Identification of factors associated with stillbirth in Zimbabwe – a cross sectional study

Dube, Kushupika, Lavender, Tina, Blaikie, Kieran, Sutton, Christopher J., Heazell, Alexander E. P. and Smyth, Rebecca M. D. (2021) 'Identification of factors associated with stillbirth in Zimbabwe – a cross sectional study'. BMC Pregnancy and Childbirth, Vol 21, Issue 662.

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Abstract

Introduction: 98% of the 2.6 million stillbirths per annum occur in low and middle income countries. However, understanding of risk factors for stillbirth in these settings is incomplete, hampering efforts to develop effective strategies to prevent deaths.
Methods: A cross-sectional study of eligible women on the postnatal ward at Mpilo Hospital, Zimbabwe was undertaken between 01/08/2018 and 31/03/2019 (n=1,779). Data were collected from birth records for maternal characteristics, obstetric and past medical history, antenatal care and pregnancy outcome. A directed acyclic graph was constructed with multivariable logistic regression performed to fit the corresponding model specification to data comprising singleton pregnancies, excluding neonatal deaths (n=1734), using multiple imputation for missing data. Where possible, findings were validated against all women with births recorded in the hospital birth register (n=1,847).
Results: Risk factors for stillbirth included: previous stillbirth (29/1691 (2%) of livebirths and 39/43 (91%) of stillbirths, adjusted Odds Ratio (aOR) 2629, 95% CI 343 to 20163), antenatal care (aOR 44.4 no antenatal care vs. >4 antenatal care visits, 95% CI 6.8 to 291.2), maternal medical complications (aOR 7.33, 95% CI 1.99 to 26.92) and season of birth (Cold season vs. Mild aOR 14.29, 95% CI 3.09 to 66.08; Hot season vs. Mild aOR 3.39, 95% CI 0.86 to 13.27). Women who had recurrent stillbirth had a lower educational and health status (18.2% had no education vs. 10.0%) and were less likely to receive antenatal care (20.5% had no antenatal care vs. 6.6%) than women without recurrent stillbirth.
Conclusion: The increased risk in women who have a history of stillbirth is a novel finding in LMICs and is in agreement with findings from HICs, although the estimated effect size is much greater (OR in HICs ~ 5). Developing antenatal care for this group of women offers an important opportunity for stillbirth prevention.

Item Type:	Article
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WQ Obstetrics > Pregnancy Complications > WQ 225 Spontaneous abortion. Fetal death
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1186/s12884-021-04102-y
Depositing User:	Rachel Dominguez
Date Deposited:	07 Oct 2021 12:38
Last Modified:	07 Oct 2021 12:38
URI:	https://archive.lstmed.ac.uk/id/eprint/19099

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