Perinatal health monitoring in Europe: results from the EURO-PERISTAT project

Data about deliveries, births, mothers and newborn babies are collected extensively to monitor the health and care of mothers and babies during pregnancy, delivery and the post-partum period, but there is no common approach in Europe. We analysed the problems related to using the European data for international comparisons of perinatal health. We made an inventory of relevant data sources in 25 European Union (EU) member states and Norway, and collected perinatal data using a previously defined indicator list. The main sources were civil registration based on birth and death certificates, medical birth registers, hospital discharge systems, congenital anomaly registers, confidential enquiries and audits. A few countries provided data from routine perinatal surveys or from aggregated data collection systems. The main methodological problems were related to differences in registration criteria and definitions, coverage of data collection, problems in combining information from different sources, missing data and random variation for rare events. Collection of European perinatal health information is feasible, but the national health information systems need improvements to fill gaps. To improve international comparisons, stillbirth definitions should be standardised and a short list of causes of fetal and infant deaths should be developed

The prevalence of stillbirths: a systematic review

BACKGROUND: Stillbirth rate is an important indicator of access to and quality of antenatal and delivery care. Obtaining overall estimates across various regions of the world is not straightforward due to variation in definitions, data collection methods and reporting. METHODS: We conducted a systematic review of a range of pregnancy-related conditions including stillbirths and performed meta-analysis of the subset of studies reporting stillbirth rates. We examined variation across rates and used meta-regression techniques to explain observed variation. RESULTS: We identified 389 articles on stillbirth prevalence among the 2580 included in the systematic review. We included 70 providing 80 data sets from 50 countries in the meta-analysis. Pooled prevalence rates show variation across various subgroup categories. Rates per 100 births are higher in studies conducted in less developed country settings as compared to more developed (1.17 versus 0.50), of inadequate quality as compared to adequate (1.12 versus 0.66), using sub-national sample as compared to national (1.38 versus 0.68), reporting all stillbirths as compared to late stillbirths (0.95 versus 0.63), published in non-English as compared to English (0.91 versus 0.59) and as journal articles as compared to non-journal (1.37 versus 0.67). The results of the meta-regression show the significance of two predictor variables – development status of the setting and study quality – on stillbirth prevalence. CONCLUSION: Stillbirth prevalence at the community level is typically less than 1% in more developed parts of the world and could exceed 3% in less developed regions. Regular reviews of stillbirth rates in appropriately designed and reported studies are useful in monitoring the adequacy of care. Systematic reviews of prevalence studies are helpful in explaining sources of variation across rates. Exploring these methodological issues will lead to improved standards for assessing the burden of reproductive ill-health

Registration of vital data: are live births and stillbirths comparable all over Europe?

International comparisons of the perinatal mortality data derived from vital registration statistics can be made in different ways. In this article we examine the legal and administrative definitions of vital events (live births and stillbirths) in the 27 European countries that participated in an in-depth survey conducted in 1991 by the Institute of Demography, University of Louvain, Belgium. The impact of the various definitions in use on the comparability of vital event data over time and in different countries is illustrated by discussing some of the anomalies exhibited by published data (e.g., age at death in different European countries and the trends in infant mortality or stillbirth rate in selected countries). Analysed is the potential for vital registration systems to produce standardized perinatal mortality data that satisfy WHO recommendations for international comparisons, taking into account the contents of the vital registration forms and the data processing (record linkage) methods useful in different countries

Direct and indirect paths leading to contraceptive use in urban Africa

Cet article examine le recours à la contraception dans les capitales de quatre pays africains, le Burkina Faso, le Ghana, le Maroc et le Sénégal. L'article cherche à répondre à deux questions : (i) quel est l'ordre hiérarchique des relations causales entre les caractéristiques individuelles associées au recours à la contraception dans les quatre populations urbaines considérées ? Plus particulièrement, (ii) comme l'instruction est un facteur majeur de la transition démographique, les données confirment-elles les deux chemins indirects allant de l'instruction au recours à la contraception qui ont été proposés dans la littérature, à savoir un chemin union-re­production et un chemin socio-culturel ? À partir d'une analyse secondaire des En­quêtes Démographie et Santé (EDS), la méthodologie se base sur des modèles structurels récursifs représentés par des graphes acycliques orientés. L'analyse em­pirique confirme l'importance de variables telles que le désir d'enfants et l'accord parental en matière de planification familiale pour expliquer le recours à la contraception. L'analyse met aussi en relief un chemin structurel union-reproduction as­sociant instruction féminine et recours à la contraception. En revanche, l'analyse aboutit à rejeter l'existence d'un chemin socioculturel, celui-ci étant infirmé par les données disponibles. La validité de ces résultats est discutée

Parents’ age at birth of their offspring and child survival

This study presents some new results on parental age as a risk factor for child survival. The study is based on individual registration forms for live births and infant deaths collected in Hungary from 1984 to 1988. Logistic regression models have been fitted for early neonatal and neonatal mortality on the one hand, and post-neonatal mortality on the other hand. Children of older males and females have significantly higher early neonatal and neonatal mortality rates compared to those of younger males and females. The impact of age of both parents remains, however, slighter than that of other biological characteristics such as previous number of fetal deaths, induced abortions, or live births. The authors discuss possible biological explanations