2014.ISDS.Abstracts.Final.pdf


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ISDS 2014 Conference Abstracts

Tiny Footprints Embedded on Grieving Mother’s Heart: 
Stillbirths in the Health and Demographic Surveillance 
System

Muhammad Ilyas*, Murtaza Ali, Muhammad Imran Nisar, Fyezah Jehan and Abdul Momin 
Kazi

Pediatrics, The Aga Khan University, Karachi, Karachi, Pakistan

Objective
Objective: To describe characteristic of stillbirth in a diverse 

population in Karachi health and demographic surveillance system.

Introduction
Stillbirth is an unfortunate event in a woman life which remains 

uncounted in developing countries, thus, seldom caught attention 
until recently. Among 3.2 million stillbirths globally, 98% occurs in 
LMICs with majority in South Asia, and 75% of those are preventable. 
Globally, it counts as equal to neonatal deaths and is not mentioned 
in MGDs, global charters and programs priority. Besides immense 
information gap, it is mostly not part of vital registration system. 
Mostly, the data for stillbirths is mostly collected in demographic 
surveys, clinical studies or retrospective records, underestimating the 
counts. Besides, lack of optimal national vital registration system, 
Pakistan has highest rate of stillbirth. Hence, to collect prospective 
data, efforts are made by Department of Paediatrics of Aga Khan 
University to maintain a Demographic & Health Surveillance System 
(DHSS) at Karachi to provide more robust data over years.

Methods
Our catchment area is 19 sq km with a population of around 274,856 

with 69699 females between 15 to 49 years of age. Surveillance 
catchment area is divided into clusters/blocks of about 200 to 250 
structures, each marked with a unique number. Each married woman, 
pregnant woman and <5 year child’s unique ID is collated with GPS 
coordinate of structures they live in. Block boundary is mapped 
using GPS track log technique. Structures, streets and landmarks are 
digitized through GIS. Our community health workers (CHWs) visit 
each household quarterly in DHSS area to identify new pregnancies 
and follow pregnant woman until pregnancy outcome. Further verbal 
autopsies (VA) are conducted for all stillbirths, <5 years children 
deaths and adult female deaths (13-49 years) including maternal 
deaths to obtain cause-specific mortality. VA’s are attempted after 
allowing 2 weeks of grieving time to family.

Results
During 2012 we captured 13979 pregnant women, 9136 live births 

and 239 still births yielding stillbirth rate of 25.5 per 1000 births. VAs 
for 79% stillbirths was completed. In 82% of VA interview respondent 
were mothers. Majority stillbirths were Males (n= 107) 58%. Most 
number of stillbirths occurred in hospitals 47.5% and 43% occurred 
in multi gravida women. 33% pregnant women with SB reported high 
blood pressure, 2.1% had epilepsy during pregnancy and 2.7% had 
convulsion during last month of pregnancy. Furthermore 6.6% of the 
women with SB had excessive vaginal bleeding during first six month 
of pregnancy, 9.3% during last month of pregnancy, and nearly 25% 
during the intrapartum period. 72% of SBs were delivered by doctors, 
nurses or midwives and 28% by tradition birth attendants (TBAs). 
88% women had normal vaginal deliveries, 12% had caesarian 
section; 22.4% were premature and 89% were fresh stillbirths.

Conclusions
Majority of still births occur near to birth and can be prevented by 

improving the quality of obstetric care especially around the time of 
birth.

Keywords
Stillbirths; Demographic & Health Surveillance System; Verbal 
Autopsy; Pakistan

References

Ilyas, M., Nisar, M. I., Kazi, A. M., Ali, M. T., & Zaidi, A. (2014). 
A Health and Demographic Surveillance System in a Low 
Socioeconomic Setting in Karachi, Pakistan. Online Journal of Public 
Health Informatics, 6(1).

Ali, M. T., Kazi, A. M., Nisar, M. I., Ilyas, M., & Zaidi, A. (2014). 
Geospatial Reporting of Health Demographic Surveillance in a Peri 
Urban Setting. Online Journal of Public Health Informatics, 6(1).

Stillbirth Collaborative Research Network Writing Group. Causes of 
death among stillbirths. JAMA: the journal of the American Medical 
Association306.22 (2011): 2459.

Lawn, Joy E., et al. Stillbirths: Where? When? Why? How to make the 
data count? The Lancet 377.9775 (2011): 1448-1463.

*Muhammad Ilyas

E-mail: ilyas.muhammad@aku.edu    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * (1):e31, 201