Stanton Cynthia, Lawn Joy E, Rahman Hafiz, Wilczynska-Ketende Katarzyna, Hill Kenneth
The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Lancet. 2006 May 6;367(9521):1487-94. doi: 10.1016/S0140-6736(06)68586-3.
While information about 4 million neonatal deaths worldwide is limited, even less information is available for stillbirths (babies born dead in the last 12 weeks of pregnancy) and there are no published, systematic global estimates. We sought to identify available data and use these to estimate the rates and numbers of stillbirths for 190 countries for the year 2000, and provide uncertainty estimates.
We assessed three sources of stillbirth data according to specified inclusion criteria: vital registration; demographic and health surveys (DHS), based on a new analysis of contraceptive calendar data; and study reports that include published studies identified through systematic literature searches of more than 30,000 abstracts and unpublished studies. A random effects regression model was developed to predict national stillbirth rates and associated uncertainty intervals.
Data from 44 countries with vital registration (71,442 stillbirths), 30 DHS surveys from 16 countries (2989 stillbirths), and 249 study populations from 103 countries (93,023 stillbirths) met the inclusion criteria. Model-based estimates were used for 128 countries. For 62 countries, the observed values were adjusted by a correction factor derived from the model. The resultant stillbirth rates ranged from five per 1000 in rich countries to 32 per 1000 in south Asia and sub-Saharan Africa. The estimated number of global stillbirths is 3.2 million (uncertainty range 2.5-4.1 million). In light of the data limitations and the conservative approach taken, the real number might be higher than this.
The numbers of stillbirths are high and there is a dearth of usable data in countries and regions in which most stillbirths occur, with under-reporting being a major challenge. Although our estimates are probably underestimates, they represent a rigorous attempt to measure the numbers of babies dying during the last trimester of pregnancy. Improving stillbirth data is the first step towards making stillbirths count in public-health action.
虽然全球约400万新生儿死亡的信息有限，但死产（妊娠最后12周内出生即死亡的婴儿）的信息更少，且尚无已发表的系统性全球估算数据。我们试图确定可用数据，并利用这些数据估算2000年190个国家的死产率和死产数，并提供不确定性估算。
我们根据特定纳入标准评估了三个死产数据来源：生命登记；基于对避孕日历数据的新分析的人口与健康调查（DHS）；以及研究报告，包括通过对30000多篇摘要进行系统文献检索确定的已发表研究和未发表研究。开发了一个随机效应回归模型来预测各国死产率及相关不确定性区间。
来自44个有生命登记的国家的数据（71442例死产）、来自16个国家的30项DHS调查数据（2989例死产）以及来自103个国家的249个研究群体的数据（93023例死产）符合纳入标准。128个国家使用了基于模型的估算值。对于62个国家，观察值通过从模型得出的校正因子进行了调整。由此得出的死产率范围从富裕国家的每1000例中有5例到南亚和撒哈拉以南非洲的每1000例中有32例。全球死产估计数为320万（不确定性范围为250万 - 410万）。鉴于数据限制和所采用的保守方法，实际数字可能高于此。
死产数很高，且在大多数死产发生的国家和地区缺乏可用数据，漏报是一个主要挑战。尽管我们的估计可能偏低，但它们是对妊娠最后三个月死亡婴儿数量进行测量的一次严谨尝试。改善死产数据是在公共卫生行动中重视死产问题的第一步。
