Perinatal death in Northern Uganda: incidence and risk factors in a community-based prospective cohort study

Abstract

Background : Perinatal mortality in Uganda remains high at 38 deaths/1,000 births, an estimate greater than the every newborn action plan (ENAP) target of ≤24/1,000 births by 2030. To improve perinatal survival, there is a need to understand the persisting risk factors for death. Objective : We determined the incidence, risk factors, and causes of perinatal death in Lira district, Northern Uganda. Methods : This was a community-based prospective cohort study among pregnant women in Lira district, Northern Uganda. Female community volunteers identified pregnant women in each household who were recruited at ≥28 weeks of gestation and followed until 50 days postpartum. Information on perinatal survival was gathered from participants within 24 hours after childbirth and at 7 days postpartum. The cause of death was ascertained using verbal autopsies. We used generalized estimating equations of the Poisson family to determine the risk factors for perinatal death. Results : Of the 1,877 women enrolled, the majority were ≤30 years old (79.8%), married or cohabiting (91.3%), and had attained only a primary education (77.7%). There were 81 perinatal deaths among them, giving a perinatal mortality rate of 43/1,000 births [95% confidence interval (95% CI: 35, 53)], of these 37 were stillbirths (20 deaths/1,000 total births) and 44 were early neonatal deaths (23 deaths/1,000 live births). Birth asphyxia, respiratory failure, infections and intra-partum events were the major probable contributors to perinatal death. The risk factors for perinatal death were nulliparity at enrolment (adjusted IRR 2.7, [95% CI: 1.3, 5.6]) and maternal age >30 years (adjusted IRR 2.5, [95% CI: 1.1, 5.8]). Conclusion : The incidence of perinatal death in this region was higher than had previously been reported in Uganda. Risk factors for perinatal mortality were nulliparity and maternal age >30 years. Pregnant women in this region need improved access to care during pregnancy and childbirth.

“Your heart keeps bleeding”: lived experiences of parents with a perinatal death in Northern Uganda

“…The estimated stillbirth risk in Uganda is similar to Kenya and Tanzania at about 17.8/1000 total births [ 2 ]. These deaths have been associated with risk factors such as maternal age, infections, nutrition and lifestyle factors, and socioeconomic factors [ 3 – 8 ]. Rural areas are reported to contribute higher proportions of perinatal deaths than peri/urban areas [ 5 , 7 ].…”

“…Given the several ethnic groups in Uganda with varying cultural beliefs and practices which may have a bearing on how perinatal loss is experienced in different contexts. Northern Uganda is poorly studied despite the high perinatal mortality rate (~ 40/1000 births) [ 3 ].…”

Individual and community-level factors of perinatal mortality in the high mortality regions of Ethiopia: a multilevel mixed-effect analysis

“…Perinatal mortality is known to be associated with factors such as paritry [ 13 – 15 ], age of mother [ 13 , 16 ], maternal education [ 17 , 18 ], Attending antenatal care visits(ANC) [ 14 – 16 , 19 ], skilled birth attendant [ 14 ], previous history of perinatal mortality [ 14 , 16 , 20 ], low family income, birth interval [ 12 , 19 , 20 ], the total number of under 5 children [ 20 ], access to participation in decision making [ 20 ], conceived during teenage [ 21 ], and place of delivery [ 22 , 23 ] and residency [ 15 ], and access to clean water supply [ 1 ].…”

A cross‐sectional study of haemolytic disease of the newborn in Uganda

“…In our study, 82% of infants with HDN also had neonatal sepsis and birth asphyxia—the two leading cause of neonatal morbidity and mortality in these settings [17]. The coexistence with these severe disease entities may mask HDN, resulting in its misdiagnosis and underreporting.…”