New study in Bangladesh shows that introducing surveillance for stillbirths at community level is possible

News article 21 Jun 2018

Over the last couple of decades, the stillbirth rate in Bangladesh has shown the fastest annual reduction in South Asia. However, with a stillbirth rate of 25.4 per 1,000 births, Bangladesh bears the 7th highest burden of stillbirth in the world, with over 83,000 babies born dead each year.

In an effort to reduce this burden, The Government of Bangladesh implemented a population-based Maternal and Perinatal Death Review (MPDR) system in four rural districts of the country in 2011. Through this system, cases of stillbirth were reviewed with a view to identifying the cause of death as well as factors that might have contributed to the death, providing vital information for action.

After the programme, it was unclear whether a population-based surveillance system for stillbirths was feasible for scale up throughout all the districts in Bangladesh. It was also unclear whether verbal autopsy (interviews with parents and relatives about the circumstances surrounding the death), which was used in the MPDR system, could be used to document the cause of and factors contributing to stillbirths occurring either at facility level or in the community.

In collaboration with the Centre for Injury Prevention and Research Bangladesh in Dhaka, Bangladesh, the Centre for Maternal and Newborn Health conducted a study to find answers to the above areas. We developed and used computer-based algorithms to assign cause of death. This is a unique and faster way of establishing cause of death for thousands of cases, as opposed to manual review of cases – a more tedious process that requires more human resources.

The study, which is published in BMC Pregnancy and Childbirth, demonstrated that introducing surveillance for stillbirths at community level is feasible in a low-resource setting. However, it found that verbal autopsy yields limited data for identifying cause of death. Thus, information collected through verbal autopsy should be combined with information obtained through patient’s case note review to provide adequate data for more accurate diagnosis of cause of death.

Additionally, the study highlighted that most women accessed and received care from a qualified healthcare professional some time during their pregnancy or at the time of childbirth. Thus, to reduce the number of preventable stillbirths, the focus now needs to be on improving the quality of care during both pregnancy and childbirth.

Dr Mamuda Aminu, a Senior Clinical Research Associate at CMNH, who took part in the study, explained that, “Stillbirth is a huge problem in many developing countries with over 2.6 million babies born dead worldwide, every year... Sadly, many countries do not even count stillbirths in their national statistics. This study has now provided the evidence that any country, irrespective of its economic status, can and should establish a surveillance system for stillbirth and collect meaningful data to guide the development of context-specific interventions. This is vital if we are to see a significant reduction in global stillbirth by the year 2035, as endorsed by the World Health Assembly in 2014.”