Stillbirths and neonatal mortality in LMICs: A community-based mother-infant cohort study

Lison Rambliere (1, 2) , Agathe de Lauzanne (3) , Jean-Baptiste Diouf (4) , Andrianirina Zafitsara Zo (5) , Myriam Landau (6) , Perlinot Herindrainy (6) , Delphine Hivernaud (7, 8) , Fatoumata Diene Sarr (9) , Touch Sok (10) , Muriel Vray (9) , Jean-Marc Collard (11) , Laurence Borand (3, 12) , Elisabeth Delarocque-Astagneau (2, 13) , Didier Guillemot (1, 2, 13) , Elsa Kermorvant-Duchemin (6) , Bich-Tram Huynh (1, 2) , Birdy Study Group

1 EMAE - Epidémiologie et modélisation de la résistance aux antimicrobiens - Epidemiology and modelling of bacterial escape to antimicrobials
2 CESP - Centre de recherche en épidémiologie et santé des populations
3 Institut Pasteur du Cambodge
4 Centre Hospitalier Roi Baudouin Guédiawaye [Dakar, Senegal]
5 CENHOSOA - Centre Hospitalier de Soavinandriana
6 Unité d’Épidémiologie et de Recherche clinique [Antananarivo, Madagascar]
7 Hôpital Necker - Enfants Malades [AP-HP]
8 UPCité - Université Paris Cité
9 Institut Pasteur de Dakar
10 Ministry of Health [Phnom Penh]
11 IPM - Unité de Bactériologie Expérimentale [Antananarivo, Madagascar]
12 Johns Hopkins University School of Medicine [Baltimore]
13 Hôpital Raymond Poincaré (Garches) [GHU AP-HP Université Paris-Saclay]

Background The exact timing, causes, and circumstances of stillbirth and neonatal mortality in low- and middle-income countries (LMICs) remain poorly described, especially for antenatal stillbirths and deaths occurring at home. We aimed to provide reliable estimates of the incidence of stillbirth and neonatal death in three LMICs (Madagascar, Cambodia and Senegal) and to identify their main causes and associated risk factors. Methods This study is based on data from an international, multicentric, prospective, longitudinal, community-based mother-infant cohort. We included pregnant mothers and prospectively followed up their children in the community. Stillbirths and deaths were systematically reported; information across healthcare settings was collected and verbal autopsies were performed to document the circumstances and timing of death. Results Among the 4436 pregnancies and 4334 live births, the peripartum period and the first day of life were the key periods of mortality. The estimated incidence of stillbirth was 11 per 1000 total births in Cambodia, 15 per 1000 in Madagascar, and 12 per 1000 in Senegal. We estimated neonatal mortality at 18 per 1000 live births in Cambodia, 24 per 1000 in Madagascar, and 23 per 1000 in Senegal. Based on ultrasound biometric data, 16.1% of infants in Madagascar were born prematurely, where 42% of deliveries and 33% of deaths occurred outside healthcare facilities. Risk factors associated with neonatal death were mainly related to delivery or to events that newborns faced during the first week of life. Conclusions These findings underscore the immediate need to improve care for and monitoring of children at birth and during early life to decrease infant mortality. Surveillance of stillbirth and neonatal mortality and their causes should be improved to mitigate this burden in LMICs.

Domaines: Pédiatrie

Lison Rambliere, Agathe de Lauzanne, Jean-Baptiste Diouf, Andrianirina Zafitsara Zo, Myriam Landau, et al.. Stillbirths and neonatal mortality in LMICs: A community-based mother-infant cohort study. Journal of Global Health, 2023, 13, pp.04031. ⟨10.7189/jogh.13.04031⟩. ⟨pasteur-04072424⟩