Most stillbirths, neonatal deaths in Jordan found to be ‘preventable’

New study indicates that three-quarters of stillbirths and neonatal deaths caused by delay

still birth illustration
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AMMAN — Over three-quarters of neonatal deaths and stillbirths in Jordan are caused not by disease, but by delays related to appropriate healthcare, according to a new study from professors at the Jordan University of Science and Technology, supported by UNICEF and the International Development Research Center of Canada. اضافة اعلان

A total of 10,726 births were included in the sample for the study, of which 156 were neonatal deaths and 108 were stillbirths. Three kinds of delays were identified: A delay in recognizing the need for care and in the decision to seek care was believed to be responsible for 118 (44.6 percent) deaths. The two other delays, which included a delay in seeking or reaching appropriate care due to transportation issues and a delay in receiving appropriate care at a suitable healthcare facility, were responsible for 3.5 percent and 30.7 percent of deaths respectively.

A total of 78.8 percent of stillbirths and neonatal deaths were attributed to some kind of delay — making them most likely preventable, “if optimal care is provided”.

The idea for the study originated when researchers noticed that there was no reliable system for tracking stillbirths and neonatal deaths, according to lead investigator Yousef Khader. Khader explained that in 2012, when his team began studying these deaths, only 14 percent were registered. Stillbirths and newborn deaths “go unnoticed without any registration”, he told Jordan News. “If you don’t register deaths (and) you don’t know the causes, how can you prevent them?”

The research team implemented a new electronic stillbirths and neonatal deaths surveillance system called J-SANDS, an electronic stillbirths and neonatal deaths surveillance system in five large hospitals in three of Jordan’s largest cities in August 2019. The system automatically collects and reports data to the Ministry of Health, providing basic functions such as counts of all births and deaths in the participating hospitals and information about the causes of the deaths, including social determinants related to equity.

Additionally, they established a “death auditing system” through which committees of medical staff meet monthly to discuss each stillbirth or neonatal death and identify future interventions.

The project produced “plenty of data that can be used by decision-makers to prevent and minimize” the deaths, said Khader. “So we expect with suitable interventions we can prevent almost three quarters of neonatal deaths and the stillbirths.”

“The major cause of death is related to those who are low birth weight babies, or those who are pre-term babies,” explained Khader. He pointed out that premature babies in particular need advanced care from trained staff — which is not always available in Jordan.

“The quality of antenatal care in other studies has been found in Jordan to be very poor,” added Khader. According to the researcher, women often visit health centers for their prenatal care but then deliver the baby in a hospital — with a medical team that knows nothing about them or their possible health problems. “They’re not informed about the situation,” he said.

Delayed care is a “major cause” of stillbirths and neonatal deaths, according to Raghad Al-Hadidi, a neonatal and child health (NCH) expert and consultant at the World Health Organization (WHO). She explained in an interview with Jordan News that though clinics are well-distributed across the country, the level of services varies dramatically, and that obtaining “ultrasounds and early detection for stillbirths and complications is very difficult.” Particularly for women in rural areas, she said, reaching high-quality care in the case of emergencies can be very difficult.

Additionally, she described the “poor” state of health education in Jordan. She explained that midwives and doctors — overworked in health centers — “cannot have enough time to educate mothers about the dangers, how to prepare, how to detect stillbirths from an early time.” Accordingly, women don’t know when they should seek out medical care or when the pregnancy is in danger.

While the number of stillbirths and neonatal deaths in Jordan is relatively low, Hadidi emphasized the fact that many of these deaths are preventable. “Especially if the cause is infection, the cause is hypertension during pregnancy, diseases of the mother, this must be controlled and detected early and managed early,” she said.

For Hadidi, the solution to preventing stillbirths and neonatal deaths is straightforward: Jordan should establish more prenatal clinics to provide preconception health services and screenings for women before they even become pregnant.

“This is an important issue, because we lack this type of service,” she said. When a woman gets married “immediately she becomes pregnant; she doesn't know anything about her health situation, if she has any disease” or risk factors that may increase the chance of a stillbirth or miscarriage.

“Even taking folic acid before getting pregnant, this is not implemented in Jordan,” she said, referencing the common prenatal vitamin women are recommended to take before and during pregnancy.

Khader explained that as a solution to this lack of awareness, his team is developing a mobile app to help pregnant women identify signs that they should seek medical attention.

A previous study by Khader found that 9.9 per 1000 total births in Jordan, or approximately 1 percent, were stillbirths between August 2019 and January 2020. This rate was described as lower than that in other countries in the region.

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