An Initiative towards reducing Stillbirth: Stillbirth Surveillance Review & Response (SBSRR)

An Initiative towards reducing Stillbirth: Stillbirth Surveillance Review & Response (SBSRR)

Dr Bharti Sharma (1), Dr Neelam Aggarwal (1), Dr Vanita Suri (1)1, Dr Anoma Jayathilaka (2), Dr Priya Karna (2), Dr Neena Raina (2)

(1) Department of Obstetrics & Gynecology, PGIMER Chandigarh India, (2) Department of Family health, Gender and Life course, WHO SEARO, New Delhi, India

Introduction
India has the highest number of stillbirth in the world-592, 100 in 2015 with an estimated Stillbirth rate of 23 per 1000births. Towards better identification and documentation, stillbirth surveillance pilot was conducted in North India by WHO SEARO 10 hospitals between 2014 and 2018. This study is an attempt to showcase that surveillance is feasible but to understand and better plan preventive strategies there is need to know beyond counting stillbirth numbers.

Methods
The framework provided in “WHO Making every baby count” is followed and mortality audit for thematic cases is being done in six steps; (1) identifying cases; (2) collecting information; (3) analysis ;(4) recommending solutions; (5) implementing solutions; and (6) evaluation.

Results
360,736 total births were examined between 2014 and 2018; 14, 167 stillbirths were identified, giving a stillbirth rate of 39 per 1000 births across ten hospitals. Stillbirth Surveillance review and Response (SBSRR) was introduced in one of the tertiary care. In a period of Eight months, out of 205 stillbirths (SBR 205/4094=50 per 1000 total births), 165 thematic cases were reviewed and recommendations were formulated like to strengthen obstetrics triage, start following fetal growth charts, strengthen the existing referral system and improve the communication skills of health care provider for better compliance. Some of these recommendations which have been implemented like Obstetrics triage protocols, to assess the fetal growth by measuring symphysio fundal height and follow growth charts, sensitization of doctors to emphasize on the danger signs and daily fetal movement count during antenatal care.

Conclusion
Conducting stillbirth surveillance review and response of thematic cases in low-middle income countries setting is feasible. As countries progress towards ending preventable mortality, this has the potential to serve as a key process in improving evidence-based and context-specific planning and preventive strategies towards improving quality of care.

Ethics statement:
Ethical clearance from Institutional ethical committee given.

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