Introduction
Stillbirth is a significant global public health issue, with an estimated 2.6 million women affected every year. 1-3Approximately 98% of stillbirths occur in low-and middle-income countries (LMICs), with this burden most heavily felt in South-Asian and African countries. 2-5 Many stillbirths in LMICs are thought to be preventable. Despite this, little progress has been made in reducing these numbers compared to other perinatal outcomes.
The Solomon Islands is a Pacific LMIC with a population of approximately 700,000, spanning across 993 islands. The country faces significant geographical, socioeconomic and cultural barriers to achieving health equity. The National Referral Hospital, situated on the main island of Guadalcanal, is the only tertiary hospital in the country. Despite this, there are limited midwifery staff, only 4 consultant obstetricians and just one or two working cardiotocograph machines at any given time. Like many of its counterparts in the Asia-Pacific, the Solomon Islands has poor perinatal outcomes, with a recent study showing a high rate of preventable maternal mortality6 and an estimated stillbirth rate of 17.6 per 1000 births in 2015 from World Health Organization data. 7 In contrast, the rate of stillbirth in Australia, one of the nation’s closest neighbours, has a stillbirth rate of 6.8 per 1000 births. 8 Despite this, there has been little research into improving perinatal outcomes, and in particular, no previous targeted research investigating causes of stillbirth in the Solomon Islands.
In order to reduce the global burden of stillbirths, accurate recording of cause of death and preventable risk factors is required. This could help direct where to place scarce resources to have maximal impact in reducing rates of stillbirth. However, in many LMICs this is a significant challenge due to a lack of health worker training and diagnostic tools. 9 Furthermore, many countries do not have a national registration system for perinatal deaths, particularly in the Asia-Pacific region. 2, 10 While there is also no national registry or classification of stillbirths in the Solomon Islands, they are audited at National Referral Hospital. This recording of cases creates an opportunity to investigate the causes of stillbirth and identify those that may be preventable, as well as identifying gaps in information with the current data collection system. Such an investigation would assist in directing scarce resources towards the most effective clinical service with the aim of ultimately reducing stillbirth in the Solomon Islands and other similar Pacific Island nations. Thus, we undertook a retrospective cohort study investigating the incidence of stillbirth and associated risk factors in the Solomon Islands.