Causes of stillbirth in sub-Saharan Africa and South Asia: Findings from Child Health and Mortality Prevention Surveillance, 2016–2023

BACKGROUND: Globally, an estimated 1.9 million stillbirths occur annually, yet significant knowledge gaps exist regarding the causes of stillbirths, particularly in high-burden regions. We investigated fetal and maternal conditions causing stillbirths in seven countries in sub-Saharan Africa and South Asia and described missed opportunities for prevention. METHODS: Child Health and Mortality Prevention Surveillance (CHAMPS) identified stillbirths at sites in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa. We asked families for consent to conduct minimally invasive tissue sampling (MITS) from December 2016 to December 2023. An expert panel reviewed test results, clinical information, and verbal autopsy data and assigned fetal and maternal conditions leading to stillbirths and identified missed opportunities for prevention. FINDINGS: A cause of death (fetal or maternal condition) was determined for 94% (2342/2492) of stillbirths; the most frequent condition in the fetus was intrauterine hypoxia (75%, 1864/2492) across all sites, resulting from either maternal condition (49%, 922/1864) or placental causes (33%, 610/1864). Congenital infections were determined to be the cause of 9% (228/2492) of stillbirths, accounting for the highest proportion in South Africa (31%, 96/306). Group B Streptococcus, Escherichia coli, and Enterococcus faecalis were the most common causative pathogens. Congenital birth defects caused 9% (227/2492) overall and were most common in Ethiopia (24%, 136/568). Primary maternal conditions were identified in 72%, most often placental complications (18%, 446/2492) and maternal hypertension (17%, 414/2492). Complications of placenta, cord and membranes were more common in Mali (43%, 92/212) while maternal medical and surgical conditions were most frequently observed in South Africa (40%, 121/306) and Bangladesh (39%, 158/405). Most (72%, 1808/2492) causes of stillbirth were considered preventable, with heterogeneity observed across sites on the recommended prevention strategies. INTERPRETATION: Complications of pregnancy or delivery accounted for most stillbirths across all sites, with intrauterine hypoxia identified as the predominant fetal condition highlighting widespread and persistent gaps in the timely identification and management of maternal and placental conditions during antenatal and obstetric care across sites in Africa and South Asia. At the same time, substantial geographic variation in causes and prevention opportunities, including for infections and birth defects, underscored the need for locally tailored strategies. Strengthening facility-based care alongside targeted interventions based on site-specific patterns, will be critical to reducing the stillbirth burden in these high-priority regions. FUNDING: The Gates Foundation.

Authors

Institutions

Publication Details

Journal
PLOS Global Public Health
Published
2026-10-27
DOI
https://doi.org/10.1371/journal.pgph.0005235
Primary Topic
Global Maternal and Child Health
Type
article
Field-Weighted Citation Impact
0.00

Funders

Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Causes of stillbirth in sub-Saharan Africa and South Asia: Findings from Child Health and Mortality Prevention Surveillance, 2016–2023

Yasmin Adam, Dianna M. Blau, J. Anthony G. Scott, Fikremelekot Temesgen et al.
1 links
PLOS Global Public Health
Global Maternal and Child Health
article

Causes of stillbirth in sub-Saharan Africa and South Asia: Findings from Child Health and Mortality Prevention Surveillance, 2016–2023

Yasmin Adam, Dianna M. Blau, J. Anthony G. Scott, Fikremelekot Temesgen, Solomon S Samura, Melisachew Mulatu Yeshi, Kyu Han Lee, Karen L. Kotloff, Richard Omore, Atique Iqbal Chowdhury, Inácio Mandomando, Amy J. Wise, Lola Madrid, Julius Ojulong, Elizabeth Oele, Victor Akelo, Sana Mahtab, Dickens Onyango, Erick Kaluma, Portia Chipo Mutevedzi, Samba Ousmane Sow, Sara A Ajanovic, Milagritos D. Tapia, Ikechukwu Udo Ogbuanu, Emily S. Gurley, Kiranpreet Kaur Chawla, Cynthia G. Whitney, Shabir Ahmed Madhi, Nega Assefa, Adama Mamby Keita, Robert F. Breiman, Rosauro Varo, Elisio G. Xerinda, Christopher Mugah, Quique Bassat, Muntasir Alam, Kitiezo Aggrey Igunza, Ziyaad Dangor, Afruna Rahman, Shams El Arifeen, Mohammad Zahid Hossain, Afsana Afrin, Lucy Liu
article en

Abstract

BACKGROUND: Globally, an estimated 1.9 million stillbirths occur annually, yet significant knowledge gaps exist regarding the causes of stillbirths, particularly in high-burden regions. We investigated fetal and maternal conditions causing stillbirths in seven countries in sub-Saharan Africa and South Asia and described missed opportunities for prevention. METHODS: Child Health and Mortality Prevention Surveillance (CHAMPS) identified stillbirths at sites in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa. We asked families for consent to conduct minimally invasive tissue sampling (MITS) from December 2016 to December 2023. An expert panel reviewed test results, clinical information, and verbal autopsy data and assigned fetal and maternal conditions leading to stillbirths and identified missed opportunities for prevention. FINDINGS: A cause of death (fetal or maternal condition) was determined for 94% (2342/2492) of stillbirths; the most frequent condition in the fetus was intrauterine hypoxia (75%, 1864/2492) across all sites, resulting from either maternal condition (49%, 922/1864) or placental causes (33%, 610/1864). Congenital infections were determined to be the cause of 9% (228/2492) of stillbirths, accounting for the highest proportion in South Africa (31%, 96/306). Group B Streptococcus, Escherichia coli, and Enterococcus faecalis were the most common causative pathogens. Congenital birth defects caused 9% (227/2492) overall and were most common in Ethiopia (24%, 136/568). Primary maternal conditions were identified in 72%, most often placental complications (18%, 446/2492) and maternal hypertension (17%, 414/2492). Complications of placenta, cord and membranes were more common in Mali (43%, 92/212) while maternal medical and surgical conditions were most frequently observed in South Africa (40%, 121/306) and Bangladesh (39%, 158/405). Most (72%, 1808/2492) causes of stillbirth were considered preventable, with heterogeneity observed across sites on the recommended prevention strategies. INTERPRETATION: Complications of pregnancy or delivery accounted for most stillbirths across all sites, with intrauterine hypoxia identified as the predominant fetal condition highlighting widespread and persistent gaps in the timely identification and management of maternal and placental conditions during antenatal and obstetric care across sites in Africa and South Asia. At the same time, substantial geographic variation in causes and prevention opportunities, including for infections and birth defects, underscored the need for locally tailored strategies. Strengthening facility-based care alongside targeted interventions based on site-specific patterns, will be critical to reducing the stillbirth burden in these high-priority regions. FUNDING: The Gates Foundation.

PLOS Global Public HealthVol. 6(10)
Institució Catalana de Recerca i Estudis Avançats (ES), University of Maryland, Baltimore (US), Centers for Disease Control and Prevention (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), Instituto de Salud Carlos III (ES), Kenya Medical Research Institute (KE), Centre Pour le Développement des Vaccins-Mali (ML), London School of Hygiene & Tropical Medicine (GB), Centers for Disease Control and Prevention (UG), Hospital Clínic de Barcelona (ES), Collaborative Group (United States) (US), Manhiça Health Research Centre (MZ), Center for Global Health (US), Instituto Nacional de Saúde (MZ), Centers for Disease Control and Prevention (KE), Barcelona Institute for Global Health (ES), Agricultural Research Council of South Africa (ZA), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES), Emory Global Health Institute (US), Addis Ababa University (ET), Universitat de Barcelona (ES), Mekelle University (ET)
Bill and Melinda Gates Foundation, Emory University, Centers for Disease Control and Prevention
Good health and well-being
Openalex Percentile: Top 7%
Global Maternal and Child Health
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.

Laika access coming soon