Dataset Information

Stillbirth among women in nine states in India: rate and risk factors in study of 886,505 women from the annual health survey.

ABSTRACT:

Objectives

To assess the rate of stillbirth and associated risk factors across nine states in India.

Design

Secondary analysis of cross-sectional data from the Indian Annual Health Survey (2010-2013).

Setting

Nine states in India: Madhya Pradesh, Chhattisgarh, Rajasthan, Uttarakhand, Jharkhand, Odisha, Bihar, Assam and Uttar Pradesh.

Participants

886?505 women, aged 15-49 years.

Main outcome measures

Stillbirth rate with 95% CI. Adjusted OR to examine the associations between stillbirth and (1) socioeconomic, behavioural and biodemographic risk factors and (2) complications in pregnancy (anaemia, eclampsia, other hypertensive disorders, antepartum and intrapartum haemorrhage, obstructed labour, breech presentation, abnormal fetal position).

Results

The overall rate of stillbirth was 10 per 1000 total births (95%?CI 9.8 to 10.3). Indicators of socioeconomic deprivation were strongly associated with an increase in stillbirth: rural residence (adjusted OR (aOR) 1.27, 95%?CI 1.16 to 1.39), female illiteracy (aOR 1.43, 95%?CI 1.17 to 1.74), low socioeconomic status (aOR 2.42, 95%?CI 1.82 to 3.21), schedule caste background (aOR 1.11, 95%?CI 1.04 to 1.19) and woman not in paid employment (aOR 1.15, 95%?CI 1.07 to 1.24). Women from minority religious groups were at higher risk than the Hindu majority (Muslim (aOR 1.33, 95%?CI 1.25 to 1.43); Christian (aOR 1.42, 95%?CI 1.19 to 1.70)). While a few women smoked (<1%), around 9% reported chewing tobacco, which was associated with an increased odds of stillbirth (aOR 1.11, 95%?CI 1.02 to 1.21). Adverse pregnancy and birth characteristics were also associated with stillbirth: antenatal care visits <4 (aOR 1.08, 95%?CI 1.01 to 1.15), maternal age <25 years (aOR 1.29, 95%?CI 1.21 to 1.37) and ?35 years (aOR 1.16, 95%?CI 1.04 to 1.29), multigravida (aOR 3.06, 95%?CI 2.42 to 3.86), multiple pregnancy (aOR 1.77, 95%?CI 1.47 to 2.15), assisted delivery (aOR 3.45, 95%?CI 3.02 to 3.93), caesarean section (aOR 1.73, 95%?CI 1.58 to 1.89), as were pregnancy complications (aOR 1.42, 95%?CI 1.33 to 1.51).

Conclusion

India is an emerging market economy experiencing a rapid health transition, yet these findings demonstrate the marked disparity in risk of stillbirth by women's socioeconomic status. Tobacco chewing and maternal and fetal complications were each found to be important modifiable risk factors. Targeting the 'at-risk' population identified here, improved recording of stillbirths and the introduction of local reviews would be important steps to reduce the high burden of stillbirths in India.

SUBMITTER: Altijani N

PROVIDER: S-EPMC6231551 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Stillbirth among women in nine states in India: rate and risk factors in study of 886,505 women from the annual health survey.

Altijani Noon N Carson Claire C Choudhury Saswati Sanyal SS Rani Anjali A Sarma Umesh C UC Knight Marian M Nair Manisha M

BMJ open 20181108 11

<h4>Objectives</h4>To assess the rate of stillbirth and associated risk factors across nine states in India.<h4>Design</h4>Secondary analysis of cross-sectional data from the Indian Annual Health Survey (2010-2013).<h4>Setting</h4>Nine states in India: Madhya Pradesh, Chhattisgarh, Rajasthan, Uttarakhand, Jharkhand, Odisha, Bihar, Assam and Uttar Pradesh.<h4>Participants</h4>886 505 women, aged 15-49 years.<h4>Main outcome measures</h4>Stillbirth rate with 95% CI. Adjusted OR to examine the asso ...[more]

PMID: 30413502

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Project description:Aims/hypothesisStillbirth risk is increased in pregnancy complicated by diabetes. Fear of stillbirth has major influence on obstetric management, particularly timing of delivery. We analysed population-level data from Scotland to describe timing of stillbirths in women with diabetes and associated risk factors.MethodsA retrospective cohort of singleton deliveries to mothers with type 1 (n?=?3778) and type 2 diabetes (n?=?1614) from 1 April 1998 to 30 June 2016 was analysed using linked routine care datasets. Maternal and fetal characteristics, HbA1c data and delivery timing were compared between stillborn and liveborn groups.ResultsStillbirth rates were 16.1 (95% CI 12.4, 20.8) and 22.9 (95% CI 16.4, 31.8) per 1000 births in women with type 1 (n?=?61) and type 2 diabetes (n?=?37), respectively. In women with type 1 diabetes, higher HbA1c before pregnancy (OR 1.03 [95% CI 1.01, 1.04]; p?=?0.0003) and in later pregnancy (OR 1.06 [95% CI 1.04, 1.08]; p <?0.0001) were associated with stillbirth, while in women with type 2 diabetes, higher maternal BMI (OR 1.07 [95% CI 1.01, 1.14]; p?=?0.02) and pre-pregnancy HbA1c (OR 1.02 [95% CI 1.00, 1.04]; p?=?0.016) were associated with stillbirth. Risk was highest in infants with birthweights <10th centile (sixfold higher born to women with type 1 diabetes [n?=?5 stillbirths, 67 livebirths]; threefold higher for women with type 2 diabetes [n?=?4 stillbirths, 78 livebirths]) compared with those in the 10th-90th centile (n?=?20 stillbirths, 1685 livebirths). Risk was twofold higher in infants with birthweights >95th centile born to women with type 2 diabetes (n?=?15 stillbirths, 402 livebirths). A high proportion of stillborn infants were male among mothers with type 2 diabetes (81.1% vs 50.5% livebirths, p?=?0.0002). A third of stillbirths occurred at term, with highest rates in the 38th week (7.0 [95% CI 3.7, 12.9] per 1000 ongoing pregnancies) among mothers with type 1 diabetes and in the 39th week (9.3 [95% CI 2.4, 29.2]) for type 2 diabetes.Conclusions/interpretationMaternal blood glucose levels and BMI are important modifiable risk factors for stillbirth in diabetes. Babies at extremes of weight centiles are at most risk. Many stillbirths occur at term and could potentially be prevented by change in routine care and delivery policies.

Project description:BackgroundCompared to women with a live birth, women with a stillbirth are more likely to have maternal complications during pregnancy and at birth, but risk factors related to their postpartum health are uncertain.ObjectiveThis study aimed to identify patient-level risk factors for postpartum hospital readmission among women after having a stillbirth.Study designThis was a population-based cohort study of 29,654 women with a stillbirth in California from 1997 to 2011. Using logistic regression models, we examined the association of maternal patient-level factors with postpartum readmission among women after a stillbirth within 6 weeks of hospital discharge and between 6 weeks and 9 months after delivery.ResultsWithin 6 weeks after a stillbirth, 642 women (2.2%) had a postpartum readmission. Risk factors for postpartum readmission after a stillbirth were severe maternal morbidity excluding transfusion (adjusted odds ratio, 3.02; 95% confidence interval, 2.28-4.00), transfusion at delivery but no other indication of severe maternal morbidity (adjusted odds ratio, 1.95; 95% confidence interval, 1.35-2.81), gestational hypertension or preeclampsia (adjusted odds ratio, 1.93; 95% confidence interval, 1.54-2.42), prepregnancy hypertension (adjusted odds ratio, 1.80; 95% confidence interval, 1.36-2.37), diabetes mellitus (adjusted odds ratio, 1.78; 95% confidence interval, 1.33-2.37), antenatal hospitalization (adjusted odds ratio, 1.78; 95% confidence interval, 1.43-2.21), cesarean delivery (adjusted odds ratio, 1.73; 95% confidence interval, 1.43-2.21), long length of stay in the hospital after delivery (>2 days for vaginal delivery and >4 days for cesarean delivery) (adjusted odds ratio, 1.59; 95% confidence interval, 1.33-1.89), non-Hispanic black race and ethnicity (adjusted odds ratio, 1.38; 95% confidence interval, 1.08-1.76), and having less than a high school education (adjusted odds ratio, 1.35; 95% confidence interval, 1.02-1.80). From 6 weeks to 9 months, 1169 women (3.90%) had a postpartum readmission; significantly associated risk factors were largely similar to those for earlier readmission.ConclusionWomen with comorbidities, with birth-related complications, of non-Hispanic black race and ethnicity, or with less education had increased odds of postpartum readmission after having a stillbirth, highlighting the importance of continued care for these women after discharge from the hospital.

Project description:BackgroundInstitutional delivery rate among women in rural communities in Bangladesh remains low after several governmental interventions. A recent analysis of maternal mortality in Bangladesh revealed that women in rural communities were more likely to die from maternal complications than those in urban areas.ObjectiveThis study assessed the institutional delivery rate and associated factors among women in rural communities in Bangladesh.DesignThis was a cross-sectional study that used the 2017-2018 Bangladesh Demographic and Health Survey for analysis. To determine the factors associated with institutional delivery, multivariate logistic regression analysis was performed.Setting and participantsThe study was conducted in Bangladesh and among 3245 women who delivered live births 3 years before the survey.Main outcome measureThe outcome variable was the place of delivery which was dichotomised into institutional and home delivery/other non-professional places.ResultsThe institutional delivery rate was 44.82% (95% CI 42.02% to 47.65%). We found that women between the ages of 30 and 49 years (aOR=1.51, 95% CI 1.05 to 2.18), women whose partners attained higher education (aOR=2.02, 95% CI 1.39 to 2.94), women who had antenatal visits of 1-3 (aOR=2.54, 95% CI 1.65 to 3.90), 4-7 (aOR=4.79, 95% CI 3.04 to 7.53), and ≥8 (aOR=6.13, 95% CI 3.71 to 10.42), women who watched television (aOR=1.35, 95% CI 1.09 to 1.67) and women in the middle (aOR=1.38, 95% CI 1.05 to 1.82), rich (aOR=1.84, 95% CI 1.34 to 2.54) and richest (aOR=2.67, 95% CI 1.82 to 3.91) households were more likely to use institutional delivery. On the other hand, women who were working (aOR=0.73, 95% CI 0.60 to 0.89), women who were Muslims (aOR=0.62, 95% CI 0.44 to 0.89) and women who gave birth to two (aOR=0.61, 95% CI 0.48 to 0.77) or ≥3 children (aOR=0.46, 95% CI 0.35 to 0.60) were less likely to use institutional delivery.ConclusionThe study revealed that a low proportion of women in rural communities in Bangladesh used institutional delivery. The results of this study should be taken into account by policy-makers and governmental efforts when creating interventions or programmes aimed at increasing institutional delivery in Bangladesh.

Project description:BackgroundHeterogeneity of the HIV epidemic across districts of south India is reflected in HIV positivity among antenatal clinic (ANC) attendees. Along with individual factors, contextual factors also need consideration for effective HIV interventions. Thus, identifying district and individual level factors that influence ANC HIV positivity assumes importance to intervene effectively.MethodsData on HIV sentinel surveillance among the ANC population were obtained from the National AIDS Control Organization (NACO) between years 2004 and 2007. Data from serial cross-sectional studies among female sex workers (FSWs) conducted during this time period in 24 districts were used to generate district level variables corresponding to parameters concerning this high risk population. Other district level data were obtained from various official/governmental agencies. Multilevel logistic regression was used to identify individual and district level factors associated with ANC-HIV positivity.ResultsThe average ANC-HIV prevalence from 2004 to 2007 in the 24 integrated biological and behavioural assessments (IBBA) districts ranged from 0.25 to 3.25%. HIV positivity was significantly higher among ANC women with age ? 25 years [adjusted odds ratio (AOR):1.49; 95% confidence interval (95%CI):1.27 to 1.76] compared to those with age<25 years; illiterate (AOR:1.62; 95%CI:1.03 to 2.54) compared to literate; employed in agriculture (AOR:1.34; 95%CI:1.11 to 1.62) or with occupations like driver/helper/industry/factory workers/hotel staff (AOR:1.59; 95%CI:1.26 to 2.01) compared to unemployed. District level HIV prevalence among FSWs (AOR:1.03; 95%CI:1.0 to 1.05) and percentage women marrying under 18 years were significantly associated with ANC-HIV positivity (AOR:1.02; 95%CI:1.00 to 1.04).ConclusionIlliteracy of the woman, higher HIV prevalence among FSWs and early marriage were associated with HIV positivity among pregnant women in southern India. In addition to targeted HIV preventive interventions among FSWs, studying and changing the behavior of FSW clients and addressing structural drivers of the epidemic might indirectly help reduce HIV infection among women in southern India.

Dataset Information

Stillbirth among women in nine states in India: rate and risk factors in study of 886,505 women from the annual health survey.

Objectives

Design

Setting

Participants

Main outcome measures

Results

Conclusion

Publications

Stillbirth among women in nine states in India: rate and risk factors in study of 886,505 women from the annual health survey.

Similar Datasets

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