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

Abstract

BackgroundThe aim of this study was to estimate the rate and predisposing factors associated with stillbirth in the African Great Lakes region (Burundi, Congo Democratic Republic, Kenya, Rwanda, Tanzania and Uganda).Methods and findingsCross-sectional data from the most recent Demographic and Health Surveys (DHS) of countries in the African Great Lakes region were used in this study. DHS from Congo Democratic Republic was not included in the analyses because data was not collected for stillbirth in the country survey. A pooled sample of 57046 pregnancies of 7+ months’ duration and 1002 stillbirths were included in the final analysis. The analyses were restricted to stillbirths reported in the 5 years preceding the surveys. Stillbirth was defined as foetal death in the third trimester (≥ 28 weeks’ gestation). Multilevel logistic regression analyses that adjusted for cluster and survey weights were used to determine the factors associated with stillbirth in the Africa Great Lakes region. Health service variables and maternal medical condition variables were not included in the analysis because DHS do not collect data on these variables for pregnancies that did not result in a live birth. Burundi had the highest stillbirth rate per 1000 births [23% (95% CI: 20, 25)] within the region. Factors associated with stillbirth across the region were: no schooling [1.85 (95%Cl: 1.44, 2.38)] and primary education [1.64 (1.32, 2.05)], advanced maternal age [2.39 (95% CI: 1.59, 3.59)], smoking [1.99 (95% CI: 1.19, 3.32)] and drinking water from unimproved sources [1.18 (95% CI: 1.01, 1.37)].ConclusionTo achieve Every Newborn Action Plan (ENAP) stillbirth target of 12 per 1000 births or less by 2030, policy interventions to prevent stillbirth should focus on promoting community-based socio-educational programmes which encourages a healthy lifestyle especially among uneducated women in the advanced age spectrum.

Factors associated with stillbirth in selected countries of South Asia: A systematic review of observational studies

“…The association between lower socioeconomic status and higher stillbirth in this review is in agreement with previous studies conducted in other developing countries [ 44 , 45 ]. In addition, this review found a significant association between stillbirth and lower maternal education in Nepal, India, and Bangladesh; consistent with the Demographic and Health Survey in the African Great Lakes region [ 46 ]. However, studies conducted in Pakistan have found no significant association between stillbirth and maternal education [ 22 , 29 ].…”

Trends of stillbirth among reproductive-age women in Ethiopia based on Ethiopian demographic and health surveys: a multivariate decomposition analysis

“…An increase in the composition of urban resident women over the survey showed a significant effect on the decrease in stillbirth. This finding is consistent within South Africa [34], African Great lake Regions [35], Nigeria [20], Northern Ghana [23] and Ethiopia [24]. This could be due to the increase in urbanization in Ethiopia over time [36] and increased urbanization has significant role in improving access to maternal health service especially emergency obstetric cases can be managed since they are near to the health facilities, and had relatively improved awareness towards maternal health service utilization as compared to rural residents [37].…”

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“…The stillbirth rate of 67.5 per 1000 deliveries obtained in this study was much higher than the rate of 25 per 1000 deliveries recognized for low income and middle-income countries (Saleem et al, 2018). This rate is also a far cry from the stillbirth rate of 12 per 1000 deliveries recommended by the United Nations' Every Newborn Action Plan, which has set this goal to be attained in 2030 by all countries (Akombi et al, 2018;Saleem et al, 2018). The stillbirth rate of this study in Uyo, South-east health zone of Nigeria is comparable to the rate of 74 per 1000 deliveries that was obtained in Enugu, South-east Nigeria, probably because both study centers in Nigeria belong to the same health zone.…”

“…In the Enugu, South-east Nigerian study, the odds of an un-booked mother being delivered of a stillborn infant was 1.56, p = 0.04, whereas parity was not significantly associated with the odds of stillbirth occurring (Ezugwu et al, 2011). On the other hand, a community based survey of 3 East African countries found, low level of education, advanced maternal age, smoking and drinking, as well as non-availability of potable water as risk factors that predisposed mothers to have stillbirth in that study (Akombi et al, 2018). Notwithstanding the preponderance of stillbirths among mothers with those risk factors, these may have confounded with their socioeconomic circumstance, which could have undermined their ability to receive quality antenatal care.…”

“…Notwithstanding, an institutional based study in Enugu, South-east Nigeria had recorded 47.7% of macerated stillbirth as against a fresh stillbirth rate of 52.3% (Goldenberg, McClure and Belizán, 2009;Ezugwu et al, 2011). Complications of pregnancy resulting in intrauterine fetal demise and macerated stillbirth have been elaborately studied (Olusanya and Solanke, 2009;Ezugwu et al, 2011;Kayode et al, 2016;Akombi et al, 2018;Kaiser, 2018). A vast majority (66.11%) of the macerated stillborn infants were significantly (p= 0.…”