New study reports on the feasibility of using new WHO classification system for stillbirths

News article 22 May 2019

Annually, an estimated 2.6 million stillbirths occur worldwide, the majority (98%) of which happen in low- and middle-income countries (LMIC). Sub-Saharan Africa and South Asia are said to account for 55% of the global burden of stillbirth.

To tackle this burden, a globally-accepted classification system is needed to categorise the cause of death uniformly and enable comparison between different parts of the world. This will also help to identify priority areas for action.

There are many of these classification systems; an earlier study conducted by researchers at the Centre for Maternal and Newborn Health (CMNH) reported more than 30. However, none of these have been adopted globally.

In 2016, the World Health Organization (WHO) therefore developed a new classification system. Named The WHO application of ICD-10 to deaths during the perinatal period (and abbreviated to “ICD-PM”), the new system has the potential for use in both low- and high-income countries (LMIC). It classifies conditions affecting the baby as well as those affecting the mother. However, there is a lack of data to show whether the new system would work in LMIC, where the majority of stillbirths occur.

Researchers at CMNH therefore conducted a study in four sub-Saharan African countries to apply the new classification system and generate vital information on any areas of challenges in using the system in LMIC.

The study, which was published by PLOS ONE journal, shows that using the new WHO ICD-PM classification in low-resource settings is feasible, but some changes may be required. The study found that although there were challenges with classifying the cause of stillbirth by conditions that directly affect the baby, most cases (76%) were able to be classified using information relating to conditions affecting the mother.

In addition, the study also found that 51% of the stillbirths occurred after the onset of labour or during childbirth. This means interventions designed to reduce stillbirth would be more effective and cost-effective if focused on this 24-hour period, compared to the whole nine months of pregnancy. 

Dr Mamuda Aminu, a Senior Clinical Research Associate at CMNH, who led the study, explains that: “Stillbirth represents one of the major public health problems in low- and middle-income countries. It is the fifth leading cause of death globally. Many countries have been waiting for a classification system that works in their setting. I think ICD-PM is our best chance so far to finally be able to compare data from across the globe and get our priorities right. With the results of this study, I’m even more optimistic that this is possible. I urge stakeholders to expedite action on stillbirth and encourage healthcare providers to use ICD-PM in their practice. It is only with more data that we can be able to know where ICD-PM works and where it needs to be improved.”