Four decades of measuring stillbirths and neonatal deaths in Demographic and Health Surveys: historical review

Akuze, Joseph; Lawn, Joy E; Waiswa, Peter; Gordeev, Vladimir Sergeevich; Arnold, Fred; Croft, Trevor; Baschieri, Angela; Blencowe, Hannah

doi:10.1186/s12963-020-00225-0

Cited by 17 publications

(24 citation statements)

References 24 publications

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“…Third, while we hypothesize that improved quality of care in hospitals may be a key factor for the observed associations, limited cross-country data on quality of care prevent direct measurement. Finally, this analysis did not consider stillbirths as an outcome because they were inconsistently recorded in versions of the DHS that relied on a full birth history rather than a full pregnancy history [ 33 ]; neonatal deaths by cause were also not considered as that information is unavailable.…”

Section: Discussionmentioning

confidence: 99%

Hospital delivery and neonatal mortality in 37 countries in sub-Saharan Africa and South Asia: An ecological study

et al. 2021

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Background Widespread increases in facility delivery have not substantially reduced neonatal mortality in sub-Saharan Africa and South Asia over the past 2 decades. This may be due to poor quality care available in widely used primary care clinics. In this study, we examine the association between hospital delivery and neonatal mortality. Methods and findings We used an ecological study design to assess cross-sectional associations between the share of hospital delivery and neonatal mortality across country regions. Data were from the Demographic and Health Surveys from 2009 to 2018, covering 682,239 births across all regions. We assess the association between the share of facility births in a region that occurred in hospitals (versus lower-level clinics) and early (0 to 7 days) neonatal mortality per 1,000 births, controlling for potential confounders including the share of facility births, small at birth, maternal age, maternal education, urbanicity, antenatal care visits, income, region, and survey year. We examined changes in this association in different contexts of country income, global region, and urbanicity using interaction models. Across the 1,143 regions from 37 countries in sub-Saharan Africa and South Asia, 42%, 29%, and 28% of births took place in a hospital, clinic, and at home, respectively. A 10-percentage point higher share of facility deliveries occurring in hospitals was associated with 1.2 per 1,000 fewer deaths (p-value < 0.01; 95% CI: 0.82 to 1.60), relative to mean mortality of 22. Associations were strongest in South Asian countries, middle-income countries, and urban regions. The study’s limitations include the inability to control for all confounding factors given the ecological and cross-sectional design and potential misclassification of facility levels in our data. Conclusions Regions with more hospital deliveries than clinic deliveries have reduced neonatal mortality. Increasing delivery in hospitals while improving quality across the health system may help to reduce high neonatal mortality.

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Section: Discussionmentioning

confidence: 99%

Hospital delivery and neonatal mortality in 37 countries in sub-Saharan Africa and South Asia: An ecological study

et al. 2021

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“…Though other estimates of crude birth rates for Rohingya refugees are available we used the DHS estimate 9. The DHS has robust methodology to estimate crude birth rates, using pregnancy history, and is the standard in global health 18. Total births were calculated as the sum of the estimated live births described and stillbirths captured through our community-based surveillance.…”

Section: Methodsmentioning

confidence: 99%

“…This is due, in large part, to complex methodological challenges in the acute phase of a humanitarian crisis. In the absence of civil registration of vital events (ie, births, deaths), low-income and middle-income countries depend on household surveys, such as the Demographic and Health Survey (DHS), to estimate neonatal mortality 17 18. The DHS uses full birth history and/or full pregnancy history as recalled retrospectively by the respondent that captures data from women of reproductive age on their pregnancies and pregnancy outcomes 18.…”

Section: Introductionmentioning

confidence: 99%

Estimating stillbirth and neonatal mortality rate among Rohingya refugees in Bangladesh, September 2017 to December 2018: a prospective surveillance

et al. 2022

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IntroductionThere is limited literature on neonatal mortality in humanitarian emergencies. We estimated neonatal mortality and stillbirth rates; determined whether an association exists between proximity to a secondary health facility and neonatal mortality or stillbirth; and tested the correlation between the number of health facilities in a camp and neonatal mortality or stillbirth rates in Rohingya refugee camps in Bangladesh.MethodsWe conducted a prospective community-based mortality surveillance in 29 out of 34 Rohingya refugee camps between September 2017 and December 2018, covering approximately 811 543 Rohingya refugees with 19 477 estimated live births. We linked mortality surveillance data with publicly available information on camp population, number of functional health facilities and camp and health facility geospatial coordinates. Using descriptive statistics and spatial analyses, we estimated the mortality rate and tested for correlations.ResultsOverall, the estimated neonatal mortality rate was 27.0 (95% CI: 22.3 to 31.8) per 1000 live births, and the stillbirth rate was 15.2 (95% CI: 10.8 to 19.6) per 1000 total births. The majority of neonatal deaths (76.3%, n=405/531) and stillbirths (72.1%, n=202/280) occurred at home or in the community. A positive correlation existed between the camp population size and number of health facilities inside the camp (Spearman’s rho=0.56, p value<0.01). No statistically significant correlation existed between the camp neonatal mortality rate or stillbirth rate and number of health facilities inside the camp. Camps that were located closer to a secondary health facility as compared with a labour room/sexual and reproductive health unit had a lower neonatal mortality rate (p value<0.01).ConclusionsThe results provide insight into the neonatal mortality and stillbirth rates in Rohingya refugees camps in Bangladesh during 2017–2018. Prospective community-based mortality surveillance may be a feasible method to evaluate the effectiveness of humanitarian responses in improving neonatal survival and preventing stillbirths.

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“…Because vital registration systems in many countries are underdeveloped, sample surveys are often used to understand population health trends. However, sample surveys like the Demographic and Health Survey (DHS) have been inconsistent in recording stillbirth (Bradley et al 2015, MacQuarrie et al 2018, Akuze et al 2020, Akuze et al 2021. In a recent study looking across DHS surveys between 2005 and 2015, Christou et al (2017) found that many different methods are used to collect data on pregnancy loss.…”

Section: Stillbirth In the Demography Literaturementioning

confidence: 99%

Population science implications of the inclusion of stillbirths in demographic estimates of child mortality

Hathi¹

2022

Preprint

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Similar factors cause both early neonatal mortality and stillbirth, and most stillbirths are preventable. Yet stillbirths are not counted in commonly used summary measures of mortality, such as life expectancy and child mortality. The bioethics literature has recognized that this is paradoxical because it implies that a population in which many babies are stillborn is equally healthy as one in which those same babies survive. However, the demography literature fails to account for stillbirth despite the field’s primary aim of describing population processes. In this article, I show that current thinking about how to measure mortality mischaracterizes population health challenges and contributes to the neglect of stillbirth measurement. To address these shortcomings, I examine stillbirth data from reproductive calendars in Demographic and Health Surveys across 42 countries in Asia, Latin America, and Africa. I find that stillbirth undermeasurement is not uniform across places: the places with worse early life health may have poorer measurement of stillbirth than places with better early life health. Through the calculation of “stillbirth-adjusted” infant and neonatal mortality rates, I demonstrate that it is possible to implement population health measures that include stillbirth. Adjusted rates show that a substantial portion of early-life mortality is left out of traditional demographic mortality measures. These findings have implications for population theory, forcing us to reconsider underlying assumptions in demographic measurement. They also allow for a more complete assessment of the health of societies.

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Four decades of measuring stillbirths and neonatal deaths in Demographic and Health Surveys: historical review

Cited by 17 publications

References 24 publications

Hospital delivery and neonatal mortality in 37 countries in sub-Saharan Africa and South Asia: An ecological study

Hospital delivery and neonatal mortality in 37 countries in sub-Saharan Africa and South Asia: An ecological study

Estimating stillbirth and neonatal mortality rate among Rohingya refugees in Bangladesh, September 2017 to December 2018: a prospective surveillance

Population science implications of the inclusion of stillbirths in demographic estimates of child mortality

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