CMNH study highlights major causes of stillbirths in sub-Saharan Africa

News article 19 Dec 2019

The Centre for Maternal and Newborn Health (CMNH) has published a new research article highlighting the major causes of stillbirth in sub-Saharan Africa. The article was based on a study conducted in 12 hospitals in Kenya, Malawi, Sierra Leone and Zimbabwe. It has just been published in BMC Pregnancy and Childbirth: “Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa.”


The study reviewed 1563 stillbirths (born after 28 weeks or more) across the 12 hospitals. It found the lowest stillbirth rate was in health facilities in Malawi (20.3 stillbirths per 1000 births) and the highest rate was in Sierra Leone (118.1 per 1000 births). It also revealed that more than half of all stillbirths occurred during labour and childbirth.

The major causes of stillbirth were asphyxia, placental disorders, maternal hypertensive disorders, infections, cord problems and ruptured uterus due to obstructed labour. Given the significant proportion of deaths that occurred during labour and childbirth, the authors call for urgent actions to improve emergency obstetric and newborn care.

The study also compared three different methods of assigning the cause of death for stillbirths: assigned by healthcare providers, assigned by an expert panel and using computer-based algorithms. It was concluded that using computer-based algorithms to assign the cause of death would require revision before further use.

Dr Mamuda Aminu, a Senior Clinical Research Associate at CMNH, who led the study, explained that: “By using real-life data, rather than estimates, this study confirms the high stillbirth rate reported in low- and middle-income countries, particularly in sub-Saharan Africa. These deaths are unacceptably high, especially because half of them occur in hospitals.

“Nevertheless, these findings also present new opportunities for action. For example, we know that half of these deaths occur within the narrow window of labour and childbirth. We can target interventions at this period and potentially make a big impact on our effort to reduce the burden of stillbirth.

“I would like to encourage stakeholders to support healthcare providers in conducting perinatal death audit to generate the information they need to effect changes in practice that could help save more lives.”