Identifying risk factors for perinatal death at Tororo District Hospital, Uganda: a case-control study

Abstract

Background: Sub-Saharan Africa faces a disproportionate burden of perinatal deaths globally. However, data to inform targeted interventions on an institutional level is lacking, especially in rural settings. The objective of this study is to identify risk factors for perinatal death at a resource-limited hospital in Uganda. Methods: This is a retrospective case-control study at a district hospital in eastern Uganda using birth registry data. Cases were admissions with stillbirths at or beyond 24 weeks or neonatal deaths within 28 days of birth. Controls were admissions that resulted in deliveries immediately preceding and following each case. We compared demographic and obstetric factors between cases and controls to identify risk factors for perinatal death. Subgroup analysis of type of perinatal death was also performed. Chi square, Fisher's exact, t-test, and Wilcoxon-Mann-Whitney rank sum tests were utilized for bivariate analysis, and multiple logistic regression for multivariate analysis. Results: From January 2014 to December 2014, there were 185 cases of perinatal death, of which 36% (n = 69) were macerated stillbirths, 40% (n = 76) were fresh stillbirths, and 25% (n = 47) were neonatal deaths. The rate of perinatal death among all deliveries at the institution was 35.5 per 1000 deliveries. Factors associated with increased odds perinatal death included: prematurity (adjusted odds ratio (aOR) 19.7, 95% confidence interval (CI) 7.2-49.2), breech presentation (aOR 7.0, CI 1.4-35.5), multiple gestation (aOR 4.0, CI 1.1-13.9), cesarean delivery (aOR 3.8, CI 2.3-6.4) and low birth weight (aOR 2.5, CI 1.1-5.3). Analysis by subtype of perinatal death revealed distinct associations with the aforementioned risk factors, in particular for antepartum hemorrhage, which was only associated with fresh stillbirths (aOR 6.7, CI 1.6-28.8), and low birth weight. Conclusions: The rate of perinatal death at our rural hospital site was higher than national targets, and these deaths were associated with prematurity, low birth weight, breech presentation, multiple gestation, and cesarean delivery. This data and the approach utilized to acquire it can be leveraged to inform targeted interventions to reduce the rate of stillbirths and neonatal deaths in similar low resource settings.

Perinatal care and its association with perinatal death among women attending care in three district hospitals of western Uganda

“…Even with the supervision of a trained health worker, vaginal deliveries may have higher risks of perinatal deaths than operative deliveries. This could be because of malpresentations that may not be easily corrected due to limited time for manipulation, emergency deliveries when there are pregnancy complications like pre-eclampsia and eclampsia, multiple gestation, and preterm deliveries resulting in adverse outcomes [31,32]. This observation is similar to findings from other studies including a study conducted in Ghana which showed a 5.9% prevalence of stillbirths among women who had delivered vaginally [31].…”

Perinatal Mortality Analysis in Espírito Santo, Brazil, 2008 to 2017

“…Increased risk of perinatal death was associated with a low level of maternal education, rural residence, <4 ANC visits, PPH, placental abruption, LBW delivery, the child’s sex, and referral for delivery [ 45 ]. Prematurity, a low birth weight, breech presentation, multiple gestation, and cesarean delivery reduce preventability goals related to perinatal death [ 46 ].…”

“…These data and the approach used to acquire them can be used to inform interventions aimed at reducing the rate of stillbirths and neonatal deaths in non-developed, developing, and developed countries that, even with low perinatal mortality rates, are influenced by factors that characterize the deaths [ 13 , 46 , 47 , 48 ].…”

Prediction of stillbirth low resource setting in Northern Uganda

“…Women of Afro-Caribbean and Asian origin are more at risk of stillbirths 7,[11][12][13][14] and this may be associated with racial disparities in accessing health care 12 . Incidence of stillbirth in Uganda is about 2.0% − 3.6% 15,16 . However, due to challenges in access to care and policies on death registration in the global south, most stillbirths are not registered 17 .…”