{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T14:07:35Z","timestamp":1791727655623,"version":"4.3.4"},"reference-count":66,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"London School of Hygiene & Tropical Medicine Wellcome Trust Institutional Strategic Support Fund","award":["204928\/Z\/16\/Z"],"award-info":[{"award-number":["204928\/Z\/16\/Z"]}]},{"name":"EU","award":["MC UP A900\/115"],"award-info":[{"award-number":["MC UP A900\/115"]}]},{"name":"EU","award":["MC UP_A900\/1122"],"award-info":[{"award-number":["MC UP_A900\/1122"]}]},{"name":"UK Department for International Development","award":["MRC\/DIFD Concordat Agreement"],"award-info":[{"award-number":["MRC\/DIFD Concordat Agreement"]}]},{"name":"UNICEF The Gambia"},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MRC\/DIFD Concordat Agreement"],"award-info":[{"award-number":["MRC\/DIFD Concordat Agreement"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,3,17]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Stillbirths are disproportionately concentrated in sub-Saharan Africa, where geographical accessibility to basic\/comprehensive emergency obstetric and newborn care (BEmONC and CEmONC) significantly influences maternal and perinatal outcomes. This study describes stillbirth rates within healthcare facilities in The Gambia and examines their distribution in relation to the geographical accessibility of these facilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed 97\u2009276 births recorded between 1 January 2013 and 31 December 2018, from 10 major public healthcare facilities in The Gambia. To standardise definitions, stillbirths were defined as fetal deaths with a birth weight of \u2265500 g. Fresh stillbirths were reclassified as intrapartum, and macerated stillbirths were reclassified as antepartum. Linear regression with cubic splines was used to model trends, and AccessMod software estimated travel times to facilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among recorded births, 5.1% (4873) were stillbirths, with an overall stillbirth rate of 51.3 per 1000 births (95% CI: 27.5 to 93.6). Intrapartum stillbirths accounted for 53.8% (27.6 per 1000 births; 95%\u2009CI: 14.4 to 49.8). Fully functional CEmONC facilities reported the highest stillbirth rates, including the National Teaching Hospital (101.7 per 1000 births, 95%\u2009CI: 96.8 to 106.8). Approximately 42.8%, 58.9% and 68.3% of women aged 15\u201349 lived within a 10, 20 and 30\u2009min travel time, respectively, to fully functional CEmONC facilities, where high stillbirth rates were concentrated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In The Gambia, intrapartum stillbirth rates remain alarmingly high, even in geographically accessible CEmONC facilities. Inadequate documentation of fetal heart rate on admission hampers accurate classification, complicating targeted interventions. Ensuring that EmONC-designated facilities\u2014particularly those providing BEmONC services\u2014are fully functional with essential equipment, trained staff and robust referral systems, while enhancing the timeliness and quality of obstetric care, is crucial to reducing stillbirth rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-016579","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T02:40:15Z","timestamp":1743734415000},"page":"e016579","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Beyond proximity: an observational study of stillbirth rates and emergency obstetric and newborn care accessibility in The Gambia"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7432-8995","authenticated-orcid":false,"given":"Oghenebrume","family":"Wariri","sequence":"first","affiliation":[{"name":"Vaccines and Immunity Theme, MRC 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Francis Small Teaching Hospital, Government of the Gambia, Banjul, Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Momodou T","family":"Nyassi","sequence":"additional","affiliation":[{"name":"Directorate of Health Services, Ministry of Health, Government of the Gambia, Banjul, Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Musa","family":"Marena","sequence":"additional","affiliation":[{"name":"Reproductive, Maternal, Newborn, Child, and Adolescent Health Program, Ministry of Health, Government of the Gambia, Banjul, Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sainey","family":"Sanneh","sequence":"additional","affiliation":[{"name":"Directorate of Health Research, Ministry of Health, Government of the Gambia, Banjul, Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariama","family":"Janneh","sequence":"additional","affiliation":[{"name":"The Gambia, UNICEF, Cape Point, 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