Journal
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY
Volume 124, Issue 9, Pages 1346-1354Publisher
WILEY
DOI: 10.1111/1471-0528.14548
Keywords
Global health; low income country; perinatal health; preterm birth; stillbirth
Categories
Funding
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction
- WHO
- USAID
- Ministry of Health, Labor and Welfare of Japan
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Objective To evaluate the extent to which stillbirths affect international comparisons of preterm birth rates in low-and middle-income countries. Design Secondary analysis of a multi-country cross-sectional study. Setting 29 countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. Population 258 215 singleton deliveries in 286 hospitals. Methods We describe how inclusion or exclusion of stillbirth affect rates of preterm births in 29 countries. Main outcome measures Preterm delivery. Results In all countries, preterm birth rates were substantially lower when based on live births only, than when based on total births. However, the increase in preterm birth rates with inclusion of stillbirths was substantially higher in low Human Development Index (HDI) countries [ median 18.2%, interquartile range (17.2-34.6%)] compared with medium (4.3%, 3.0-6.7%), and high-HDI countries (4.8%, 4.4-5.5%). Conclusion Inclusion of stillbirths leads to higher estimates of preterm birth rate in all countries, with a disproportionately large effect in low-HDI countries. Preterm birth rates based on live births alone do not accurately reflect international disparities in perinatal health; thus improved registration and reporting of stillbirths are necessary.
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