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

Abstract

Background Over 2.6 million babies are lost later in pregnancy, during labour, and or in the first week of life. Global perinatal mortality reduced from 5.7 million since 2000 to 4.1 million in 2015. High-income countries account for 45% of this data. The rest are in low-income countries, 77% of which are in sub-Saharan Africa. Perinatal mortality rates for sub-Saharan Africa and Zambia are 42.95 and 33/1000 live births, respectively. The aim of this study was to determine the predictors of perinatal mortality at the seven major hospitals of Lusaka, Zambia. Methods this was a multi-centre unmatched case control study from September 2023 to January 2024. Cases included perinatal death (>24 weeks gestation or >500g stillborn, and death of neonate within seven days of life) and controls were live births. Stepwise multivariate logistic regression analysis determined predictors using adjusted odd ratios and p-values. Results The study had 630 participants, 210 cases and 420 controls were analysed: ratio 1:2. Antenatal care booking after 12 weeks gestation had almost three times odds of experiencing perinatal (AOR 2.909, 95% CI: 1.97-4.296), p <0.001 compared to those who booked early. Walking as means of reaching healthcare facility had over three odds perinatal mortality (AOR3.482, 95% CI: 1.87-6.49) than personal transport users. Anaemia during pregnancy had over three times risk of perinatal death (AOR 3.581, 95% CI: 1.72-7.44) than those without it. History of loss of baby before birth had five fold odds to experience perinatal mortality than to those who had not (AOR 5.047, 95% CI: 2.99-8.51). Conclusion This study revealed that late antenatal care booking, walking, as means of transport to access health facility, anaemia in pregnancy, and previous history of loss of baby before birth perinatal death were the main predictors with statistical significance of perinatal death experience.