Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
Popul Health Metr. 2021 Feb 8;19(Suppl 1):11. doi: 10.1186/s12963-020-00240-1.
Household surveys remain important sources of maternal and child health data, but until now, standard surveys such as Demographic and Health Surveys (DHS) have not collected information on maternity care for women who have experienced a stillbirth. Thus, nationally representative data are lacking to inform programmes to address the millions of stillbirths which occur annually.
The EN-INDEPTH population-based survey of women of reproductive age was undertaken in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017-2018). All women answered a full birth history with additional questions on pregnancy losses (FBH+) or full pregnancy history (FPH). A sub-sample, including all women reporting a recent stillbirth or neonatal death, was asked additional maternity care questions. These were evaluated using descriptive measures. Associations between stillbirth and maternal socio-demographic characteristics, babies' characteristics and maternity care use were assessed using a weighted logistic regression model for women in the FBH+ group.
A total of 15,591 women reporting a birth since 1 January 2012 answered maternity care questions. Completeness was very high (> 99%), with similar proportions of responses for both live and stillbirths. Amongst the 14,991 births in the FBH+ group, poorer wealth status, higher parity, large perceived baby size-at-birth, preterm or post-term birth, birth in a government hospital compared to other locations and vaginal birth were associated with increased risk of stillbirth after adjusting for potential confounding factors. Regarding association with reported postnatal care, women with a stillbirth were more likely to report hospital stays of > 1 day. However, women with a stillbirth were less likely to report having received a postnatal check compared to those with a live birth.
Women who had experienced stillbirth were able to respond to questions about pregnancy and birth, and we found no reason to omit questions to these women in household surveys. Our analysis identified several potentially modifiable factors associated with stillbirth, adding to the evidence-base for policy and action in low- and middle-income contexts. Including these questions in DHS-8 would lead to increased availability of population-level data to inform action to end preventable stillbirths.
家庭调查仍然是母婴健康数据的重要来源，但到目前为止，人口与健康调查（DHS）等标准调查并未收集经历死胎的妇女的分娩护理信息。因此，缺乏全国代表性数据来为每年发生的数百万例死胎提供信息。
在孟加拉国、埃塞俄比亚、加纳、几内亚比绍和乌干达的五个健康和人口监测系统站点进行了基于人群的 EN-INDEPTH 调查，该调查涵盖了育龄妇女。所有妇女均回答了完整的生育史，并补充了妊娠丢失（FBH+）或完整妊娠史（FPH）的问题。一个亚样本包括所有报告最近死胎或新生儿死亡的妇女，她们被问到更多的分娩护理问题。这些问题使用描述性措施进行了评估。使用加权逻辑回归模型评估了死产与产妇社会人口特征、婴儿特征和分娩护理使用之间的关系，该模型适用于 FBH+组中的妇女。
自 2012 年 1 月 1 日以来，共有 15591 名报告分娩的妇女回答了分娩护理问题。完整性非常高（>99%），活产和死产的回答比例相似。在 FBH+组的 14991 例分娩中，在调整了潜在混杂因素后，较贫穷的财富状况、较高的生育次数、出生时感知到的婴儿较大、早产或过期分娩、在政府医院分娩而不是其他地点分娩以及阴道分娩与死产风险增加相关。关于与报告的产后护理的关联，死产的妇女更有可能报告住院时间超过 1 天。然而，与活产妇女相比，死产妇女更有可能报告没有接受产后检查。
经历过死产的妇女能够回答有关妊娠和分娩的问题，我们没有理由在家庭调查中对这些妇女省略问题。我们的分析确定了与死产相关的一些潜在可改变因素，为中低收入国家的政策和行动提供了更多证据。将这些问题纳入 DHS-8 将导致更多的人群水平数据，以提供信息，推动预防可避免的死产行动。
