Professor & Director Aga Khan University Karachi, Sindh, Pakistan
Background: Stillbirths are a critical public health issue, leading to a global annual estimate of 2.8 million stillbirths, with a rate of 13.9 per 1,000 total births. Despite a commitment to SDGs, Pakistan faces a substantial burden of stillbirths (30.6 stillbirths/1000 births) – (PDHS 2006-07); however, the information is limited on updated rates, cause-specific mortality, and timings of deaths. In this regard, a verbal-social autopsy (VASA) study was carried out by the Centre of Excellence in Women and Child Health, Aga Khan University, in collaboration with Johns Hopkins University (JHU). The study aims to estimate the cause distribution and proportion of antepartum and intrapartum stillbirths through population-based data. Objective: To evaluate causes of Stillbirth from a population survey Design/Methods: The study was conducted from August 2018-2019, and collected information from 2100 urban and rural households on births and stillbirths from all provinces, AJK, and Gilgit Baltistan. A mortality survey questionnaire obtained information regarding total births, live births, and stillbirths. whereas the VASA questionnaire was developed with the integration of verbal autopsy (WHO-2016) and social autopsy (JHU) tools to assess the causes of death, background, and maternal characteristics of stillbirths. This was followed by cause of death analysis through the Physician Coded Verbal Autopsy (PCVA) method. Results: The study recorded 2076 stillbirths from 2100 households, and the rate of stillbirth at the country level was 30.5/1000 total births, with higher rates observed in rural areas. The findings indicate that 66% of stillbirth occurs in the antepartum period while 34% in the intrapartum period. The causes of stillbirth death were pregnancy-induced hypertension, maternal infections, antepartum hemorrhage, and obstructed labor, with slight variations in the frequency for antepartum and intrapartum cases. Significant pathway delays were observed, including delays in recognizing early warning signs (88%), lack of adequate healthcare from providers (44%), delayed decision-making (42%), and transportation issues (14.4%)
Conclusion(s): The higher incidence of stillbirths in the antepartum stage emphasizes the need for early identification and management of complicated pregnancies and the provision of adequate antenatal obstetric interventions to ensure positive maternal outcomes. Efforts should be made to develop effective interventions that could meaningfully contribute to reducing the huge burden of stillbirths.
