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

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 = 1779). 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 = 1847). Results Risk factors for stillbirth included: previous stillbirth (29/1691 (2%) of livebirths and 39/43 (91%) of stillbirths, adjusted Odds Ratio (aOR) 2628.9, 95% CI 342.8 to 20,163.0), antenatal care (aOR 44.49 no antenatal care vs. > 4 antenatal care visits, 95% CI 6.80 to 291.19), 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 Low and Middle Income Countries (LMICs) and is in agreement with findings from High Income Countries (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.

Predictors of perinatal mortality in the seven major hospitals of Lusaka Zambia: A Case Control Study

“…A recent study on stillbirths determinants reported similar findings of higher risk of stillbirth among those with prior experience of stillbirth (36). This is also in line with another similar study by Dube and Lavender (37) in Zimbabwe that reported similar findings. History of abortion in this study demonstrated statistical significance as predictor of perinatal mortality.…”

The Factors Associated with Stillbirths among Sub-Saharan African Deliveries: A Systematic review and Meta-analysis

“…The geographical distribution of the forty-one (41) included articles revealed that Eastern African countries accounted for the majority of the research (58.5%). Five (5) of the studies were carried out in Cameroon ( 1), (10-13), nineteen (19) of the investigations were carried out in Ethiopia ( 2), ( 3), (5-9), (14-25), 6 in Ghana ( 4), (26-30), 4 in Tanzania (31)(32)(33)(34), 4 in Nigeria (35)(36)(37)(38), 1 in Zimbabwe (39), 1 in Uganda ( 40), and 1 in Burkina Faso (41). Of those studies, 37 were carried out in institutions or using facility-based records, while 4 were carried out in the community using survey data from the general population.…”

“…In relation to the response rate, the primary articles incorporated in the meta-analysis ranged from 92.7-100%, and essentially all the studies had a good response rate. Forty (40) of the forty-one (41) studies were published (1)-( 30), (32)(33)(34)(35)(36)(37)(38)(39)(40)(41), while one (1) was unpublished (a PhD thesis) in reputable journals (31). Lastly, the primary studies included in the present systematic review and meta-analysis had a quality score of 8-10 out of 10 points.…”