Stillbirth rates and its spatial patterns in India: an exploration of HMIS data

Impact of COVID-19 on Maternal Health Service Uptake and Perinatal Outcomes in Sub-Saharan Africa: A Systematic Review

Coronavirus 2019 (COVID-19) is a major global public health threat that has impeded health infrastructures in low- and middle-income countries. This systematic review examines the impact of COVID-19 on maternal health service uptake and perinatal outcomes in Sub-Saharan Africa. We searched four databases in August 2020 and updated the search on 22 December 2023: PubMed/MEDLINE, CINAHL, Maternity and Infant Care, and EMBASE. Data extraction was performed using a standardised Joana Briggs Institute data extraction format for the eligibility of articles, and any discrepancies were solved through discussion and consensus. This systematic review includes 36 studies that met the inclusion criteria. Antenatal care attendance and institutional childbirth significantly decreased during the COVID-19 pandemic, and home births increased. Fear of contracting the virus, a lack of transport, a shortage of logistic supplies, a lack of personal protective equipment, lockdown policies, economic and food security, stigmatisation of sick persons, long waiting times in the hospital, and health system weakness were barriers to accessing maternity care. The findings of this review showed a significant decrease in antenatal care attendance and institutional birth during the COVID-19 pandemic. Based on our findings, we recommend that stakeholders ensure the availability of essential medical supplies in the hospital.

Trend, Pattern, and Prevalence of Adverse Pregnancy Outcomes among Women of Reproductive Age in India, 1992-2021

Background

Adverse pregnancy outcomes (APOs) are the most important vital statistics used to assess maternal health and child health statistics. They are an indicator of the quality of maternal and child health care services, i.e., antenatal care, intrapartum care, and medical services.

Material and Methods

The objective of the study is to analyze the trend, pattern, and prevalence of APOs among women of reproductive age group at the national level over successive NFHS rounds. The current study uses data from the National Family Health Survey (NFHS), conducted during 1992-2021. The study uses geo-spatial mapping techniques through QGIS software and report analysis to arrive at definitive conclusions.

Results

The study finds that the incidence of APOs among women of reproductive age (15-49 years) has increased over the years. Twenty states and union territories have APOs that are below the national average. On the other hand, States like Madhya Pradesh, Meghalaya, Sikkim, Goa, Maharashtra, Andhra Pradesh, Karnataka, and Kerala have witnessed their APOs worsening as per NFHS-5 vis-à-vis NFHS-4. The study also finds that apart from the Himalayan belt and the east coast of India, APOs are more prominent in the contiguous regions adjoining these areas.

Conclusions

The findings of the study have thrown on very interesting facts. Despite rapid economic development during the intervening period between NFHS-4 and NFHS-5, rising APOs are a testament to the fact that the policymakers in the country need to be more target-oriented and get their acts together.

Seasonal and District Level Geo-Spatial Variations in Stillbirth Rates in India: An Analysis of Secondary Data

Stillbirth is a major public health problem across the world as well as in India. The programmatic interventions to tackle stillbirth require granular data upto local levels. The Health Management Information System (HMIS) in India is one of the best sources of granular data on stillbirth. This analysis was conducted using HMIS stillbirth data of three pre-pandemic years 2017-2020 to study the geo-spatial patterns of stillbirth at district level in nine states of India, forming a high burden cluster of four central Indian states and a low burden cluster of five southern states. Geo-spatial variation at sub-district level was studied for Maharashtra given the ready availability of sub-district shapefiles required for such analysis. The analysis also explores the seasonal variations in stillbirths at all-India level. A granular intra-cluster spatial pattern of stillbirth was observed in all states analyzed, with a clear hotspot across a few districts in Odisha and Chhattisgarh (>20 stillbirths/1,000 total births in 2019-20). Even in the southern cluster, the hotspots (8-20 stillbirths/1,000 total births) were found. Availability of sub-district level data in Maharashtra helped to identify intra-state regional variations in stillbirth with high prevalence in certain district clusters. In temporal terms, stillbirths exhibit a regular peak during August-October and a dip during February-April which is inclined with the birth seasonality patterns. This review and analysis underscore the need for more granular data availability, regular analysis of such data by expert and program managers, more decentralized and context specific programme intervention both in locational and seasonal terms.

Trends and risk factors of stillbirth among women of reproductive age in Pakistan: A multivariate decomposition analysis

Background

Every year, 2 million babies are stillborn in the world. Globally, there has been a decline in the stillbirth rate of 2%. Despite advancements in prenatal care and the implementation of new medical technologies, the incidence of early stillbirths remains unchanged. A slight decrease in the rate of late-term stillbirth has been observed. Pakistan ranked third in South Asia for having the highest stillbirth rate. Compared to its neighbors and other developing nations, Pakistan has shown a lack of progress in reducing maternal and neonatal fatalities. Therefore, the purpose of this study is to use a multivariate decomposition analysis to examine the trends and factors that have contributed to the change in the stillbirth rate over time.

Methods

To conduct this study, we used a secondary data analysis approach and analyzed data from the Pakistan Demographic and Health Survey (PDHS) of 2012-2013 and 2017-2018). For the analysis, a total sample of 15,068 births in 2017-2018 and 13,558 births in the PDHS from 2012 to 2013 were taken into account. Using the MVDCMP function within STATA version 15 statistical software, a logit-based multivariate decomposition model was fitted to determine the variables that influence the change in stillbirth. The current study used two cross-sectional surveys to identify important risk factors for stillbirths.

Results

Over the past 5 years, Pakistan's stillbirth rate has risen from 3.98 to 5.75%. According to the total multivariate decomposition analysis, the change in coefficient (change in the effect of attributes) accounted for 81.17% of the overall change in the proportion of stillbirths. In contrast, the change in endowment was not statistically significant. Changes in maternal education, individual and community-level wealth status, and mode of delivery all significantly impacted the rate of stillbirths over time.

Conclusion

Stillbirths increased in Pakistan from 2012 to 2017. Stillbirths are observed more frequently for women residing in Punjab, Sindh, and rural areas. A major concern that is directly related to the prevalence of stillbirths in Pakistan is the lack of accessible, affordable, and high-quality maternal healthcare facilities. Older, overweight, and uneducated women are more likely to have stillbirths than women who deliver vaginally. High parity and short birth intervals also accelerated the rate of stillbirths. An effective remedy to control stillbirths is the provision of accessible and affordable healthcare services. Awareness campaigns for the health education of pregnant women should focus on raising awareness to support better pregnancy outcomes for poor women living in communities with higher education levels. The risk of stillbirth can be reduced by offering free diagnostics for early detection of birth complications in low-resource settings and referring these cases to knowledgeable gynecologists for safe delivery.