Stillbirths: what difference can we make and at what cost?
Worldwide, 2·65 million (uncertainty range 2·08 million to 3·79 million) stillbirths occur yearly, of which 98% occur in countries of low and middle income. Despite the fact that more than 45% of the global burden of stillbirths occur intrapartum, the perception is that little is known about effecti...
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| Veröffentlicht in: | The Lancet (British edition) 2011, Vol.377 (9776), p.1523-1538 |
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| creator | Bhutta, Zulfiqar A, Prof Yakoob, Mohammad Yawar, MBBS Lawn, Joy E, PhD Rizvi, Arjumand, MSc Friberg, Ingrid K, PhD Weissman, Eva, PhD Buchmann, Eckhart, Prof Goldenberg, Robert L, Prof |
| description | Worldwide, 2·65 million (uncertainty range 2·08 million to 3·79 million) stillbirths occur yearly, of which 98% occur in countries of low and middle income. Despite the fact that more than 45% of the global burden of stillbirths occur intrapartum, the perception is that little is known about effective interventions, especially those that can be implemented in low-resource settings. We undertook a systematic review of randomised trials and observational studies of interventions which could reduce the burden of stillbirths, particularly in low-income and middle-income countries. We identified several interventions with sufficient evidence to recommend implementation in health systems, including periconceptional folic acid supplementation or fortification, prevention of malaria, and improved detection and management of syphilis during pregnancy in endemic areas. Basic and comprehensive emergency obstetric care were identified as key effective interventions to reduce intrapartum stillbirths. Broad-scale implementation of intervention packages across 68 countries listed as priorities in the Countdown to 2015 report could avert up to 45% of stillbirths according to a model generated from the Lives Saved Tool. The overall costs for these interventions are within the general estimates of cost-effective interventions for maternal care, especially in view of the effects on outcomes across maternal, fetal, and neonatal health. |
| doi_str_mv | 10.1016/S0140-6736(10)62269-6 |
| format | Article |
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Despite the fact that more than 45% of the global burden of stillbirths occur intrapartum, the perception is that little is known about effective interventions, especially those that can be implemented in low-resource settings. We undertook a systematic review of randomised trials and observational studies of interventions which could reduce the burden of stillbirths, particularly in low-income and middle-income countries. We identified several interventions with sufficient evidence to recommend implementation in health systems, including periconceptional folic acid supplementation or fortification, prevention of malaria, and improved detection and management of syphilis during pregnancy in endemic areas. Basic and comprehensive emergency obstetric care were identified as key effective interventions to reduce intrapartum stillbirths. Broad-scale implementation of intervention packages across 68 countries listed as priorities in the Countdown to 2015 report could avert up to 45% of stillbirths according to a model generated from the Lives Saved Tool. The overall costs for these interventions are within the general estimates of cost-effective interventions for maternal care, especially in view of the effects on outcomes across maternal, fetal, and neonatal health.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(10)62269-6</identifier><identifier>PMID: 21496906</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Biological and medical sciences ; cost effectiveness ; Delivery, Obstetric - standards ; Developing Countries ; Emergency Medical Services ; Female ; Fetal Monitoring ; folic acid ; General aspects ; Humans ; income ; Internal Medicine ; malaria ; Maternal Health Services ; Medical sciences ; Midwifery ; Miscellaneous ; Models, Statistical ; observational studies ; Preconception Care - economics ; Pregnancy ; Pregnancy Complications - diagnosis ; Pregnancy Complications - prevention & control ; Pregnancy Complications - therapy ; Prenatal Care - economics ; Prenatal Nutritional Physiological Phenomena ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Stillbirth - epidemiology ; systematic review ; Treponema pallidum ; uncertainty</subject><ispartof>The Lancet (British edition), 2011, Vol.377 (9776), p.1523-1538</ispartof><rights>Elsevier Ltd</rights><rights>2011 Elsevier Ltd</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Elsevier Ltd. 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Despite the fact that more than 45% of the global burden of stillbirths occur intrapartum, the perception is that little is known about effective interventions, especially those that can be implemented in low-resource settings. We undertook a systematic review of randomised trials and observational studies of interventions which could reduce the burden of stillbirths, particularly in low-income and middle-income countries. We identified several interventions with sufficient evidence to recommend implementation in health systems, including periconceptional folic acid supplementation or fortification, prevention of malaria, and improved detection and management of syphilis during pregnancy in endemic areas. Basic and comprehensive emergency obstetric care were identified as key effective interventions to reduce intrapartum stillbirths. Broad-scale implementation of intervention packages across 68 countries listed as priorities in the Countdown to 2015 report could avert up to 45% of stillbirths according to a model generated from the Lives Saved Tool. The overall costs for these interventions are within the general estimates of cost-effective interventions for maternal care, especially in view of the effects on outcomes across maternal, fetal, and neonatal health.</description><subject>Biological and medical sciences</subject><subject>cost effectiveness</subject><subject>Delivery, Obstetric - standards</subject><subject>Developing Countries</subject><subject>Emergency Medical Services</subject><subject>Female</subject><subject>Fetal Monitoring</subject><subject>folic acid</subject><subject>General aspects</subject><subject>Humans</subject><subject>income</subject><subject>Internal Medicine</subject><subject>malaria</subject><subject>Maternal Health Services</subject><subject>Medical sciences</subject><subject>Midwifery</subject><subject>Miscellaneous</subject><subject>Models, Statistical</subject><subject>observational studies</subject><subject>Preconception Care - economics</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - diagnosis</subject><subject>Pregnancy Complications - prevention & control</subject><subject>Pregnancy Complications - therapy</subject><subject>Prenatal Care - economics</subject><subject>Prenatal Nutritional Physiological Phenomena</subject><subject>Public health. Hygiene</subject><subject>Public health. 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Despite the fact that more than 45% of the global burden of stillbirths occur intrapartum, the perception is that little is known about effective interventions, especially those that can be implemented in low-resource settings. We undertook a systematic review of randomised trials and observational studies of interventions which could reduce the burden of stillbirths, particularly in low-income and middle-income countries. We identified several interventions with sufficient evidence to recommend implementation in health systems, including periconceptional folic acid supplementation or fortification, prevention of malaria, and improved detection and management of syphilis during pregnancy in endemic areas. Basic and comprehensive emergency obstetric care were identified as key effective interventions to reduce intrapartum stillbirths. Broad-scale implementation of intervention packages across 68 countries listed as priorities in the Countdown to 2015 report could avert up to 45% of stillbirths according to a model generated from the Lives Saved Tool. The overall costs for these interventions are within the general estimates of cost-effective interventions for maternal care, especially in view of the effects on outcomes across maternal, fetal, and neonatal health.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>21496906</pmid><doi>10.1016/S0140-6736(10)62269-6</doi><tpages>16</tpages></addata></record> |
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| identifier | ISSN: 0140-6736 |
| ispartof | The Lancet (British edition), 2011, Vol.377 (9776), p.1523-1538 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Biological and medical sciences cost effectiveness Delivery, Obstetric - standards Developing Countries Emergency Medical Services Female Fetal Monitoring folic acid General aspects Humans income Internal Medicine malaria Maternal Health Services Medical sciences Midwifery Miscellaneous Models, Statistical observational studies Preconception Care - economics Pregnancy Pregnancy Complications - diagnosis Pregnancy Complications - prevention & control Pregnancy Complications - therapy Prenatal Care - economics Prenatal Nutritional Physiological Phenomena Public health. Hygiene Public health. Hygiene-occupational medicine Stillbirth - epidemiology systematic review Treponema pallidum uncertainty |
| title | Stillbirths: what difference can we make and at what cost? |
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