Prediction of stillbirth low resource setting in Northern Uganda

Abstract

Objective: To examine predictors for stillbirth in low resource setting in Northern Uganda.Methods: Prospective cohort study at St. Mary’s hospital Lacor in Northern Uganda. Recruited 1,285 pregnant mothers at 16-24 weeks. Their history, physical findings, blood tests and uterine artery Doppler indices were taken, and the mothers followed up until delivery. Primary outcome was stillbirth (birth ≥24 weeks). Built models in RStudio. Since the data was imbalanced with low stillbirth rate, used ROSE package to over-sample stillbirths and under-sample live-births to balance the data. We cross-validated the models with the ROSE-derived data using K (10)-fold cross-validation and obtained the area under curve (AUC) with accuracy, sensitivity and specificity.Results: The incidence of stillbirth was 2.5%. Predictors of stillbirth were history of abortion, bilateral end-diastolic notch, personal history of preeclampsia, and haemoglobin 9.5 – 12.1g/dL. The models’ AUC was 75.0% with 68.1% accuracy, 69.1% sensitivity and 67.1% specificity.Conclusion: Risk factors for stillbirth include history of abortion (aOR = 3.07, 95% CI 1.11 - 8.05, p=0.0243) and bilateral end-diastolic notch (aOR = 3.51, 95% CI 1.13 - 9.92, p=0.0209), while haemoglobin of 9.5 - 12.1g/dL is protective (aOR = 0.33, 95% CI 0.11 - 0.93, p=0.0375).