International researchers have found, that stillbirths that are not generally included in the worldwide infant mortality statistics, could account for 3.2 million or more additional deaths each year. Stillbirths are defined as delivery of a dead infant in the last 12 weeks of pregnancy.
Joy E. Lawn, M.D., of the Medical Research Council of South Africa here, and his colleagues said that their estimates suggests that more than 3.2 million babies are born dead every year, and the true figure would probably be higher if not for the limitations of the available data and the fact that stillbirths are many a times underreported.
AdvertisementThe authors wrote in an early online release from the May 6 issue of The Lancet, that the explanation of the data could mean that the uncertainty intervals are enormous, ranging from 2.5 to 4.1 million. The researchers said that it is important to have better counting, as not only was it important for the epidemology but for also the prevention as they felt that deaths of most of the babies are avoidable. They explained their point by showing evidence of low stillbirth rates of four per thousand as seen in rich countries as compared to rates of 40 per 1000 or much higher in poorer countries where the health systems were also poor.
The authors explained that stillbirths are not counted in WHO, mortality statistics, and are not reported in most population based surveillance studies, but they felt that such data were essential for improving health care for women and children in the developing world. To get a rough idea of the magnitude of the problem, they looked at three different sources of information: vital records (births, deaths), demographic and health surveys (including information on contraception and pregnancy) from women in 16 countries, and from published studies.
They used these data's to create a statistical model of stillbirth rates and associated uncertainty intervals (margins of error). Their main goal was to estimate stillbirth rates for 190 countries. They found that the data from vital registries of 44 countries on 71,442 stillbirths, information from 30 demographic and health surveys from 16 countries containing data on an additional 2,989, and 249 study populations from 103 countries with information on 93,023 stillbirths.
They estimated stillbirth rates based on the model for 128 of the 190 countries, and for the remaining 62 countries they used a correction factor derived from their model to adjust observational data. They then found that stillbirth rates ranged from a relatively low five per 1,000 in wealthy developed nations to 32 per 1,000 in south Asia (accounting for 40% of all stillbirths worldwide), and sub-Saharan Africa (accounting for 28% of all stillbirths.
Half of all stillbirths, 51% they found occurred in four countries Bangladesh, China, India and Pakistan. Rates they found were lower in Eurasia (12.2/1000), Southeast Asia (12.7/1000), and Latin America and the Caribbean (13.2/1000), but were still more than double as in wealthy nations.
They estimated that overall, the number of stillbirths is approximately 3.2 million. They said that the real number could be much higher if not for data limitations, and a conservative approach. They noted that efforts to make accurate estimates of stillbirth rates are hampered by the lack of vital statistics, especially from impoverished nations with high mortality rates.
They concluded by saying that despite efforts to identify the best available data, both the quality and the quantity of data are inadequate, and that no modelling technique can overcome the fact that at the global level they were all stumbling around in the dark.