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Torkashvand Moradabadi M, Ardian N, Mazloomy-Mahmoodabad SS, Farajkhoda T, Yoshani N, Afshani SA, Paliwal D. Investigation of Factors Related to Stillbirth. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241236272. [PMID: 38445612 PMCID: PMC10919122 DOI: 10.1177/00469580241236272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 03/07/2024]
Abstract
The stillbirth rate is among the most important indicators of access to and quality of care during pregnancy. This study investigated the factors related to the stillbirth rate in the Yazd province, Iran. The current research is descriptive and cross-sectional and the results of Shahdieh city cohort study which was conducted on 4756 women were used. Data related to the history of stillbirth, demographic characteristics, fertility history and, various female diseases were extracted from the results of the cohort study. The result shows that 7.2% of studied women had a history of stillbirth. Among the multiple variables, predictor variables including education level, marriage age, age of the first conception, number of children, consanguineous marriage, Employment status, and diseases like diabetes, hypertension, and history of depression had a significant relationship with a history of stillbirth (P ≤ .05). The stillbirth rate in Shahedieh is high compared to the global stillbirth Rate, but it is comparable with the stillbirth Rate in Yazd province. Although Yazd province, as one of the industrial hubs of Iran, has relatively acceptable indicators of income, employment, and medical and health facilities and welfare compared to other provinces, this study showed that factors such as diabetes, hypertension, low level of women's education, consanguineous marriage, and women's employment status and social welfare can affect Stillbirth Rate.
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Affiliation(s)
| | - Nahid Ardian
- Social Determinants of Health Research Center, School of Public Health, Department of Health Education and Promotion, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Saeed Mazloomy-Mahmoodabad
- Social Determinants of Health Research Center, School of Public Health, Department of Health Education and Promotion, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Tahmineh Farajkhoda
- Research Center for Nursing and Midwifery Care, Non-Communicable Diseases Institute, Midwifery Department, Nursing and Midwifery School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nooshin Yoshani
- Social Determinants of Health Research Center, School of Public Health, Department of Health Education and Promotion, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Deepak Paliwal
- School of Social Sciences, Indira Gandhi National Open University, New Delhi, Delhi, India
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Dah AK, Osarfo J, Ampofo GD, Appiah-Kubi A, Mbroh H, Azanu WK, Sakyi AT, Abradu L, Morhe ESK. Stillbirth incidence and determinants in a tertiary health facility in the Volta Region of Ghana. PLoS One 2023; 18:e0296076. [PMID: 38128029 PMCID: PMC10734929 DOI: 10.1371/journal.pone.0296076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Stillbirths are indicators of the quality of obstetrics care in health systems. Stillbirth rates and their associating factors vary by socio-economic and geographical settings. Published data on stillbirths and their associating factors in the Volta Region of Ghana are limited. This limits understanding of local factors that must be considered in designing appropriate interventions to mitigate the occurrence of stillbirths. This study determined the incidence of stillbirths and associated factors among deliveries at Ho Teaching Hospital (HTH) and contributes to understanding the consistent high stillbirths in the country and potentially in other low-resourced settings in sub-Saharan Africa. METHOD This was a prospective cohort study involving pregnant women admitted for delivery at HTH between October 2019 and March 2020. Data on socio-demographic characteristics such as age and employment, obstetric factors including gestational age at delivery and delivery outcomes like birthweight were collected using a pretested structured questionnaire. The primary outcome was the incidence of stillbirths at the facility. Summary statistics were reported as frequencies, percentages and means. Logistic regression methods were used to assess for association between stillbirths and independent variables including age and birthweight. Odds ratios were reported with 95% confidence intervals and associations with p-values < 0.05 were considered statistically significant. RESULTS A total of 687 women and their 702 newborns contributed data for analysis. The mean age (SD) was 29.3 (6.3) years and close to two-thirds had had at least one delivery previously. Overall stillbirth incidence was 31.3 per 1000 births. Of the 22 stillbirths, 17 were antepartum. Pre-eclampsia was the most common hypertensive disorder of pregnancy observed (49.3%, 33/67). Among others, less than 3 antenatal visits and low birthweight increased the odds of stillbirths in the bivariate analysis. In the final multivariate model, pregnancy and delivery at 28-34 weeks gestation [AOR 9.37(95% CI 1.18-74.53); p = 0.034] and induction of labour [AOR 11.06 (95% CI 3.10-39.42); p < 0.001] remained significantly associated with stillbirths. CONCLUSION Stillbirth incidence was 31.3 per 1000 births with more than half being antepartum stillbirths. Pregnancy/delivery at 28-34 weeks' gestation increased the odds of a stillbirth. Improving the quality of antenatal services, ensuring adherence to evidence-based protocols, accurate and prompt diagnosis and timely interventions of medical conditions in pregnancy particularly at 28-34 weeks' gestation could reduce incidence of stillbirths.
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Affiliation(s)
- Anthony Kwame Dah
- Department of Obstetrics and Gynaecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
- Directorate of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
| | - Joseph Osarfo
- Department of Community Health, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Gifty Dufie Ampofo
- Department of Community Health, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Adu Appiah-Kubi
- Department of Obstetrics and Gynaecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
- Directorate of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
| | - Hintermann Mbroh
- Directorate of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
| | - Wisdom Klutse Azanu
- Department of Obstetrics and Gynaecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
- Directorate of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
| | - Afia Tabuaa Sakyi
- Directorate of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
| | - Lydia Abradu
- Directorate of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
| | - Emmanuel Senanu Komla Morhe
- Department of Obstetrics and Gynaecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
- Directorate of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
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Sneak-peek into iron deficiency anemia in India: The need for food-based interventions and enhancing iron bioavailability. Food Res Int 2022; 162:111927. [DOI: 10.1016/j.foodres.2022.111927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 11/22/2022]
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Ravula PC, Veluganti S, Gopireddy MMR, Aziz N. Impact of introduction of the growth assessment protocol in a South Indian tertiary hospital on SGA detection, stillbirth rate and neonatal outcome. J Perinat Med 2022; 50:729-736. [PMID: 35689297 DOI: 10.1515/jpm-2022-0111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/07/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES India has a high rate of stillbirths, and many deaths are due to fetal growth restriction and potentially preventable. Screening and identification of the small for gestational age (SGA) fetus during the antenatal period has been shown to reduce stillbirths. We set out to evaluate the impact of implementing the Growth Assessment Protocol (GAP), a programme designed for screening for SGA. METHODS Observational study comparing two-time epochs; before (years 2011-2014) and after (years 2015-2018) introduction of GAP. The programme includes identification of risk factors, risk categorization, serial fundal height measurement, customised fetal growth charts and appropriate referral protocols. Fetal growth charts and birth centiles were generated based on the hospital database of normal outcome pregnancies, customised to women's ethnicity, parity, height, and weight. The protocol was introduced following training of obstetric and midwifery care providers. We evaluated SGA detection rates, stillbirth rates (from 28 weeks) and neonatal morbidity at term. RESULTS There were 26,199 and 31,498 births, with 115 and 108 stillbirths in the pre and post-GAP implementation periods, respectively. SGA detection rates increased from 51.1 to 67.1%, representing a 31% improvement (p<0.001). Overall stillbirth rates declined from 4.4 to 3.4 per 1000 births (RR 0.78 CI 95% 0.60-1.02) and at term from 1.5 to 0.6 (RR 0.37 CI 95% 0.20-0.66). Neonatal intensive care admission and neonatal encephalopathy in term neonates also decreased significantly. CONCLUSIONS Introduction of the GAP programme in an Indian tertiary maternity service was associated with improved antenatal detection of SGA and reduced stillbirth rates and neonatal morbidity.
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Affiliation(s)
| | - Sridevi Veluganti
- Obstetric registrar, Department of Obstetrics, Fernandez Foundation, Hyderabad, India
| | | | - Nuzhat Aziz
- Consultant, Department of Obstetrics, Fernandez Foundation, Hyderabad, India
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Tesfay N, Legesse F, Kebede M, Woldeyohannes F. Determinants of stillbirth among reviewed perinatal deaths in Ethiopia. Front Pediatr 2022; 10:1030981. [PMID: 36518781 PMCID: PMC9743177 DOI: 10.3389/fped.2022.1030981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The global burden of stillbirth has declined over time. However, the problem is still prominent in South Asian and Sub-Saharan African countries. Ethiopia is one of the top stillbirth-reporting countries worldwide. Despite several measures taken to reduce the burden of stillbirth; the pace of decline was not as good as the post-neonatal death. Thus, this study is aimed at identifying potential factors related to stillbirth in Ethiopia based on nationally reviewed perinatal deaths. METHOD The national perinatal death surveillance data were used for this study. A total of 3,814 reviewed perinatal death were included in the study. Two model families,namely generalized estimating equation, and alternating logistic regression models from marginal model family were employed to investigate the risk factors of stillbirth. The alternating logistic regression model was selected as the best fit for the final analysis. RESULT Among reviewed perinatal deaths nearly forty percent (37.4%) were stillbirths. The findings from the multivariate analysis demonstrated that the place of birth (in transit and at home), cause of death (infection, and congenital and chromosomal abnormalities), maternal health condition (women with complications of pregnancy, placenta, and cord), delay one (delay in deciding to seek care) and delay three (delay in receiving adequate care) were associated with an increased risk of having a stillbirth. On the other hand, maternal education (women with primary and above education level) and the type of health facility (women who were treated in secondary and tertiary health care) were associated with a decreased risk of having a stillbirth. CONCLUSION The study identified that both individual (place of delivery, cause of death, maternal health condition, maternal education, and delay one) and facility level (type of health facility and delay three) factors contributed to stillbirth outcome. Therefore, policies that are aimed at encouraging institutional delivery, improving health seeking behavior, and strengthening facility-level readiness should be devised to reduce the high burden of stillbirth in Ethiopia.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Frehiwot Legesse
- Center of Public Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Mandefro Kebede
- Center of Public Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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