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Global, regional, and national stillbirths at 20 weeks' gestation or longer in 204 countries and territories, 1990–2021: findings from the Global Burden of Disease Study 2021

Global, regional, and national stillbirths at 20 weeks' gestation or longer in 204 countries and territories, 1990–2021: findings from the Global Burden of Disease Study 2021

Amin, Tarek Tawfik; Kassebaum, Nicholas J.; Dandona, Rakhi; Amhare, Abebe Feyissa; Murray, Christopher J. L.; Ameyaw, Edward Kwabena; Hay, Simon I.; Zuhriyah, Lilik; Amani, Reza; Aly, Safwat; Aly, Hany; Altirkawi, Khalid A.; Almustanyir, Sami; Almidani, Louay; Zielinska, Magdalena; Zhong, Claire Chenwen; Zhao, Hanqing; Zhang, Zhi-Jiang; Zhang, Yunquan; Zhang, Haijun; Zastrozhin, Michael; Zaman, Burhan Abdullah; Zamagni, Giulia; Zaki, Nazar; Yonemoto, Naohiro; Yip, Paul; Yigit, Arzu; Yi, Siyan; Yehualashet, Sisay Shewasinad; Yano, Yuichiro; Yadav, Vikas; Xu, Xiaoyue; Wolde, Asrat Arja; Weerakoon, Kosala Gayan; Wassie, Emebet Gashaw; Wang, Yanzhong; Wang, Yanqing; Wang, Shu; Wang, Fang; Dhulipala, Vishal R.; Walde, Mandaras Tariku; Vlassov, Vasily; Violante, Francesco S.; Villani, Leonardo; Verras, Georgios-Ioannis; Veroux, Massimiliano; Varthya, Shoban Babu; Van den Eynde, Jef; Valizadeh, Rohollah; Valenti, Mario; Tahbaz, Sahel Valadan; Vaithinathan, Asokan Govindaraj; Unim, Brigid; Umakanthan, Srikanth; Umair, Muhammad; Ubah, Chukwudi S.; Tromans, Samuel Joseph; Tripathy, Jaya Prasad; Tovani-Palone, Marcos Roberto; Topor-Madry, Roman; Tiyuri, Amir; Titova, Mariya Vladimirovna; Thomas, Nihal; Thavamani, Aravind; Tharwat, Samar; Teye-Kwadjo, Enoch; Tesfamariam, Wegen Beyene; Teramoto, Masayuki; Temsah, Mohamad-Hani; Tefera, Yibekal Manaye; Taye, Birhan Tsegaw; Oliaee, Razieh Tavakoli; Tarigan, Ingan Ukur; Tan, Ker-Kan; Tamuzi, Jacques Lukenze; Al-Mekhlafi, Hesham M.; Soodejani, Moslem Taheri; Taheri, Majid; Tabish, Mohammad; Tabatabai, Shima; Tabarés-Seisdedos, Rafael; Szeto, Mindy D.; Sun, Jing; Sultana, Saima; Yigit, Vahit; Suleman, Muhammad; Dhali, Arkadeep; Stergachis, Andy; Sreeramareddy, Chandrashekhar T.; Spartalis, Michael; Song, Yi; Song, Suhang; Dessie, Anteneh Mengist; Atreya, Alok; Derviševic, Emina; Solomon, Yonatan; Almazan, Joseph Uy; Aljunid, Syed Mohamed; Soleimani, Hamidreza; Sohag, Abdullah Al Mamun; Socea, Bogdan; Skhvitaridze, Natia; Singh, Surjit; Atteraya, Madhu Sudhan; Alif, Sheikh Mohammad; Singh, Paramdeep; Singh, Jasvinder A.; Simpson, Colin R.; Silva, João Pedro; Sidamo, Negussie Boti; Sibhat, Migbar Mekonnen; Shuval, Kerem; Shuja, Kanwar Hamza; Shorofi, Seyed Afshin; Shool, Sina; Aujayeb, Avinash; Quintanilla, Beatriz Paulina Ayala; Shivalli, Siddharudha; Shirkoohi, Reza; Shiri, Rahman; Ayatollahi, Haleh; Shetty, Pavanchand H.; Shetty, B. Suresh Kumar; Shetty, Adithi; Sharma, Manoj; Sharew, Mequannent Melaku; Ali, Mohammed Usman; Shannawaz, Mohammed; Shanawaz, Mohd; Ali, Liaqat; Sham, Sunder; Shaikh, Masood Ali; Ali, Abid; Shahid, Samiah; Al-Gheethi, Adel Ali Saeed; Shah, Pritik A.; Algammal, Abdelazeem M.; Shah, Jaffer; Shafie, Mahan; Seylani, Allen; SeyedAlinaghi, SeyedAhmad; Alemi, Sharifullah; Albashtawy, Mohammed; Alanzi, Turki M.; Ayyoubzadeh, Seyed Mohammad; Alanezi, Fahad Mashhour; Azadnajafabad, Sina; Alam, Khurshid; Al-Aly, Ziyad; Serban, Dragos; Azevedo, Rui M. S.; Sepanlou, Sadaf G.; Al Hasan, Syed Mahfuz; Akinosoglou, Karolina; Ajami, Marjan; Ahmed, Luai A.; Senthilkumaran, Subramanian; Sengupta, Pallav; Ahmed, Haroon; Ahmed, Ayman; Ahmadi, Ali; Sun, Haitong Zhe; Atout, Maha Moh'd Wahbi; Atlaw, Daniel; Asresie, Melash Belachew; Ed-Dra, Abdelaziz; Ashraf, Tahira; Asgedom, Akeza Awealom; Edvardsson, Kristina; Asemu, Mulu Tiruneh; Eini, Ebrahim; Asemi, Zatollah; Ekholuenetale, Michael; Aryal, Umesh Raj; El SayedZaki, Maysaa; Artamonov, Anton A.; Elgendy, Islam Y.; Aregawi, Brhane Berhe; Elhadi, Muhammed; Elshaer, Mohammed; Elsohaby, Ibrahim; Emeto, Theophilus I.; Bain, Luchuo Engelbert; Esayas, Hawi Leul; Eshrati, Babak; Esposito, Francesco; Areda, Demelash; Aravkin, Aleksandr Y.; Arab-Zozani, Morteza; Appiah, Francis; Fagbamigbe, Adeniyi Francis; Anwer, Razique; Anvari, Davood; Ansar, Adnan; Anoushiravani, Amir; Fakhradiyev, Ildar Ravisovich; Yang, Lin; Faramarzi, Ali; Faro, Andre; Andrei, Tudorel; Andrei, Catalina Liliana; Amiri, Sohrab; Fatehizadeh, Ali; Fekadu, Ginenus; Fischer, Florian; Fomenkov, Artem Alekseevich; Fukumoto, Takeshi; Gaal, Peter Andras; Gaidhane, Abhay Motiramji; Gajdács, Márió; Galali, Yaseen; Gallus, Silvano; Ganesan, Balasankar; Dziedzic, Arkadiusz Marian; Gazzelloni, Federica; Gebrehiwot, Mesfin; Gebremedhin, Amanuel Tesfay; Gebremeskel, Teferi Gebru; Geda, Yohannes Fikadu; Gezae, Kebede Embaye; Ghasemi, Mohammed-Reza; Ghazy, Ramy Mohamed; Gheno, Gloria; Dutta, Sulagna; Gialluisi, Alessandro; Gissler, Mika; Glasbey, James C.; Glasstetter, Logan M.; Golechha, Mahaveer; Goleij, Pouya; Golinelli, Davide; Duraes, Andre Rodrigues; Grivna, Michal; Dsouza, Haneil Larson; Dora, Bezabih Terefe; Guha, Avirup; Guicciardi, Stefano; Dong, Wanyue; Dirac, M. Ashworth; Guo, Hanbing; Gupta, Sapna; Gupta, Veer Bala; Gupta, Vivek Kumar; Haller, Sebastian; Halwani, Rabih; Hamidi, Samer; Handal, Alexis J.; Haro, Josep Maria; Hartman, Nicholas Nathaniel; Hasan, Taufiq; Hasanpour-Dehkordi, Ali; Hasnain, Md Saquib; Hassanipour, Soheil; Naghavi, Mohsen; Hosseinzadeh, Hassan; Hosseinzadeh, Mehdi; Nangia, Vinay; Nambi, Gopal; Najmuldeen, Hastyar Hama Rashid; Nair, Tapas Sadasivan; Muriithi, Moses K.; Mulita, Francesk; Mulita, Admir; Mughal, Faraz; Chauhan, Dhun; Asl, Farshad Bahrami; Hostiuc, Mihaela; Mueller, Ulrich Otto; Mousavi, Parsa; Bai, Ruhai; Bakshi, Ravleen Kaur; Hostiuc, Sorin; Hu, Chengxi; Huang, Junjie; Huda, M. Mamun; Huda, Md Nazmul; Huynh, Hong-Han; Hwang, Bing-Fang; Iftikhar, Pulwasha Maria; Ilesanmi, Olayinka Stephen; Bam, Kiran; Banach, Maciej; Mouodi, Simin; Mosapour, Abbas; Morovatdar, Negar; Moraga, Paula; Ghalibaf, AmirAli Moodi; Moni, Mohammad Ali; Monasta, Lorenzo; Momtazmanesh, Sara; Molinaro, Sabrina; Mokdad, Ali H.; Mohammed, Shafiu; Mohammed, Salahuddin; Mohammed, Ghada; Mohammad-Alizadeh-Charandabi, Sakineh; Mohamed, Nouh Saad; Mizana, Biru Abdissa; Misra, Sanjeev; Bawa, Eric Mishio; Mirza, Moonis; Mirrakhimov, Erkin M.; Mirica, Andreea; Mirghafourvand, Mojgan; Mirfakhraie, Reza; Minh, Le Huu Nhat; Michalek, Irmina Maria; Meretoja, Tuomo J.; Meretoja, Atte; Menezes, Ritesh G.; Mendoza, Walter; Ilic, Irena M.; Ilic, Milena D.; Immurana, Mustapha; Mendez-Lopez, Max Alberto; Chattu, Vijay Kumar; Meles, Hadush Negash; Kumar, G. Anil; Meles, Gebrekiros Gebremichael; Mehrabani-Zeinabad, Kamran; Mediratta, Rishi P.; Mazaheri, Maryam; Mayeli, Mahsa; Charan, Jaykaran; Chacón-Uscamaita, Pamela Roxana; Cerin, Ester; Maugeri, Andrea; Mattiello, Rita; Mathangasinghe, Yasith; Marzan, Melvin Barrientos; Martorell, Miquel; Iranmehr, Arad; Martins-Melo, Francisco Rogerlândio Rogerlândio; Iravanpour, Farideh; Martini, Santi; Maravilla, Joemer C.; Mallhi, Tauqeer Hussain; Malik, Iram; Malik, Ahmad Azam; Cembranel, Francieli; Malhotra, Kashish; Rad, Elaheh Malakan; Iwagami, Masao; Iwu, Chidozie Declan; Iyasu, Assefa N.; Majeed, Azeem; Magee, Laura A.; Madureira-Carvalho, Áurea M.; Afifi, Ahmed M.; Lotfizadeh, Masoud; Lorenzovici, László; Liu, Xuefeng; Liu, Jue; Liu, Gang; Lim, Stephen S.; Jaafari, Jalil; Jafarzadeh, Abdollah; Jahrami, Haitham; Janodia, Manthan Dilipkumar; Cattaruzza, Maria Sofia; Campos-Nonato, Ismael; Javadi, Nilofer; Javaheri, Tahereh; Jayapal, Sathish Kumar; Jema, Alelign Tasew; Jokar, Mohammad; Joseph, Nitin; Joshua, Charity Ehimwenma; Jürisson, Mikk; Kabir, Ali; Kabir, Zubair; Karaye, Ibraheem M.; Karimi, Hanie; Kasraei, Hengameh; Cadri, Abdul; Kauppila, Joonas H.; Kendal, Evie Shoshannah; Butt, Zahid A.; Ligade, Virendra S.; Li, Shanshan; Li, Ming-Chieh; Lenzi, Jacopo; Lee, Yo Han; Lee, Wei-Chen; Lee, Sang-Woong; Lee, Munjae; Le, Thao Thi Thu; Latifinaibin, Kaveh; Latief, Kamaluddin; Banke-Thomas, Aduragbemi; Bansal, Hansi; Lasrado, Savita; Lal, Dharmesh Kumar; Keykhaei, Mohammad; Laksono, Tri; Khalid, Nauman; Lahariya, Chandrakant; Khamesipour, Faham; Bantie, Berihun Bantie; Butt, Nadeem Shafique; Khan, M. Nuruzzaman; Khan, Maseer; Bustanji, Yasser; Khan, Yusra H.; Barchitta, Martina; Bardhan, Mainak; Khatab, Khaled; Bashiri, Azadeh; Basiru, Afisu; Baskaran, Pritish; Batra, Kavita; Bayani, Mojtaba; Brenner, Hermann; Braithwaite, Dejana; Bodolica, Virginia; Bhattarai, Suraj; Bhaskar, Sonu; Khatatbeh, Haitham; Bhardwaj, Pankaj; Bhardwaj, Nikha; Khatatbeh, Moawiah Mohammad; Bhandari, Dinesh; Bhandari, Bharti; Beyene, Kebede A.; Bermudez, Amiel Nazer C.; Belgaumi, Uzma Iqbal; Khateri, Sorour; Behnoush, Amir Hossein; Kashani, Hamid Reza Khayat; Bayleyegn, Nebiyou Simegnew; Khormali, Moein; Kim, Min Seo; Kim, Thanh V.; Kim, Yun Jin; Kimokoti, Ruth W.; Kisa, Adnan; Kisa, Sezer; Kochhar, Sonali; Kolahi, Ali-Asghar; Bedi, Neeraj; Kompani, Farzad; Koohestani, Hamid Reza; Kosen, Soewarta; Koyanagi, Ai; Begum, Tahmina; Krishan, Kewal; Krishnamoorthy, Vijay; Defo, Barthelemy Kuate; Kuchay, Raja Amir Hassan; Kuddus, Mohammed; Deribe, Kebede; Schuermans, Art; Schneider, Ione Jayce Ceola; Schlaich, Markus P.; Saylan, Mete; Saya, Ganesh Kumar; Sawhney, Monika; Satpathy, Maheswar; Sarode, Sachin C.; Sarikhani, Yaser; Sanjeev, Rama Krishna; Samy, Abdallah M.; Salem, Marwa Rashad; Salehi, Sana; Ahmad, Danish; Ahmad, Aqeel; Ahinkorah, Bright Opoku; Saleh, Mohamed A.; Agyemang-Duah, Williams; Sahoo, Soumya Swaroop; Sahoo, Harihar; Sahebkar, Amirhossein; Saheb Sharif-Askari, Narjes; Agodi, Antonella; Agampodi, Suneth Buddhika; Afzal, Saira; Adnani, Qorinah Estiningtyas Sakilah; Adeyinka, Daniel Adedayo; Adetunji, Charles Oluwaseun; Adesina, Miracle Ayomikun; Adema, Bulcha Guye; Addo, Isaac Yeboah; Adane, Mesafint Molla; Abu-Rmeileh, Niveen M. E.; Abu-Gharbieh, Eman; Abrigo, Michael R. M.; Saheb Sharif-Askari, Fatemeh; Abolhassani, Hassan; Aboagye, Richard Gyan; Abiodun, Olumide; Abidi, Hassan; Abedi, Aidin; Abebe, Mesfin; Sagoe, Dominic; Abdulkader, Rizwan Suliankatchi; Saghazadeh, Amene; Abdoun, Meriem; Abdissa, Daba; Abd-Elsalam, Sherief; Abdelmasseh, Michael; ElHafeez, Samar Abd; Abbastabar, Hedayat; Abate, Yohannes Habtegiorgis; Alam, Tahiya; Saeed, Umar; Verghese, Nicholas Alexander; Teply, Corey; Leever, Andrew T.; Taylor, Heather Jean; Frisch, Meghan E.; Fuller, John E.; Saeb, Mohammad Reza; Sadeghi, Malihe; Gardner, William M.; Paulson, Katherine R.; May, Erin A.; Harris, Ashley; Schumacher, Austin E.; McHugh, Theresa A.; Comfort, Haley; Saddik, Basema Ahmad; Sabour, Siamak; Saadatian, Zahra; Saad, Aly M. A.; Rwegerera, Godfrey M.; Ronfani, Luca; Azzam, Ahmed Y.; Rohloff, Peter; Roever, Leonardo; Robinson-Oden, Hannah Elizabeth; Rezaeian, Mohsen; Rezaei, Negar; Rezaei, Nazila; Renzaho, Andre M. N.; Darshan, B.B.; Rengasamy, Kannan R. R.; Remuzzi, Giuseppe; Redwan, Elrashdy Moustafa Mohamed; Rawassizadeh, Reza; Rashid, Ahmed Mustafa; Rasella, Davide; Rao, Sowmya J.; Babaei, Mahsa; Badar, Muhammad; Badiye, Ashish D.; Rao, Chythra R.; Baghcheghi, Nayereh; Derese, Msganaw; Rancic, Nemanja; Debele, Aklilu Tamire; Debela, Berhanu Gidisa; Baghdadi, Soroush; Bagheri, Nasser; Davletov, Kairat; Dávila-Cervantes, Claudio Alberto; Dash, Nihar Ranjan; Ranabhat, Chhabi Lal; Ramasamy, Shakthi Kumaran; Raimondo, Ivano; Rahmanian, Vahid; Rahman, Mosiur; Das, Saswati; Raghav, Pankaja; Shahraki, Hadi Raeisi; Pradhan, Pranil Man Singh; Lacey, Ben; Vecchia, Carlo La; Kurmi, Om P.; Poddighe, Dimitri; Podder, Vivek; He, Wen-Qiang; Heidari, Mohammad; Piracha, Zahra Zahid; Pigeolet, Manon; Philip, Anil K.; Phan, My Kieu; Pham, Tom; Pezeshki, Parmida Sadat; Petermann-Rocha, Fanny Emily; Petcu, Ionela-Roxana; Pesudovs, Konrad; Perico, Norberto; Bagherieh, Sara; Perianayagam, Arokiasamy; Pereira, Maria Odete; Pereira, Marcos; Pereira, Jeevan; Herrera-Serna, Brenda Yuliana; Pereira, Gavin; Das, Jai K.; Darwesh, Aso Mohammad; Peprah, Prince; Pepito, Veincent Christian Filipino; Pedersini, Paolo; Dandona, Lalit; Dalaba, Maxwell Ayindenaba; Dagnew, Gizachew Worku; Dadras, Omid; Cruz-Martins, Natalia; Chu, Dinh-Toi; Pawar, Shrikant; Choudhari, Sonali Gajanan; Patil, Shankargouda; Herteliu, Claudiu; Patel, Sangram Kishor; Hessami, Kamran; Pashaei, Ava; Cho, William C. S.; Parikh, Romil R.; Chitheer, Abdulaal; Parija, Pragyan Paramita; Pana, Adrian; Padubidri, Jagadish Rao; Padron-Monedero, Alicia; Owolabi, Mayowa O.; Ouyahia, Amel; Chi, Gerald; Otstavnov, Stanislav S.; Otstavnov, Nikita; Otoiu, Adrian; Osuagwu, Uchechukwu Levi; Osman, Wael M. S.; Ortega-Altamirano, Doris V.; Ordak, Michal; Olusanya, Bolajoko Olubukunola; Olufadewa, Isaac Iyinoluwa; Olatubi, Matthew Idowu; Olakunde, Babayemi Oluwaseun; Olagunju, Andrew T.; Okwute, Patrick Godwin; Okonji, Osaretin Christabel; Okekunle, Akinkunmi Paul; Okeke, Sylvester Reuben; Ogunsakin, Ropo Ebenezer; Obamiro, Kehinde O.; Oancea, Bogdan; Chen, Simiao; Nzoputam, Ogochukwu Janet; Nzoputam, Chimezie Igwegbe; Nurrika, Dieta; Noreen, Mamoona; Nomura, Shuhei; Noman, Efaq Ali; Nnyanzi, Lawrence Achilles; Nikoobar, Ali; Niazi, Robina Khan; Nguyen, Phat Tuan; Chavula, Malizgani Paul; Nguyen, Hien Quang; Nguyen, Hau Thi Hien; Nguyen, Dang H.; Ngunjiri, Josephine W.; Nguefack-Tsague, Georges; Nematollahi, Mohammad Hadi; Nejadghaderi, Seyed Aria; Nauman, Javaid; Nascimento, Gustavo G.; Hezam, Kamal; Hiraike, Yuta; Holla, Ramesh; Hossain, Md Mahbub
URI: http://acikerisim.sdu.edu.tr/xmlui/handle/123456789/100743

Description:

Background: Stillbirth is a devastating and often avoidable adverse pregnancy outcome. Monitoring stillbirth levels and trends—in a comprehensive manner that leaves no one uncounted—is imperative for continuing progress in pregnancy loss reduction. This analysis, completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, methodically accounted for different stillbirth definitions with the aim of comprehensively estimating all stillbirths at 20 weeks or longer for 204 countries and territories from 1990 to 2021. Methods: We extracted data on stillbirths from 11 412 sources across 185 of 204 countries and territories, including 234 surveys, 231 published studies, 1633 vital statistics reports, and 10 585 unique location-year combinations from vital registration systems. Our final dataset comprised 11 different definitions, which were adjusted to match two gestational age thresholds: 20 weeks or longer (reference) and 28 weeks or longer (for comparisons). We modelled the ratio of stillbirth rate to neonatal mortality rate with spatiotemporal Gaussian process regression for each location and year, and then used final GBD 2021 assessments of fertility and all-cause neonatal mortality to calculate total stillbirths. Secondary analyses evaluated the number of stillbirths missed with the more restrictive gestational age definition, trends in stillbirths as a function of Socio-demographic Index, and progress in reducing stillbirths relative to neonatal deaths. Findings: In 2021, the global stillbirth rate was 23·0 (95% uncertainty interval [UI] 19·7–27·2) per 1000 births (stillbirths plus livebirths) at 20 weeks' gestation or longer, compared to 16·1 (13·9–19·0) per 1000 births at 28 weeks' gestation or longer. The global neonatal mortality rate in 2021 was 17·1 (14·8–19·9) per 1000 livebirths, corresponding to 2·19 million (1·90–2·55) neonatal deaths. The estimated number of stillbirths occurring at 20 weeks' gestation or longer decreased from 5·08 million (95% UI 4·07–6·35) in 1990 to 3·04 million (2·61–3·62) in 2021, corresponding to a 39·8% (31·8–48·0) reduction, which lagged behind a global improvement in neonatal deaths of 45·6% (36·3–53·1) for the same period (down from 4·03 million [3·86–4·22] neonatal deaths in 1990). Stillbirths in south Asia and sub-Saharan Africa comprised 77·4% (2·35 million of 3·04 million) of the global total, an increase from 60·3% (3·07 million of 5·08 million) in 1990. In 2021, 0·926 million (0·792–1·10) stillbirths, corresponding to 30·5% of the global total (3·04 million), occurred between 20 weeks' gestation and 28 weeks' gestation, with substantial variation at the country level. Interpretation: Despite the gradual global decline in stillbirths between 1990 and 2021, the overall number of stillbirths remains substantially high. Counting all stillbirths is paramount to progress, as nearly a third—close to 1 million in total—are left uncounted at the 28 weeks or longer threshold. Our findings draw attention to the differential progress in reducing stillbirths, with a high burden concentrated in countries with low development status. Scarce data availability and poor data quality constrain our capacity to precisely account for stillbirths in many locations. Addressing inequities in universal maternal health coverage, strengthening the quality of maternal health care, and improving the robustness of data systems are urgently needed to reduce the global burden of stillbirths. Funding: Bill & Melinda Gates Foundation.

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