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. 2023 Apr 14:13:04031.
doi: 10.7189/jogh.13.04031.

Stillbirths and neonatal mortality in LMICs: A community-based mother-infant cohort study

Lison Rambliere  1   2 , Agathe de Lauzanne  3 , Jean-Baptiste Diouf  4 , Andrianirina Zafitsara Zo  5 , Myriam Landau  6 , Perlinot Herindrainy  6 , Delphine Hivernaud  7 , Fatoumata Diene Sarr  8 , Touch Sok  9 , Muriel Vray  8 , Jean-Marc Collard  10 , Laurence Borand  3   11 , Elisabeth Delarocque-Astagneau  2   12 , Didier Guillemot  1   2   12 , Elsa Kermorvant-Duchemin  6 , Bich-Tram Huynh  1   2 ; BIRDY study group
Collaborators, Affiliations

Stillbirths and neonatal mortality in LMICs: A community-based mother-infant cohort study

Lison Rambliere et al. J Glob Health. .

Abstract

Background: The exact timing, causes, and circumstances of stillbirth and neonatal mortality in low- and middle-income countries (LMICs) remain poorly described, especially for antenatal stillbirths and deaths occurring at home. We aimed to provide reliable estimates of the incidence of stillbirth and neonatal death in three LMICs (Madagascar, Cambodia and Senegal) and to identify their main causes and associated risk factors.

Methods: This study is based on data from an international, multicentric, prospective, longitudinal, community-based mother-infant cohort. We included pregnant mothers and prospectively followed up their children in the community. Stillbirths and deaths were systematically reported; information across healthcare settings was collected and verbal autopsies were performed to document the circumstances and timing of death.

Results: Among the 4436 pregnancies and 4334 live births, the peripartum period and the first day of life were the key periods of mortality. The estimated incidence of stillbirth was 11 per 1000 total births in Cambodia, 15 per 1000 in Madagascar, and 12 per 1000 in Senegal. We estimated neonatal mortality at 18 per 1000 live births in Cambodia, 24 per 1000 in Madagascar, and 23 per 1000 in Senegal. Based on ultrasound biometric data, 16.1% of infants in Madagascar were born prematurely, where 42% of deliveries and 33% of deaths occurred outside healthcare facilities. Risk factors associated with neonatal death were mainly related to delivery or to events that newborns faced during the first week of life.

Conclusions: These findings underscore the immediate need to improve care for and monitoring of children at birth and during early life to decrease infant mortality. Surveillance of stillbirth and neonatal mortality and their causes should be improved to mitigate this burden in LMICs.

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Conflict of interest statement

Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests.

Figures

Figure 1
Figure 1
Definitions of stillbirth and deaths used in this study according to international recommendations; outcomes assessed were early stillbirth (22-28 WG, BIRDY2 only), stillbirth (>28 WG), early neonatal death (0-7 days), and late (8-28 days) and extended neonatal death (29 days to 2 months), as defined according to international definitions. Stillbirths were classified as antepartum if they occurred prior to labour and intrapartum if they occurred after labour onset. WG – weeks of gestation, d – days, m – months.
Figure 2
Figure 2
Flow-chart of combined BIRDY1 and BIRDY2 cohorts in Madagascar, Cambodia, and Senegal (2012-2021). *Three deaths of undetermined cause, that could not be classified as intrapartum stillbirth or early neonatal death.
Figure 3
Figure 3
Neonatal mortality in Madagascar, Cambodia. and Senegal (BIRDY1/BIRDY2 cohorts, 2012-2021). Panel A. Survival curve of infants. Panel B. Possible causes of death. *Including bronchiolitis and pneumonia. †Including sepsis and meningitis.
Figure 4
Figure 4
Risk factors associated with death from multivariate logistic regression (BIRDY1/BIRDY2 cohorts, 2012-2021). Panel A. Stillbirth (live birth = 3685, stillbirth = 44) in Madagascar and Cambodia. Panel B. Early neonatal death (survived = 4428, died = 72) in Madagascar, Senegal, and Cambodia (0-7 days).
See this image and copyright information in PMC

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