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Tufa FA, Yilma D, Yadesa D, Tura MR. Determinants of stillbirth among deliveries conducted at west Shoa zone public hospitals, central Ethiopia: a case-control study. BMC Pediatr 2024; 24:482. [PMID: 39068401 PMCID: PMC11282670 DOI: 10.1186/s12887-024-04953-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Globally, 2.6 million stillbirths are estimated to occur each year. The causes of stillbirth are often unknown but can be attributed to various causes. Therefore, identifying the determinants of stillbirth is quite important for applying further meaningful interventions. The purpose of this study was to identify the determinants of stillbirth among deliveries conducted at selected public hospitals in the West Shoa Zone, Oromia, Ethiopia. METHODS A hospital-based unmatched case‒control study with a 1:4 ratio was conducted. A total of 431 (87 cases and 344 controls) participants were involved. A systematic random sampling method was used for control selection. Data were collected using interview administered questionnaire and analysed using SPSS version 26 software. Binary logistic regression analyses were performed for the independent variables and outcome variables. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated to assess the strength of the associations, and statistical significance was declared at P value < 0.05. RESULTS In this study, 428 mothers who delivered (85 patients and 343 controls) participated, for a 99.3% response rate. Preeclampsia/eclampsia (AOR = 13.43, 95% CI: 5.67-31.82), other health conditions (AOR = 5.39, 95% CI: 2.34-12.46), mal-presentation (AOR = 3.42, 95% CI: 1.50-7.76), umbilical cord accidents (AOR = 2.57, 95% CI: 1.11-5.93), meconium-stained amniotic fluid problems (AOR = 5.01, 95% CI: 2.15-11.67) and low birth weight (AOR = 2.91, 95% CI: 1.28-6.59) were identified as determinant variables of stillbirth. CONCLUSIONS Low birth weight, referral status, meconium-stained amniotic fluid problems, umbilical cord accidents, mal-presentation and preeclampsia/eclampsia were identified as independent determinants of stillbirth. Therefore, hospitals and health workers are recommended to focus on identifying and preventing these factors.
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Affiliation(s)
- Fayisa Abdisa Tufa
- Department of Public Health, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Delelegn Yilma
- Department of Public Health, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Dereje Yadesa
- Department of Medicine, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Meseret Robi Tura
- Department of Nursing, College of Health Sciences and Referral Hospital, Ambo University, P.O. Box 19, Ambo, Ethiopia.
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Hofmeyr GJ, Moreri-Ntshabele B, Qureshi Z, Memo N, Hanson S, Muller E, Singata-Madliki M. Improving management of first and second stages of labour in low- and middle-income countries. Best Pract Res Clin Obstet Gynaecol 2024; 95:102517. [PMID: 38902106 DOI: 10.1016/j.bpobgyn.2024.102517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/01/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024]
Abstract
Labour care must balance aspirations of parents with vigilance for unanticipated calamities. The 'on-site midwife-led primary care birth unit' facilitates this. The World Health Organization have replaced the traditional partograph with the 'Labour Care Guide'. An implementation project in Botswana included the mnemonic COPE: Companion, Oral fluids, Pain relief and Eliminate the supine position. The Parto-Ma project in Tanzania used guidelines, training and support to improve childbirth outcomes. We list labour practices supported by recent evidence, and highlight new developments. Foetal macrosomia increases risk but mistaken diagnosis increases caesarean births. Obstructed labour is a complex clinical diagnosis, and is difficult to predict. For shoulder dystocia prioritise delivery of the posterior shoulder, facilitated if needed by posterior axilla sling traction. 'Extended balloon labour induction' with two or three Foley catheters side by side, may reduce risks associated with uterine stimulants. Bedside ultrasound may facilitate the diagnosis of cephalic malpositions and malpresentations.
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Affiliation(s)
- G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana; Effective Care Research Unit, University of the Witwatersrand, East London, South Africa; Department of Obstetrics and Gynaecology, Walter Sisulu University, East London, South Africa.
| | | | - Zahida Qureshi
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
| | - Ndiwo Memo
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana.
| | - Sarah Hanson
- Botswana Global Health Elective, Botswana-Harvard Partnership, Department of Obstetrics and Gynecology, Division of Global and Community Health, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Elani Muller
- Effective Care Research Unit, University of the Witwatersrand, East London, South Africa.
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Abriham AA, Shitie E, Melese S, Dessie AM, Bizuneh AD. Determinants of stillbirth among women who delivered in hospitals of North Wollo Zone, Northeast Ethiopia: A case-control study. PLoS One 2024; 19:e0301602. [PMID: 38603732 PMCID: PMC11008825 DOI: 10.1371/journal.pone.0301602] [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: 07/19/2023] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Stillbirth is a silent tragedy that shatters the lives of women, families, and nations. Though affecting over 2 million infants globally in 2019, it remains overlooked, with no specific targets dedicated to its reduction in the sustainable development goals. Insufficient knowledge regarding the primary risk factors contributing to stillbirths hinders efforts to reduce its occurrence. Driven by this urgency, this study focused on identifying the determinants of stillbirth among women giving birth in hospitals across North Wollo Zone, Northeast Ethiopia. METHODOLOGY This study employed an institution-based unmatched case-control design, involving a randomly selected sample of 412 women (103 cases and 309 controls) who gave birth in hospitals of North Wollo Zone. Data were collected using a structured data extraction checklist. Data entry was conducted using Epi-data version 3.1, and analysis was performed using SPSS version 25.0. Employing a multivariable logistic regression model, we identified independent predictors of stillbirth. The level of statistical significance was declared at a p-value < 0.05. RESULTS Our analysis revealed several critical factors associated with an increased risk of stillbirth. Women who experienced premature rupture of membranes (AOR = 5.53, 95% CI: 2.33-9.94), induced labor (AOR = 2.24, 95% CI: 1.24-4.07), prolonged labor exceeding 24 hours (AOR = 3.80, 95% CI: 1.94-7.45), absence of partograph monitoring during labor (AOR = 2.45, 95% CI: 1.41-4.26) were all significantly associated with increased risk of stillbirth. Preterm birth (AOR = 3.46, 95% CI: 1.87-6.39), post-term birth (AOR = 3.47, 95% CI: 1.35-8.91), and carrying a female fetus (AOR = 1.81, 95% CI: 1.02-3.22) were at a higher risk of stillbirth. CONCLUSION These findings highlight the importance of early intervention and close monitoring for women experiencing premature rupture of membranes, prolonged labor, or induced labor. Additionally, consistent partograph use and enhanced prenatal care for pregnancies at risk of preterm or post-term birth could potentially contribute to reducing stillbirth rates and improving maternal and neonatal outcomes. Further research is needed to investigate the underlying mechanisms behind the observed association between fetal sex and stillbirth risk.
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Affiliation(s)
- Atnaf Alem Abriham
- Gubalafto Health Office, North Wollo Zonal Health Department, Woldia, Amhara Region, Ethiopia
| | - Eyob Shitie
- School of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Sisay Melese
- CDC Project HIV Case Detection, Linkage, Care and Treatment Coordinator, Woldia, Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asmamaw Demis Bizuneh
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
- Monash Center for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Sequeira Dmello B, John TW, Housseine N, Meyrowitsch DW, van Roosmalen J, van den Akker T, Kujabi ML, Festo C, Nkungu D, Muniro Z, Kabanda I, Msumi R, Maembe L, Sangalala M, Hyera E, Lema J, Bayongo S, Mshiu J, Kidanto HL, Maaløe N. Incidence and determinants of perinatal mortality in five urban hospitals in Dar es Salaam, Tanzania: a cohort study with an embedded case-control analysis. BMC Pregnancy Childbirth 2024; 24:62. [PMID: 38218766 PMCID: PMC10787400 DOI: 10.1186/s12884-023-06096-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/30/2023] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Tanzania has one of the highest burdens of perinatal mortality, with a higher risk among urban versus rural women. To understand the characteristics of perinatal mortality in urban health facilities, study objectives were: I. To assess the incidence of perinatal deaths in public health facilities in Dar es Salaam and classify these into a) pre-facility stillbirths (absence of fetal heart tones on admission to the study health facilities) and b) intra-facility perinatal deaths before discharge; and II. To identify determinants of perinatal deaths by comparing each of the two groups of perinatal deaths with healthy newborns. METHODS This was a retrospective cohort study among women who gave birth in five urban, public health facilities in Dar es Salaam. I. Incidence of perinatal death in the year 2020 was calculated based on routinely collected health facility records and the Perinatal Problem Identification Database. II. An embedded case-control study was conducted within a sub-population of singletons with birthweight ≥ 2000 g (excluding newborns with congenital malformations); pre-facility stillbirths and intra-facility perinatal deaths were compared with 'healthy newborns' (Apgar score ≥ 8 at one and ≥ 9 at five minutes and discharged home alive). Descriptive and logistic regression analyses were performed to explore the determinants of deaths. RESULTS A total of 37,787 births were recorded in 2020. The pre-discharge perinatal death rate was 38.3 per 1,000 total births: a stillbirth rate of 27.7 per 1,000 total births and an intra-facility neonatal death rate of 10.9 per 1,000 live births. Pre-facility stillbirths accounted for 88.4% of the stillbirths. The case-control study included 2,224 women (452 pre-facility stillbirths; 287 intra-facility perinatal deaths and 1,485 controls), 99% of whom attended antenatal clinic (75% with more than three visits). Pre-facility stillbirths were associated with low birth weight (cOR 4.40; (95% CI: 3.13-6.18) and with maternal hypertension (cOR 4.72; 95% CI: 3.30-6.76). Intra-facility perinatal deaths were associated with breech presentation (aOR 40.3; 95% CI: 8.75-185.61), complications in the second stage (aOR 20.04; 95% CI: 12.02-33.41), low birth weight (aOR 5.57; 95% CI: 2.62-11.84), cervical dilation crossing the partograph's action line (aOR 4.16; 95% CI:2.29-7.56), and hypertension during intrapartum care (aOR 2.9; 95% CI 1.03-8.14), among other factors. CONCLUSION: The perinatal death rate in the five urban hospitals was linked to gaps in the quality of antenatal and intrapartum care, in the study health facilities and in lower-level referral clinics. Urgent action is required to implement context-specific interventions and conduct implementation research to strengthen the urban referral system across the entire continuum of care from pregnancy onset to postpartum. The role of hypertensive disorders in pregnancy as a crucial determinant of perinatal deaths emphasizes the complexities of maternal-perinatal health within urban settings.
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Affiliation(s)
- Brenda Sequeira Dmello
- Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), P. O Box 23310, Dar Es Salaam, Tanzania.
- Medical College, East Africa, Aga Khan University, Dar es Salaam, Tanzania.
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark.
| | - Thomas Wiswa John
- Medical College, East Africa, Aga Khan University, Dar es Salaam, Tanzania
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Natasha Housseine
- Medical College, East Africa, Aga Khan University, Dar es Salaam, Tanzania
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Dan Wolf Meyrowitsch
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Thomas van den Akker
- Athena Institute, VU University, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Monica Lauridsen Kujabi
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | | | - Daniel Nkungu
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Zainab Muniro
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Idrissa Kabanda
- Presidents Office, Regional and Local Government, Municipal Maternity Hospitals Ubungo and Temeke, Dar es Salaam, Tanzania
| | - Rukia Msumi
- Presidents Office, Regional and Local Government, Municipal Maternity Hospitals Ubungo and Temeke, Dar es Salaam, Tanzania
| | - Luzango Maembe
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Mtingele Sangalala
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Ester Hyera
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Joyce Lema
- Presidents Office, Regional and Local Government, Municipal Maternity Hospitals Ubungo and Temeke, Dar es Salaam, Tanzania
| | - Scolastica Bayongo
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Johnson Mshiu
- Muhimbili Medical Research Center, National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | - Nanna Maaløe
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
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Gwacham-Anisiobi U, Boo YY, Oladimeji A, Kurinczuk JJ, Roberts N, Opondo C, Nair M. Effects of community-based interventions for stillbirths in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2024; 67:102386. [PMID: 38152414 PMCID: PMC10751841 DOI: 10.1016/j.eclinm.2023.102386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023] Open
Abstract
Background Sub-Saharan Africa (SSA) alone contributed to 42% of global stillbirths in 2019, and the rate of stillbirth reduction has remained slow. There has been an increased uptake of community-based interventions to combat stillbirth in the region, but the effects of these interventions have been poorly assessed. Our objectives were to examine the effect of community-based interventions on stillbirth in SSA. Methods In this systematic review and meta-analysis, we searched eight databases (MEDLINE [OvidSP], Embase [OvidSP], Cochrane Central Register of Controlled Trials, Global Health, Science Citation Index and Social Science Citation index [Web of Science Core Collection], CINAHL [EBSCOhost] and Global Index Medicus) and four grey literature sources from January 1, 2000 to July 7, 2023 for relevant studies from SSA. Community-based interventions targeting stillbirths solely or as part of complex interventions, with or without hospital interventions were included, while hospital-only interventions, microcredit schemes and maternity waiting home interventions were excluded. Study quality was assessed using the Cochrane risk of bias and National Heart, Lung and Blood Institute's tools. The study outcome was odds of stillbirth in intervention versus control communities. Pooled odds ratios (ORs) were estimated using random-effects models, and subgroup analyses were performed by intervention type and strategies. Publication bias was evaluated by funnel plot and Egger's test. This study is registered with PROSPERO, CRD42021296623. Findings Of the 4223 records identified, seventeen studies from fifteen SSA countries were eligible for inclusion. One study had four arms (community only, hospital only, community and hospital, and control arms), so information was extracted from each arm. Analysis of 13 of the 17 studies which had community-only intervention showed that the odds of stillbirth did not vary significantly between community-based intervention and control groups (OR 0.96; 95% CI 0.78-1.17, I2 = 57%, p ≤ 0.01, n = 63,884). However, analysis of four (out of five) studies that included both community and health facility components found that in comparison with community only interventions, this combination strategy significantly reduced the odds of stillbirth by 17% (OR 0.83; 95% CI 0.79-0.87, I2 = 11%, p = 0.37, n = 244,868), after excluding a study with high risk of bias. The quality of the 17 studies were graded as poor (n = 2), fair (n = 9) and good (n = 6). Interpretation Community-based interventions alone, without strengthening the quality and capacity of health facilities, are unlikely to have a substantial effect on reducing stillbirths in SSA. Funding Nuffield Department of Population Health, Balliol College, the Clarendon Fund, Medical Research Council.
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Affiliation(s)
- Uchenna Gwacham-Anisiobi
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yebeen Ysabelle Boo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Mukherjee A, Di Stefano L, Blencowe H, Mee P. Determinants of stillbirths in sub-Saharan Africa: A systematic review. BJOG 2024; 131:140-150. [PMID: 37272228 DOI: 10.1111/1471-0528.17562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/07/2023] [Accepted: 05/13/2023] [Indexed: 06/06/2023]
Abstract
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.
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Affiliation(s)
- Ankita Mukherjee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Monitoring, Evaluation and Research, New Delhi, India
| | | | - Hannah Blencowe
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Mee
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Lincoln International Institute for Rural Health, College of Social Science, University of Lincoln, Lincoln, UK
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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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Movendane Y, Sipalo MG, Chan LCZ. Advances in Folic Acid Biosensors and Their Significance in Maternal, Perinatal, and Paediatric Preventive Medicine. BIOSENSORS 2023; 13:912. [PMID: 37887105 PMCID: PMC10605181 DOI: 10.3390/bios13100912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023]
Abstract
Auxotrophic primates like human beings rely on exogenous dietary vitamin B9 supplementation to meet their metabolic demands. Folates play a crucial role in nucleotide synthesis and DNA methylation. Maternal folate deficiency causes several pregnancy-related complications, perinatal defects, and early childhood cognitive impairments. New evidence suggests excess FA is a potential risk factor resulting in unfavourable genomic and epigenomic alterations. Thus, it is essential to revisit the need to consistently monitor maternal folate levels during pregnancy. Yet, to date, no point-of-care folate-monitoring biosensor is commercially available. Here, we critically appraise the advances in folate biosensors to understand the translational gaps in biosensor design. Further, our review sheds light on the potential role of folate biosensors in strengthening maternal, perinatal, and child healthcare.
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Affiliation(s)
- Yogesh Movendane
- Singapore Institute of Manufacturing Technology (SIMTech), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-04, Singapore 138634, Singapore;
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore 117583, Singapore
| | - Mbozu G. Sipalo
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Leon C. Z. Chan
- Singapore Institute of Manufacturing Technology (SIMTech), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-04, Singapore 138634, Singapore;
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Skytte TB, Holm-Hansen CC, Ali SM, Ame S, Molenaar J, Greisen G, Poulsen A, Sorensen JL, Lund S. Risk factors of stillbirths in four district hospitals on Pemba Island, Tanzania: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:288. [PMID: 37101264 PMCID: PMC10131471 DOI: 10.1186/s12884-023-05613-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND More than 2 million third-trimester stillbirths occur yearly, most of them in low- and middle-income countries. Data on stillbirths in these countries are rarely collected systematically. This study investigated the stillbirth rate and risk factors associated with stillbirth in four district hospitals in Pemba Island, Tanzania. METHODS A prospective cohort study was completed between the 13th of September and the 29th of November 2019. All singleton births were eligible for inclusion. Events and history during pregnancy and indicators for adherence to guidelines were analysed in a logistic regression model that identified odds ratios [OR] with a 95% confidence interval [95% CI]. RESULTS A stillbirth rate of 22 per 1000 total births in the cohort was identified; 35.5% were intrapartum stillbirths (total number of stillbirths in the cohort, n = 31). Risk factors for stillbirth were breech or cephalic malpresentation (OR 17.67, CI 7.5-41.64), decreased or no foetal movements (OR 2.6, CI 1.13-5.98), caesarean section [CS] (OR 5.19, CI 2.32-11.62), previous CS (OR 2.63, CI 1.05-6.59), preeclampsia (OR 21.54, CI 5.28-87.8), premature rupture of membranes or rupture of membranes 18 h before birth (OR 2.5, CI 1.06-5.94) and meconium stained amniotic fluid (OR 12.03, CI 5.23-27.67). Blood pressure was not routinely measured, and 25% of women with stillbirths with no registered foetal heart rate [FHR] at admission underwent CS. CONCLUSIONS The stillbirth rate in this cohort was 22 per 1000 total births and did not fulfil the Every Newborn Action Plan's goal of 12 stillbirths per 1000 total births in 2030. Awareness of risk factors associated with stillbirth, preventive interventions and improved adherence to clinical guidelines during labour, and hence improved quality of care, are needed to decrease the stillbirth rate in resource-limited settings.
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Affiliation(s)
- Tine Bruhn Skytte
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark.
| | - Charlotte Carina Holm-Hansen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
| | | | - Shaali Ame
- Public Health Laboratory, Ivo de Carneri, Pemba, Tanzania
| | - Jil Molenaar
- Reproductive and Maternal Health Research Group, Public Health Department, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Family Medicine and Population Health (FAMPOP), Faculty of Medical Sciences, University of Antwerp, Antwerp, Belgium
| | - Gorm Greisen
- Department of Neonatology, Juliane Marie Center, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anja Poulsen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
| | - Jette Led Sorensen
- Juliane Marie Centre for Children, Women and Reproduction, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stine Lund
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Neonatology, Juliane Marie Center, University Hospital Copenhagen, Copenhagen, Denmark
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Milton R, Modibbo F, Gillespie D, Alkali FI, Mukaddas AS, Kassim A, Sa'ad FH, Tukur FM, Khalid RY, Muhammad MY, Bello M, Edwin CP, Ogudo E, Iregbu KC, Jones L, Hood K, Ghazal P, Sanders J, Hassan B, Belga FJ, Walsh TR. Incidence and sociodemographic, living environment and maternal health associations with stillbirth in a tertiary healthcare setting in Kano, Northern Nigeria. BMC Pregnancy Childbirth 2022; 22:692. [PMID: 36076161 PMCID: PMC9454147 DOI: 10.1186/s12884-022-04971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Rebecca Milton
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - F Modibbo
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - D Gillespie
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - F I Alkali
- Department of Biochemistry, Bayero University, Kano, Nigeria
| | - A S Mukaddas
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - A Kassim
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - F H Sa'ad
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | - F M Tukur
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - R Y Khalid
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - M Y Muhammad
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - M Bello
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - C P Edwin
- Department of Microbiology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - E Ogudo
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - K C Iregbu
- Department of Medical Microbiology, National Hospital Abuja, Abuja, Nigeria
| | - L Jones
- Department of Medical Microbiology Cardiff, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - K Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - P Ghazal
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - B Hassan
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - F J Belga
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - T R Walsh
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.,Department of Zoology, Ineos Institute of Antimicrobial Research, University of Oxford, Oxford, UK
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11
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Muluneh AG, Asratie MH, Gebremariam T, Adu A, Enyew MM, Cherkos EA, Melkamu S, Berta M, Mamo W, Kassahun D, Tsega NT, Kebede AA, Asmamaw DB, Kassa GM, Mihret MS. Lifetime adverse pregnancy outcomes and associated factors among antenatal care booked women in Central Gondar zone and Gondar city administration, Northwest Ethiopia. Front Public Health 2022; 10:966055. [PMID: 36033730 PMCID: PMC9399634 DOI: 10.3389/fpubh.2022.966055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/22/2022] [Indexed: 01/24/2023] Open
Abstract
Background In developing countries, adverse pregnancy outcomes are major public health issues. It is one of the leading causes of neonatal morbidity and mortality worldwide. Despite the fact that ending prenatal mortality and morbidity is one of the third Sustainable Development Goals (SDG), the burden of the problem continues to be a huge concern in developing countries, including Ethiopia. Hence, this study aimed to determine the prevalence and associated factors of lifetime adverse pregnancy outcomes among antenatal care (ANC) booked women in Northwest Ethiopia. Methods An institutional-based cross-sectional study design was conducted in Northwest Ethiopia, between March 2021 and June 2021. A multi-stage stratified random sampling technique was employed to recruit participants. An interviewer-administered and checklist questionnaire were used to collect the data. The data were entered into Epi-data version 4.6 software and exported to Stata version 16 for analysis. The binary logistic regression model was fitted to identify an association between associated factors and the outcome variable. Variables with a p-value of < 0.05 in the multivariable logistic regression model were declared as statistically significant. Results In this study, the lifetime prevalence of adverse pregnancy outcome among study participants was 14.53% (95%CI: 11.61, 18.04). Road access to the health facilities (AOR = 2.62; 95% CI: 1.14, 6.02) and husband-supported pregnancy (AOR = 2.63; 95 CI: 1.46, 4.72) were significantly associated with adverse pregnancy outcomes. Conclusions More than one in 10 reproductive age women had adverse pregnancy outcome throughout their life. Road access to health facilities and husband-supported pregnancy were statistically significant factors for adverse events in pregnancy. Therefore, it is better to give more attention to expanding infrastructure like road accessibility and increasing husband-supported pregnancy to reduce adverse pregnancy outcomes.
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Affiliation(s)
- Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tesfamichael Gebremariam
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aynalem Adu
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mihretu Molla Enyew
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Endeshaw Admasu Cherkos
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Senetsehuf Melkamu
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Martha Berta
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Worku Mamo
- North Gondar Zonal Health Department, Carter Center Zonal Project Coordinator, Gondar, Ethiopia
| | - Dawit Kassahun
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nuhamin Tesfa Tsega
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,*Correspondence: Desale Bihonegn Asmamaw
| | - Getahun Molla Kassa
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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12
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Soltanghoraee H, Moradi-Lakeh M, Khalili N, Soltani A. A retrospective autopsy study of 42 cases of stillbirth in Avicenna Research Institute. BMC Pregnancy Childbirth 2022; 22:507. [PMID: 35739463 PMCID: PMC9229882 DOI: 10.1186/s12884-022-04822-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to the World Health Organization about 2.6 million deaths were reported worldwide in 2015. More than 98% of stillbirths occur in developing countries. At present, the causes of many cases of stillbirth are unknown due to the lack of necessary data and autopsies in Iran. The aim of this study was to investigate the most plausible cause of stillbirth by evaluating clinical records and autopsies. METHODS A cross-sectional study of 42 stillbirth autopsies in Avicenna Research Institute from 2012 to 2019, was conducted. Data were extracted from a checklist prepared by the project researchers. The checklist contains maternal demographic information, medical history and maternal illness, pregnancy risk factors, placenta and stillbirth information. Collected data were reviewed and classified according to the ReCoDe (Relevant Condition at Death) system. RESULTS In the present study, based on ReCoDe classification, related causes of 95.2% of stillbirths were identified and 4.8% were in the unclassified group. The most common causes were: Fetal causes (64.3%), umbilical cord (14.3%), placenta (7.1%), amniotic fluid (4.8%), maternal medical conditions (2.4%). The causes of about 70% of stillbirth in Iran are unexplained, but in this study, using autopsy results and ReCoDe classification, only 4.8% of stillbirth causes remained unexplained. CONCLUSIONS In our study, unknown cases were rare after autopsy. But considering the limitations and costs of autopsy, we need to design the guideline to specify cases who need an autopsy. Fetal autopsy, placental examination and clinical information could reduce the proportion of stillbirths that remain unexplained.
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Affiliation(s)
- Haleh Soltanghoraee
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research InstituteDepartment of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Narjes Khalili
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research InstituteDepartment of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Azadeh Soltani
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
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Dinh N, Agarwal S, Avery L, Ponnappan P, Chelangat J, Amendola P, Labrique A, Bartlett L. Implementation Outcomes Assessment of a Digital Clinical Support Tool for Intrapartum Care in Rural Kenya: Observational Analysis. JMIR Form Res 2022; 6:e34741. [PMID: 35723911 PMCID: PMC9253974 DOI: 10.2196/34741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022] Open
Abstract
Background iDeliver, a digital clinical support system for maternal and neonatal care, was developed to support quality of care improvements in Kenya. Objective Taking an implementation research approach, we evaluated the adoption and fidelity of iDeliver over time and assessed the feasibility of its use to provide routine Ministry of Health (MOH) reports. Methods We analyzed routinely collected data from iDeliver, which was implemented at the Transmara West Sub-County Hospital from December 2018 to September 2020. To evaluate its adoption, we assessed the proportion of actual facility deliveries that was recorded in iDeliver over time. We evaluated the fidelity of iDeliver use by studying the completeness of data entry by care providers during each stage of the labor and delivery workflow and whether the use reflected iDeliver’s envisioned function. We also examined the data completeness of the maternal and neonatal indicators prioritized by the Kenya MOH. Results A total of 1164 deliveries were registered in iDeliver, capturing 45.31% (1164/2569) of the facility’s deliveries over 22 months. This uptake of registration improved significantly over time by 6.7% (SE 2.1) on average in each quarter-year (P=.005), from 9.6% (15/157) in the fourth quarter of 2018 to 64% (235/367) in the third quarter of 2020. Across iDeliver’s workflow, the overall completion rate of all variables improved significantly by 2.9% (SE 0.4) on average in each quarter-year (P<.001), from 22.25% (257/1155) in the fourth quarter of 2018 to 49.21% (8905/18,095) in the third quarter of 2020. Data completion was highest for the discharge-labor summary stage (16,796/23,280, 72.15%) and lowest for the labor signs stage (848/5820, 14.57%). The completion rate of the key MOH indicators also improved significantly by 4.6% (SE 0.5) on average in each quarter-year (P<.001), from 27.1% (69/255) in the fourth quarter of 2018 to 83.75% (3346/3995) in the third quarter of 2020. Conclusions iDeliver’s adoption and data completeness improved significantly over time. The assessment of iDeliver’ use fidelity suggested that some features were more easily used because providers had time to enter data; however, there was low use during active childbirth, which is when providers are necessarily engaged with the woman and newborn. These insights on the adoption and fidelity of iDeliver use prompted the team to adapt the application to reflect the users’ culture of use and further improve the implementation of iDeliver.
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Affiliation(s)
- Nhi Dinh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Smisha Agarwal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Lisa Avery
- Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | | | | | | | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Linda Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Changede P, Venkateswaran S, Nayak A, Wade D, Sonawane P, Patel R, Rajput H. Causes and Demographic Factors Affecting Stillbirth in a Tertiary Care Centre in India. J Obstet Gynaecol India 2022; 72:225-235. [DOI: 10.1007/s13224-021-01571-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/19/2021] [Indexed: 10/19/2022] Open
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15
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Incidence of Intrapartum-Related Events at the Largest Obstetric Hospital in Hanoi, Vietnam: A Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030321. [PMID: 35327693 PMCID: PMC8947411 DOI: 10.3390/children9030321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Every year, 2.4 million neonates die during their first month of life and even more suffer permanent injury. The main causes are intrapartum-related events, prematurity, and infection, with sub-Saharan Africa and southern Asia being the worst affected regions. With a focus on intrapartum-related events, we aimed to assess the neonatal demographic characteristics, clinical management, and outcomes among neonates born at the largest obstetric hospital in Hanoi, Vietnam. This was a retrospective cross-sectional study that included all the inborn neonates in November 2019, which was selected as a representative month. A total of 4554 neonates were born during the study period. Of these, 1.0% (n = 44) were stillbirths, 0.15% (n = 7) died in hospital, 0.61% (n = 28) received positive pressure ventilation at birth, and 0.15% (n = 7) were diagnosed with hypoxic ischemic encephalopathy. A total of 581 (13%) neonates were admitted to the neonatal unit, among which the most common diagnoses were prematurity (37%, n = 217) and infection (15%, n = 89). Except for the intrapartum-related events, our findings are consistent with the previously documented data on neonatal morbidity. The intrapartum-related events, however, were surprisingly low in number even in comparison to high-income countries. Research on the current clinical practice at Phu San Hanoi Hospital may bring further clarity to identify the success factors.
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Milton R, Zara Modibbo F, Watkins WJ, Gillespie D, Alkali FI, Bello M, Edwin CP, Habib Sa ad F, Hood K, Iregbu K, Kassim A, Khalid RY, Muhammad MY, Mukaddas AS, Ogudo E, Tukur FM, Walsh TR. Determinants of Stillbirth From Two Observational Studies Investigating Deliveries in Kano, Nigeria. Front Glob Womens Health 2022; 2:788157. [PMID: 35098214 PMCID: PMC8795591 DOI: 10.3389/fgwh.2021.788157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/19/2021] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Rebecca Milton
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | | | - William John Watkins
- Department of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - David Gillespie
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | | | | | | | | | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | | | | | | | | | | | - Ese Ogudo
- Murtala Muhammad Specialist Hospital, Kano, Nigeria
| | | | - Timothy Rutland Walsh
- Department of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Department of Zoology, Ineos Institute of Antimicrobial Research, University of Oxford, Oxford, United Kingdom
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17
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Milton R, Alkali FI, Modibbo F, Sanders J, Mukaddas AS, Kassim A, Sa'ad FH, Tukur FM, Pell B, Hood K, Ghazal P, Iregbu KC. A qualitative focus group study concerning perceptions and experiences of Nigerian mothers on stillbirths. BMC Pregnancy Childbirth 2021; 21:830. [PMID: 34906118 PMCID: PMC8670111 DOI: 10.1186/s12884-021-04207-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- R Milton
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - F I Alkali
- Department of Biochemistry, Bayero University, Kano, Nigeria
| | - F Modibbo
- Murtala Muhammad Specialist Hospital, Kano, Nigeria
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - A S Mukaddas
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - A Kassim
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - F H Sa'ad
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | - F M Tukur
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - B Pell
- Centre for the Development and Evaluation of Complex Intervention for Public Health Improvement, Cardiff University, Cardiff, UK
| | - K Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - P Ghazal
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - K C Iregbu
- Department of Medical Microbiology, National Hospital, Abuja, Nigeria
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van den Broek N. Keep it simple - Effective training in obstetrics for low- and middle-income countries. Best Pract Res Clin Obstet Gynaecol 2021; 80:25-38. [PMID: 34872860 DOI: 10.1016/j.bpobgyn.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Abstract
In low-and middle-income countries, the burden of disease related to pregnancy and childbirth remains high. The health of the mother is intricately linked to that of the baby. Neonatal mortality is most likely to occur in the first week of life accounting for almost half of all deaths among children under 5-year old. Many babies are stillborn each year. It is important that healthcare is accessible, available, and of good quality. This requires a functioning health system with motivated, competent healthcare providers who were able to provide the continuum of care for mothers and babies. Pre- and in-service training is effective if it uses adult learning approaches, includes all members of the maternity team, and is focused on the core content of the care packages that are agreed for each setting. Most programmes that seek to build the capacity of the health system include training as one of the interventions to be implemented.
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Affiliation(s)
- Nynke van den Broek
- Maternal and Newborn Health, Independent Consultant Global Health, 5 Newcroft Road, Liverpool, L25 6EP, United Kingdom.
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Association of Stillbirths with Maternal and Fetal Risk Factors in a Tertiary Care Hospital in South India. Obstet Gynecol Int 2021; 2021:8033248. [PMID: 34335785 PMCID: PMC8324385 DOI: 10.1155/2021/8033248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/16/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022] Open
Abstract
Background Birth of a fetus with no signs of life after a predefined age of viability is a nightmare for the obstetrician. Stillbirth is a sensitive indicator of maternal care during the antepartum and intrapartum period. Though there has been a renewed global focus on stillbirth as a public health concern, the decline in stillbirth rate (SBR) has not been satisfactory across the nations, with a large number of stillbirths occurring in the low- to middle-income countries (LMICs). Hence, the study was carried out to analyze maternal and fetal risk factors and their association with stillbirths in a tertiary care center in South India. Methods This observational prospective study included pregnant women with stillbirth beyond 20 weeks of gestation or fetal weight more than 500 grams. Stillbirths were classified according to the simplified causes of death and associated conditions (CODAC) classification. Association between the risk factor and stillbirths was calculated with chi-square test and odds ratio with 95% confidence interval. Results There were 171 stillbirths (2.97%) among total 5755 births. The SBR was 29.71/1000 births. Risk factors such as preterm delivery (OR: 22.33, 95% CI: 15.35–32.50), anemia (OR: 21.87, 95% CI: 15.69–30.48), congenital malformation (OR: 11.24, 95% CI: 6.99–18.06), abruption (OR: 10.14, 95% CI: 6.43–15.97), oligohydramnios (OR: 4.88, 95% CI: 3.23–7.39), and hypertensive disorder (OR: 3.01, 95% CI: 2.03–4.46) were significantly associated with stillbirths. The proportion of intrapartum stillbirths was found to be 5 (3%) among the study population. Conclusion Highest prevalent risk factors associated with stillbirth are anemia and prematurity. Intrapartum stillbirths can be reduced significantly through evidence-based clinical interventions and practices in resource-poor settings. There is a need to provide and assure access to specialized quality antenatal care to pregnant women to control the risk factors associated with stillbirths.
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Abebe H, Shitu S, Workye H, Mose A. Predictors of stillbirth among women who had given birth in Southern Ethiopia, 2020: A case-control study. PLoS One 2021; 16:e0249865. [PMID: 33939713 PMCID: PMC8092801 DOI: 10.1371/journal.pone.0249865] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Although the rate of stillbirth has decreased globally, it remains unacceptably high in low- and middle-income countries. Only ten countries including Ethiopia attribute more than 65% of global burden of still birth. Ethiopia has the 7th highest still birth rate in the world. Identifying the predictors of stillbirth is critical for developing successful interventions and monitoring public health programs. Although certain studies have assessed the predictors of stillbirth, they failed in identify the proximate predictors of stillbirth. In addition, the inconsistent findings in identify the predictors of stillbirth, and the methodological limitations in previously published works are some of the gaps. Therefore, this study aimed to identify the predictors of stillbirth among mothers who gave birth in six referral hospitals in Southern, Ethiopia. Methods A hospital-based unmatched case-control study was conducted in six referral hospitals in Southern, Ethiopia from October 2019 to June 2020. Consecutive sampling techniques and simple random techniques were used to recruit cases and controls respectively. A structured standard tool was used to identify the predictors of stillbirth. Data were entered into Epi Info 7 and exported to SPSS 23 for analysis. A multivariable logistic regression model was used to identify the independent predictors of stillbirth. The goodness of fit was tested using the Hosmer and Lemeshow goodness-of-fit. In this study P-value < 0.05 was considered to declare a result as a statistically significant association. Results In this study 138 stillbirth cases and 269 controls were included. Women with multiple pregnancy [AOR = 2.98, 95%CI: 1.39–6.36], having preterm birth [AOR = 2.83, 95%CI: 1.58–508], having cesarean mode of delivery [AOR = 3.19, 95%CI: 1.87–5.44], having no ANC visit [AOR = 4.17, 95%CI: 2.38–7.33], and being hypertensive during pregnancy [AOR = 3.43, 95%CI: 1.93–6.06] were significantly associated with stillbirth. Conclusions The predictors of stillbirth identified are manageable and can be amenable to interventions. Therefore, strengthening maternal antenatal care utilization should be encouraged by providing appropriate information to the mothers. There is a need to identify, screen, and critically follow high-risk mothers: those who have different complications during pregnancy, and those undergoing cesarean section due to different indications.
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Affiliation(s)
- Haimanot Abebe
- Department of Public Health, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
- * E-mail:
| | - Solomon Shitu
- Department of Midwifery, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
| | - Haile Workye
- Department of Nursing, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
| | - Ayenew Mose
- Department of Midwifery, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
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Gizaw W, Feyisa M, Hailu D, Nigussie T. Determinants of stillbirth in hospitals of North Shoa Zone, Oromia region, Central Ethiopia: A case control study. Heliyon 2021; 7:e07070. [PMID: 34041408 PMCID: PMC8141871 DOI: 10.1016/j.heliyon.2021.e07070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/04/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND World Health Organization defined stillbirth as birth of fetus at 28 weeks or above gestation with a birth weight of ≥1000 g or body length of ≥35 cm. Majority of stillbirths occur in low and middle income nations. Efforts made in Ethiopia to improve maternal and child health are showing encouraging results, even though the magnitude didn't reach the expected level. Identification of determinants of stillbirth is quite substantial to apply further meaningful actions. OBJECTIVE To assess the determinants of stillbirth in hospitals of North Shoa Zone, Oromia region, Central Ethiopia. METHOD Institution based unmatched Case control study was conducted from March 01 to May 30/2019 among 342 women who gave birth in Fitche, Kuyu, Gundomeskel, and Muketurihospitals. Sample size was calculated by using Epi-info version 7.1.1 software package. Statistical Package for Social Sciences version 25 was used to analyze the data. Descriptive statistics, bivariate and multivariate logistic regression analysis were conducted. Variables having P-value ≤ 0.05 in multivariable logistic regression were considered as statistically significant. RESULT Type of labor (AOR = 3.79, 95%CI = 1.53, 9.38), duration of labor (AOR = 3.59, 95% CI = 1.53, 8.33), mal-presentation (AOR = 3.45, 95%CI = 1.99, 9.8), preeclampsia/eclampsia (AOR = 4.58, 95%CI = 1.45, 14.48) and birth defect (AOR = 3.05, 95%CI = 1.31, 7.1) were found to be the determinants of stillbirth. CONCLUSION AND RECOMMENDATION Causes of still birth in more than two third of the cases were identified. Type of labor, duration of labor, mal presentation, preeclampsia/eclampsia were identified as determinants of stillbirth from mothers' side while birth defect was found to be determinant of stillbirth from fetal side. Heath care providers, policy makers, and other stakeholders, should focus on identified factors to combat problems associated with still birth.
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Affiliation(s)
- Workineh Gizaw
- Department of Midwifery, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Mulugeta Feyisa
- Department of Midwifery, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Dejene Hailu
- Department of Nursing, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Tadesse Nigussie
- Department of Public Health, College of Health Sciences, Mizan Tepi University, Mizan Aman, Ethiopia
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Canuto IMDB, Macêdo VCD, Frias PGD, Oliveira CMD, Costa HVVD, Portugal JL, Bonfim CVD. Spatial patterns of avoidable fetal mortality and social deprivation. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210007. [PMID: 33886880 DOI: 10.1590/1980-549720210007.supl.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/03/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To develop a social need index for stratification of municipalities and identification of priority areas for reducing fetal mortality. METHODS ecological study, carried out in the state of Pernambuco, between 2010 and 2017. The technique of factor analysis by main components was used for the elaboration of the social need index. In the spatial analysis, the local empirical Bayesian estimator was applied and Moran's spatial autocorrelation was verified. RESULTS The social deprivation index selected two factors that, together, explained 77.63% of the total variance. The preventable fetal mortality rate increased among strata of social need, with rates of 8.0 per thousand births (low deprivation), 8.1 per thousand (medium deprivation), 8.8 per thousand (high deprivation), and 10.7 per thousand (very high social deprivation). Some municipalities in the São Francisco and Sertão Mesoregions had both high fetal and preventable fetal mortality, in addition to a very high social deprivation rate. Conclusion: The spatial analysis identified areas with the highest risk for fetal mortality. The social deprivation index listed some determinants of fetal deaths in areas with worse living conditions. Priority areas for intervention in public policies to reduce fetal mortality and its determinants were detected.
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Antenatal Uterotonics as a Risk Factor for Intrapartum Stillbirth and First-day Death in Haryana, India: A Nested Case-control Study. Epidemiology 2021; 31:668-676. [PMID: 32618713 DOI: 10.1097/ede.0000000000001224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Use of uterotonics like oxytocin to induce or augment labor has been shown to reduce placental perfusion and oxygen supply to the fetus, and studies indicate that it may increase the risk of stillbirth and neonatal asphyxia. Antenatal use of uterotonics, even without the required fetal monitoring and prompt access to cesarean section, is widespread, yet no study has adequately estimated the risk of intrapartum stillbirth and early neonatal deaths ascribed to such use. We conducted a case-control study to estimate this risk. METHODS We conducted a population-based case-control study nested in a cluster-randomized trial. From 2008 to 2010, we followed pregnant women in rural Haryana, India, monthly until delivery. We visited all live-born infants on day 29 to ascertain whether they were alive. We conducted verbal autopsies for stillbirths and neonatal deaths. Cases (n = 2,076) were the intrapartum stillbirths and day-1 deaths (early deaths), and controls (n = 532) were live-born babies who died between day 8 and 28 (late deaths). RESULTS Antenatal administration of uterotonics preceded 74% of early and 62% of late deaths, translating to an adjusted odds ratio (95% confidence interval [CI]) for early deaths of 1.7 (95% CI = 1.4, 2.1), and a population attributable risk of 31% (95% CI = 22%, 38%). CONCLUSIONS Antenatal administration of uterotonics was associated with a substantially increased risk of intrapartum stillbirth and day-1 death. See video abstract: http://links.lww.com/EDE/B707.
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Bedwell C, Blaikie K, Actis Danna V, Sutton C, Laisser R, Tembo Kasengele C, Wakasiaka S, Victor S, Lavender T. Understanding the complexities of unexplained stillbirth in sub-Saharan Africa: a mixed-methods study. BJOG 2021; 128:1206-1214. [PMID: 33319470 PMCID: PMC8248405 DOI: 10.1111/1471-0528.16629] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 01/10/2023]
Abstract
Objective To understand the complexities surrounding unexplained stillbirth for the development and implementation of culturally acceptable interventions to underpin care in Tanzania and Zambia. Design Mixed‐methods study. Setting Tertiary, secondary and primary care facilities in Mansa, Zambia, and Mwanza, Tanzania. Sample Quantitative: 1997 women giving birth at two tertiary care facilities (one in each country). Qualitative: 48 women and 19 partners from tertiary, secondary and primary care facilities. Methods Case review using data from a target of 2000 consecutive case records. Qualitative interviews with a purposive sample of women and partners, using a grounded theory approach. Results A total of 261 stillbirths were recorded, with a rate of 16% in Tanzania and 10% in Zambia, which is higher than the previous estimates of 2.24 and 2.09%, respectively, for those countries. Women in both countries who reported a previous stillbirth were more likely to have stillbirth (RR 1.86, 95% CI 1.23–2.81). The cause of death was unexplained in 28% of cases. Qualitative findings indicated that not knowing what caused the baby to be stillborn prevented women from grieving. This was compounded by the poor communication skills of health professionals, who displayed little empathy and skill when counselling bereaved families. Conclusions The stillbirth risk in both facilities was far higher than the risk recorded from national data, with women reporting a previous stillbirth being at higher risk. Women want to know the cause of stillbirth and an exploration of appropriate investigations in this setting is required. Providing health professionals with support and continuing training is key to improving the experiences of women and future care. Tweetable abstract Stillbirths receive little investigation and are often unexplained. Communication with women about the death of their baby is limited. Stillbirths receive little investigation and are often unexplained. Communication with women about the death of their baby is limited.
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Affiliation(s)
- C Bedwell
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Blaikie
- School of Health Sciences, University of Manchester, Manchester, UK
| | - V Actis Danna
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - C Sutton
- School of Health Sciences, University of Manchester, Manchester, UK
| | - R Laisser
- Archbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Health Sciences, Mwanza, Tanzania
| | - C Tembo Kasengele
- Department of Public Health and Research, Ministry of Health Headquarters, Lusaka, Zambia
| | | | - S Victor
- Perinatal Imaging and Health, King's College London, London, UK
| | - T Lavender
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Gwako GN, Obimbo MM, Gichangi PB, Kinuthia J, Gachuno OW, Were F. Association between obstetric and medical risk factors and stillbirths in a low-income urban setting. Int J Gynaecol Obstet 2020; 154:331-336. [PMID: 33306840 DOI: 10.1002/ijgo.13528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/08/2020] [Accepted: 12/08/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the association between obstetric and medical risk factors and stillbirths in a Kenyan set-up. METHODS A case-control study was conducted in four hospitals between August 2018 and April 2019. Two hundred and fourteen women with stillbirths and 428 with live births at more than >28 weeks of gestation were enrolled. Data collection was via interviews and abstraction from medical records. Outcome variables were stillbirth and live birth; exposure variables were sociodemographic characteristics, and medical and obstetric factors. The two-sample t test and χ2 test were used to compare continuous and categorical variables respectively. The association between the exposure and outcome variable was done using logistic regression. A P value less than 0.05 was considered statistically significant. RESULTS Stillbirth was associated with pre-eclampsia without severe features (odds ratio [OR] 9.1, 95% confidence interval [CI] 2.6-32.5), pre-eclampsia with severe features (OR 7.4, 95% CI 2.4-22.8); eclampsia (OR 9.2, 95% CI 2.6-32.5), placenta previa (OR 8.6 95% CI 2.8-25.9), placental abruption (OR 6.9 95% CI 2.2-21.3), preterm delivery(OR 9.5, 95% CI 5.7-16), and gestational diabetes mellitus, (OR 11.5, 95% CI 2.5-52.6). Stillbirth was not associated with multiparity, anemia, and HIV. CONCLUSION Proper antepartum care and surveillance to identify and manage medical and obstetric conditions with the potential to cause stillbirth are recommended.
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Affiliation(s)
- George N Gwako
- Department of Obstetrics & Gynecology, University of Nairobi, Nairobi, Kenya
| | - Moses M Obimbo
- Department of Obstetrics & Gynecology, University of Nairobi, Nairobi, Kenya.,Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Peter B Gichangi
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.,Deputy Vice-Chancellor Academic, Research and Extension, Technical University of Mombasa, Mombasa, Kenya
| | - John Kinuthia
- Department of Obstetrics & Gynecology, University of Nairobi, Nairobi, Kenya.,Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Onesmus W Gachuno
- Department of Obstetrics & Gynecology, University of Nairobi, Nairobi, Kenya
| | - Fredrick Were
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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