The first comprehensive set of stillbirth estimates has said 42 out every child 1,000 children born in Nigeria would have been stillbirth, a record that has put Nigeria in the list of countries in the world with the highest rate of stillbirths.
Although other African countries were listed among countries with similar records, Nigeria distinctly had the worst records in this regards. The estimates published recently in the journal, Lancet, also listed Democratic Republic of Congo, Ethiopia and Tanzania as other countries in Africa with high rates of stillbirths.
In the report featured on the Africa Science, Technology and Innovation website (www.africasti.com), perinatal epidemiologist, Chair of the International Stillbirth Alliance, and author of the paper on stillbirths in high-income countries for The Lancet’s Stillbirths Series Vicki Flenady, was quoted as saying, “An African woman has a 24 times higher chance of having a stillbirth at the time of delivery than a woman in a high-income country.”
It points out that the rate varies sharply by country. It noted that in Nigeria, 42 stillbirths would be recorded out of 1, 000 live births. This is a sharp departure from the lowest rates of two per 1,000 births in Finland and Singapore and 2.2 per 1,000 births in Denmark and Norway. The highest was recorded in Pakistan with 47 per 1,000, 36 in Bangladesh, and 34 in Djibouti and Senegal.
The report showed that about 2.6 million third trimester stillbirths occur every year worldwide. However, an estimated 1.8 million stillbirths occur in ten countries including Nigeria, India, Pakistan, China, Bangladesh, Democratic Republic of the Congo, Ethiopia, Indonesia, Afghanistan and United Republic of Tanzania.
A rather more worrisome trend is that half of all stillbirths occur in Nigeria, India, Pakistan, China and Bangladesh alone, marked as countries with abysmal records on maternal and newborn deaths.
According to the report, two-thirds of stillbirths happen in rural areas, where skilled birth attendants, in particular midwives and physicians, are not always available for essential care during childbirth and for obstetric emergencies, including caesarean sections.
The report states that every day more than 7,300 babies are stillborn. This, it says happens more in the low income countries although wealthier nations are not immune, as it has been found that one in 200 pregnancies result in a stillbirth, with two thirds occurring in the last trimester of pregnancy, a rate that has stagnated in the last decade.
The report attributed the huge number of stillbirths in these countries to five main causes including childbirth complications, maternal infections in pregnancy, maternal disorders, especially pre-eclampsia and diabetes, fetal growth restriction and congenital abnormalities.
Accordingly, the Lancet’s Stillbirths Series, authored by 69 experts from more than 50 organizations in 18 countries says all causes of stillbirth combined would place stillbirths fifth on the list of leading causes of deaths worldwide. The series comprised of six scientific papers, two research articles, and eight linked comments.
However, the number of stillbirths worldwide has declined by only 1.1 percent per year, from 3 million per year in 1995 to 2.6 million in 2009. This is slower than reductions for child and maternal mortality.
According to Assistant Director-General for Family and Community Health at the World Health Organization (WHO), Flavia Bustreo,. “Stillbirths often go unrecorded, and are not seen as a major public health problem. Yet, stillbirth is a heartbreaking loss for women and families. We need to acknowledge these losses and do everything we can to prevent them.”
Joy Lawn, Director of Global Evidence and Policy, Saving Newborn Lives/Save the Children, a lead author of The Lancet’s Stillbirths Series who coordinated the new estimates, emphasizes that “almost no burden affecting families is so big and yet so invisible both in society and on the global public health agenda.”
The number of stillbirths can be slashed, say most experts. “Stillbirths need to be an integral part of the maternal, newborn and child health agenda,” Carole Presern, Director of The Partnership for Maternal, Newborn & Child Health (PMNCH) and a midwife said, adding, “We do know how to prevent most of them.”
Besides lacking visibility, stillbirths lack leadership both locally and internationally. “Parental groups must join with professional organizations to bring a unified message on stillbirths to government agencies and the UN,” J. Frederik Frøen, an epidemiologist at The Norwegian Institute of Public Health and member of the International Stillbirth Alliance said.
Almost half of stillbirths, 1.2 million, happen when the woman is in labor. These deaths are directly related to the lack of skilled care at this critical time for mothers and babies.
Another dampening revelation by the report is that, in comparison of 1995 to 2009 stillbirth rates, the smallest declines were reported in Sub-Saharan Africa and Oceania, at a time significant declines were reported for China, Bangladesh, and India, which had a combined estimate of 400,000 fewer stillbirths in 2009 than in 1995.
“Stillbirth rates have halved in China and Mexico since 1995, demonstrating what can be accomplished in middle-income countries,” Lawn said.
According to The Lancet’s Stillbirths Series, as many as 1.1 million stillbirths could be averted comprehensive emergency obstetric care Syphilis detection and treatment programme were in place.
Other interventions capable of averting stillbirths including the detection and management of fetal growth restriction, detection and management of hypertension during pregnancy, identification and induction for mothers with 41 weeks gestation.
Malaria prevention, including bednets and drugs, folic acid fortification before conception and the detection and management of diabetes in pregnancy are other courses scaling up stillbirths.
“An additional 1.6 million deaths of mothers and newborns could be averted if you add five additional interventions beyond stillbirth interventions, such as antenatal steroids and neonatal resuscitation,” Zulfiqar A. Bhutta, Chair, Department of Pediatrics and Child Health, The Aga Khan University, Pakistan said.
Despite the large numbers, stillbirths have been relatively overlooked as a global public health problem. They are not included in the Millennium Development Goals for maternal and child health set by the United Nations.
http://www.independentngonline.com/DailyIndependent/Article.aspx?id=38301
