Risk factors and causes of stillbirths among pregnant women in Pakistan

Afshan, Kiran; Narjis, Ghulam; Qayyum, Mazhar

doi:10.4314/ahs.v19i1.24

Cited by 15 publications

(10 citation statements)

References 48 publications

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“…obesity, diabetes and hypertension]) and foetal factors (e.g. male sex, pregnancy > 42 weeks, premature birth, congenital malformations and rhesus disease) [ 2 , 6 , 7 ] (Additional file 1 ). Other factors such as birth interval and violence against pregnant women are thought to be important, but data are limited [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Stillbirth maternity care measurement and associated factors in population-based surveys: EN-INDEPTH study

Stefano

Bottecchia

Yargawa

et al. 2021

Popul Health Metrics

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Background Household surveys remain important sources of maternal and child health data, but until now, standard surveys such as Demographic and Health Surveys (DHS) have not collected information on maternity care for women who have experienced a stillbirth. Thus, nationally representative data are lacking to inform programmes to address the millions of stillbirths which occur annually. Methods The EN-INDEPTH population-based survey of women of reproductive age was undertaken in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017–2018). All women answered a full birth history with additional questions on pregnancy losses (FBH+) or full pregnancy history (FPH). A sub-sample, including all women reporting a recent stillbirth or neonatal death, was asked additional maternity care questions. These were evaluated using descriptive measures. Associations between stillbirth and maternal socio-demographic characteristics, babies’ characteristics and maternity care use were assessed using a weighted logistic regression model for women in the FBH+ group. Results A total of 15,591 women reporting a birth since 1 January 2012 answered maternity care questions. Completeness was very high (> 99%), with similar proportions of responses for both live and stillbirths. Amongst the 14,991 births in the FBH+ group, poorer wealth status, higher parity, large perceived baby size-at-birth, preterm or post-term birth, birth in a government hospital compared to other locations and vaginal birth were associated with increased risk of stillbirth after adjusting for potential confounding factors. Regarding association with reported postnatal care, women with a stillbirth were more likely to report hospital stays of > 1 day. However, women with a stillbirth were less likely to report having received a postnatal check compared to those with a live birth. Conclusions Women who had experienced stillbirth were able to respond to questions about pregnancy and birth, and we found no reason to omit questions to these women in household surveys. Our analysis identified several potentially modifiable factors associated with stillbirth, adding to the evidence-base for policy and action in low- and middle-income contexts. Including these questions in DHS-8 would lead to increased availability of population-level data to inform action to end preventable stillbirths.

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Section: Introductionmentioning

confidence: 99%

Stillbirth maternity care measurement and associated factors in population-based surveys: EN-INDEPTH study

Stefano

Bottecchia

Yargawa

et al. 2021

Popul Health Metrics

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“…Potential maternal obstetric related factors include parity [17], preceding birth interval [18], multiple gestation [19], mode of delivery [20], place of delivery [21], wanted pregnancy [22], and Antenatal Care (ANC) visit [23]. Socio-demographic and economic factors that have a significant correlation with stillbirth are maternal age [24], maternal education [25], household wealth status [26], residence [27], marital status [28], and husband education [29].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of stillbirth and its associated factors in East Africa: generalized linear mixed modeling

Tesema

Tessema

Tamirat

et al. 2021

BMC Pregnancy Childbirth

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Background Stillbirth is the most frequently reported adverse pregnancy outcome worldwide, which imposes significant psychological and economic consequences to mothers and affected families. East African countries account for one-third of the 2.6 million stillbirths globally. Though stillbirth is a common public health problem in East African countries, there is limited evidence on the pooled prevalence and associated factors of stillbirth in East Africa. Therefore, this study aimed to investigate the prevalence of stillbirth and its associated factors in East Africa. Methods This study was based on the most recent Demographic and Health Surveys (DHSs) of 12 East African countries. A total weighted sample of 138,800 reproductive-age women who gave birth during the study period were included in this study. The prevalence of stillbirth with the 95% Confidence Interval (CI) was reported using a forest plot. A mixed-effect binary logistic regression analysis was done to identify significantly associated factors of stillbirth. Since the DHS data has hierarchical nature, the presence of clustering effect was assessed using the Likelihood Ratio (LR) test, and Intra-cluster Correlation Coefficient (ICC), and deviance were used for model comparison. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable mixed-effect binary logistic regression analysis, the Adjusted Odds Ratio (AOR) with 95% CI were reported to declare the strength and significance of the association. Results The prevalence of stillbirth in East Africa was 0.86% (95% CI: 0.82, 0.91) ranged from 0.39% in Kenya to 2.28% in Burundi. In the mixed-effect analysis; country, women aged 25–34 years (AOR = 1.27, 95% CI: 1.11, 1.45), women aged ≥ 35 years (AOR = 1.19, 95% CI: 1.01, 1.44), poor household wealth (AOR = 1.07, 95% CI: 1.02, 1.23), women who didn’t have media exposure (AOR = 1.11, 95% CI: 1.01, 1.25), divorced/widowed/separated marital status (AOR = 2.99, 95% CI: 2.04, 4.39), caesarean delivery (AOR = 1.81, 95% CI: 1.52, 2.15), preceding birth interval < 24 months (AOR = 1.15, 95% CI: 1.06, 1.24), women attained secondary education or above (AOR = 0.68, 95% CI: 0.56, 0.81) and preceding birth interval ≥ 49 months (AOR = 1.45, 95% CI: 1.28, 1.65) were significantly associated with stillbirth. Conclusions Stillbirth remains a major public health problem in East Africa, which varied significantly across countries. These findings highlight the weak health care system of East African countries. Preceding birth interval, county, maternal education media exposure, household wealth status, marital status, and mode of delivery were significantly associated with stillbirth. Therefore, public health programs enhancing maternal education, media access, and optimizing birth spacing should be designed to reduce the incidence of stillbirth.

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“…In 2018, Pakistan has been considered one of the riskiest places in the world for childbirth (2), as measured by its high stillbirth rate (43/1000 births) and neonatal mortality rate (46/1000 livebirths) [1]. Risk factors for stillbirths include lack of access to appropriate antenatal and obstetric care, poor maternal health, and low socioeconomic status [3, 4]. The leading causes of neonatal mortality include preterm birth complications (36%), intrapartum related events (22%), sepsis (18%), congenital abnormalities (6%), and pneumonia (6%) [5].…”

Section: Introductionmentioning

confidence: 99%

Perceptions of health professionals regarding minimally invasive tissue sampling (MITS) to identify the cause of death in stillbirths and neonates: results from a qualitative study

Feroz

Ali

Ibrahim

et al. 2019

matern health, neonatol and perinatol

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BackgroundPakistan is considered to be one of the riskiest places in the world for childbirth as measured by its high stillbirth and neonatal mortality rates. Complete diagnostic autopsy remains the gold standard to determine the cause of death (CoD); however, it is not routinely implemented due to religious objections, sociocultural beliefs, limited resources and low demand from physicians and families. Recently, minimally invasive tissue sampling (MITS) using needle biopsies of multiple tissues to obtain tissue for histological examination and organism identification with PCR has been developed and promoted to determine CoD in low-resource areas. To ensure successful implementation of MITS, it is important to understand health professionals’ attitudes and perceptions related to MITS.MethodsA qualitative study was conducted at the National Institute of Child Health (NICH), Karachi, Pakistan. Focus group discussions (FGDs) and Key-informant interviews (KIIs) were conducted with health professionals including doctors, nurses, trainees, clinicians, bioethics experts and public health experts to explore their perceptions and views on acceptability of MITS. Data were analyzed using NVivo 10 software.ResultsA total of 12 interviews (FGDs = 4; KIIs = 8) were conducted. Four overarching themes were identified: (I) acceptability of MITS; (II) perceived benefits of the MITS procedure; (III) factors facilitating the implementation of MITS; and (IV) health system requirements for implementing the MITS procedure. Generally, MITS was considered as a positive development for the health system. Diagnostic accuracy and identification of less common causes of death were highlighted as two main benefits of the MITS procedure. The study highlighted a number of facilitators for the acceptability of MITS including effective counseling, building trust with parents, fast procedure time, and approaching families within a few hours of death. In addition, lack of skilled staff, poorly equipped healthcare facilities and the potential high cost to conduct MITS were identified as challenges for the implementation of MITS.ConclusionsThis formative research provided a unique opportunity to explore health professionals’ views and attitudes towards the MITS procedure. Such insights are crucial to ensure successful implementation and integration of a new technique into the existing health system. The research identified the factors influencing the acceptability of MITS among health professionals in Pakistan. The study also informed factors that could help facilitate the implementation of the MITS procedures in the context of Pakistan and similar settings.

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Risk factors and causes of stillbirths among pregnant women in Pakistan

Cited by 15 publications

References 48 publications

Stillbirth maternity care measurement and associated factors in population-based surveys: EN-INDEPTH study

Stillbirth maternity care measurement and associated factors in population-based surveys: EN-INDEPTH study

Prevalence of stillbirth and its associated factors in East Africa: generalized linear mixed modeling

Perceptions of health professionals regarding minimally invasive tissue sampling (MITS) to identify the cause of death in stillbirths and neonates: results from a qualitative study

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