Background Low-and-middle-income countries, notably in sub-Saharan Africa, bear a disproportionate burden of global stillbirths, which are associated with multiple adverse health, social and economic outcomes for parents and communities. Meeting international targets to reduce preventable deaths and ensure bereaved parents receive compassionate support requires significantly accelerated progress. Context-specific evidence to underpin effective interventions in sub-Saharan Africa is extremely limited. Aims To address critical research gaps for (1) stillbirth prevention and (2) support for bereaved parents in Kenya, Malawi, Tanzania, Uganda, Zambia and Zimbabwe, with the following objectives: To explore the risks and associated factors for stillbirth and improve care for women at risk To understand the current context of maternity and childbirth care to improve access, uptake and quality To explore of parent’s and health workers’ experiences following stillbirth to ensure appropriate support when a baby dies. Design An equitable, midwife-led partnership, including United Kingdom and the Lugina Africa Midwives Research Network. Research and parallel research capacity strengthening activities, focusing on midwifery and nursing. The partners previously collaborated in a multicountry research capacity strengthening programme and subsequent exploratory research. Settings Kenya, Malawi, Tanzania, Uganda, Zambia and Zimbabwe. Main methods Pragmatic mixed-methods, participatory research, underpinned by the National Institute for Health and Care Research/Medical Research Council complex intervention framework. Community engagement and involvement across all partner countries and throughout the research cycle. Findings Case note review and qualitative studies in Zimbabwe, Tanzania and Zambia identified limited antenatal contacts restricting the identification of complications, empowerment of women and birth preparedness. Contributing factors included long distances, lack of resources and unavailability of transport, which inhibited care uptake, particularly in rural areas. In Tanzania and Zambia, distance and lack of ‘connectedness’ characterised dysfunctional intrapartum referral systems and pathways. Women’s and family’s willingness to access maternity services was also diminished by experiences and perceptions of disrespect and abuse in health facilities. Qualitative studies in Kenya and Uganda revealed that bereaved parents experienced insensitive communication, lack of information and individualised support. Lack of health worker preparation, organisational support and environmental factors contributed to suboptimal care. Exploratory findings supported intervention development to improve access, uptake and quality of facility care and community support, immediately following stillbirth and neonatal death and in subsequent pregnancy and feasibility assessment (pre and post cohort studies). Limitations Individual studies were conducted in one to three countries. Use of secondary data sources and limited inclusion of male partners, women birthing outside health facilities and rural communities, in some studies, could impact transferability. Conclusions The National Institute for Health and Care Research Global Health Group on Stillbirth Prevention and Management in sub-Saharan Africa delivered a unique research and capacity development programme focused on stillbirth. Building an equitable and sustainable six-country partnership was key to generation of high-quality research evidence, raising the profile of stillbirth and challenging taboos and stigma. The input from community engagement and involvement teams was critical to successful delivery of the programme. Future work Following our exploratory work, we identified the need to develop and evaluate sustainable, cost-effective strategies to (1) improve access and uptake of antenatal care, including vulnerable groups; (2) improve the quality of intrapartum care, including implementation of evidence-based guidance; and (3) determine best practice in providing care for women and families whose baby dies, including those with comorbidities, and supporting health workers to deliver compassionate care. Funding This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 16/137/53.
Mills et al. (Tue,) studied this question.