Determinants of stillbirth among reviewed perinatal deaths in Ethiopia

Abstract

BackgroundThe global burden of stillbirth has declined over time. However, the problem is still prominent in South Asian and Sub-Saharan African countries. Ethiopia is one of the top stillbirth-reporting countries worldwide. Despite several measures taken to reduce the burden of stillbirth; the pace of decline was not as good as the post-neonatal death. Thus, this study is aimed at identifying potential factors related to stillbirth in Ethiopia based on nationally reviewed perinatal deathsMethodThe national perinatal death surveillance data were used for this study. A total of 3,814 reviewed perinatal death were included in the study. Two model families,namely generalized estimating equation, and alternating logistic regression models from marginal model family were employed to investigate the risk factors of stillbirth. The alternating logistic regression model was selected as the best fit for the final analysis.ResultAmong reviewed perinatal deaths nearly forty percent (37.4%) were stillbirths. The findings from the multivariate analysis demonstrated that the place of birth (in transit and at home), cause of death (infection, and congenital and chromosomal abnormalities), maternal health condition (women with complications of pregnancy, placenta, and cord), delay one (delay in deciding to seek care) and delay three (delay in receiving adequate care) were associated with an increased risk of having a stillbirth. On the other hand, maternal education (women with primary and above education level) and the type of health facility (women who were treated in secondary and tertiary health care) were associated with a decreased risk of having a stillbirth.ConclusionThe study identified that both individual (place of delivery, cause of death, maternal health condition, maternal education, and delay one) and facility level (type of health facility and delay three) factors contributed to stillbirth outcome. Therefore, policies that are aimed at encouraging institutional delivery, improving health seeking behavior, and strengthening facility-level readiness should be devised to reduce the high burden of stillbirth in Ethiopia.

Birth prevalence and risk factors of neural tube defects in Ethiopia: a systematic review and meta-analysis

“…[43][44][45][46] Recent evidence coming out of the Ethiopian perinatal death surveillance and response system indicates that CAs have a significant role in perinatal mortality. [47][48][49] In addition to this, limited capacity to manage NTD cases at tertiary facilities, resulting in poor prognoses after treatment due to high rates of readmission and reoperation, is another critical factor contributing to the escalated national burden at this point. 50 51 In Ethiopia, preventative measures have not yet been endorsed and implemented in such a way that would put a solid footing to combat the untoward impacts of NTDs due to a lack of feasibility assessment, local capacity and policy directives that would enforce preventive measures.…”

“…Recent evidence coming out of the Ethiopian perinatal death surveillance and response system indicates that CAs have a significant role in perinatal mortality 47–49. In addition to this, limited capacity to manage NTD cases at tertiary facilities, resulting in poor prognoses after treatment due to high rates of readmission and reoperation, is another critical factor contributing to the escalated national burden at this point 50 51.…”

Timing of perinatal death; causes, circumstances, and regional variations among reviewed deaths in Ethiopia

“…One of the key recommendations that the World Health Organization(WHO) put in place to reduce the burden of maternal and child mortality is understanding the number, and cause of death by establishing a nationwide surveillance system [ 12 ]. Per the recommendation, Ethiopia established Maternal Death Surveillance and Response (MDSR) system in 2013, and later in 2017, Perinatal Death Surveillance and Response (PDSR) was implemented by integrating perinatal death into the existing MDSR system [ 13 ]. Later in 2017, the name of the system was changed to the Maternal and Perinatal Death Surveillance and Response (MPDSR) system incorporating both maternal and perinatal components [ 14 ].…”