Delays in Illness Recognition, Healthcare Seeking, and Healthcare Provision for Stillbirths and Neonatal Deaths in Seven Low- and Middle-Income Countries

Abstract

An estimated 1.9 million stillbirths and 2.3 million neonatal deaths occur globally annually, disproportionately clustered in sub-Saharan Africa and South Asia. The aim for the present study was to determine the frequency of delays in illness recognition, healthcare seeking, and healthcare receipt among stillbirths and neonatal deaths, characterize the most common delays, and describe the frequency of antenatal care visits preceding stillbirths and neonatal deaths. A descriptive analysis was conducted using data collected from 2016 to 2023 in the Child Health and Mortality Prevention Surveillance network, which prospectively studies stillbirths and child deaths in seven low- and middle-income countries. Delays in 1) illness recognition in the home or decision to seek care, 2) transportation to healthcare facilities, and 3) the provision of clinical care (e.g., timely administration of medications) in healthcare facilities were categorized according to the "Three Delays-in-Healthcare" framework. A total of 7,079 deaths (3,424 stillbirths, 3,655 neonatal deaths) were included. Among included stillbirths, 53.6% were male; the median maternal gestational age was 36 weeks (interquartile range [IQR]: 32-38 weeks). Among included neonatal deaths, 57.3% were male; the median maternal gestational age at delivery was 34 weeks (IQR: 30-38 weeks). A total of 96.8% (N = 3,313) of stillbirths and 97.7% (N = 3,571) of neonatal deaths had ≥1 delay identified, the most common being those related to the delivery of high-quality clinical care in health facilities. Nearly half of mothers of stillbirths (48%) and 41% of mothers of deceased neonates had only one to three antenatal care visits. Delays in healthcare provision were common, suggesting that improving the quality of facility-based clinical care may be the most impactful intervention for reducing perinatal mortality.

The authors' abstract, as published at the source. American Journal of Tropical Medicine and Hygiene, 2026 · DOI ↗