Deferred and referred deliveries contribute to stillbirths in the Indian state of Bihar: results from a population-based survey of all births
Abstract Background The India Newborn Action Plan (INAP) aims for < 10 stillbirths per 1000 births by 2030. A population-based understanding of risk factors for stillbirths compared with live births that could assist with reduction of stillbirths is not readily available for the Indian population...
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BMC
2019-02-01
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| Series: | BMC Medicine |
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| Online Access: | http://link.springer.com/article/10.1186/s12916-019-1265-1 |
| _version_ | 1828353172817575936 |
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| author | Rakhi Dandona G. Anil Kumar Md. Akbar Debarshi Bhattacharya Priya Nanda Lalit Dandona |
| author_facet | Rakhi Dandona G. Anil Kumar Md. Akbar Debarshi Bhattacharya Priya Nanda Lalit Dandona |
| author_sort | Rakhi Dandona |
| collection | DOAJ |
| description | Abstract Background The India Newborn Action Plan (INAP) aims for < 10 stillbirths per 1000 births by 2030. A population-based understanding of risk factors for stillbirths compared with live births that could assist with reduction of stillbirths is not readily available for the Indian population. Methods Detailed interviews were conducted in a representative sample of all births between January and December 2016 from 182,486 households (96.2% participation) in 1657 clusters in the Indian state of Bihar. A stillbirth was defined as foetal death with gestation period of ≥ 7 months wherein the foetus did not show any sign of life. The association of stillbirth was investigated with a variety of risk factors among all births using a hierarchical logistic regression model approach. Results A total of 23,940 births including 338 stillbirths were identified giving the state stillbirth rate (SBR) of 15.4 (95% CI 13.2–17.9) per 1000 births, with no difference in SBR by sex. Antepartum and intrapartum SBR was 5.6 (95% CI 4.3–7.2) and 4.5 (95% CI 3.3–6.1) per 1000 births, respectively. Detailed interview was available for 20,152 (84.2% participation) births including 275 stillbirths (81.4% participation). In the final regression model, significantly higher odds of stillbirth were documented for deliveries with gestation period of ≤ 8 months (OR 11.36, 95% CI 8.13–15.88), for first born (OR 5.79, 95% CI 4.06–8.26), deferred deliveries wherein a woman was sent back home and asked to come later for delivery by a health provider (OR 5.51, 95% CI 2.81–10.78), and in those with forceful push/pull during the delivery by the health provider (OR 4.85, 95% CI 3.39–6.95). The other significant risk factors were maternal age ≥ 30 years (OR 3.20, 95% CI 1.52–6.74), pregnancies with multiple foetuses (OR 2.82, 95% CI 1.49–5.33), breech presentation of the baby (OR 2.70, 95% CI 1.75–4.18), and births in private facilities (OR 1.75, 95% CI 1.19–2.56) and home (OR 2.60, 95% CI 1.87–3.62). Varied risk factors were associated with antepartum and intrapartum stillbirths. Birth weight was available only for 40 (14.5%) stillborns. Among the facility deliveries, the women who were referred from one facility to another for delivery had significantly high odds of stillbirth (OR 3.32, 95% CI 2.03–5.43). Conclusions We found an increased risk of stillbirths in deferred and referred deliveries in addition to demographic and clinical risk factors for antepartum and intrapartum stillbirths, highlighting aspects of health care that need attention in addition to improving skills of health providers to reduce stillbirths. The INAP could utilise these findings to further strengthen its approach to meet the stillbirth reduction target by 2030. |
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| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-04-14T02:03:38Z |
| publishDate | 2019-02-01 |
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| spelling | doaj.art-7bcd52937c7645d398e75563df9123ba2022-12-22T02:18:45ZengBMCBMC Medicine1741-70152019-02-0117111710.1186/s12916-019-1265-1Deferred and referred deliveries contribute to stillbirths in the Indian state of Bihar: results from a population-based survey of all birthsRakhi Dandona0G. Anil Kumar1Md. Akbar2Debarshi Bhattacharya3Priya Nanda4Lalit Dandona5Public Health Foundation of IndiaPublic Health Foundation of IndiaPublic Health Foundation of IndiaBill & Melinda Gates Foundation, India Country OfficeBill & Melinda Gates Foundation, India Country OfficePublic Health Foundation of IndiaAbstract Background The India Newborn Action Plan (INAP) aims for < 10 stillbirths per 1000 births by 2030. A population-based understanding of risk factors for stillbirths compared with live births that could assist with reduction of stillbirths is not readily available for the Indian population. Methods Detailed interviews were conducted in a representative sample of all births between January and December 2016 from 182,486 households (96.2% participation) in 1657 clusters in the Indian state of Bihar. A stillbirth was defined as foetal death with gestation period of ≥ 7 months wherein the foetus did not show any sign of life. The association of stillbirth was investigated with a variety of risk factors among all births using a hierarchical logistic regression model approach. Results A total of 23,940 births including 338 stillbirths were identified giving the state stillbirth rate (SBR) of 15.4 (95% CI 13.2–17.9) per 1000 births, with no difference in SBR by sex. Antepartum and intrapartum SBR was 5.6 (95% CI 4.3–7.2) and 4.5 (95% CI 3.3–6.1) per 1000 births, respectively. Detailed interview was available for 20,152 (84.2% participation) births including 275 stillbirths (81.4% participation). In the final regression model, significantly higher odds of stillbirth were documented for deliveries with gestation period of ≤ 8 months (OR 11.36, 95% CI 8.13–15.88), for first born (OR 5.79, 95% CI 4.06–8.26), deferred deliveries wherein a woman was sent back home and asked to come later for delivery by a health provider (OR 5.51, 95% CI 2.81–10.78), and in those with forceful push/pull during the delivery by the health provider (OR 4.85, 95% CI 3.39–6.95). The other significant risk factors were maternal age ≥ 30 years (OR 3.20, 95% CI 1.52–6.74), pregnancies with multiple foetuses (OR 2.82, 95% CI 1.49–5.33), breech presentation of the baby (OR 2.70, 95% CI 1.75–4.18), and births in private facilities (OR 1.75, 95% CI 1.19–2.56) and home (OR 2.60, 95% CI 1.87–3.62). Varied risk factors were associated with antepartum and intrapartum stillbirths. Birth weight was available only for 40 (14.5%) stillborns. Among the facility deliveries, the women who were referred from one facility to another for delivery had significantly high odds of stillbirth (OR 3.32, 95% CI 2.03–5.43). Conclusions We found an increased risk of stillbirths in deferred and referred deliveries in addition to demographic and clinical risk factors for antepartum and intrapartum stillbirths, highlighting aspects of health care that need attention in addition to improving skills of health providers to reduce stillbirths. The INAP could utilise these findings to further strengthen its approach to meet the stillbirth reduction target by 2030.http://link.springer.com/article/10.1186/s12916-019-1265-1AntepartumDeferred deliveryIndiaIntrapartumRateStillbirth |
| spellingShingle | Rakhi Dandona G. Anil Kumar Md. Akbar Debarshi Bhattacharya Priya Nanda Lalit Dandona Deferred and referred deliveries contribute to stillbirths in the Indian state of Bihar: results from a population-based survey of all births BMC Medicine Antepartum Deferred delivery India Intrapartum Rate Stillbirth |
| title | Deferred and referred deliveries contribute to stillbirths in the Indian state of Bihar: results from a population-based survey of all births |
| title_full | Deferred and referred deliveries contribute to stillbirths in the Indian state of Bihar: results from a population-based survey of all births |
| title_fullStr | Deferred and referred deliveries contribute to stillbirths in the Indian state of Bihar: results from a population-based survey of all births |
| title_full_unstemmed | Deferred and referred deliveries contribute to stillbirths in the Indian state of Bihar: results from a population-based survey of all births |
| title_short | Deferred and referred deliveries contribute to stillbirths in the Indian state of Bihar: results from a population-based survey of all births |
| title_sort | deferred and referred deliveries contribute to stillbirths in the indian state of bihar results from a population based survey of all births |
| topic | Antepartum Deferred delivery India Intrapartum Rate Stillbirth |
| url | http://link.springer.com/article/10.1186/s12916-019-1265-1 |
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