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Abate M, Arefaynie M, Muche A, Molla A, Wodajo S, Temesgen K, Fentaw Z, Tefera Z, Habtewold TD. The effect of maternal age on still birth in Africa: A systematic review and meta-analysis. Health Sci Rep 2024; 7:e2105. [PMID: 38784246 PMCID: PMC11111610 DOI: 10.1002/hsr2.2105] [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: 06/04/2023] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024] Open
Abstract
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.
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Affiliation(s)
- Mengistu Abate
- Department of Midwifery, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Amare Muche
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Asressie Molla
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Shambel Wodajo
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Kibir Temesgen
- Department of Midwifery, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Zinabu Fentaw
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Zenebe Tefera
- Department of Midwifery, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Tesfa D. Habtewold
- Department of EpidemiologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
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Mforteh AAA, Pisoh DW, Boten M, Andoh NEL, Tameh TY, Mbi-Kobenge AFE, Ombaku KS, Takang WA, Mbu RE. Stillbirth rate and associated factors at the Bamenda Regional hospital, North-West region, Cameroon, from 2018 to 2022: a case control study. BMC Pregnancy Childbirth 2024; 24:270. [PMID: 38609848 PMCID: PMC11010432 DOI: 10.1186/s12884-024-06486-z] [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: 08/27/2023] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Stillbirth is a common adverse pregnancy outcome worldwide, with an estimated 2.6 million stillbirths yearly. In Cameroon, the reported rate in 2015 was 19.6 per 1000 live births. Several risk factors have been described, but region-specific risk factors are not known in the northwest region of Cameroon. This study aims to determine the stillbirth rate and associated factors at the Bamenda Regional hospital, North-West region of Cameroon. MATERIALS AND METHODS A Hospital-based case‒control study conducted from December 2022 to June 2023 on medical files from 2018 to 2022 at the Bamenda Regional Hospital. Cases were women with stillbirths that occurred at a gestational age of ≥ 28 weeks, while controls were women with livebirths matched in a 1:2 (1 case for 2 controls) ratio using maternal age. Sociodemographic, obstetric, medical, and neonatal factors were used as exposure variables. Multivariable logistic regression was used to determine adjusted odds ratios of exposure variables with 95% confidence intervals and a p value of < 0.05. RESULTS A total of 12,980 births including 116 stillbirths giving a stillbirth rate of 8.9 per 1000 live births. A hundred cases and 200 controls were included. Factors associated with stillbirths after multivariable analysis include nulliparity (aOR = 3.89; 95% CI: 1.19-12.71; p = 0.025), not attending antenatal care (aOR = 104; 95% CI: 3.17-3472; p = 0.009), history of stillbirth (aOR = 44; 95% CI: 7-270; p < 0.0001), placenta abruption (aOR = 14; 95% CI: 2.4-84; p = 0.003), hypertensive disorder in pregnancy (aOR = 18; 95% CI: 3.4-98; p = 0.001), malaria (aOR = 8; 95% CI: 1.51-42; p = 0.015), alcohol consumption (aOR = 9; 95% CI: 1.72-50; p = 0.01), birth weight less than 2500 g (aOR = 16; 95% CI: 3.0-89; p = 0.001), and congenital malformations (aOR = 12.6; 95% CI: 1.06-149.7;p = 0.045). CONCLUSION The stillbirth rate in BRH is 8.9 per 1000 live births. Associated factors for stillbirth include nulliparity, not attending antenatal care, history of stillbirth, placental abruption, hypertensive disorder in pregnancy, malaria, alcohol consumption, birth weight less than 2500 g, and congenital malformations. Close antenatal care follow-up of women with such associated factors is recommended.
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Affiliation(s)
- Achuo Ascensius Ambe Mforteh
- Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bamenda, Cameroon.
- Bamenda Regional Hospital, Bamenda, Cameroon.
| | - Dobgima Walter Pisoh
- Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bamenda, Cameroon
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Merlin Boten
- Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bamenda, Cameroon
| | | | | | | | | | - William Ako Takang
- Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bamenda, Cameroon
| | - Robinson Enow Mbu
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
- Yaoundé Gyneco-Obstetric and Paediatric Hospital, Yaounde, Cameroon
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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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Arega BN, Feleke LA, Tilahun HA, Ahmed DM, Hailu FG. Proportion of stillbirth and associated factors among women who deliver at public hospitals in Bahir Dar city, north-West Ethiopia. BMC Womens Health 2024; 24:122. [PMID: 38365779 PMCID: PMC10870528 DOI: 10.1186/s12905-024-02920-8] [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: 05/28/2023] [Accepted: 01/21/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION The annual global burden of stillbirths is estimated to be 3.2 million, of which 98% occur in low and middle-income countries (LMICs). In the Amhara region of Ethiopia, the prevalence of stillbirth outcomes was 85 per 1000. Ethiopia is experiencing an increase in the number of health professionals attending deliveries, however, stillbirth rates are not decreasing as anticipated. However, there are limited numbers of studies done related to the proportion of stillbirths and associated factors in the study area. This study aimed to assess the proportion of stillbirths and associated factors among women who attended deliveries at Tibebe Ghion Specialized Hospital and Felege Hiwot Comprehensive Specialized Hospital. METHODS An institutional-based cross-sectional study was conducted on 366 women who delivered at two referral hospitals in Bahir Dar from April 1, 2020, to August 30, 2020. Study participants were selected using systematic random sampling techniques. A checklist and structured questionnaire were used to retrieve information from the clients and their attendants. The collected data were cleaned, coded, and entered into Epi-data version 3.1 and then exported into SPSS 23 for analysis. Bivariate and multivariable logistic regression analysis was computed to identify statistically significant associated factors with a P value < 0.05. The results were presented in tables and charts. RESULT The proportion of stillbirths was 3.8% in this study area. This study showed that level of education, who completed primary school (AOR = 0.12; 95% CI (0.01, 0.98)), not using partograph (AOR = 3.77, 95%; CI (1.02; 13.93)), and obstetric complication (AOR = 6.7; 95% CI (1.54, 29.79) were the major factors affecting the stillbirth. CONCLUSION Our study found that stillbirth rate remains a major public health problem. Illiteracy, not using a partograph, and having obstetric complications were major associated factors for stillbirth. The risk factors identified in this study can be prevented and managed by providing appropriate care during preconception, antepartum, and intrapartum periods.
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Affiliation(s)
- Bantayehu Nega Arega
- Department of obstetrics and gynecology, college of medicine and health sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Lakachew Asrade Feleke
- Department of obstetrics and gynecology, college of medicine and health sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Hiwotemariam Alemu Tilahun
- Department of obstetrics and gynecology, college of medicine and health sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Dawud Muhammed Ahmed
- Department of obstetrics and gynecology, college of medicine and health sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fekadie Getachew Hailu
- Department of obstetrics and gynecology, college of medicine and health sciences, Bahir Dar University, Bahir Dar, Ethiopia
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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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Kasa GA, Woldemariam AY, Adella A, Alemu B. The factors associated with stillbirths among sub-saharan African deliveries: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:835. [PMID: 38049743 PMCID: PMC10696713 DOI: 10.1186/s12884-023-06148-6] [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: 05/23/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023] Open
Abstract
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.
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Affiliation(s)
- Getachew Adela Kasa
- School of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | | | - Alemayehu Adella
- West Shoa Zone Health Bureau, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Bezatu Alemu
- School of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Mulatu T, Debella A, Feto T, Dessie Y. Determinants of stillbirth among women who gave birth at Hiwot Fana Specialized University Hospital, Eastern Ethiopia: A facility-based cross-sectional study. SAGE Open Med 2022; 10:20503121221076370. [PMID: 35154742 PMCID: PMC8832588 DOI: 10.1177/20503121221076370] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/10/2022] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Teshale Mulatu
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilaye Feto
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Mengistu S, Debella A, Mulatu T, Mesfin F, Danusa KT, Dheresa M. Stillbirth and Associated Factors Among Women Who Gave Birth at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia. Front Pediatr 2022; 10:820308. [PMID: 35633972 PMCID: PMC9133714 DOI: 10.3389/fped.2022.820308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Seble Mengistu
- Hiwot Fana Specialized University Hospital, College of Health and Medical Science, Haramaya University, Dire Dawa, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Dire Dawa, Ethiopia
| | - Teshale Mulatu
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Dire Dawa, Ethiopia
| | - Firehiwot Mesfin
- School of Public Health, College of Health and Medical Science, Haramaya University, Dire Dawa, Ethiopia
| | - Kababa Temesgen Danusa
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Dire Dawa, Ethiopia
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Liyew AD, Molla M, Azene ZN. Risk Factors of Stillbirth Among Women Who Gave Birth in Amhara Region Referral Hospitals, Ethiopia, in 2019: A Case-Control Study. Int J Womens Health 2021; 13:557-567. [PMID: 34149288 PMCID: PMC8205615 DOI: 10.2147/ijwh.s305786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
| | - Mihretu Molla
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zelalem Nigussie Azene
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Fikre R, Ejeta S, Gari T, Alemayhu A. Determinants of stillbirths among women who gave birth at Hawassa university comprehensive specialized hospital, Hawassa, Sidama, Ethiopia 2019: a case-control study. Matern Health Neonatol Perinatol 2021; 7:10. [PMID: 33597030 PMCID: PMC7888129 DOI: 10.1186/s40748-021-00128-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/14/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Globally over 2.6 million pregnancy ends with stillbirth annually. Despite this fact, only a few sherds of evidence were available about factors associated with stillbirth in Ethiopia. Therefore, the study aimed to spot factors related to stillbirth among women who gave birth at Hawassa University Comprehensive Specialized Hospital Hawassa, Sidama Ethiopia, 2019. METHODS Facility-based unmatched case-control study was conducted at Hawassa University Comprehensive Specialized Hospital. Cases were selected using simple random sampling technique and controls were recruited to the study consecutively after every case selection with case to control ratio of 1 to 3. Data were coded and entered into Epi-data version 3.1 and exported to SPSS version 24 for analysis. RESULTS A total of 106 cases and 318 controls were included in the study. Number of antenatal care visit [AOR = 0.38, 95% CI (0.15, 0.95)], lack of partograph utilization [AOR = 4.1 95% CI (2.04, 10.5)], prolonged labor [AOR = 6.5, 95% CI (2.9, 14.4)], obstructed labor [AOR = 3.5, 95% CI (1.5, 9.4)], and congenital defect [AOR = 9.7, 95% CI (4.08, 23.0)] were significantly associated with stillbirth. CONCLUSION Absence of partograph utilization, prolonged labor, obstructed labor, antepartum hemorrhage and congenital anomaly were found to have positive association with stillbirth.
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Affiliation(s)
- Rekiku Fikre
- Mettu University, College of Health Science, P.O. Box 2156, Mettu, Ethiopia.
| | - Samuel Ejeta
- Mettu University, College of Health Science, P.O. Box 2156, Mettu, Ethiopia.
| | - Taye Gari
- Mettu University, College of Health Science, P.O. Box 2156, Mettu, Ethiopia
| | - Akalewold Alemayhu
- Hawassa University, College of Medicine and Health Science, School of public health, P.O. Box 1560, Awassa, Ethiopia
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Okunowo AA, Smith-Okonu ST. The trend and characteristics of stillbirth delivery in a university teaching hospital in Lagos, Nigeria. Ann Afr Med 2021; 19:221-229. [PMID: 33243944 PMCID: PMC8015951 DOI: 10.4103/aam.aam_44_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: The burden of stillbirth is so huge in sub-Saharan Africa, especially in Nigeria where many mothers and mothers-to-be are denied the joy of motherhood. Despite the frequent occurrence of this obstetric problem in our environment, little priority is placed on it. Objectives: The study aims to bring to the fore, the burden, trend, and characteristics of stillbirth delivery in Lagos, Nigeria. Subjects and Methods: This was a 5-year descriptive retrospective study of the case records of women who had stillbirth delivery at Lagos University Teaching Hospital from January 2009 to December 2013. Relevant information was obtained using a study pro forma, and data analysis was carried out using SPSS version 20.0. Results: The prevalence of stillbirth was 6.2%, and the rate was 61.8/1000 total births. Women who did not book for antenatal care accounted for 76.2% of the cases, and the antenatal and intrapartum stillbirths accounted for 64.6% and 35.4%, respectively. The mean gestational age was 35.5 ± 1.2 weeks, while the mean birth weight was 2.9 ± 1.0 kg. Majority of the stillbirths were male fetuses (54.5%). Previous history of stillbirth (36.0%), hypertensive disorders in pregnancy (33.0%), placental abruption (28.8%), intrauterine growth restriction (13.0%), and ruptured uterus (11.3%) were the common clinical risk factors identified. Conclusion: The burden of stillbirth is high in our environment, and majority is due to preventable or manageable obstetric conditions. There is a need to encourage early referral of complicated pregnancies and labor to specialized centers that can cater for them, so as to avoid unnecessary and preventable deaths.
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Affiliation(s)
- Adeyemi Adebola Okunowo
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
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Lema G, Mremi A, Amsi P, Pyuza JJ, Alloyce JP, Mchome B, Mlay P. Placental pathology and maternal factors associated with stillbirth: An institutional based case-control study in Northern Tanzania. PLoS One 2020; 15:e0243455. [PMID: 33382728 PMCID: PMC7775101 DOI: 10.1371/journal.pone.0243455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/22/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the placental pathologies and maternal factors associated with stillbirth at Kilimanjaro Christian Medical Centre, a tertiary referral hospital in Northern Tanzania. METHODS A 1:2 unmatched case-control study was carried out among deliveries over an 8-month period. Stillbirths were a case group and live births were the control group. Respective placentas of the newborns from both groups were histopathologically analyzed. Maternal information was collected via chart review. Mean and standard deviation were used to summarize the numerical variables while frequency and percentage were used to summarize categorical variables. Crude and adjusted logistic regressions were done to test the association between each variable and the risk of stillbirth. RESULTS A total of 2305 women delivered during the study period. Their mean age was 30 ± 5.9 years. Of all deliveries, 2207 (95.8%) were live births while 98 (4.2%) were stillbirths. Of these, 96 stillbirths (cases) and 192 live births (controls) were enrolled. The average gestational age for the enrolled cases was 33.8 ±3.2 weeks while that of the controls was 36.3±3.6 weeks, (p-value 0.244). Of all stillbirths, nearly two thirds 61(63.5%) were males while the females were 35(36.5%). Of the stillbirth, 41were fresh stillbirths while 55 were macerated. The risk of stillbirth was significantly associated with lower maternal education [aOR (95% CI): 5.22(2.01-13.58)], history of stillbirth [aOR (95%CI): 3.17(1.20-8.36)], lower number of antenatal visits [aOR (95%CI): 6.68(2.71-16.48), pre/eclampsia [aOR (95%CI): 4.06(2.03-8.13)], and ante partum haemorrhage [OR (95%CI): 2.39(1.04-5.53)]. Placental pathology associated with stillbirth included utero-placental vascular pathology and acute chorioamnionitis. CONCLUSIONS Educating the mothers on the importance of regular antenatal clinic attendance, monitoring and managing maternal conditions during antenatal periods should be emphasized. Placentas from stillbirths should be histo-pathologically evaluated to better understand the possible aetiology of stillbirths.
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Affiliation(s)
- Godwin Lema
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Alex Mremi
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Pathology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Patrick Amsi
- Department of Pathology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Jeremia J. Pyuza
- Department of Pathology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Julius P. Alloyce
- Cancer Registry Unit, Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Bariki Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Pendo Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Egbe TO, Ewane EN, Tendongfor N. Stillbirth rates and associated risk factors at the Buea and Limbe regional hospitals, Cameroon: a case-control study. BMC Pregnancy Childbirth 2020; 20:75. [PMID: 32013904 PMCID: PMC6998238 DOI: 10.1186/s12884-020-2767-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/24/2020] [Indexed: 12/20/2022] Open
Abstract
Background Stillbirths bring grief to both mother and family but have been underreported in Cameroon. We aimed at determining the stillbirth rates and associated risk factors in the Buea Regional Hospital (BRH) and the Limbe Regional Hospital (LRH), Cameroon. Materials and methods This was a hospital-based unmatched case-control study in which files of women with stillbirth (cases) were analysed. A woman with a live birth in the same maternity during the same period served as a control. Data were collected using a pre-tested questionnaire. The stillbirth rate was the number of stillbirths per thousand births. Logistic regression analysis was used to identify independent factors associated with stillbirth. Results Stillbirth rates at the BRH and LRH were 33.72 and 36.45 per 1000 live births. The factors that were independently associated with stillbirth were: referral status (AOR 3.95; 95% CI: 1.85–6.58, p = 0.000), late booking visit - after 12 weeks (AOR 13.64; 95% CI: 1.49–124.83, p = 0.021), preeclampsia (AOR 3.21; 95% CI: 1.23–8.35, p = 0.01), placental abruption (AOR 21.46; 95% CI: 2.36–194.77, p = 0.006), moderate anaemia (AOR 2.04; 95% CI: 1.09–3.83, p = 0.03), labour dystocia (AOR 5.37; 95% CI: 1.77–15.92, p = 0.003), low birth weight (AOR 5.27; 95% CI: 1.48–3.53, p = 0.000), and preterm delivery (AOR 2.81; 95% CI: 1.48–3.35, p = 0.002). Conclusion Stillbirth rates are high in both health facilities. Risk factors of stillbirths include referral from another health facility, anaemia, preeclampsia and late booking visit, placental abruption, labour dystocia, preterm birth, and low birth weight. Term, post-term and macrosomia were protective of stillbirth. We recommend electronic data storage in hospitals in Cameroon.
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Affiliation(s)
- Thomas Obinchemti Egbe
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon. .,Department of Obstetrics and Gynaecology, Douala Referral Hospital, Douala, Cameroon.
| | | | - Nicholas Tendongfor
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Okonofua FE, Ntoimo LFC, Ogu R, Galadanci H, Mohammed G, Adetoye D, Abe E, Okike O, Agholor K, Abdus-Salam R, Randawa A. Prevalence and determinants of stillbirth in Nigerian referral hospitals: a multicentre study. BMC Pregnancy Childbirth 2019; 19:533. [PMID: 31888536 PMCID: PMC6937841 DOI: 10.1186/s12884-019-2682-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 12/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2015, Nigeria's estimated 317,700 stillbirths accounted for 12.2% of the 2.6 million estimated global stillbirths. This suggests that Nigeria still makes substantial contribution to the global burden of stillbirths. This study was conducted to determine the prevalence and identify the causes and factors associated with stillbirth in eight referral hospitals in Nigeria. METHODS This was a cross-sectional study of all deliveries over a period of 6 months in six general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the north) in Nigeria. The study population was women delivering in the hospitals during the study period. A pre-tested study protocol was used to obtain clinical data on pregnancies, live births and stillbirths in the hospitals over a 6 months period. Data were analyzed centrally using univariate, bivariate and multivariate logistic regression analyses. The main outcome measure was stillbirth rate in the hospitals (individually and overall). RESULTS There were 4416 single births and 175 stillbirths, and a mean stillbirth rate of 39.6 per 1000 births (range: 12.7 to 67.3/1000 births) in the hospitals. Antepartum (macerated) constituted 22.3% of the stillbirths; 47.4% were intrapartum (fresh stillbirths); while 30.3% was unclassified. Acute hypoxia accounted for 32.6% of the stillbirths. Other causes were maternal hypertensive disease (6.9%), and intrapartum unexplained (5.7%) among others. After adjusting for confounding variables, significant predictors of stillbirth were referral status, parity, past experience of stillbirth, birth weight, gestational age at delivery and mode of delivery. CONCLUSION We conclude that the rate of stillbirth is high in Nigeria's referral hospitals largely because of patients' related factors and the high rates of pregnancy complications. Efforts to address these factors through improved patients' education and emergency obstetric care would reduce the rate of stillbirth in the country. TRIAL REGISTRATION Trial Registration Number NCTR91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/ Registered April 14th 2016.
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Affiliation(s)
- Friday E Okonofua
- Women's Health and Action Research Centre/WHO Implementation Research Group, Benin City, Nigeria. .,Women's Health and Action Research Centre, and Vice-Chancellor, University of Medical Sciences, Ondo City, Ondo State, Nigeria. .,Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State, Nigeria. .,, Benin City, Edo State, Nigeria.
| | - Lorretta Favour C Ntoimo
- Women's Health and Action Research Centre/WHO Implementation Research Group, Benin City, Nigeria.,Department of Demography and Social Statistics, Federal University Oye-Ekiti, Oye-Ekiti, Ekiti State, Nigeria
| | - Rosemary Ogu
- Women's Health and Action Research Centre/WHO Implementation Research Group, Benin City, Nigeria.,Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State, Nigeria.,Department of Obstetrics and Gynaecology, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | | | | | | | - Eghe Abe
- Central Hospital, Benin City, Edo State, Nigeria
| | - Ola Okike
- Karshi General Hospital, Federal Capital Territory, Abuja, Nigeria
| | | | | | - Abdullahi Randawa
- Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
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Berhe T, Gebreyesus H, Teklay H. Prevalence and determinants of stillbirth among women attended deliveries in Aksum General Hospital: a facility based cross-sectional study. BMC Res Notes 2019; 12:368. [PMID: 31262356 PMCID: PMC6604274 DOI: 10.1186/s13104-019-4397-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/22/2019] [Indexed: 12/15/2022] Open
Abstract
Objective In Ethiopia skilled deliveries are increasing but stillbirth is not reducing as required. However; there are limited numbers of up to date studies done related to stillbirth in the study area. Therefore this was aimed to assess the prevalence and determinants of stillbirth using facility based cross-sectional study among women attended deliveries at Aksum General Hospital in 2018. Systematic random sampling method was used to select 573 study participants from the deliveries attended during the study period. The data was entered into Epi-data version 3.1 and exported to Statistical Package for Social Science version 21 for analysis. Bivariate and multivariable logistic regression analysis were conducted to identify significant predictors and strength of association was measured based on adjusted odds ratio with 95% confidence level and statistical significance was declared at p-value less than 0.05. Results The prevalence of stillbirth was 3.68% in this study area. Maternal age 20–35 (AOR = 0.25; 95% CI (0.08, 0.80)), not using partograph (AOR = 8.66; 95% CI (2.88, 26.10)) and gestational age < 37 weeks (AOR = 3.86; 95% CI (1.27, 11.69)) were the independent factors affecting the stillbirth.
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Affiliation(s)
- Tesfay Berhe
- Department of Public Health, College of Health Sciences, Aksum University, P. O. Box: 298, Aksum, Ethiopia.
| | - Hailay Gebreyesus
- Department of Public Health, College of Health Sciences, Aksum University, P. O. Box: 298, Aksum, Ethiopia
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Afulani PA, Altman M, Musana J, Sudhinaraset M. Conceptualizing pathways linking women's empowerment and prematurity in developing countries. BMC Pregnancy Childbirth 2017; 17:338. [PMID: 29143627 PMCID: PMC5688445 DOI: 10.1186/s12884-017-1502-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Globally, prematurity is the leading cause of death in children under the age of 5. Many efforts have focused on clinical approaches to improve the survival of premature babies. There is a need, however, to explore psychosocial, sociocultural, economic, and other factors as potential mechanisms to reduce the burden of prematurity. Women's empowerment may be a catalyst for moving the needle in this direction. The goal of this paper is to examine links between women's empowerment and prematurity in developing settings. We propose a conceptual model that shows pathways by which women's empowerment can affect prematurity and review and summarize the literature supporting the relationships we posit. We also suggest future directions for research on women's empowerment and prematurity. METHODS The key words we used for empowerment in the search were "empowerment," "women's status," "autonomy," and "decision-making," and for prematurity we used "preterm," "premature," and "prematurity." We did not use date, language, and regional restrictions. The search was done in PubMed, Population Information Online (POPLINE), and Web of Science. We selected intervening factors-factors that could potentially mediate the relationship between empowerment and prematurity-based on reviews of the risk factors and interventions to address prematurity and the determinants of those factors. RESULTS There is limited evidence supporting a direct link between women's empowerment and prematurity. However, there is evidence linking several dimensions of empowerment to factors known to be associated with prematurity and outcomes for premature babies. Our review of the literature shows that women's empowerment may reduce prematurity by (1) preventing early marriage and promoting family planning, which will delay age at first pregnancy and increase interpregnancy intervals; (2) improving women's nutritional status; (3) reducing domestic violence and other stressors to improve psychological health; and (4) improving access to and receipt of recommended health services during pregnancy and delivery to help prevent prematurity and improve survival of premature babies. CONCLUSIONS Women's empowerment is an important distal factor that affects prematurity through several intervening factors. Improving women's empowerment will help prevent prematurity and improve survival of preterm babies. Research to empirically show the links between women's empowerment and prematurity is however needed.
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Affiliation(s)
- Patience A. Afulani
- Preterm Birth Initiative, University of California, San Francisco (UCSF), San Francisco, CA USA
- UCSF School of Medicine, San Francisco, CA USA
| | - Molly Altman
- Preterm Birth Initiative, University of California, San Francisco (UCSF), San Francisco, CA USA
- UCSF School of Nursing, San Francisco, CA USA
| | - Joseph Musana
- Preterm Birth Initiative, University of California, San Francisco (UCSF), San Francisco, CA USA
- UCSF School of Medicine, San Francisco, CA USA
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Ghimire PR, Agho KE, Renzaho A, Christou A, Nisha MK, Dibley M, Raynes-Greenow C. Socio-economic predictors of stillbirths in Nepal (2001-2011). PLoS One 2017; 12:e0181332. [PMID: 28704548 PMCID: PMC5509325 DOI: 10.1371/journal.pone.0181332] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/29/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Stillbirth has a long-lasting impact on parents and families. This study examined socio-economic predictors associated with stillbirth in Nepal for the year 2001, 2006 and 2011. METHODS The Nepalese Demographic and Health Survey (NDHS) data for the period (2001-2011) were pooled to estimate socio-economic predictors associated with stillbirths in Nepal using binomial logistic regression while taking clustering and sampling weights into account. RESULTS A total of 18,386 pregnancies of at least 28 weeks gestation were identified. Of these pregnancies, 335 stillbirths were reported. Stillbirth increased significantly among women that lived in the hills ecological zones (aRR 1.38, 95% CI 1.02, 1.87) or in the mountains ecological zones (aRR 1.71, 95% CI 1.10, 2.66). Women with no schooling (aRR 1.72, 95% CI 1.10, 2.69), women with primary education (aRR 1.81, 95% CI 1.11, 2.97); open defecation (aRR 1.48, 95% CI 1.00, 2.18), and those whose major occupation was agriculture (aRR 1.80, 95% CI 1.16, 2.78) are more likely to report higher stillbirth. CONCLUSIONS Low levels of education, ecological zones and open defecation were found to be strong predictors of stillbirth. Access to antenatal care services and skilled birth attendants for women in the mountainous and hilly ecological zones of Nepal is needed to further reduce stillbirth and improved services should also focus on women with low levels of education.
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Affiliation(s)
- Pramesh Raj Ghimire
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Kingsley Emwinyore Agho
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Andre Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Aliki Christou
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Monjura Khatun Nisha
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michael Dibley
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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