title: Beyond counting stillbirths to understanding their determinants in low- and middle-income countries: a systematic assessment of stillbirth data availability in household surveys.
abstract: To systematically map data availability for stillbirths from all countries with Demographic and Health Surveys (DHS) surveys to outline the limitations and challenges with using the data for understanding the determinants and causes of stillbirths, and for cross-country comparisons.
  
  
  
  We assessed data sources from the DHS programme website, including published DHS reports and their associated questionnaires for surveys completed between 2005 and 2015.
  
  
  
  Between 2005 and 2015, the DHS programme completed 114 surveys across 70 low- and middle-income countries. Ninety-eight (86.0%) surveys from 66 countries collected stillbirth data adequately to calculate a stillbirth rate, while 16 surveys from 12 countries did not. The method used to count stillbirths varied; 96 (84.2%) surveys used a live birth history with a reproductive calendar, while 16 (14.0%) surveys from 12 countries did a full pregnancy history. Based on assessment of questionnaires, antenatal and delivery care information for stillbirths was only available in 15 surveys (13.2%) from 12 countries (17.1%). Data on maternal conditions/complications were captured in 17 surveys (16.0%), but only in six could these be linked to stillbirths. Data on other recognised risk factors were scarce, varying considerably across surveys. Upon further examination of data sets from surveys with maternity care data on non-live births, we found incomplete capture of these data; only two surveys had adequately and completely collected these for stillbirths.
  
  
  
  Substantial variation exists in DHS surveys in the measurement of stillbirths, with limited scope to examine risk factors or causes. Without immediate improvements, our understanding of country-specific trends and determinants for stillbirths will remain hampered, limiting the development and prioritisation of programmatic interventions to prevent these deaths.
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Aliki
authors.initials: A
authors.lastname: Christou
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dibley
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Camille
authors.initials: C
authors.lastname: Raynes-Greenow
mesh_terms: D003906:Developing Countries; D005260:Female; D005313:Fetal Death; D014943:Global Health; D006306:Health Surveys / Q000592:standards*; D006801:Humans; D007182:Income; D011247:Pregnancy; D012307:Risk Factors; D050497:Stillbirth
keywords: Demographic and Health Survey; foetal death; low- and middle-income countries; measurement; perinatal mortality; stillbirth