Stillbirth among women in nine states in India: rate and risk factors in study of 886,505 women from the annual health survey.
Stillbirth among women in nine states in India: rate and risk factors in study of 886,505 women from the annual health survey.
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DOI：
10.1136/bmjopen-2018-022583
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发表时间：
2018-11-08
期刊：
影响因子：
2.9
通讯作者：
Nair M
中科院分区：
文献类型：
--
作者：
Altijani N;Carson C;Choudhury SS;Rani A;Sarma UC;Knight M;Nair M
评估印度9个邦的死产率及相关风险因素。对印度年度健康调查（2010-2013年）横断面数据的二次分析。印度9个邦：中央邦、恰蒂斯加尔邦、拉贾斯坦邦、北阿坎德邦、贾坎德邦、奥里萨邦、比哈尔邦、阿萨姆邦和北方邦。886 505名妇女，年龄15-49岁。死胎率，95% CI。调整OR以检查死产与(1)社会经济、行为和生物统计学危险因素和(2)妊娠并发症（贫血、子痫、其他高血压疾病、产前和产时出血、难产、臀位、胎儿位置异常）之间的关系。死产的总比率为每1000个分娩中有10个死产（95% CI 9.8 - 10.3）。社会经济剥夺指标与死产增加密切相关：农村居住（调整OR (aOR) 1.27, 95% CI 1.16至1.39）、女性文盲（aOR 1.43, 95% CI 1.17至1.74）、低社会经济地位（aOR 2.42, 95% CI 1.82至3.21）、种姓背景（aOR 1.11, 95% CI 1.04至1.19）和无薪就业妇女（aOR 1.15, 95% CI 1.07至1.24）。来自少数宗教团体的妇女比占多数的印度教徒（穆斯林）的风险更高（aOR 1.33, 95% CI 1.25至1.43）；（aOR 1.42, 95% CI 1.19 - 1.70）)。虽然有少数女性吸烟（<1%），但约有9%的女性嚼烟，这与死产的几率增加有关（aOR 1.11, 95% CI 1.02至1.21）。不良妊娠和分娩特征也与死产有关：产前保健访问<4次（aOR 1.08, 95% CI 1.01 ~ 1.15），产妇年龄<25岁（aOR 1.29, 95% CI 1.21 ~ 1.37）和≥35岁（aOR 1.16, 95% CI 1.04 ~ 1.29），多胎（aOR 3.06, 95% CI 2.42 ~ 3.86），多胎妊娠（aOR 1.77, 95% CI 1.47 ~ 2.15），辅助分娩（aOR 3.45, 95% CI 3.02 ~ 3.93），剖宫产（aOR 1.73, 95% CI 1.58 ~ 1.51），妊娠并发症（aOR 1.42, 95% CI 1.33 ~ 1.51）。印度是一个正在经历快速健康转型的新兴市场经济体，但这些调查结果表明，妇女的社会经济地位在死产风险方面存在显著差异。咀嚼烟草和母胎并发症都被发现是重要的可改变的危险因素。针对这里确定的“高危”人群，改进死产记录和引入当地审查将是减少印度死产高负担的重要步骤。
To assess the rate of stillbirth and associated risk factors across nine states in India. Secondary analysis of cross-sectional data from the Indian Annual Health Survey (2010–2013). Nine states in India: Madhya Pradesh, Chhattisgarh, Rajasthan, Uttarakhand, Jharkhand, Odisha, Bihar, Assam and Uttar Pradesh. 886 505 women, aged 15–49 years. Stillbirth rate with 95% CI. Adjusted OR to examine the associations between stillbirth and (1) socioeconomic, behavioural and biodemographic risk factors and (2) complications in pregnancy (anaemia, eclampsia, other hypertensive disorders, antepartum and intrapartum haemorrhage, obstructed labour, breech presentation, abnormal fetal position). The overall rate of stillbirth was 10 per 1000 total births (95% CI 9.8 to 10.3). Indicators of socioeconomic deprivation were strongly associated with an increase in stillbirth: rural residence (adjusted OR (aOR) 1.27, 95% CI 1.16 to 1.39), female illiteracy (aOR 1.43, 95% CI 1.17 to 1.74), low socioeconomic status (aOR 2.42, 95% CI 1.82 to 3.21), schedule caste background (aOR 1.11, 95% CI 1.04 to 1.19) and woman not in paid employment (aOR 1.15, 95% CI 1.07 to 1.24). Women from minority religious groups were at higher risk than the Hindu majority (Muslim (aOR 1.33, 95% CI 1.25 to 1.43); Christian (aOR 1.42, 95% CI 1.19 to 1.70)). While a few women smoked (<1%), around 9% reported chewing tobacco, which was associated with an increased odds of stillbirth (aOR 1.11, 95% CI 1.02 to 1.21). Adverse pregnancy and birth characteristics were also associated with stillbirth: antenatal care visits <4 (aOR 1.08, 95% CI 1.01 to 1.15), maternal age <25 years (aOR 1.29, 95% CI 1.21 to 1.37) and ≥35 years (aOR 1.16, 95% CI 1.04 to 1.29), multigravida (aOR 3.06, 95% CI 2.42 to 3.86), multiple pregnancy (aOR 1.77, 95% CI 1.47 to 2.15), assisted delivery (aOR 3.45, 95% CI 3.02 to 3.93), caesarean section (aOR 1.73, 95% CI 1.58 to 1.89), as were pregnancy complications (aOR 1.42, 95% CI 1.33 to 1.51). India is an emerging market economy experiencing a rapid health transition, yet these findings demonstrate the marked disparity in risk of stillbirth by women’s socioeconomic status. Tobacco chewing and maternal and fetal complications were each found to be important modifiable risk factors. Targeting the ‘at-risk’ population identified here, improved recording of stillbirths and the introduction of local reviews would be important steps to reduce the high burden of stillbirths in India.
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