the sex of their stillborn baby. Response completeness for stillbirth timing (18.3-95.1%) and estimated proportion intrapartum (15.6-90.0%) varied by question and site. Congenital malformations were reported in 3.1% stillbirths. Perceived value in weighing a stillborn baby varied and barriers to weighing at birth a nd knowing birthweight were common.

Conclusions: Improving stillbirth data in surveys will require investment in improving the measurement of vital status, gestational age and birthweight by healthcare providers, communication of these with women, and overcoming reporting barriers. Given the large burden and effect on families, improved data must be made available to end preventable stillbirths.

Keywords: Classification; Measurement; Stillbirth; Survey.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig 1
Fig 1
Classification of stillbirths and neonatal deaths in EN-INDEPTH study
Fig. 2
Fig. 2
Flow diagram of EN-INDEPTH study population and data included for stillbirth analyses
Fig. 3
Fig. 3
Gestational age in months by outcome, overall and by site (n = 66,793)
Fig. 4
Fig. 4
Gestational age–specific combined stillbirth and early neonatal mortality rates, 5 sites (n = 66,793)
Fig. 5
Fig. 5
Birthweight heaping for stillbirths in EN-INDEPTH survey (n = 161)
Fig. 6
Fig. 6
Sex of stillborn babies by gestational age reported in EN-INDEPTH survey (FPH arm only) (n = 631)
See this image and copyright information in PMC

References

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