Causes of stillbirth in sub-Saharan Africa and South Asia: Findings from Child Health and Mortality Prevention Surveillance, 2016–2023

@article{rahman2026causes,
  title = {{Causes of stillbirth in sub-Saharan Africa and South Asia: Findings from Child Health and Mortality Prevention Surveillance, 2016–2023}},
  author = {Afruna Rahman and Kyu Han Lee and Shams El Arifeen and Mohammad Zahid Hossain and Atique Iqbal Chowdhury and Muntasir Alam and Afsana Afrin and Ikechukwu Udo Ogbuanu and Solomon Samura and Erick Kaluma and Julius Ojulong and Samba Sow and Adama Mamby Keita and Milagritos D. Tapia and Kiranpreet Kaur Chawla and Karen Kotloff and Shabir A. Madhi and Sana Mahtab and Yasmin Adam and Amy Wise and Ziyaad Dangor and Christopher Mugah and Elizabeth Oele and Richard Omore and Aggrey K. Igunza and Dickens Onyango and Inacio Mandomando and Quique Bassat and Sara Ajanovic and Rosauro Varo and Elisio Xerinda and Nega Assefa and J. Anthony G. Scott and Lola Madrid and Melisachew M. Yeshi and Fikremelekot Temesgen and Lucy Liu and Portia Mutevedzi and Dianna M. Blau and Victor Akelo and Robert F. Breiman and Cynthia G. Whitney and Emily S. Gurley and for the CHAMPS Consortium},
  journal = {PLOS Global Public Health},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pgph.0005235},
  url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005235},
  note = {CC0},
}

TY  - JOUR
TI  - Causes of stillbirth in sub-Saharan Africa and South Asia: Findings from Child Health and Mortality Prevention Surveillance, 2016–2023
AU  - Afruna Rahman
AU  - Kyu Han Lee
AU  - Shams El Arifeen
AU  - Mohammad Zahid Hossain
AU  - Atique Iqbal Chowdhury
AU  - Muntasir Alam
AU  - Afsana Afrin
AU  - Ikechukwu Udo Ogbuanu
AU  - Solomon Samura
AU  - Erick Kaluma
AU  - Julius Ojulong
AU  - Samba Sow
AU  - Adama Mamby Keita
AU  - Milagritos D. Tapia
AU  - Kiranpreet Kaur Chawla
AU  - Karen Kotloff
AU  - Shabir A. Madhi
AU  - Sana Mahtab
AU  - Yasmin Adam
AU  - Amy Wise
AU  - Ziyaad Dangor
AU  - Christopher Mugah
AU  - Elizabeth Oele
AU  - Richard Omore
AU  - Aggrey K. Igunza
AU  - Dickens Onyango
AU  - Inacio Mandomando
AU  - Quique Bassat
AU  - Sara Ajanovic
AU  - Rosauro Varo
AU  - Elisio Xerinda
AU  - Nega Assefa
AU  - J. Anthony G. Scott
AU  - Lola Madrid
AU  - Melisachew M. Yeshi
AU  - Fikremelekot Temesgen
AU  - Lucy Liu
AU  - Portia Mutevedzi
AU  - Dianna M. Blau
AU  - Victor Akelo
AU  - Robert F. Breiman
AU  - Cynthia G. Whitney
AU  - Emily S. Gurley
AU  - for the CHAMPS Consortium
PY  - 2026
DA  - 2026/10/27
JO  - PLOS Global Public Health
DO  - 10.1371/journal.pgph.0005235
UR  - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005235
AB  - Background: Globally, an estimated 1.9 million stillbirths occur annually, yet significant knowledge gaps exist regarding the causes of stillbirths, particularly in high-burden regions. We investigated fetal and maternal conditions causing stillbirths in seven countries in sub-Saharan Africa and South Asia and described missed opportunities for prevention. Methods: Child Health and Mortality Prevention Surveillance (CHAMPS) identified stillbirths at sites in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa. We asked families for consent to conduct minimally invasive tissue sampling (MITS) from December 2016 to December 2023. An expert panel reviewed test results, clinical information, and verbal autopsy data and assigned fetal and maternal conditions leading to stillbirths and identified missed opportunities for prevention. Findings: A cause of death (fetal or maternal condition) was determined for 94% (2342/2492) of stillbirths; the most frequent condition in the fetus was intrauterine hypoxia (75%, 1864/2492) across all sites, resulting from either maternal condition (49%, 922/1864) or placental causes (33%, 610/1864). Congenital infections were determined to be the cause of 9% (228/2492) of stillbirths, accounting for the highest proportion in South Africa (31%, 96/306). Group B Streptococcus, Escherichia coli, and Enterococcus faecalis were the most common causative pathogens. Congenital birth defects caused 9% (227/2492) overall and were most common in Ethiopia (24%, 136/568). Primary maternal conditions were identified in 72%, most often placental complications (18%, 446/2492) and maternal hypertension (17%, 414/2492). Complications of placenta, cord and membranes were more common in Mali (43%, 92/212) while maternal medical and surgical conditions were most frequently observed in South Africa (40%, 121/306) and Bangladesh (39%, 158/405). Most (72%, 1808/2492) causes of stillbirth were considered preventable, with heterogeneity observed across sites on the recommended prevention strategies. Interpretation: Complications of pregnancy or delivery accounted for most stillbirths across all sites, with intrauterine hypoxia identified as the predominant fetal condition highlighting widespread and persistent gaps in the timely identification and management of maternal and placental conditions during antenatal and obstetric care across sites in Africa and South Asia. At the same time, substantial geographic variation in causes and prevention opportunities, including for infections and birth defects, underscored the need for locally tailored strategies. Strengthening facility-based care alongside targeted interventions based on site-specific patterns, will be critical to reducing the stillbirth burden in these high-priority regions. Funding: The Gates Foundation
SN  - 2767-3375
ER  -