Prevalence and determinants of stillbirth in Nigerian referral hospitals: a multicentre study

Abstract

BackgroundIn 2015, Nigeria’s estimated 317,700 stillbirths accounted for 12.2% of the 2.6 million estimated global stillbirths. This suggests that Nigeria still makes substantial contribution to the global burden of stillbirths. This study was conducted to determine the prevalence and identify the causes and factors associated with stillbirth in eight referral hospitals in Nigeria.MethodsThis was a cross-sectional study of all deliveries over a period of 6 months in six general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the north) in Nigeria. The study population was women delivering in the hospitals during the study period. A pre-tested study protocol was used to obtain clinical data on pregnancies, live births and stillbirths in the hospitals over a 6 months period. Data were analyzed centrally using univariate, bivariate and multivariate logistic regression analyses. The main outcome measure was stillbirth rate in the hospitals (individually and overall).ResultsThere were 4416 single births and 175 stillbirths, and a mean stillbirth rate of 39.6 per 1000 births (range: 12.7 to 67.3/1000 births) in the hospitals. Antepartum (macerated) constituted 22.3% of the stillbirths; 47.4% were intrapartum (fresh stillbirths); while 30.3% was unclassified. Acute hypoxia accounted for 32.6% of the stillbirths. Other causes were maternal hypertensive disease (6.9%), and intrapartum unexplained (5.7%) among others. After adjusting for confounding variables, significant predictors of stillbirth were referral status, parity, past experience of stillbirth, birth weight, gestational age at delivery and mode of delivery.ConclusionWe conclude that the rate of stillbirth is high in Nigeria’s referral hospitals largely because of patients’ related factors and the high rates of pregnancy complications. Efforts to address these factors through improved patients’ education and emergency obstetric care would reduce the rate of stillbirth in the country.Trial registrationTrial Registration Number NCTR91540209.Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/Registered April 14th 2016.

Perinatal morbidity and mortality and the impact of neonatal resuscitation day-by-day calamity evidenced by a prospective descriptive study in Guinea-Conakry

“…The few documented stillbirth rates in hospitals are usually higher than those estimated in the community (15). Nevertheless, the here reported stillbirth rate with 82 stillbirths /1000 total births is very high in comparison to other countries and hospital reports (15)(16)(17). A large metaanalysis about stillbirth reports from 50 countries showed a variety of causes.…”

The influence of travel time to health facilities on stillbirths: A geospatial case-control analysis of facility-based data in Gombe, Nigeria

“…Despite the substantial estimated burden of stillbirths in Nigeria, there is persistent inaccurate data on its predictors to inform appropriate policy interventions. Most studies focus on reporting stillbirth prevalence rates and exploring their clinical determinants [16][17][18][19]. Also, available studies investigated geographic accessibility factors known to strongly influence the use of skilled birth attendant and EmONC for pregnant women but not stillbirth outcome [20,21].…”

“…Also, available studies investigated geographic accessibility factors known to strongly influence the use of skilled birth attendant and EmONC for pregnant women but not stillbirth outcome [20,21]. Furthermore, existing local stillbirth literature shows substantial regional disparity as they are mainly focused on southern Nigeria [16][17][18][19].…”

Caesarean section rate in Nigeria between 2013 and 2018 by obstetric risk and socio‐economic status

“…According to the latest Nigeria DHS, the maternal mortality ratio is still high at 512 per 100 000 live births (95% confidence interval (CI): 447-578) [11]. Further, the prevalence of stillbirths is estimated at 39.6/1000 births, and 32% of those stillbirths could be associated with asphyxia [12]. A study showed that infants born by CS in Nigeria were roughly three times more likely to die than those born vaginally [13], indicating that the intervention might be used too late.…”

“…A study showed that infants born by CS in Nigeria were roughly three times more likely to die than those born vaginally [13], indicating that the intervention might be used too late. Other factors associated with increased risk of adverse neonatal outcome during labour in Nigeria include referral status, parity, gestational age [12], male gender and rural residence [13].…”