Socio-Demographic Determinants of Antepartum Fetal Death

Abstract

Background: Antepartum fetal death (AFD) contributes signifi cantly to stillbirths (SB) in low-and middle-income countries (LMIC). Modifying locally-prevalent demographic risk factors could lessen the burden of SB in the region.Objective: This study seeks to identify the prevalence and modifi able socio-demographic risks for antepartum fetal death (AFD) in a Nigerian setting with the aim of recommending appropriate interventions to reduce the burden. Method: Hospital-based 6 year (2009-2014) review of obstetric records at Ekiti State University Teaching Hospital (EKSUTH), Nigeria.Results: Stillbirth (SB) rate was 29/1000 births and AFD rate was 22.5/1000 birth. AFD was more among women with age ≤20years (93.8%), who had no antenatal care (83.2%), single (92.3%), with no formal education (95.6%), unskilled occupation (81.1%), parity ≥ 5 (92.3%), those with prior history of SB (81.0%) and Muslims (81.8%). Logistic regression analysis showed that absence of antenatal care (AOR: 3.32, 95% CI: 1.80-6.21, P<0.001) and lack of formal education (AOR: 0.18, 95% CI: 0.03-0.64, P= 0.005) signifi cantly predict likelihood of AFD. Conclusion:Absence of antenatal care and lack of formal education are associated with AFD during pregnancy. Educating women and health promotion towards improving the utilization of antenatal services can remarkably reduce the burden in low-resource settings. Research Article Socio-Demographic Determinants of Antepartum Fetal Death IntroductionDelivery of a still baby marks the tragic end of many months of joyful anticipation and the beginning of, sometimes un-abating, grief for the affected family. But, despite the serious adverse impact stillbirth (SB) could have on families, appropriate recognition is not given to it in the Global Burden of Disease, yet when compared with communicable and noncommunicable causes of death worldwide, SB would rank fi fth among the global health burdens -ahead of diarrhoea, HIV/ AIDS, tuberculosis, traffi c accidents and any form of cancer [1].Globally, up to three-quarters of all babies born dead died before labour began, with intra-partum deaths making up the remaining [2]. Estimates from a multi-centre intercontinental study show that 98% of the 3.2 million SB that occur annually are in low-and middle-income countries (LMIC) with the heaviest burdens occurring in South Asia and Africa [3].In the West African sub-region for example, SB accounts for 62% of perinatal deaths, out of which close to half are antepartum fetal death (AFD) [4,5]. Within the sub-region, on some occasions the baby's death is attributed to handiwork of evil spirits. However, often the grief of the families is compounded by social stigmatization that the SB was as a result of maternal sins [6].Some authors that evaluated strategies for prevention of SB concluded that recognition of risk factors, including modifi able socio-economic risk, will assist in identifying women in need of specialized care, surveillance and/or interventions to improve outcomes and prevent SB [7][8][9]. In spi...