Delays in Illness Recognition, Healthcare Seeking, and Healthcare Provision for Stillbirths and Neonatal Deaths in Seven Low- and Middle-Income Countries

An estimated 1.9 million stillbirths and 2.3 million neonatal deaths occur globally annually, disproportionately clustered in sub-Saharan Africa and South Asia. The aim for the present study was to determine the frequency of delays in illness recognition, healthcare seeking, and healthcare receipt among stillbirths and neonatal deaths, characterize the most common delays, and describe the frequency of antenatal care visits preceding stillbirths and neonatal deaths. A descriptive analysis was conducted using data collected from 2016 to 2023 in the Child Health and Mortality Prevention Surveillance network, which prospectively studies stillbirths and child deaths in seven low- and middle-income countries. Delays in 1) illness recognition in the home or decision to seek care, 2) transportation to healthcare facilities, and 3) the provision of clinical care (e.g., timely administration of medications) in healthcare facilities were categorized according to the "Three Delays-in-Healthcare" framework. A total of 7,079 deaths (3,424 stillbirths, 3,655 neonatal deaths) were included. Among included stillbirths, 53.6% were male; the median maternal gestational age was 36 weeks (interquartile range [IQR]: 32-38 weeks). Among included neonatal deaths, 57.3% were male; the median maternal gestational age at delivery was 34 weeks (IQR: 30-38 weeks). A total of 96.8% (N = 3,313) of stillbirths and 97.7% (N = 3,571) of neonatal deaths had ≥1 delay identified, the most common being those related to the delivery of high-quality clinical care in health facilities. Nearly half of mothers of stillbirths (48%) and 41% of mothers of deceased neonates had only one to three antenatal care visits. Delays in healthcare provision were common, suggesting that improving the quality of facility-based clinical care may be the most impactful intervention for reducing perinatal mortality.

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Journal
American Journal of Tropical Medicine and Hygiene
Published
2026-10-27
DOI
https://doi.org/10.4269/ajtmh.26-0164
Primary Topic
Global Maternal and Child Health
Type
article
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article

Delays in Illness Recognition, Healthcare Seeking, and Healthcare Provision for Stillbirths and Neonatal Deaths in Seven Low- and Middle-Income Countries

Marcelino Garrine, María Maixenchs, Ronita Désirée Cornelia Luke, J. Anthony G. Scott et al.
2 links
American Journal of Tropical Medicine and Hygiene
Global Maternal and Child Health
article

Delays in Illness Recognition, Healthcare Seeking, and Healthcare Provision for Stillbirths and Neonatal Deaths in Seven Low- and Middle-Income Countries

Marcelino Garrine, María Maixenchs, Ronita Désirée Cornelia Luke, J. Anthony G. Scott, Haleluya Leulseged, John Blevins, Megan Dempster, Karen L. Kotloff, Rajib Biswas, Inácio Mandomando, Victor Akelo, Zachary J. Madewell, Konjit Eshetu, Meron Kebede, Erick Kaluma, Portia Chipo Mutevedzi, Samba Ousmane Sow, Ikechukwu Udo Ogbuanu, Emily S. Gurley, Cynthia G. Whitney, Shabir Ahmed Madhi, Nega Assefa, Rosauro Varo, Christopher Mugah, Quique Bassat, Chris A. Rees, Hellen C Muttai, Sithembiso Velaphi, Kitiezo Aggrey Igunza, Abeed Sarker, Ziyaad Dangor, Milton Kincardett, Ima-Abasi E. Bassey, Shams El Arifeen, Mohammad Zahid Hossain, Oluseyi Balogun, Afsana Afrin, Namrata Ramakrishna, Marguerite Hall, Paul Mitei, Yuting Guo
article en

Abstract

An estimated 1.9 million stillbirths and 2.3 million neonatal deaths occur globally annually, disproportionately clustered in sub-Saharan Africa and South Asia. The aim for the present study was to determine the frequency of delays in illness recognition, healthcare seeking, and healthcare receipt among stillbirths and neonatal deaths, characterize the most common delays, and describe the frequency of antenatal care visits preceding stillbirths and neonatal deaths. A descriptive analysis was conducted using data collected from 2016 to 2023 in the Child Health and Mortality Prevention Surveillance network, which prospectively studies stillbirths and child deaths in seven low- and middle-income countries. Delays in 1) illness recognition in the home or decision to seek care, 2) transportation to healthcare facilities, and 3) the provision of clinical care (e.g., timely administration of medications) in healthcare facilities were categorized according to the "Three Delays-in-Healthcare" framework. A total of 7,079 deaths (3,424 stillbirths, 3,655 neonatal deaths) were included. Among included stillbirths, 53.6% were male; the median maternal gestational age was 36 weeks (interquartile range [IQR]: 32-38 weeks). Among included neonatal deaths, 57.3% were male; the median maternal gestational age at delivery was 34 weeks (IQR: 30-38 weeks). A total of 96.8% (N = 3,313) of stillbirths and 97.7% (N = 3,571) of neonatal deaths had ≥1 delay identified, the most common being those related to the delivery of high-quality clinical care in health facilities. Nearly half of mothers of stillbirths (48%) and 41% of mothers of deceased neonates had only one to three antenatal care visits. Delays in healthcare provision were common, suggesting that improving the quality of facility-based clinical care may be the most impactful intervention for reducing perinatal mortality.

American Journal of Tropical Medicine and Hygiene
South African Medical Research Council (ZA), Institució Catalana de Recerca i Estudis Avançats (ES), University of Maryland, Baltimore (US), Hospital Sant Joan de Déu Barcelona (ES), Johns Hopkins University (US), Emory University (US), Haramaya University (ET), University of the Witwatersrand (ZA), Liverpool School of Tropical Medicine (GB), International Centre for Diarrhoeal Disease Research (BD), Kenya Medical Research Institute (KE), Centre Pour le Développement des Vaccins-Mali (ML), London School of Hygiene & Tropical Medicine (GB), Ministry of Health and Sanitation (SL), Hospital Clínic de Barcelona (ES), Manhiça Health Research Centre (MZ), The Task Force for Global Health (US), Barcelona Institute for Global Health (ES), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES), Institut de Recerca Sant Joan de Déu (ES), Great Lakes University of Kisumu (KE)
Good health and well-being
Openalex Percentile: Top 7%
Global Maternal and Child Health
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