Determinants of stillbirth among women deliveries at Amhara region, Ethiopia

The effect of maternal age on still birth in Africa: A systematic review and meta-analysis

Background and Aims

Stillbirth is a public health as well as a development problem in low and middle-income countries. The studies that found out maternal age as a factor for the risk of stillbirth reported different findings. This systematic review and meta-analysis is believed to fill the inconclusiveness of these findings. Hence, the aim of this systematic review and meta-analysis is to estimate the pooled effect of advanced maternal age on stillbirth in Africa.

Methods

PubMed & HINARY databases and Google Scholar search engine were searched to access the primary studies. The extracted data using Microsoft excel was exported to Stata 15 software for analysis. The presence of heterogeneity was checked using Cochran's Q statistic and the I 2 test. Publication bias was examined by using funnel plot and Egger's test. The pooled effect measure with DerSimonian and Laird method of random-effect model was reported using odds ratio (OR) with respective 95% confidence interval.

Results

Totally, 14 articles are included for the systematic review and meta-analysis. The stillbirth reported by the studies ranges from 15 to 146.7 per 1000 births. The overall OR of advanced maternal age (≥35 years) on stillbirth is 1.42 (1.18, 1.71) when compared with the age group of 20-35 years. The cumulative effect of getting pregnant at advanced age on stillbirth was slightly increasing from year to year.

Conclusion

Advanced maternal age is a risk factor for stillbirth. Health Information Communication on the risk of getting pregnant at the advanced ages on stillbirth should be well addressed to all women of reproductive age group.

Adverse birth outcome among women who gave birth at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia

BACKGROUND

In Ethiopia, various maternal and child health interventions, including comprehensive and basic obstetric cares were conducted to curb high neonatal and infant morbidity and mortality. As such, adverse birth outcome has been a public health concern in the country. Thus, this study aimed to assess the burden and associated factors with adverse birth outcomes among women who gave birth at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

METHODS

A health facility-based cross-sectional study was employed from 30 March to 01 May 2021 at the University of Gondar Comprehensive Specialized Hospital. A total of 455 women were interviewed using a structured questionnaire. A binary logistic regression model was fitted Adjusted Odds Ratio (AOR) with 95%CI and p-value < 0.05 were used to declare factors significantly associated with adverse birth outcomes.

RESULTS

In this study, 28% of women had adverse birth outcomes (8.4% stillbirths, 22.9% preterm births, and 10.11% low birth weights). Women aged 20-34) (AOR: 0.32, 95%CI: 0.14, 0.76), rural dwellers (AOR: 2.7, 95%CI: 1.06, 6.32), lack of ANC visits (AOR: 4.10, 95%CI: 1.55, 10.85), APH (AOR: 3.0, 95%CI: 1.27, 7.10) and fever (AOR: 7.80, 95%CI: 3.57, 17.02) were associated to stillbirths. Multiple pregnancy (AOR:7.30, 95%CI:1.75, 20.47), rural dwellers (AOR:4.60, 95%CI:1.36, 15.52), preterm births (AOR: 8.60, 95% CI: 3.88, 19.23), previous perinatal death (AOR:2.90, 95%CI:1.35, 6.24), fever (AOR:2.7,95%CI:1.17 ,6.23) and premature rupture of membrane (AOR:2.60, 95% CI:1.02, 6.57) were affecting low birth weights. In addition, previous antepartum hemorrhage (AOR: 2.40, 95%CI: 1.37, 4.10) and fever (AOR: 3.8, 95%CI: 2.13, 6.89) were also factors contributing to preterm births.

CONCLUSION

Adverse birth outcomes continue to pose a significant public health concern. Such high rates of adverse birth outcomes, such as preterm birth, low birth weight, and birth defects, can have serious and long-lasting effects on the health and well-being of both infants and their families, and the community at large. As such, public health efforts are crucial in addressing and mitigating the risk factors associated with adverse birth outcomes. This may involve implementing interventions and policies to improve maternal health, access to prenatal care and nutritional support, and reducing exposure to environmental risks.

Determinants of stillbirths in sub-Saharan Africa: A systematic review

BACKGROUND

Sub-Saharan African (SSA) countries have high stillbirth rates compared with high-income countries, yet research on risk factors for stillbirth in SSA remain scant.

OBJECTIVES

To identify the modifiable risk factors of stillbirths in SSA and investigate their strength of association using a systematic review.

SEARCH STRATEGY

CINAHL Plus, EMBASE, Global Health and MEDLINE databases were searched for literature.

SELECTION CRITERIA

Observational population- and facility-level studies exploring stillbirth risk factors, published in 2013-2019 were included.

DATA COLLECTION AND ANALYSIS

A narrative synthesis of data was undertaken and the potential risk factors were classified into subgroups.

MAIN RESULTS

Thirty-seven studies were included, encompassing 20 264 stillbirths. The risk factors were categorised as: maternal antepartum factors (0-4 antenatal care visits, multiple gestations, hypertension, birth interval of >3 years, history of perinatal death); socio-economic factors (maternal lower wealth index and basic education, advanced maternal age, grand multiparity of ≥5); intrapartum factors (direct obstetric complication); fetal factors (low birthweight and gestational age of <37 weeks) and health systems factors (poor quality of antenatal care, emergency referrals, ill-equipped facility). The proportion of unexplained stillbirths remained very high. No association was found between stillbirths and body mass index, diabetes, distance from the facility or HIV.

CONCLUSIONS

The overall quality of evidence was low, as many studies were facility based and did not adjust for confounding factors. This review identified preventable risk factors for stillbirth. Focused programmatic strategies to improve antenatal care, emergency obstetric care, maternal perinatal education, referral and outreach systems, and birth attendant training should be developed. More population-based, high-quality research is needed.

The factors associated with stillbirths among sub-saharan African deliveries: a systematic review and meta-analysis

BACKGROUND

Globally, more than 2.6 million stillbirths occur each year. The vast majority (98%) of stillbirths occur in low- and middle-income countries, and over fifty percent (55%) of these happen in rural sub-Saharan Africa.

METHODS

This is a systematic review and meta-analysis developed using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. A literature search was performed using PubMed, the Cochrane Library, Google Scholar, EMBASE, Scopus, the Web of Sciences, and gray literature. Rayyan`s software was used for literature screening. A random effects meta-analysis was conducted with STATA version 17. Heterogeneity was checked by using Cochran's Q and I2 tests. Funnel plots and Egger's test were used to examine the risk of publication bias. The protocol of the study was registered in PROSPERO with a registration number of CRD42023391874.

RESULTS

Forty-one studies gathered from eight sub-Saharan countries with a total of 192,916 sample sizes were included. Nine variables were highly linked with stillbirth. These include advanced maternal age (aOR: 1.43, 95% CI: 1.16, 1.70), high educational attainment (aOR: 0.55, 95% CI: 0.47, 0.63), antenatal care (aOR: 0.45, 95% CI: 0.35, 0.55), antepartum hemorrhage (aOR: 2.70, 95% CI: 1.91, 3.50), low birth weight (aOR: 1.72, 95% CI: 1.56-1.87), admission by referral (aOR: 1.55, 95% CI: 1.41, 1.68), history of stillbirth (aOR: 2.43, 95% CI: 1.84, 3.03), anemia (aOR: 2.62, 95% CI: 1.93, 3.31), and hypertension (aOR: 2.22, 95% CI: 1.70, 2.75).

CONCLUSION

A significant association was found between stillbirth and maternal age, educational status, antenatal care, antepartum hemorrhage, birth weight, mode of arrival, history of previous stillbirth, anemia, and hypertension. Integrating maternal health and obstetric factors will help identify the risk factors as early as possible and provide early interventions.

Birth spacing and risk of adverse pregnancy and birth outcomes: A systematic review and dose-response meta-analysis

INTRODUCTION

The association between extreme birth spacing and adverse outcomes is controversial, and available evidence is fragmented into different classifications of birth spacing.

MATERIAL AND METHODS

We conducted a systematic review of observational studies to evaluate the association between birth spacing (i.e., interpregnancy interval and interoutcome interval) and adverse outcomes (i.e., pregnancy complications, adverse birth outcomes). Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using a random-effects model, and the dose-response relationships were evaluated using generalized least squares trend estimation.

RESULTS

A total of 129 studies involving 46 874 843 pregnancies were included. In the general population, compared with an interpregnancy interval of 18-23 months, extreme intervals (<6 months and ≥ 60 months) were associated with an increased risk of adverse outcomes, including preterm birth, small for gestational age, low birthweight, fetal death, birth defects, early neonatal death, and premature rupture of fetal membranes (pooled OR range: 1.08-1.56; p < 0.05). The dose-response analyses further confirmed these J-shaped relationships (pnon-linear  < 0.001-0.009). Long interpregnancy interval was only associated with an increased risk of preeclampsia and gestational diabetes (pnon-linear  < 0.005 and pnon-linear  < 0.001, respectively). Similar associations were observed between interoutcome interval and risk of low birthweight and preterm birth (pnon-linear  < 0.001). Moreover, interoutcome interval of ≥60 months was associated with an increased risk of cesarean delivery (pooled OR 1.72, 95% CI 1.04-2.83). For pregnancies following preterm births, an interpregnancy interval of 9 months was not associated with an increased risk of preterm birth, according to dose-response analyses (pnon-linear  = 0.008). Based on limited evidence, we did not observe significant associations between interpregnancy interval or interoutcome interval after pregnancy losses and risk of small for gestational age, fetal death, miscarriage, or preeclampsia (pooled OR range: 0.76-1.21; p > 0.05).

CONCLUSIONS

Extreme birth spacing has extensive adverse effects on maternal and infant health. In the general population, interpregnancy interval of 18-23 months may be associated with potential benefits for both mothers and infants. For women with previous preterm birth, the optimal birth spacing may be 9 months.

Clinical analysis of diabetes in pregnancy with stillbirth

We analyzed the clinical characteristics of patients with diabetes in pregnancy (DIP) associated with stillbirth and explored strategies to reduce its incidence. We retrospectively analyzed 71 stillbirths associated with DIP (group A) and 150 normal pregnancies (group B) during 2009 to 2018. The incidence of the following was higher in group A (P < .05): hypertensive disorders (38.03% vs 6.00%), placenta previa (14.08% vs 2.67%), placental abruption (5.63% vs 0.67%), fetal malformation (8.45% vs 0.67%), fasting plasma glucose (FPG) ≥ 7.0 mmol/L (46.48% vs 0.67%), 2-h postprandial plasma glucose ≥ 11.1 mmol/L (57.75% vs 6.00%), HbA1c ≥ 6.5% (63.38% vs 6.00%), and polyhydramnios (11.27% vs 4.67). The incidence of oligohydramnios (4.23% vs 6.67%) was lower in group A than in group B (P < .05). According to the gestational age at the time of stillbirth, Group-A cases were subgrouped into miscarriages (20-27+6 weeks), premature deliveries (28-36+6 weeks), and full-term deliveries (≥37 weeks). Age, parity, and DIP type did not differ among the subgroups (P > .05). Among patients with DIP, antenatal FPG, 2-h postprandial plasma glucose, and HbA1c were significantly associated with stillbirth (P < .05). Stillbirth was first detected at 22 weeks and typically occurred at 28-36+6 weeks. DIP was associated with a higher incidence of stillbirth, and FPG, 2-h postprandial plasma glucose, and HbA1c were potential indicators of stillbirth in DIP. Age (odds ratio [OR]: 2.21, 95% confidence interval [CI]: 1.67-2.74), gestational hypertension (OR: 3.44, 95% CI: 2.21-4.67), body mass index (OR: 2.86, 95% CI: 1.95-3.76), preeclampsia (OR: 2.29, 95% CI: 1.45-3.12), and diabetic ketoacidosis (OR: 3.99, 95% CI: 1.22-6.76) were positively correlated with the occurrence of stillbirth in DIP. Controlling perinatal plasma glucose, accurately detecting and managing comorbidities/complications, and timely termination of pregnancy can reduce the incidence of stillbirths associated with DIP.

Prevalence of stillbirth and associated factors among deliveries attended in health facilities in Southern Ethiopia

BACKGROUND

Stillbirth is an unfavorable outcome of pregnancy, which is still prevalent in many countries despite remarkable efforts made to improve the care of pregnant women. While producing estimates consistent with other national reports, all are hindered by limited data and important causes of death are likely to be missed. However; there is a scarcity of data on stillbirth in Ethiopia particularly in the Wolaita zone.

OBJECTIVE

To assess the prevalence and associated factors of stillbirth among women giving birth at public hospitals in the Wolaita zone, southern Ethiopia.

METHODS

A facility-based cross-sectional study was conducted in public hospitals in the Wolaita zone. A stratified sampling technique was used to select 737 women. A pre-tested interviewer-administered questionnaire was used for data collection. Data were entered using Epidata version 3.1 and analyzed using SPSS version 20. Bivariate and multiple logistic regression analysis were used and the crude and adjusted odds ratios at a 95% confidence interval with P-value <0.05 were considered to declare the result as statistically significant.

RESULT

This study reported an 8.7% [95% CI: 6.5-10.8] prevalence of stillbirth. Women who lived in rural areas, had pregnancy and labor complications, a high number of pregnancies, a prior history of stillbirth, and a complicated delivery were associated with stillbirth. When compared to urban residents, being a rural resident increased the risk of stillbirth by 2.57 fold [adjusted OR = 2.57, 95% CI: 1.23, 5.40]. When compared to their counterparts, women who experienced complications during pregnancy and labor increased 6.23 fold [AOR = 6.23, 95% CI: 2.67-14.58], having a previous history of stillbirth increased 6.89 fold [AOR = 6.89, 95% CI: 2.57-13.57], and the type of delivery increased 7.13 fold the risk of stillbirth [AOR = 7.13, 95% CI: 2.71-18.73].

CONCLUSION AND RECOMMENDATION

The prevalence of stillbirth among women who gave birth in public hospitals in the Wolaita zone was found to be high compared to national and regional figures. Therefore, the federal and regional governments should strengthen inter-sectoral collaboration with health facilities to promote the maternal and health care services utilization. The zonal health department and other concerned bodies should focus on the implementation of the strategies and policies that address and reduce the causes of stillbirth.

A Review of the National Family Health Survey Data in Addressing India’s Maternal Health Situation

Objective: This study aims to understand the trend of research conducted on issues of maternal health in India considering data provided in five rounds of National Family Health Survey (NFHS).

Methods: Systematic review of literature has been conducted using multi-stage search and review process adapted from Page et al.’s (2021) PRISMA. Initially 14,570 studies were identified and only 134 articles meeting selection criterion were considered in this study.

Results: Approximately 32% studies have focused on regional and state variation of maternal health status; while 27% dealt with utilization of maternal healthcare services; and 19% the socio-economic determinants of maternal health. While few studies have discussed the place of delivery, antenatal care and post-natal care visits, only five studies focus on issues related to women’s autonomy, including their health-seeking behaviour, knowledge, attitude and practices related to maternal health.

Conclusion: Non-communicable diseases and its role in maternal health still remains an unexplored domain of research on maternal health in India. Moreover, there exists geographical skewness in the number of studies conducted, focusing especially on few provinces while none on few others.

Incidence and sociodemographic, living environment and maternal health associations with stillbirth in a tertiary healthcare setting in Kano, Northern Nigeria

Background

Almost two million stillbirths occur annually, most occurring in low- and middle-income countries. Nigeria is reported to have one of the highest stillbirth rates on the African continent. The aim was to identify sociodemographic, living environment, and health status factors associated with stillbirth and determine the associations between pregnancy and birth factors and stillbirth in the Murtala Mohammed Specialist Hospital, Kano, Nigeria.

Methods

A three-month single-site prospective observational feasibility study. Demographic and clinical data were collected. We fitted bivariable and multivariable models for stillbirth (yes/no) and three-category livebirth/macerated stillbirth/non-macerated stillbirth outcomes to explore their association with demographic and clinical factors.

Findings

1,998 neonates and 1,926 mothers were enrolled. Higher odds of stillbirth were associated with low-levels of maternal education, a further distance to travel to the hospital, living in a shack, maternal hypertension, previous stillbirth, birthing complications, increased duration of labour, antepartum haemorrhage, prolonged or obstructed labour, vaginal breech delivery, emergency caesarean-section, and signs of trauma to the neonate following birth.

Interpretation

This work has obtained data on some factors influencing stillbirth. This in turn will facilitate the development of improved public health interventions to reduce preventable deaths and to progress maternal health within this site.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04971-x.

Negative effects of short birth interval on child mortality in low- and middle-income countries: A systematic review and meta-analysis

Methods

Eight databases, PubMed, CINAHL, Web of Science, Embase, PsycINFO, Cochrane Library, Popline, and Maternity and Infant Care, were searched, covering the period of January 2000 to January 2022. Studies that had examined the association between SBI and any form of child mortality were included. The findings of the included studies were summarized through fixed-effects or random-effects meta-analysis and the model was selected based on the heterogeneity index.

Results

A total of 51 studies were included. Of them, 19 were conducted in Ethiopia, 10 in Nigeria and 7 in Bangladesh. Significant higher likelihoods of stillbirth (odds ratio (OR) = 2.11; 95% confidence interval (CI) = 1.32-3.38), early neonatal mortality (OR = 1.58; 95% CI = 1.04-2.41), perinatal mortality (OR = 1.71; 95% CI = 1.32-2.21), neonatal mortality (OR = 1.85; 95% CI = 1.68-2.04), post-neonatal mortality (OR = 3.01; 95% CI = 1.43-6.33), infant mortality (OR = 1.92; 95% CI = 1.77-2.07), child mortality (OR = 1.67; 95% CI = 1.27-2.19) and under-five mortality (OR = 1.95; 95% CI = 1.56-2.44) were found among babies born in short birth intervals than those who born in normal intervals.

Conclusions

SBI significantly increases the risk of child mortality in LMICs. Programmes to reduce pregnancies in short intervals need to be expanded and strengthened. Reproductive health interventions aimed at reducing child mortality should include proper counselling on family planning, distribution of appropriate contraceptives and increased awareness of the adverse effects of SBI on maternal and child health.

Determinants of stillbirth among women who gave birth at Hiwot Fana Specialized University Hospital, Eastern Ethiopia: A facility-based cross-sectional study

Introduction/objectives:

Stillbirths are an adverse birth outcome and a significant public health problem in low- and high-income countries. Ethiopia is ranked seventh among ten countries that constitute 66% of the world’s stillbirths. However, there is a dearth of evidence about stillbirths and the determinants in the country, particularly in Eastern Ethiopia. Hence, this study aimed to assess the prevalence and determinants of stillbirths among women who gave birth at Hiwot Fana Specialized University Hospital, Eastern Ethiopia.

Methods:

We conducted a hospital-based cross-sectional study among women who gave birth from October to December 2017. The study participants were selected through a systematic random sampling method. We collected the data using a pretested questionnaire through face-to-face interviews and maternal medical record reviews. The multi-variable logistic regression model was applied to identify the determinants with adjusted odds ratios at a 95% confidence interval. Statistical significance was declared at a p-value less than 0.05.

Results:

Five hundred fifty-five women were included in the study, and 6.7% ((95% confidence interval = 4.7%, 9.2%)) experienced a stillbirth. Previous history of adverse birth outcome (adjusted odds ratio = 9.55; 95% confidence interval = (4.37, 20.85), p = 0.003), multiple pregnancies (adjusted odds ratio = 7.04; 95% confidence interval = (2.12, 23.40), p = 0.000), and spontaneous vaginal delivery (adjusted odds ratio = 0.17; 95% confidence interval = (0.05, 0.51), p = 0.002) were the identified determinants of stillbirth.

Conclusion:

The prevalence of stillbirth in this study was similar to previous reports in the country. Early detection and treatment of complications among mothers with multiple pregnancies and prior history of adverse outcomes are vital to alleviate the problem.

Determinants of Stillbirth From Two Observational Studies Investigating Deliveries in Kano, Nigeria

BACKGROUND

Stillbirths are a poignant representation of global inequality. Nigeria is documented to have the second highest rate; yet, the reporting system is inadequate in most Nigerian healthcare facilities. The aim was to identify the determinants of stillbirth among deliveries in the Murtala Muhammad Specialist Hospital (MMSH), Kano, Nigeria.

METHODS

Two study designs were used: a case-control study (S1) and a prospective cohort study (S2). Both studies were carried out at the MMSH. For S1, stillbirths were retrospectively matched to a livebirth by time (target of 24 hours' time variation) to establish a case-control study with a 1:1 ratio. Eligibility into S2 included all mothers who were presented at the MMSH in labour regardless of birth outcome. Both were based on recruitment durations, not sample sizes (3 months and 2 months, respectively, 2017-2018). The demographic and clinical data were collected through paper-based questionnaires. Univariable logistic regression was used. Multivariable logistic regression was used to explore relationships between area type and other specific factors.

FINDINGS

Stillbirth incidence in S2 was 180/1,000 births. Stillbirth was associated with the following factors; no maternal education, previous stillbirth(s), prematurity, living in both semi-rural and rural settings, and having extended time periods between rupture of membranes and delivery. Findings of the multivariable analysis (S1 and S2) indicated that the odds of stillbirth, for those living in a rural area, were further exacerbated in those mothers who had no education, lived in a shack, or had any maternal disease.

INTERPRETATION

This research identifies the gravity of this situation in this area and highlights the need for action. Further understanding of some of the findings and exploration into associations are required to inform intervention development.

FUNDING

This collaboration was partially supported by funding from Health and Care Research Wales.

The utility of delivery ward register data for determining the causes of perinatal mortality in one specialized and one general hospital in south Ethiopia

Background

Globally, the burden of perinatal mortality is high. Reliable measures of perinatal mortality are necessary for planning and assessing prenatal, obstetric, and newborn care services. However, accurate record-keeping is often a major challenge in low resource settings. In this study we aimed to assess the utility of delivery ward register data, captured at birth by healthcare providers, to determine causes of perinatal mortality in one specialized and one general hospital in south Ethiopia.

Methods

Three years (2014–2016) of delivery register for 13,236 births were reviewed from July 12 to September 29, 2018, in two selected hospitals in south Ethiopia. Data were collected using a structured pretested data extraction form. Descriptive statistics assessed early neonatal mortality rate, stillbirth rate, perinatal mortality rate and causes of neonatal deaths. Factors associated with early neonatal deaths and stillbirths were examined using logistic regression. The adjusted odds ratios with a 95% confidence interval were reported to show the strength of the association.

Result

The perinatal mortality ratio declined from 96.6 to 75.5 per 1000 births during the three-year study period. Early neonatal mortality and stillbirth rates were 29.3 per 1000 live births and 55.2 per 1000 total births, respectively. The leading causes of neonatal death were prematurity 47.5%, and asphyxia 20.7%. The cause of death for 15.6% of newborns was not recorded in the delivery registers. Similarly, the cause of neonatal morbidity was not recorded in 1.5% of the delivery registers. Treatment given for 94.5% of neonates were blank in the delivery registers, so it is unknown if the neonates received treatment or not. Factors associated with increased early neonatal deaths were maternal deaths and complications, vaginal births, APGAR scores less than 7 at five minutes and low birth weight (2500 g). Maternal deaths and complications and vaginal births were associated with increased stillbirths.

Conclusion

Our findings show that an opportunity exists to identify perinatal death and newborn outcomes from the delivery ward registers, but some important neonatal outcomes were not recorded/missing. Efforts towards improving the medical record systems are needed. Furthermore, there is a need to improve maternal health during pregnancy and birth, especially neonatal care for those neonates who experienced low APGAR scores and birth weight to reduce the prevalence of perinatal deaths.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-03058-4.

Stillbirth and Associated Factors Among Women Who Gave Birth at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia

BACKGROUND

Stillbirth, which accounts for half of all the perinatal mortality, is not counted on policy, program, and investment agendas around the globe. It has been underestimated public health burden, particularly in developing countries. Ethiopia is among the top countries with a large prevalence of stillbirth in the world. However, there is a dearth of study on the current magnitude of stillbirth in the study area. Therefore, this study intended to assess the prevalence of stillbirth and its associated factors to bridge the gap.

METHODS

A hospital-based retrospective study was conducted from 1 to 28 February 2019 and data were collected by reviewing the chart records of all the women who gave birth in the past 2 years (January 2016 to December 2018) at Hiwot Fana Specialized University Hospital. Data were entered into EpiData version 4.2.0.0 software and transported to SPSS version 23 for analysis. Descriptive statistics such as frequency, mean, and SDs were generated. Determinants of stillbirth were analyzed using a binary logistic regression and presented by adjusted odds ratio (AOR) with a 95% CI.

RESULTS

The prevalence of stillbirth was 14.5% (95% CI: 11.7%, 17.6%). Low birth weight (AOR = 2.42, 95% CI: 1.23-4.76), prematurity (AOR = 2.10, 95% CI: 1.10-4.01), premature rupture of membranes (AOR = 2.08, 95% CI: 1.14-3.77), antepartum hemorrhage (AOR = 3.33, 95% CI: 1.66-6.67), obstructed labor (AOR = 2.87, 95% CI: 1.48-5.56), and preeclampsia (AOR = 2.91, 95% CI: 1.28-6.62) were an independently associated with stillbirth.

CONCLUSION

The prevalence of stillbirth in this study was high. Low birth weight, preterm birth, premature rupture of membranes, antepartum hemorrhage, obstructed labor, and preeclampsia were independently associated with a stillbirth. Therefore, much study is needed involving different stakeholders to reduce stillbirths by improving the health status of women through the provision of quality maternal care including referral systems.

The effect of inter-pregnancy interval on stillbirth in urban South Ethiopia: a community-based prospective cohort study

BACKGROUND

Stillbirth is an invisible and poorly understood adverse pregnancy outcome that remains a challenge in clinical practice in low-resource settings. It is also a key concern in Ethiopia where more than half of pregnancies occur shortly after preceding childbirth. Whether the interval between pregnancies has an effect on stillbirth or not is unclear. Therefore, we aimed to assess the effect of inter-pregnancy interval on stillbirth in urban South Ethiopia.

METHODS

A community-based prospective cohort study was conducted among 2578 pregnant women and followed until delivery. Baseline data were collected at the household level during registration and enrolment. End-line data were collected from hospitals during delivery. Exposed groups were pregnant women with inter-pregnancy intervals < 18 months and 18-23 months. Unexposed group contains women with inter-pregnancy intervals 24-60 months. A generalized linear model for binary outcome was applied, using R version 4.0.5 software. Relative risk (RR) was used to estimate the effect size with a 95% confidence level. Attributable fraction (AF) and population attributable fraction (PAF) were used to report the public health impact of exposure.

RESULTS

The overall incidence of stillbirth was 15 per 1000 total births, (95% CI: 11, 20%). However, the incidence was varied across months of inter-pregnancy intervals; 30 (< 18 months), 8 (18-23 months) and 10 (24-60 months) per 1000 total births. The risk of stillbirth was nearly four times (ARR = 3.55, 95%CI: 1.64, 7.68) higher for women with inter-pregnancy interval < 18 months as compared to 24-60 months. This means, about 72% (AF = 72, 95%CI: 39, 87%) of stillbirth among the exposed group (inter-pregnancy interval < 18 months category) and 42% (PAF = 42, 95%CI: 23, 50%) of stillbirth in the study population were attributed to inter-pregnancy interval < 18 months. These could be prevented with an inter-pregnancy interval that is at least 18 months or longer.

CONCLUSIONS

Inter-pregnancy interval under 18 months increases the risk of stillbirth in this population in urban South Ethiopia. Interventions targeting factors contributing to short inter-pregnancy intervals could help in reducing the risk of stillbirth. Improving contraceptive utilization in the community could be one of these interventions.

A qualitative focus group study concerning perceptions and experiences of Nigerian mothers on stillbirths

Objective

To explore the experiences and perceptions of stillbirth among mothers from a tertiary medical centre in Kano, Northern Nigeria.

Design

Qualitative, interpretative.

Setting

Tertiary healthcare facility, Murtala Muhammad Specialist Hospital (MMSH), Kano, Northern Nigeria.

Sample

Mothers who had given birth to a liveborn baby at the MMSH in the prior 6 months (n = 31). In order to capture the experiences and perception of stillbirth within this cohort we approached mothers who had in a previous pregnancy experienced a stillbirth. Of the 31 who attended 16 had a previous stillbirth.

Methods

Semi-structured Focus Group Discussions, consisting of open-ended questions about stillbirth, beliefs, experiences and influences were held in MMSH, conducted over 1 day.

Results

Our findings highlight that this is a resource-poor tertiary facility serving an ever-growing population, increasing strain on the hospital and healthcare workers. Many of the participants highlighted needing permission from certain family members before accessing healthcare or medical treatment. We identified that mothers generally have knowledge on self-care during pregnancy, yet certain societal factors prevented that from being their priority. Judgement and blame was a common theme, yet a complex area entwined with traditions, superstitions and the pressure to procreate with many mothers described being made to feel useless and worthless if they did not birth a live baby.

Conclusions

As access to healthcare becomes easier, there are certain traditions, family and social dynamics and beliefs which conflict with scientific knowledge and act as a major barrier to uptake of healthcare services. The findings highlight the need for investment in maternity care, appropriate health education and public enlightenment; they will help inform appropriate interventions aimed at reducing stigma around stillbirth and aide in educating mothers about the importance of appropriate health seeking behaviour. Stillbirths are occurring in this area of the world unnecessarily, globally there has been extensive research conducted on stillbirth prevention. This research has highlighted some of the areas which can be tackled by modifying existing successful interventions to work towards reducing preventable stillbirths.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04207-4.

Health facility delivery among women of reproductive age in Nigeria: Does age at first birth matter?

BACKGROUND

High maternal mortality ratio in sub-Saharan Africa (SSA) has been linked to inadequate medical care for pregnant women due to limited health facility delivery utilization. Thus, this study, examined the association between age at first childbirth and health facility delivery among women of reproductive age in Nigeria.

METHODS

The study used the most recent secondary dataset from Nigeria's Demographic and Health Survey (NDHS) conducted in 2018. Only women aged15-49 were considered for the study (N = 34,193). Bi-variate and multivariable logistic regression models were used to examine the association between age at first birth and place of delivery. The results were presented as crude odds ratios and adjusted odds ratios (aOR) with corresponding 95% confidence intervals (CIs). Statistical significance was set at p<0.05.

RESULTS

The results showed that the prevalence of health facility deliveries was 41% in Nigeria. Women who had their first birth below age 20 [aOR = 0.82; 95%(CI = 0.74-0.90)] were less likely to give birth at health facilities compared to those who had their first birth at age 20 and above.

CONCLUSION

Our findings suggest the need to design interventions that will encourage women of reproductive age in Nigeria who are younger than 20 years to give birth in health facilities to avoid the risks of maternal complications associated with home delivery. Such interventions should include male involvement in antenatal care visits and the education of both partners and young women on the importance of health facility delivery.

Perinatal mortality and its association with antenatal care visit, maternal tetanus toxoid immunization and partograph utilization in Ethiopia: a meta-analysis

Despite remarkable progress in the reduction of under-five mortality; perinatal mortality is the major public health problem in Africa. In Ethiopia, the study findings on perinatal mortality and its predictors were inconsistent. Therefore, this systematic review and meta-analysis estimated the pooled perinatal mortality, and its association with antenatal care visit, maternal tetanus toxoid immunization, and partograph monitoring. International databases like PubMed, SCOPUS, Google Scholar and Science Direct were systematically searched. I squared statistics was used to determine the levels of heterogeneity across studies and the pooled estimate was computed using a random-effect model. The meta-analysis showed that a pooled prevalence of perinatal mortality in Ethiopia was 6.00% (95% CI 5.00%, 7.00%). The highest proportion of perinatal mortality was a stillbirth, 5.00% (95% CI 4.00%, 7.00%). Women who had antenatal care visit [OR = 0.20 (95% CI 0.12, 0.34)], maternal tetanus toxoid immunization [OR = 0.43 (95% CI 0.24, 0.77)] and partograph monitoring [POR = 0.22 (95% CI 0.06, 0.76)] reduced the risk of perinatal mortality. Whereas, previous history of perinatal mortality [POR = 7.95 (95% CI 5.59, 11.30)] and abortion history (POR = 2.02 (95% CI 1.18, 3.46)) significantly increased the risk of perinatal mortality. Therefore, antenatal care visit, maternal tetanus toxoid vaccination uptake, and partograph utilization should be an area of improvements to reduce perinatal mortality.

Bivariate binary analysis on composite index of anthropometric failure of under-five children and household wealth-index

Background

Malnutrition is the most common cause of mortality and morbidity of children in low and middle income countries including Ethiopia and household wealth index shares the highest contribution. Thus, in this study it is aimed to conduct bivariate binary logistic regression analysis by accounting the possible dependency of child composite index anthropometric failure and household wealth index.

Methods

In this study the data from Ethiopian Demographic and Health Survey (EDHS) 2016 involved 9411 under five children was considered. Child Composite Index Anthropometric Failure (CIAF) measures the aggregate child undernourished derived from the conventional anthropometric indices (stunting, underweight and wasting). The correlation between CIAF and wealth index was checked and significant correlation found. To address the dependency between the two outcome variables bivariate binary logistic regression was used to analyze the determinants of child CAIF and household wealth index jointly.

Results

Study results show that region, place of residence, religion, education level of women and husband/partner, sex of child, source of drinking water, household size and number of under five children in the household, mothers body mass index, multiple birth and anemia level of child had significant association with child CIAF. Female children were 0.82 times less likely to be CIAF compared to male and multiple birth children were more likely to be CIAF compared to single birth. Children from Oromia, Somalie, Gambela, SNNPR, Harari and Addis Ababa region were 0.6, 0.56, 0.67, 0.52, 0.6 and 0.44 times less likely to be CIAF compared to Tigray. A household from rural area were 15.49 times more likely poor compared to a household. The estimated odds of children whose mothers attended primary, and secondary and higher education was 0.82, and 0.52 times respectively the estimated odds of children from mothers who had never attended formal education.

Conclusion

The prevalence of children with composite index anthropometric failure was high and closely tied with the household wealth index. Among the determinants, region, religion, family education level, and anemia level of child were statistically significant determinants of both CIAF and household wealth index. Thus, the authors recommend to concerned bodies and policymakers work on household wealth index to reduce the prevalence of child composite anthropometric failure.

Risk Factors of Stillbirth Among Women Who Gave Birth in Amhara Region Referral Hospitals, Ethiopia, in 2019: A Case-Control Study

Background

Worldwide, 2.6 million stillbirths occur annually and more than three-quarters of them are recorded in South Asia and Sub-Saharan Africa. Thus, the aim of this study was to identify risk factors of stillbirth among women who gave birth in Amhara region referral hospitals found in northwest and northcentral, Ethiopia in 2019.

Methods

A multi-center institution-based unmatched case-control study was conducted among 456 mothers who gave birth in Amhara region referral hospitals from October 1 to December 30, 2019. Consecutive and simple random sampling was used to select the cases and controls, respectively. A semi-structured, interviewer-administered questionnaire and patient chart reviews were used to collect the data. Epidemiological (Epi) data version 4.4.2.1 and Statistical Package for the Social Sciences (SPSS) version 25.0 were used for data entry and analysis, respectively. Binary logistic regression was employed. An adjusted odds ratio with a 95% confidence interval was used to declare statistically significant variables on the basis of p-value<0.05 in the multivariable binary logistic regression model.

Results

Alcohol drinking (adjusted odds ratio (AOR)=3.02, 95% confidence interval (CI)=1.24–7.35), antepartum hemorrhage (AOR=5.74, 95% CI=2.67–12.33), premature rupture of membrane (AOR=2.21, 95% CI=1.09–4.44), meconium-stained amniotic fluid (AOR=8.18, 95% CI=4.29–15.60), non-use of partograph for labor follow-up (AOR=3.89, 95% CI=2.12–7.17), induction of labor (AOR=2.12, 95% CI=1.09–4.11), previous history of stillbirth (AOR=2.15, 95% CI=1.08–4.26), and birthweight less than 2,500 grams (AOR=7.36, 95% CI=3.43–15.81) increase the odds of stillbirth.

Conclusion

Stillbirth was higher among women who drank alcohol during their pregnancy, experienced antepartum hemorrhage, premature rupture of membrane, meconium-stained amniotic fluid, induction of labor, labor not followed by partograph, previous history of stillbirth, and birthweight less than 2,500 grams. As such, education to stop alcohol drinking during pregnancy, monitoring the progress of labor with partograph, and improving the quality of care for mothers and newborns at the time of pregnancy and childbirth will contribute to preventing stillbirth.

Predictors of adverse pregnancy outcome at Hospitals in South Gondar Zone, North-central Ethiopia: A multicenter facility-based unmatched case-control study

BACKGROUND

Adverse pregnancy outcomes are the most significant public health problem which leads to serious short and long-term health consequences to the mother and the newborn baby. Adverse pregnancy outcomes, especially prematurity and low birth weights are the major cause of neonatal morbidity and mortality in Ethiopia, particularly in the study area. Therefore, this study was aimed to determine predictors of adverse pregnancy outcome among mothers who gave birth at Hospitals in South Gondar zone, North-central Ethiopia.

METHODS

Hospital-based unmatched case-control study was conducted. A total of 441 study participants with 147 cases and 294 controls were included. The study participants were selected by multi-stage sampling technique. A combination of chart review and interview were used. Data entry and analysis were done by using Epi data version 3.1 and SPSS version 23 respectively. Descriptive & analytical statistics were computed. In the binary logistic regression, both bivariable and multivariable analysis was computed. Statistical significance was considered at P < 0.05 and the strength of association were assessed by using the adjusted odds ratio with their 95%confidence interval.

RESULT

A total of 147 cases and 294 controls were included. The mean age (±SD) of study participants was 26.8 ± 5.5 years. History of adverse birth outcome (AOR = 6.39, 95%CI = 2.55, 15.99), did not receive dietary counseling during pregnancy (AOR = 5.17, 95%CI = 2.09, 12.84), pregnancy induced hypertension (AOR = 3.74, 95%CI = 1.20, 11.62), history of hyperemesis gravidarum in the recent pregnancy (AOR = 4.01, 95%CI = 1.58, 10.21) and inter-pregnancy interval less than 24 months (AOR = 2.02, 95%CI = 1.04, 3.91) were significantly associated with adverse pregnancy outcome.

CONCLUSION

This study showed that history of adverse pregnancy outcome, pregnancy induced hypertension, did not receive dietary counseling, history of hyperemesis gravidarum, and inter-pregnancy interval less than 24 months were significantly associated with adverse pregnancy outcome. This study implies the need to improve dietary counseling for pregnant mothers during antenatal care visits. Beside to this, counseling on birth spacing should be given to improve inter-pregnancy intervals.

Determinants of Stillbirth Among Deliveries Attended in Bale Zone Hospitals, Oromia Regional State, Southeast Ethiopia: A Case-Control Study

Background

Stillbirth is one of the adverse outcomes of pregnancy, and it is among the major public health problems in developing countries including Ethiopia. Stillbirth has wide-reaching consequences for parents, care providers, community and society at large.

Purpose

To assess the determinant of stillbirth among deliveries attended in Bale zone hospitals Southeast Ethiopia.

Methods

An institution-based unmatched case-control study was conducted. Cases were deliveries whose birth outcome was stillbirth and controls were deliveries with live birth. A pretested and structured checklist was used to collect data from a sample of 402 (134 cases and 268 controls). Systematic random sampling was used to recruit samples from a list of charts in the delivery registration book. Data were entered into EpiData version 4.2 and exported to SPSS version 20 for analysis. Crude and adjusted odds ratio with 95%CI was calculated and P-value <0.05 was used to declare statistical significance.

Results

A total of 402 charts of mothers (134 cases and 268 controls) were included in the analysis. Preceding birth interval <24 months (AOR: 2.991; 95%CI: 1.351-6.621), antenatal visit started at third trimester (AOR: 2.739; 95%CI: 1.048-7.158), referred from other health facility (AOR: 3.215; 95%CI: 1.430-7.229), labor length ≥24 h (AOR: 3.169; 95%CI: 1.241-8.091), presence of meconium stained amniotic fluid (AOR: 2.670; 95%CI: 1.082-6.592) and giving birth to a baby <2500 g (AOR: 3.155; 95%CI: 1.235-8.07) were determinants of stillbirth.

Conclusion

Preceding birth interval of <24 months, antenatal visit started at third trimester, referred from other health facility, presence of meconium stained amniotic fluid, labor length ≤24 h and giving birth to a baby <2500 g were found the determinants of stillbirth. Intrapartum care, early identification of labor complications and referral system are required.

The effect of antenatal care on perinatal outcomes in Ethiopia: A systematic review and meta-analysis

BACKGROUND

The estimated annual global perinatal and neonatal death is four million. Stillbirths are almost equivalent to neonatal mortality, yet they have not received the same attention. Antenatal care is generally thought to be an effective method of improving pregnancy outcomes, but its effectiveness as a means of reducing perinatal mortality has not been evaluated in Ethiopia. Therefore, we will identify the pooled effect of antenatal care on perinatal outcomes in Ethiopia.

METHODS

Medline, Embase, Cinahl, African journal online and Google Scholar was searched for articles published in English language between January 1990 and May 2020. Two independent assessors selected studies and extracted data from eligible articles. The Risk of Bias Assessment tool for Non-Randomized Studies was used to assess the quality of each included study. Data analysis was performed using RevMan 5.3. Heterogeneity and publication bias were assessed using I2 test statistical significance and Egger's test for small-study effects respectively. The random effect model was employed, and forest plot was used to present the risk ratio (RR) with 95% confidence interval (CI).

RESULTS

Thirteen out of seventeen included studies revealed antenatal care utilization had a significant association with perinatal outcomes. The pooled risk ratio by the random-effects model for perinatal death was 0.42 (95% CI: 0.34, 0.52); stillbirth 0.34 (95% CI: 0.25, 0.46); early neonatal death 0.85 (95% CI: 0.21. 3.49).

CONCLUSION

Women who attended at least one antenatal care visit were more likely to give birth to an alive neonate that survives compared to their counterpart. Therefore, the Ethiopian Ministry of health and other stakeholders should design tailored interventions to increase antenatal care utilization since it has been shown to reduce perinatal mortality.

Spatial distribution of stillbirth and associated factors in Ethiopia: a spatial and multilevel analysis

OBJECTIVE

Although the rate of stillbirth has decreased globally, it remains unacceptably high in developing countries. Today, only 10 countries share the burden of more than 65% of the global rate of stillbirth and these include Ethiopia. Ethiopia ranks seventh in terms of high rate of stillbirths. Exploring the spatial distribution of stillbirth is critical to developing successful interventions and monitoring public health programmes. However, there is no study on the spatial distribution and the associated factors of stillbirth in Ethiopia. Therefore, this study aimed to explore the spatial distribution and the associated factors of stillbirth.

METHODS

Secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey data. A total weighted sample of 11 375 women were included in the analysis. The Bernoulli model was fitted using SaTScan V.9.6 to identify hotspot areas and ArcGIS V.10.6 to explore the spatial distribution of stillbirth. For associated factors, a multilevel binary logistic regression model was fitted using STATA V.14 software. Variables with a p value of less than 0.2 were considered for the multivariable multilevel analysis. In the multivariable multilevel analysis, adjusted OR (AOR) with 95% CI was reported to reveal significantly associated factors of stillbirth.

RESULTS

The spatial analysis showed that stillbirth has significant spatial variation across the country. The SaTScan analysis identified significant primary clusters of stillbirth in the Northeast Somali region (log likelihood ratio (LLR)=13.4, p<0.001) and secondary clusters in the border area of Oromia and Amhara regions (LLR=8.8, p<0.05). In the multilevel analysis, rural residence (AOR=4.83, 95% CI 1.44 to 16.19), primary education (AOR=0.39, 95% CI 0.20 to 0.74), no antenatal care (ANC) visit (AOR=2.77, 95% CI 1.70 to 4.51), caesarean delivery (AOR=5.07, 95% CI 1.65 to 15.58), birth interval <24 months (AOR=1.95, 95% CI 1.20 to 3.10) and height <150 cm (AOR=2.73, 95% CI 1.45 to 4.97) were significantly associated with stillbirth.

CONCLUSION AND RECOMMENDATION

In Ethiopia, stillbirth had significant spatial variations across the country. Residence, maternal stature, preceding birth interval, caesarean delivery, education and ANC visit were significantly associated with stillbirth. Therefore, public health interventions that enhance maternal healthcare service utilisation and maternal education in hotspot areas of stillbirth are crucial to reducing stillbirth in Ethiopia.

Burden of stillbirths and associated factors in Yirgalem Hospital, Southern Ethiopia: a facility based cross-sectional study

BACKGROUND

Stillbirth is an adverse pregnancy outcome of public health importance causing considerable psychosocial burden on parents and their family. Studies on stillbirth are scarce in southern Ethiopia. An assessment of stillbirths and associated factors in health care settings helps in devising strategies for tailored interventions. Therefore, we assessed the burden of stillbirths and associated factors in Yirgalem Hospital, southern Ethiopia.

METHODS

A facility based cross-sectional study was conducted between 1 and 2015 and 30 July 2016. We randomly selected medical records of pregnant women from a hospital delivery registry. Bivariate analysis was employed to assess the association between independent and dependent variables using chi-square with significant p-value. Multivariate logistic regression was used to identify independent risk factors for stillbirths and to control for confounding variables.

RESULTS

Of 374 reviewed records of pregnant women, 370 were included for the study. The magnitude of stillbirths was 92 per 1000 births. Fifteen (44.1%) of fetal deaths occurred after admission to the hospital. In multivariate logistic regression, stillbirths were higher among low birth-weight babies (< 2500grams) (adjusted odds ratio (AOR): 10.70, 95% CI 3.18-35.97) than normal birth-weight babies (2500-<4000). Pregnant women who experienced a prolonged labour for more than 48 hours were 12 times (AOR: 12.15, 95% CI 1.76-84.12) more likely to have stillbirths than pregnant women without a prolonged labour. Pregnant women with obstetric complications were 18.9 times more likely to have stillbirths than pregnant women without obstetric complications. Similarly, pregnant women with at least two pregnancies were more likely to have stillbirths than pregnant women with less than two pregnancies (AOR: 4.39, 95% CI 1.21-15.85).

CONCLUSIONS

We found a high burden of stillbirths in the study setting. Modifiable risk factors contributed to a higher risk of stillbirths; therefore, tailored interventions such as early identification and management of prolonged labour and obstetric complication at each level of health system could avert preventable stillbirths.

Youth friendly sexual and reproductive health service utilization among high and preparatory school students in Debre Tabor town, Northwest Ethiopia: A cross sectional study

BACKGROUND

Youth continue to fall victim to sexual and reproductive health problems. Despite, reproductive health needs of youth had been supported by different organizations, utilization of those services is low. All efforts have not been felt across the Ethiopian learning institutions as is evidenced by persistent reproductive health problems. Therefore, this study aimed to assess the magnitude of youth friendly sexual and reproductive health service utilization and associated factors among high and preparatory school youths in Debre Tabor town, Northwest Ethiopia.

METHODS

An institution based cross- sectional study was conducted from March 1 to 28, 2016. The data were collected using a pre-tested and structured self-administered questionnaire. Multistage cluster sampling method was used to select the study participants. The data were entered into Epi-data version 4.2.0.0 and analyzed using SPSS version 20. Binary logistics regression was used for analysis. Odds ratio along with 95%CI was estimated to measure the strength of the association. Level of statistical significance was declared at p value ≤0.05.

RESULTS

Overall utilization of reproductive health service was 28.8%. Being male (AOR = 1.54, 95% CI: 1.05, 2.25), prior discussion on reproductive health issues (AOR = 6.33, 95% CI: 4.22, 9.51), and previous sexual intercourse within the past one year (AOR = 1.95, 95% CI: 1.10, 3.44) were significantly associated with youth friendly health service utilization.

CONCLUSIONS

Youth friendly health service utilization among high school and preparatory students in Debre Tabor town was low. Ensuring gender empowerment and advocating sexual and reproductive service discussion among themselves and with others might be important in improving reproductive health utilization and health. Future researcher should address segment of population who does not enter school.

Magnitude and trend of perinatal mortality and its relationship with inter-pregnancy interval in Ethiopia: a systematic review and meta-analysis

Background

Perinatal mortality remains a problem in Ethiopia. Findings of primary studies varied on level of perinatal mortality and its predictors including inter-pregnancy interval. The aim of this review was to estimate the pooled perinatal mortality rate, its trend overtime and verify the association with inter-pregnancy interval in Ethiopian context.

Methods

Studies were accessed through the electronic web-based search strategies from PubMed, ScienceDirect, Hinari for health via Research4Life, Google and Advanced Google search, and retrieving via relevant references using a combination of medical subject headings (MeSH terms) and key words related with inter-pregnancy interval. R version 3.4.3 software was used for the meta-analysis. A forest plot and I² test were done to assess heterogeneity. Sensitivity analysis and subgroup analysis were done to deal with heterogeneity. A weighted inverse variance random-effects model was applied to estimate pooled effect sizes. A funnel plot and Egger’s regression test were done to check publication bias.

Results

A total of 34 studies used to answer review questions (30 for perinatal mortality rate and its trend estimation from 1997 to 2019 and 8 for its relationship with inter-pregnancy interval). The pooled perinatal mortality rate was 51.3 per 1000 total births (95% CI: 40.8–62.8). The pooled stillbirth rate was 36.9 per 1000 births (95% CI: 27.3–47.8) and early neonatal mortality rate was 29.5 per 1000 live births (95% CI: 23.9–35.6). Increasing trend was seen in stillbirth rate (23.7 to 36.9 per 1000 births) while decreasing trend in early neonatal mortality rate (51 to 29.5 per 1000 live births). Slight reduction trend was observed in overall perinatal mortality rate (66 to 51.3 per 1000 births). An inter-pregnancy interval less than 15 months was found to be statistically significantly associated with perinatal mortality; pooled OR = 2.76 (95% CI: 2.1–3.62). Spacing pregnancy for at least 15 months was related with reducing perinatal mortality by 64% (95% CI: 52.38, 72.38%).

Conclusions

In Ethiopia, perinatal mortality rate remains high. Insignificant reduction trend was observed in overall perinatal mortality rate. Counseling couples about the importance of spacing pregnancy and intensifying long-acting contraceptive use will help in reducing perinatal mortality related to poor pregnancy spacing.

Applying the WHO ICD-PM classification system to stillbirths in a major referral Centre in Northeast Nigeria: a retrospective analysis from 2010-2018

Background

Lack of a unified and comparable classification system to unravel the underlying causes of stillbirth hampers the development and implementation of targeted interventions to reduce the unacceptably high stillbirth rates (SBR) in sub-Saharan Africa. Our aim was to track the SBR and the predominant maternal and fetal causes of stillbirths using the WHO ICD-PM Classification system.

Methods

This was a retrospective observational study in a major referral centre in northeast Nigeria between 2010 and 2018. Specialist Obstetricians and Gynaecologists assigned causes of stillbirths after an extensive audit of available stillbirths’ records. Cause of death was assigned via consensus using the ICD-PM classification system.

Results

There were 21,462 births between 1 January 2010 and 31 December 2018 in our study setting; of these, 1177 culminated in stillbirths with a total hospital SBR of 55 per 1000 births (95% CI: 52, 58). There were two peaks of stillbirths in 2012 [62 per 1000 births (95% CI: 53, 71)], and 2015 [65 per 1000 births (95% CI, 55, 76)]. Antepartum and intrapartum stillbirths were almost equally prevalent (48% vs 52%). Maternal medical and surgical conditions (M4) were the commonest (69.3%) cause of antepartum stillbirths while complications of placenta, cord and membranes (M3) accounted for the majority (45.8%) of intrapartum stillbirths and the trends were similar between 2010 and 2018. Antepartum and intrapartum fetal causes of stillbirths were mainly due to prematurity which is a disorder of fetal growth (A5 and I6).

Conclusions

Most causes of stillbirths in our setting are due to preventable causes and the trends have remained unabated between 2010 and 2018. Progress toward global SBR targets are off-track, requiring more interventions to halt and reduce the high SBR.

Effect of antenatal depression on adverse birth outcomes in Gondar town, Ethiopia: A community-based cohort study

BACKGROUND

The impact of antenatal depression on pregnancy outcomes has been well investigated in developed countries, but few studies have been conducted in low-income countries. As depression is significantly affected by socio-economic and cultural factors, it would be difficult to generalize evidence from high-income countries to low-income countries. We conducted a community-based cohort study to estimate the incidence of adverse birth outcomes and the direct and indirect pathways via which depression and other psychosocial risk factors may impact such birth outcomes within Gondar town, Ethiopia.

METHODS

The study followed 916 pregnant women who were screened for antenatal depression using the Edinburgh Postnatal Depression Scale (EPDS). We also assessed the incidence of preterm births, Low Birth Weight (LBW) and stillbirths. Modified Poisson regression was used to estimate the relative risk of predictors on adverse birth outcomes and a Generalized Structural Equation Model (GSEM) was used to estimate the direct and indirect effect of antenatal depression and other psychological risk factors on adverse birth outcomes.

RESULTS

The cumulative incidence of stillbirth, LBW and preterm was 1.90%, 5.25%, and 16.42%, respectively. The risk of preterm birth was 1.61, 1.46, 1.49, and 1.77 times higher among participants who identified as Muslim, reported being fearful of delivery, were government employee's, and who had no antenatal care services, respectively. Partner support moderated the association between depression, preterm birth, and LBW. Depression had no direct effect on birth outcomes but indirectly affected preterm birth via partner support. Religion had both direct and indirect effects on preterm birth, while occupation and fear of delivery had direct effects. The risk of LBW was 9.44 and 2.19 times higher among preterm births and those who had exposure to tobacco, respectively. Stress coping was indirectly associated, and preterm birth and tobacco exposure were directly associated with LBW. The risk of stillbirth was 3.22 times higher in women with antenatal depression and 73% lower in women with higher coping abilities.

CONCLUSIONS

There was a high incidence of all adverse birth outcomes in Gondar Town. Depression and psychosocial risk factors had important indirect negative effects on risk, while partner support provided a positive indirect effect on the incidence of adverse birth outcomes. Interventions that focus on increasing partner engagement and participation in antenatal support may help reduce adverse birth outcomes by enhancing maternal resilience.

Trends of stillbirth among reproductive-age women in Ethiopia based on Ethiopian demographic and health surveys: a multivariate decomposition analysis

Background

Despite the effort to reduce stillbirth, Ethiopia remains one of the countries with the highest rate in the world. Therefore, this study aimed to analyze the trends of stillbirth among births from reproductive age women over time based on Ethiopian Demographic and Health Surveys (EDHSs).

Methods

Secondary data analysis was conducted based on the Ethiopian Demographic Health Surveys (EDHSs) conducted in 2005, 2011 and 2016. A total weighted sample of 12,037, 10,588, and 11,375 in 2005, 2011 and 2016 respectively were included for analysis. Trend and Logistic based decomposition analysis technique was used for analyzing the trends of stillbirth over time and factors contributing to the change in stillbirth rate. STATA 14 was employed for data management and analyses. All analyses presented in this paper were weighted for the sampling probabilities and non-response. Complex sampling procedures were also considered during testing of statistical significance.

Results

Among women of reproductive age, the stillbirth rate declined from 13.3/1000 births in 2005 to 9.2 per 1000 births in 2016 with the annual rate of reduction of 3.1%. The study found that the stillbirth rate has been declined over time concerning the place of residence, region, antenatal care, education and place of delivery. The decomposition analysis indicated that about 82.3% of the overall change stillbirth rate was due to the difference in women’s composition. Particularly, an increase in women’s urban place of residence, health facility delivery, and cesarean delivery were significant predictors for the decline in stillbirth rate over the surveys.

Conclusions

The stillbirth rate has been declined over time. More than 3/4th of the decrease in stillbirth rate was due to the difference in characteristics of women over the surveys. The increase in women’s urban place of residence, an increase in cesarean delivery and health facility delivery significantly contributed to the decrease in stillbirth rate over time. Public health interventions targeting rural resident women, strengthening emergency obstetric services and health facility delivery would help to maintain the decreasing trend of stillbirth rate in Ethiopia.

The Association of Women's Empowerment with Stillbirths in Nepal

INTRODUCTION

Globally, 2.6 million stillbirths occur each year. Empowering women can improve their overall reproductive health and help reduce stillbirths. Women empowerment has been defined as women's ability to make choices in economic decision-making, household and health care decision-making. In this paper, we aimed to evaluate if women's empowerment is associated with stillbirths.

METHODS

Data from 2016 Nepal Demographic Health Surveys (NDHS) were analysed to evaluate the association between women's empowerment and stillbirths. Equiplots were generated to assess the distribution of stillbirths by wealth quintile, place of residence and level of maternal education using data from NHDS 1996, 2001, 2006, 2011 and 2016 data. For the association of women empowerment factors and stillbirths, univariate and multivariate analyses were conducted.

RESULTS

A total of 88 stillbirths were reported during the survey. Univariate analysis showed age of mother, education of mother, age of husband, wealth index, head of household, decision on healthcare and decision on household purchases had significant association with stillbirths (p < 0.05). In multivariate analysis, only maternal age 35 years and above was significant (aOR 2.42; 1.22-4.80). Education of mother (aOR 1.48; 0.94-2.33), age of husband (aOR 1.54; 0.86-2.76), household head (aOR 1.51; 0.88-2.59), poor wealth index (aOR 1.62; 0.98-2.68), middle wealth index (aOR 1.37; 0.76-2.47), decision making for healthcare (aOR 1.36; 0.84-2.21) and household purchases (aOR 1.01; 0.61-1.66) had no any significant association with stillbirths.

CONCLUSIONS

There are various factors linked with stillbirths. It is important to track stillbirths to improve health outcomes of mothers and newborn. Further studies are necessary to analyse women empowerment factors to understand the linkages between empowerment and stillbirths.

Determinants of stillbirth in Felege-Hiwot comprehensive specialized referral hospital, North-west, Ethiopia, 2019

Objective

The objective of this study was to identify determinants of stillbirth in Felege Hiwot comprehensive specialized referral hospital, North-west, Ethiopia: 2019. To conduct this study an institutional-based unmatched case–control study was used among 84 cases and 336 controls. Pretested, structured questioner with face to face interview was conducted and some data were also extracted from medical records using a checklist. The data were analyzed by using binary logistics regression. A p-value of < 0.05 was considered as significant at 95% confidence level and the strength of association was measured using odds ratio.

Results

Illiteracy (AOR 3.8, 95% CI 1.4–10.2), sexually transmitted infection (AOR 5.7, 95% CI 1.1–29.7), Premature rupture of membrane (AOR 4.0, 95% CI 1.4–11.3), congenital anomaly (AOR 10.4, 95% CI 2.0–11.2) and history of perinatal death (AOR 10.4, 95% CI 3.7–29.2) were the determinants of stillbirth that increase risk of fetal death. Whereas taking at least two doses of tetanus toxoid vaccine (AOR 0.5, 95% CI 0.2–0.9) and partograph use (AOR 0.2, 95% CI 0.1–0.4) were found to be protective factors for stillbirth. To overcome this problem; empowering female education, facilitating women in taking tetanus toxoid vaccine, sexually transmitted infection prevention, and encourage health professionals to use partograph during labour follow up highly strongly recommended.

Factors associated with adverse pregnancy outcome in Debre Tabor town, Northwest Ethiopia: a case control study

Objective

The aim of this study was to assess the socioeconomic and demographic factors on adverse pregnancy outcomes.

Result

The mean age of cases was 42.2 (± 13.26) years and the mean age of controls was 34.5 (± 12.23) years. Advanced maternal age, low educational status, and early sexual debut showed a significant association with an adverse pregnancy outcome. Mothers in the age group 35–44 years, AOR 2.54 (95% CI 1.27, 5.06), 35–44 years, AOR 2.79 (95% CI 1.27, 6.16) and Mothers with age 55 years and above AOR 4.18 (95% CI 1.73, 9.13) were more likely to have an adverse pregnancy outcome compared to mothers in the age group ≤ 24 years. The low educational status was also found to have an implication on adverse pregnancy outcome. Those mothers with no formal education were two times more likely to develop adverse pregnancy outcome AOR 2.15 (95% CI 1.41, 2.81) and those in primary education AOR 1.6 (95% CI 1.06, 4.6) times more likely compared to those in higher education.