Predictors of stillbirths in Bangladesh: evidence from the 2004–2014 nation-wide household surveys

Abstract

Background: Globally, stillbirth remains a significant public health issue, particularly in developing countries such as Bangladesh. Objective: This study aimed to investigate the potential predictors of stillbirths in Bangladesh over a ten-year period. Methods: The Bangladesh Demographic and Health Surveys data for the years 2004, 2007, 2011 and 2014 (n = 29,094) were used for the study to investigate the predictors of stillbirths. Stillbirth was examined against a set of community, socio-economic and child characteristics, using a multivariable logistic regression model that adjusted for cluster and sampling variability. Results: The pooled rate of stillbirth in Bangladesh was 28 in 1000 births (95% CI: 22, 34). Stillbirth rates were higher in rural compared to urban areas in Bangladesh. Mothers who had a secondary or higher level of education (OR = 0.59, 95%CI: 0.43–0.82, P = 0.002) and those with primary education (OR = 0.66, 95%CI: 0.55–0.80, P < 0.001) were less likely to experience stillbirths compared to mothers with no education. Mothers with more than two children were significantly less likely to have stillbirths compared to mothers with one child. Those from poor households reported increased odds of stillbirth compared to those from rich households. Conclusion: Our analysis indicated that no maternal education, primiparity and poor household were predictors of stillbirths in Bangladesh. A collaborative effort is needed to reduce stillbirth rates among these high-risk groups in Bangladesh, with the socio-economic and health-related Sustainable Development Goals providing a critical vehicle for the co-ordination of this work.

Burden of stillbirths and associated factors in Yirgalem Hospital, Southern Ethiopia: a facility based cross-sectional study

“…Thus, aforementioned studies were conducted in referral hospitals which have better obstetric care facilities and skilled health workforce; whereas our study setting was a general hospital with fewer obstetricians and majority of cases were referred from peripheral primary health care units with poor facilities, which provide obstetric services for a predominantly rural population. The proportion of stillbirths in our nding was also higher than the global estimates of stillbirth for Ethiopia (25,26), and other studies from developing countries such as Bangladeshi (27) and India (28). This variation could be partly explained by differences in study settings and methods because the present study was a hospital based study unlike other community based studies from developing countries.…”

Stillbirth in the African Great Lakes region: A pooled analysis of Demographic and Health Surveys

“…Previous studies have shown that an increase in maternal education could lead to a corresponding improvement in healthy behaviors such as the timely decision to seek appropriate medical care during pregnancy [26, 27]. Studies have also shown that a higher maternal education could also increase health service utilization such as antenatal care services which involves serologic screening for syphilis, iron-folic acid supplementation, malaria treatment and prophylaxis, diagnoses and treatment of asymptomatic bacteriuria, blood pressure monitoring, anti-tetanus immunization, and the prevention of mother-to-child transmission of human immunodeficiency virus (HIV) thereby leading to a reduction in stillbirth [28–31].…”

Community Engagement in Support of Moving Toward Universal Health Coverage

“…36 However, ongoing engagement provided entry points for the malaria intervention in Laos, and the flexibility of that intervention enabled issues of drinking water and other basic health care to be addressed. 35 Such integration goes beyond using local knowledge and perspectives of problems unavailable to high-level decision makers to improve information flows and delivery mechanisms for particular issues and provides the necessary platform for working toward UHC. 60 Other studies have also highlighted the need for a systemwide approach to community engagement rather than processes that are often ad hoc.…”

“…Malaria Elimination in Laos A malaria elimination project combined elements of consultative and collaborative engagement. 35 Here, a predesigned package of interventions was presented to the community through existing community partners, but the engagement was required to promote uptake and adherence-primarily a consultative form of engagement. Ongoing discussions with the residents informed adaptations in the intervention to be responsive to the needs of the community-even beyond the focus on malaria elimination-a strategy that generated buy-in and enhanced the coverage of the treatment.…”

“…It is noteworthy, however, that this was part of a timelimited study and was not integrated into local health systems. 35…”