Table 3 Summary of effects, affected fraction and baseline coverage of included interventions for stillbirths in the Lives Saved Tool
From: Modelling stillbirth mortality reduction with the Lives Saved Tool
Intervention | Effectiveness Estimatea (95% CI) | Source of effectiveness data | Affected fractionb | Input data sources for calculating the affected fraction estimate | Source for baseline coverage |
|---|---|---|---|---|---|
Micronutrient supplementation | RR 0.92 (0.86 to 0.99) | Haider et al. [30] 15 RCTs 98,808 women | All stillbirths | - | Zero as default |
Malaria prevention with ITp or ITN | RR 0.67 (0.47 to 0.97) | Gamble et al. [45], Ishaque et al [18] 3 cRCTs | Stillbirths attributable to falciparum malaria | Proportion of pregnant women exposed to falciparum malaria [47] Prevalence of placental malaria in those exposed to falciparum malaria (27.8%) [87]c Risk of stillbirth with placental malaria: OR=2.19 (1.49 鈥� 3.22) [88] | Latest DHS/MICS estimate for 鈥�% pregnant women receiving 2+ doses of Sp/Fansidar during pregnancy鈥� or 鈥�% pregnant women sleeping under an insecticide-treated bednet (ITN)鈥� as a proxy if above NA |
Balanced Energy supplementation | RR 0.60 (0.39 to 0.94) | Ota et al. [42] 5 RCTs 3,408 women | Stillbirths occurring in food-insecure households | % pop living <$1.90/day from World Bank [43] is used as a proxy | Zero as default |
Syphilis Detection and Treatment | RR 0.18, (0.10 鈥� 0.33) | Blencowe et al. [50] 8 studies 3,931 births | Stillbirths attributable to syphilis | Prevalence data from Newman et al [89] Risk of stillbirth with active syphilis: RR=10.89 (95% CI 6.61 鈥� 17.93) [90] | Defaults based upon ANC4+ coveraged: If ANC4+ <40%- assume 20%*ANC4+ If ANC4+ 40-74%-assume 50%*ANC4+ IF ANC4+ 75-95%-assume 70%*ANC4+ If ANC4+>95%-assume 100%*ANC4+ |
Diabetes screening and management | 10% reduction (IQR -5 鈥� 30% for APSB) (IQR 3.5 鈥� 25% for IPSB) | Syed et al. [17] Expert opinion from 31 experts from 6 WHO regions | Stillbirths attributable to diabetes | Prevalence data from International Diabetes Federation Atlas [91] Risk of stillbirth with diabetes: RR=3.38 [92] | Defaults based upon ANC4+ coveraged: Assumed to be 5%*ANC4+ |
Detection and management of hypertensive disease of pregnancy (including treatment with magnesium sulphate) | 20% reduction (IQR -10 鈥� 30% for APSB) (IQR 10 鈥� 40% for IPSB) | Jabeen et al. [16] Expert opinion from 33 experts from 6 WHO regions and a range of disciplines | Stillbirths attributable to hypertensive disease of pregnancy | Prevalence data from Dolea et al 2003 [93] Risk of stillbirth with hypertensive disease of pregnancy: RR=2.1e | Defaults based upon ANC4+ coveraged: Assumed to be 5%*ANC4+ |
Induction of labour for pregnancies lasting >41 weeks | RR 0.31 (0.12 鈥� 0.88) | Gulmezoglu et al. and Hussain et al. [13, 57] 17 trials 7407 women | Stillbirths attributable to prolonged pregnancy | Prevalence: 7.5% of all pregnancies are estimated to progress post term if no policy to induce at post-term [94] Risk: 1.8 [59] | Default assumption is that 100% of CEmOC deliveries have access to induction of labor for post-term pregnancies, if needed. (Only available for births in CEmOC facilities) |
Skilled attendance outside BEmOC or CEmOC facilities | RR 0.77 (0.69 鈥� 0.85) | Yakoob et al. [19] 2 studies | All intrapartum stillbirths | NA | From DHS/ MICS and other nationally representative surveys |
Childbirth care in BEmOC facility | 45% (IQR 30 鈥� 70%) | Yakoob et al. [19] Expert opinion from 27 experts from 6 WHO regions and a range of disciplines | All intrapartum stillbirths | NA | Defaults based upon facility delivery ratesf If Facility delivery: <30% assume 0% BEmOC/ 10% CEmOC 30 鈥� 50% assume 30% BEmOC/ 20% CEmOC 50 鈥� 95% assume 15% BEmOC/ 60% CEmOC >95% assume 0% BEmOC/ 100% CEmOC |
Childbirth care in CEmOC facility | 75% (IQR 50 鈥� 87%) | Yakoob et al. [19] Expert opinion from 27 experts from 6 WHO regions and a range of disciplines | All intrapartum stillbirths | NA |