Understanding the complexities of unexplained stillbirth in sub‐Saharan Africa: a mixed‐methods study

Abstract

Objective To understand the complexities surrounding unexplained stillbirth for the development and implementation of culturally acceptable interventions to underpin care in Tanzania and Zambia. Design Mixed‐methods study. Setting Tertiary, secondary and primary care facilities in Mansa, Zambia, and Mwanza, Tanzania. Sample Quantitative: 1997 women giving birth at two tertiary care facilities (one in each country). Qualitative: 48 women and 19 partners from tertiary, secondary and primary care facilities. Methods Case review using data from a target of 2000 consecutive case records. Qualitative interviews with a purposive sample of women and partners, using a grounded theory approach. Results A total of 261 stillbirths were recorded, with a rate of 16% in Tanzania and 10% in Zambia, which is higher than the previous estimates of 2.24 and 2.09%, respectively, for those countries. Women in both countries who reported a previous stillbirth were more likely to have stillbirth (RR 1.86, 95% CI 1.23–2.81). The cause of death was unexplained in 28% of cases. Qualitative findings indicated that not knowing what caused the baby to be stillborn prevented women from grieving. This was compounded by the poor communication skills of health professionals, who displayed little empathy and skill when counselling bereaved families. Conclusions The stillbirth risk in both facilities was far higher than the risk recorded from national data, with women reporting a previous stillbirth being at higher risk. Women want to know the cause of stillbirth and an exploration of appropriate investigations in this setting is required. Providing health professionals with support and continuing training is key to improving the experiences of women and future care. Tweetable abstract Stillbirths receive little investigation and are often unexplained. Communication with women about the death of their baby is limited.

Exploring the impact of healthcare workers communication with women who have experienced stillbirth in Malawi, Tanzania and Zambia. A grounded theory study

“…Motherhood of a stillborn baby is often not recognised, with women being encouraged to forget their pregnancy and its outcome [18] , [49] . These rules may find validation among healthcare workers when the death of the baby is given little attention and treated as a casual event [21] , [50] , [51] . In this study, these rules seemed to be reinforced by family members when provision of support was aimed to conform with culture and to move on, rather than reassuring the woman of the normality of her trauma and the importance to express her feelings as they emerge.…”

Prediction of stillbirth low resource setting in Northern Uganda

“…In Ethiopia, predictors of stillbirth were multiple pregnancies and having no prenatal care 20 . In Tanzania and Zambia, the predictor of stillbirth was a previous history of stillbirth 10 .…”

“…The global prevalence of stillbirth is approximately 2% 5 , with 0.3% occurring in the global north 6,7 , and more than 2% in the global south 5,[8][9][10] . Women of Afro-Caribbean and Asian origin are more at risk of stillbirths 7,[11][12][13][14] and this may be associated with racial disparities in accessing health care 12 .…”

Prediction of stillbirth low resource setting in Northern Uganda

“…The global prevalence of stillbirth is approximately 2% [ 5 ], with 0.3% occurring in the global north [ 6 , 7 ], and more than 2% in the global south [ 5 , 8 – 10 ]. Women of Afro-Caribbean and Asian origin are more at risk of stillbirths [ 7 , 11 – 14 ] and this may be associated with racial disparities in accessing health care [ 12 ].…”