Skip to main content

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 – 3.22) [88]
Latest DHS/MICS estimate for “% pregnant women receiving 2+ doses of Sp/Fansidar during pregnancy” or “% pregnant women sleeping under an insecticide-treated bednet (ITN)” 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 – 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 – 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 – 30% for APSB)
(IQR 3.5 – 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 – 30% for APSB)
(IQR 10 – 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:
Defaults based upon ANC4+ coveraged:
Assumed to be 5%*ANC4+
Induction of labour for pregnancies lasting >41 weeks RR 0.31
(0.12 – 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 – 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 – 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 – 50% assume 30% BEmOC/ 20% CEmOC
50 – 95% assume 15% BEmOC/ 60% CEmOC
>95% assume 0% BEmOC/ 100% CEmOC
Childbirth care in CEmOC facility 75%
(IQR 50 – 87%)
Yakoob et al. [19]
Expert opinion from 27 experts from 6 WHO regions and a range of disciplines
All intrapartum stillbirths NA
  1. a Further details of quality of evidence for estimate of effectiveness are presented in additional file 2
  2. b The affected fraction is the proportion of the time-specific mortality, here antepartum or intrapartum stillbirths, that is considered susceptible to that intervention
  3. c This is based on rates for primigravida in one study. The rate is 20.8% for women in second pregnancy, and 15.6% for higher order pregnancies, and hence may overestimate attributable fraction.
  4. d ANC4+ coverage from household survey data (DHS/MICS). Proportions attending ANC4+ receiving intervention assumptions based on opinion of two experts (Professors Zulfi Bhutta and Joy Lawn)
  5. e Reference not available for source used for approximation of risk. Studies from high income countries suggest aOR 1.3, 1.6 and 2.2 for pregnancy induced hypertension, pre-eclampsia and eclampsia respectively [22]. With similar orders of magnitude in low- and middle-income countries (LMIC) studies [23].
  6. f Facility delivery rates from nationally representative household survey data (DHS/MICS). Proportions receiving BEmOC/ CEmOC assumptions based on expert opinion