Improving knowledge of causes and contributors to stillbirth in Papua New Guinea

Background

It is known that 98% of stillbirths occur in low- and middle-income countries (LMIC). Australia’s nearest neighbour, Papua New Guinea (PNG) and our other close Pacific Island nations (Solomon Islands and Vanuatu) bear the burden of high stillbirth rates. Unfortunately, due to poor data collection processes the full impact of stillbirth in these nations is not realised. In LMICs, stillbirths are largely attributable to preventable or treatable conditions that occur either in conjunction with, or as a result of pregnancy, including malaria, syphilis, anaemia, diabetes, hypertension, pre-eclampsia and post-term pregnancy. Other risk factors for stillbirth, such as young maternal age, short inter-pregnancy interval, indoor air pollution and interpersonal violence against women during pregnancy also play a role. Many of these risk factors could be addressed through universal access to good-quality antenatal and intrapartum care. Modelling has suggested that up to 45% of all stillbirths could be prevented if a package of 10 proven antenatal and intrapartum interventions (including basic and emergency obstetric care) was made widely available. However, it is unknown whether these interventions would address the key issues in a country like PNG or whether they would even be feasible.

Project Aims

This project undertook two studies to examine the causes of stillbirth and neonatal death. We used data from an ongoing cluster-randomized crossover trial in 10 sites among 4600 women in Papua New Guinea.

Outcome

Three papers were produced from this work.

The findings have been used to inform other studies including one on women’s understanding of danger signs in pregnancy (led by Dr Delly Babona) and one to improve the quality of intrapartum care (Led by Professor Joshua Vogel and Dr Delly Babona).

Publications

1. Vallely LM, Calvert B, De Silva M, Panisi L, Babona D, Bolnga, Duro-Aina T, Noovao-Hill A, Naidu S, Leisher S, Flenady V, Smith RM, Vogel JP, Homer CSE. (2022). Improving maternal and newborn health and reducing stillbirths in the Western Pacific Region – current situation and the way forward. The Lancet Regional Health – Western Pacific DOI: https://doi.org/10.1016/j.lanwpc.2022.100653
2. Vallely, LM, Smith RM, Bolnga JW, Babona D, Riddell MA, Mengi A, Au L, Polomon C, Vogel JP, Pomat WS, Vallely AJ, Homer CSE. (2021) Perinatal death audit and classification of stillbirths in two provinces in Papua New Guinea: a retrospective analysis. International Journal of Obstetrics and Gynaecology 153 (1): 160-168 https://doi.org/10.1002/ijgo.13431
3. Vallely, LM, Smith RM, Bolnga JW, Babona D, Riddell MA, Mengi A, Au L, Polomon C, Vogel JP, Pomat WS, Vallely AJ, Homer CSE (2021). Early neonatal death review from two provinces in Papua New Guinea: a retrospective analysis. Journal of Paediatrics and Child Health 57 (6): 841-846 https://doi.org/10.1111/jpc.15333