Stillbirths and very low Apgar scores among vaginal births in a tertiary hospital in Ghana: a retrospective cross-sectional analysis

The effect of maternal age on still birth in Africa: A systematic review and meta-analysis

Background and Aims

Stillbirth is a public health as well as a development problem in low and middle-income countries. The studies that found out maternal age as a factor for the risk of stillbirth reported different findings. This systematic review and meta-analysis is believed to fill the inconclusiveness of these findings. Hence, the aim of this systematic review and meta-analysis is to estimate the pooled effect of advanced maternal age on stillbirth in Africa.

Methods

PubMed & HINARY databases and Google Scholar search engine were searched to access the primary studies. The extracted data using Microsoft excel was exported to Stata 15 software for analysis. The presence of heterogeneity was checked using Cochran's Q statistic and the I 2 test. Publication bias was examined by using funnel plot and Egger's test. The pooled effect measure with DerSimonian and Laird method of random-effect model was reported using odds ratio (OR) with respective 95% confidence interval.

Results

Totally, 14 articles are included for the systematic review and meta-analysis. The stillbirth reported by the studies ranges from 15 to 146.7 per 1000 births. The overall OR of advanced maternal age (≥35 years) on stillbirth is 1.42 (1.18, 1.71) when compared with the age group of 20-35 years. The cumulative effect of getting pregnant at advanced age on stillbirth was slightly increasing from year to year.

Conclusion

Advanced maternal age is a risk factor for stillbirth. Health Information Communication on the risk of getting pregnant at the advanced ages on stillbirth should be well addressed to all women of reproductive age group.

Perinatal care and its association with perinatal death among women attending care in three district hospitals of western Uganda

BACKGROUND

Provision of effective care to all women and newborns during the perinatal period is a viable strategy for achieving the Sustainable Development Goal 3 targets on reducing maternal and neonatal mortality. This study examined perinatal care (antenatal, intrapartum, postpartum) and its association with perinatal deaths at three district hospitals in Bunyoro region, Uganda.

METHODS

A cross-sectional study was conducted in which a questionnaire was administered consecutively to 872 postpartum women before discharge who had attended antenatal care and given birth in the study hospitals. Data on care received during antenatal, labour, delivery, and postpartum period, and perinatal outcome were extracted from medical records of the enrolled postnatal women using a pre-tested structured tool. The care received from antenatal to 24 h postpartum period was assessed against the standard protocol of care established by World Health Organization (WHO). Poisson regression was used to assess the association between care received and perinatal death.

RESULTS

The mean age of the women was 25 years (standard deviation [SD] 5.95). Few women had their blood tested for hemoglobin levels, HIV, and Syphilis (n = 53, 6.1%); had their urine tested for glucose and proteins (n = 27, 3.1%); undertook an ultrasound scan (n = 262, 30%); and had their maternal status assessed (n = 122, 14%) during antenatal care as well as had their uterus assessed for contraction and bleeding during postpartum care (n = 63, 7.2%). There were 19 perinatal deaths, giving a perinatal mortality rate of 22/1,000 births (95% Confidence interval [CI] 8.1-35.5). Of these 9 (47.4%) were stillbirths while the remaining 10 (52.6%) were early neonatal deaths. In the antenatal phase, only fetal examination was significantly associated with perinatal death (adjusted prevalence ratio [aPR] = 0.22, 95% CI 0.1-0.6). No significant association was found between perinatal deaths and care during labour, delivery, and the early postpartum period.

CONCLUSION

Women did not receive all the required perinatal care during the perinatal period. Perinatal mortality rate in Bunyoro region remains high, although it's lower than the national average. The study shows a reduction in the proportion of perinatal deaths for pregnancies where the mother received fetal monitoring. Strategies focused on strengthened fetal status monitoring such as fetal movement counting methods and fetal heart rate monitoring devices during pregnancy need to be devised to reduce the incidence of perinatal deaths. Findings from the study provide valuable information that would support the strengthening of perinatal care services for improved perinatal outcomes.

Determinants of stillbirths in sub-Saharan Africa: A systematic review

BACKGROUND

Sub-Saharan African (SSA) countries have high stillbirth rates compared with high-income countries, yet research on risk factors for stillbirth in SSA remain scant.

OBJECTIVES

To identify the modifiable risk factors of stillbirths in SSA and investigate their strength of association using a systematic review.

SEARCH STRATEGY

CINAHL Plus, EMBASE, Global Health and MEDLINE databases were searched for literature.

SELECTION CRITERIA

Observational population- and facility-level studies exploring stillbirth risk factors, published in 2013-2019 were included.

DATA COLLECTION AND ANALYSIS

A narrative synthesis of data was undertaken and the potential risk factors were classified into subgroups.

MAIN RESULTS

Thirty-seven studies were included, encompassing 20 264 stillbirths. The risk factors were categorised as: maternal antepartum factors (0-4 antenatal care visits, multiple gestations, hypertension, birth interval of >3 years, history of perinatal death); socio-economic factors (maternal lower wealth index and basic education, advanced maternal age, grand multiparity of ≥5); intrapartum factors (direct obstetric complication); fetal factors (low birthweight and gestational age of <37 weeks) and health systems factors (poor quality of antenatal care, emergency referrals, ill-equipped facility). The proportion of unexplained stillbirths remained very high. No association was found between stillbirths and body mass index, diabetes, distance from the facility or HIV.

CONCLUSIONS

The overall quality of evidence was low, as many studies were facility based and did not adjust for confounding factors. This review identified preventable risk factors for stillbirth. Focused programmatic strategies to improve antenatal care, emergency obstetric care, maternal perinatal education, referral and outreach systems, and birth attendant training should be developed. More population-based, high-quality research is needed.

Stillbirth incidence and determinants in a tertiary health facility in the Volta Region of Ghana

BACKGROUND

Stillbirths are indicators of the quality of obstetrics care in health systems. Stillbirth rates and their associating factors vary by socio-economic and geographical settings. Published data on stillbirths and their associating factors in the Volta Region of Ghana are limited. This limits understanding of local factors that must be considered in designing appropriate interventions to mitigate the occurrence of stillbirths. This study determined the incidence of stillbirths and associated factors among deliveries at Ho Teaching Hospital (HTH) and contributes to understanding the consistent high stillbirths in the country and potentially in other low-resourced settings in sub-Saharan Africa.

METHOD

This was a prospective cohort study involving pregnant women admitted for delivery at HTH between October 2019 and March 2020. Data on socio-demographic characteristics such as age and employment, obstetric factors including gestational age at delivery and delivery outcomes like birthweight were collected using a pretested structured questionnaire. The primary outcome was the incidence of stillbirths at the facility. Summary statistics were reported as frequencies, percentages and means. Logistic regression methods were used to assess for association between stillbirths and independent variables including age and birthweight. Odds ratios were reported with 95% confidence intervals and associations with p-values < 0.05 were considered statistically significant.

RESULTS

A total of 687 women and their 702 newborns contributed data for analysis. The mean age (SD) was 29.3 (6.3) years and close to two-thirds had had at least one delivery previously. Overall stillbirth incidence was 31.3 per 1000 births. Of the 22 stillbirths, 17 were antepartum. Pre-eclampsia was the most common hypertensive disorder of pregnancy observed (49.3%, 33/67). Among others, less than 3 antenatal visits and low birthweight increased the odds of stillbirths in the bivariate analysis. In the final multivariate model, pregnancy and delivery at 28-34 weeks gestation [AOR 9.37(95% CI 1.18-74.53); p = 0.034] and induction of labour [AOR 11.06 (95% CI 3.10-39.42); p < 0.001] remained significantly associated with stillbirths.

CONCLUSION

Stillbirth incidence was 31.3 per 1000 births with more than half being antepartum stillbirths. Pregnancy/delivery at 28-34 weeks' gestation increased the odds of a stillbirth. Improving the quality of antenatal services, ensuring adherence to evidence-based protocols, accurate and prompt diagnosis and timely interventions of medical conditions in pregnancy particularly at 28-34 weeks' gestation could reduce incidence of stillbirths.

Predictors of Neonatal Mortality: A Retrospective Cross-Sectional Study From the Special Newborn Care Unit of a Tertiary Care Hospital

Background In India, a significant number of newborns die each year, with Madhya Pradesh having the highest neonatal mortality rate. However, there is a lack of information on factors that can predict neonatal mortality. Objective This study aimed to examine the factors influencing neonatal mortality among neonates admitted to a tertiary care centre's special newborn care unit (SNCU). Methods This retrospective record-based observational study was done at a tertiary care centre, where data from the special newborn care unit (SNCU) from 1st January 2021 to 31st December 2021 was used. We included data of all newborns who were treated in SNCU during the said period and excluded those who got referred or left against medical advice. We abstracted data on age at admission, gender, category, maturity status, birth weight, place of delivery, mode of transport, type of admission, indication of admission, duration of stay and outcome. Qualitative variables were described using frequency and percentage. The chi-square test was used to find out the association of different variables with the outcome, while multivariate logistic regression was conducted to identify risk factors of neonatal mortality. A p-value of <0.05 was considered significant. Results We finalized data of 1052 neonates for analysis. Among them, 846 neonates were successfully discharged while 206 neonates were deceased. The major cause of admission was perinatal asphyxia followed by prematurity. The major cause of mortality in this study was sepsis followed by respiratory distress syndrome, birth asphyxia, and prematurity. Mortality of neonates was significantly associated with maturity status, birth weight, place of delivery, age during admission and duration of stay. Prematurity (OR=3.762, 95% CI:1.93-7.33), birth weight 1000-1499g (OR=4.78, 95% CI:2.21-10.32), birth weight <1000g (OR=25.11, 95% CI:5.71-110.24), age at admission <1-day (OR=2.312, 95% CI:1.03-5.19), duration of stay 1-3-days (OR=12.98, 95% CI:7.48-22.52) and <1-day (OR=1271.88, 95% CI:121.39-13325.69) were significant predictors of mortality in our study. Conclusion Our study emphasizes monitoring and addressing risk factors like maturity status, birth weight, and age at admission to reduce neonatal mortality, with a focus on early management of preterm births and low birth weight.

Causes, survival rates, and short-term outcomes of preterm births in a tertiary hospital in a low resource setting: An observational cohort study

Background

Prematurity is the most important cause of death among children under the age of five years. Globally, most preterm births occur in Sub-Saharan Africa. Subsequent prematurity leads to significant neonatal morbidity, mortality and long-term disabilities. This study aimed to determine the causes, survival rates and outcomes of preterm births up to six weeks of corrected age in Ghana.

Materials and methods

An observational prospective cohort study of infants born preterm was conducted in a tertiary hospital in Accra, Ghana from August 2019 to March 2020. Inclusion was performed within 48 h after birth of surviving infants; multiple pregnancies and stillbirths were excluded. Causes of preterm birth were categorized as spontaneous (including preterm pre-labour rupture of membranes) or provider-initiated (medically indicated birth based on maternal or fetal indications). Survival rates and adverse outcomes were assessed at six weeks of corrected age. Recruitment and follow-up were suspended due to the COVID-19 outbreak. Descriptive statistics and differences between determinants were calculated using Chi-squared tests or Kruskal-Wallis test.

Results

Of the 758 preterm deliveries, 654 (86.3%) infants were born alive. 179 were enrolled in the cohort and were analyzed. Nine (5%) were extremely preterm [gestational age (GA) < 28 weeks], 40 (22%) very preterm (GA 28-31 weeks), and 130 (73%) moderate to late preterm (GA 32-37 weeks) births. Most deliveries (n = 116, 65%) were provider-initiated, often due to hypertensive disorders in pregnancy (n = 79, 44.1%). Sixty-two infants were followed-up out of which fifty-two survived, presenting a survival rate of 84% (n = 52/62) at six weeks corrected age in this group. Most infants (90%, n = 47/52) experienced complications, predominantly consisted of NICU admission (92%) and interval illnesses (21%) including jaundice and sepsis.

Conclusions

The incidence of adverse outcomes associated with preterm birth in a tertiary facility with NICU capacity is high. Larger longitudinal studies are needed for an in-depth understanding of the causes and longer-term outcomes of preterm birth, and to identify effective strategies to improve outcomes in resource constrained settings.

Modeling clinical and non-clinical determinants of intrapartum stillbirths in singletons in six public hospitals in the Greater Accra Region of Ghana: a case-control study

The Greater Accra Region (GAR) of Ghana records 2000 stillbirths annually and 40% of them occur intrapartum. An understanding of the contributing factors will facilitate the development of preventive strategies to reduce the huge numbers of intrapartum stillbirths. This study identified determinants of intrapartum stillbirths in GAR. A retrospective 1:2 unmatched case-control study was conducted in six public hospitals in the Greater Accra Region of Ghana. A multivariable binary logistic regression model was used to quantify the effect of exposures on intrapartum stillbirth. The area under the receiver operating characteristics curve and the Brier scores were used to screen potential risk factors and assess the predictive performance of the regression models. The following maternal factors increased the odds of intrapartum stillbirths: pregnancy-induced hypertension (PIH) [adjusted Odds Ratio; aOR = 3.72, 95% CI:1.71-8.10, p < 0.001]; antepartum haemorrhage (APH) [aOR = 3.28, 95% CI: 1.33-8.10, p < 0.05] and premature rupture of membranes (PROM) [aOR = 3.36, 95% CI: 1.20-9.40, p < 0.05]. Improved management of PIH, APH, PROM, and preterm delivery will reduce intrapartum stillbirth. Hospitals should improve on the quality of monitoring women during labor. Auditing of intrapartum stillbirths should be mandatory for all hospitals and Ghana Health Service should include fetal autopsy in stillbirth auditing to identify other causes of fetal deaths. Interventions to reduce intrapartum stillbirth must combine maternal, fetal and service delivery factors to make them effective.

Distributed Big Data Analytics Method for the Early Prediction of the Neonatal 5-Minute Apgar Score before or during Birth and Ranking the Risk Factors from a National Dataset

One-minute and five-minute Apgar scores are good measures to assess the health status of newborns. A five-minute Apgar score can predict the risk of some disorders such as asphyxia, encephalopathy, cerebral palsy and ADHD. The early prediction of Apgar score before or during birth and ranking the risk factors can be helpful to manage and reduce the probability of birth producing low Apgar scores. Therefore, the main aim of this study is the early prediction of the neonate 5-min Apgar score before or during birth and ranking the risk factors for a big national dataset using big data analytics methods. In this study, a big dataset including 60 features describing birth cases registered in Iranian maternal and neonatal (IMAN) registry from 1 April 2016 to 1 January 2017 is collected. A distributed big data analytics method for the early prediction of neonate Apgar score and a distributed big data feature ranking method for ranking the predictors of neonate Apgar score are proposed in this study. The main aim of this study is to provide the ability to predict birth cases with low Apgar scores by analyzing the features that describe prenatal properties before or during birth. The top 14 features were identified in this study and used for training the classifiers. Our proposed stack ensemble outperforms the compared classifiers with an accuracy of 99.37 ± 1.06, precision of 99.37 ± 1.06, recall of 99.50 ± 0.61 and F-score of 99.41 ± 0.70 (for confidence interval of 95%) to predict low, moderate and high 5-min Apgar scores. Among the top predictors, fetal height around the baby’s head and fetal weight denote fetal growth status. Fetal growth restrictions can lead to low or moderate 5-min Apgar score. Moreover, hospital type and medical science university are healthcare system-related factors that can be managed via improving the quality of healthcare services all over the country.

Prediction of low Apgar score at five minutes following labor induction intervention in vaginal deliveries: machine learning approach for imbalanced data at a tertiary hospital in North Tanzania

Background

Prediction of low Apgar score for vaginal deliveries following labor induction intervention is critical for improving neonatal health outcomes. We set out to investigate important attributes and train popular machine learning (ML) algorithms to correctly classify neonates with a low Apgar scores from an imbalanced learning perspective.

Methods

We analyzed 7716 induced vaginal deliveries from the electronic birth registry of the Kilimanjaro Christian Medical Centre (KCMC). 733 (9.5%) of which constituted of low (< 7) Apgar score neonates. The ‘extra-tree classifier’ was used to assess features’ importance. We used Area Under Curve (AUC), recall, precision, F-score, Matthews Correlation Coefficient (MCC), balanced accuracy (BA), bookmaker informedness (BM), and markedness (MK) to evaluate the performance of the selected six (6) machine learning classifiers. To address class imbalances, we examined three widely used resampling techniques: the Synthetic Minority Oversampling Technique (SMOTE) and Random Oversampling Examples (ROS) and Random undersampling techniques (RUS). We applied Decision Curve Analysis (DCA) to evaluate the net benefit of the selected classifiers.

Results

Birth weight, maternal age, and gestational age were found to be important predictors for the low Apgar score following induced vaginal delivery. SMOTE, ROS and and RUS techniques were more effective at improving “recalls” among other metrics in all the models under investigation. A slight improvement was observed in the F1 score, BA, and BM. DCA revealed potential benefits of applying Boosting method for predicting low Apgar scores among the tested models.

Conclusion

There is an opportunity for more algorithms to be tested to come up with theoretical guidance on more effective rebalancing techniques suitable for this particular imbalanced ratio. Future research should prioritize a debate on which performance indicators to look up to when dealing with imbalanced or skewed data.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04534-0.

Predictors of Pregnancy Termination among Young Women in Ghana: Empirical Evidence from the 2014 Demographic and Health Survey Data

Pregnancy termination remains a delicate and contentious reproductive health issue because of a variety of political, economic, religious, and social reasons. The present study examined the associations between demographic and socio-economic factors and pregnancy termination among young Ghanaian women. This study used data from the 2014 Demographic and Health Survey of Ghana. A sample size of 2114 young women (15-24 years) was considered for the study. Both descriptive (frequency, percentages, and chi-square tests) and inferential (binary logistic regression) analyses were carried out in this study. Statistical significance was pegged at p < 0.05. Young women aged 20-24 were more likely to have a pregnancy terminated compared to those aged 15-19 (AOR = 3.81, CI = 2.62-5.54). The likelihood of having a pregnancy terminated was high among young women who were working compared to those who were not working (AOR = 1.60, CI = 1.19-2.14). Young women who had their first sex at the age of 20-24 (AOR = 0.19, CI = 0.10-0.39) and those whose first sex occurred at first union (AOR = 0.57, CI = 0.34-0.96) had lower odds of having a pregnancy terminated compared to those whose first sex happened when they were less than 15 years. Young women with parity of three or more had the lowest odds of having a pregnancy terminated compared to those with no births (AOR = 0.39, CI = 0.21-0.75). The likelihood of pregnancy termination was lower among young women who lived in rural areas (AOR = 0.65, CI = 0.46-0.92) and those in the Upper East region (AOR = 0.18, CI = 0.08-0.39). The findings indicate the importance of socio-demographic factors in pregnancy termination among young women in Ghana. Government and non-governmental organizations in Ghana should help develop programs (e.g., sexuality education) and strategies (e.g., regular sensitization programs) that reduce unintended pregnancies which often result in pregnancy termination. These programs and strategies should include easy access to contraceptives and comprehensive sexual and reproductive health education. These interventions should be designed considering the socio-demographic characteristics of young women. Such interventions will help to achieve Sustainable Development Goal 3.1 that seeks to reduce the global maternal mortality ratio to fewer than 70 per 100,000 live births by 2030.

The determinants of 5th minute low Apgar score among newborns who delivered at public hospitals in Hawassa City, South Ethiopia

BACKGROUND

Newborn morbidity and mortality are forecasted using the Apgar scores. Obstetricians worldwide have used the Apgar score for more than half a century for the assessment of immediate newborn conditions. It is a simple and convenient evaluation system that offers a standardized and effective assessment of newborn infants. Neonatal morbidity and mortality can be reduced if high-risk neonates are identified and managed adequately. This study aimed to assess the determinants of 5th minute low Apgar score among newborns at Public hospitals in Hawassa city, South Ethiopia.

METHODS

A hospital-based unmatched case-control study was conducted at Public Hospitals in Hawassa city. Data were collected from 134 cases and 267 controls using a structured and pre-tested questionnaire by observing, interviewing, and reviewing patient cards. Newborns who delivered with a 5th minute Apgar score < 7 were considered as cases; whereas a similar group of newborns with a 5th minute Apgar score of ≥ 7 were categorized as controls. A consecutive sampling technique was employed to recruit cases, while a simple random sampling technique was used to select controls. Data entry and analysis were performed using Epi Data version 3.1 and SPSS version 20 respectively. Binary and multivariable analyses with a 95 % confidence level were performed. In the final model, variables with P < 0.05 were considered statistically significant.

RESULTS

After controlling for possible confounding factors, the results showed that lack of physical and emotional support during labor and delivery [AOR = 3.5, 95 %CI:1.82-6.76], rural residence [AOR = 4, 95 %CI: 2.21-7.34], lack of antenatal care follow up [AOR = 3.5, 95 % CI: 1.91-6.33], anemia during pregnancy [AOR = 2.3,95 %CI: 1.10-4.71] and low birth weight [AOR = 6.2, 95 %CI: 2.78-14.03] were determinant factors of low Apgar scores. The area under the Apgar score ROC curve was 87.4 %.

CONCLUSIONS

Lack of physical and emotional support, rural residence, lack of ANC follow-up, low birth weight, and anemia during pregnancy were determinant factors of a low Apgar score. `Effective health education during preconception about anemia during pregnancy and ANC will help in detecting high-risk pregnancies that lead to a low Apgar score. In addition to the standard care of using electronic fetal monitoring, increasing access to compassion ships during labor and delivery is recommended.

Cause and predictors of neonatal mortality among neonates admitted to neonatal intensive care units of public hospitals in eastern Ethiopia: a facility-based prospective follow-up study

Background

The first month is the most crucial period for child survival. Neonatal mortality continues to remain high with little improvement over the years in Sub-Saharan Africa, including Ethiopia. This region shows the least progress in reducing neonatal mortality and continues to be a significant public health issue. In this study setting, the causes and predictors of neonatal death in the neonatal intensive care units are not well documented. Hence, this study aimed to determine the causes and predictors of neonatal mortality among infants admitted to neonatal intensive care units in eastern Ethiopia.

Methods

A facility-based in prospective follow-up study was conducted among neonates admitted to neonatal intensive care units of public hospitals of eastern Ethiopia from November 1 to December 30, 2018. Data were collected using a pre-tested structured questionnaire and a follow-up checklist. The main outcomes and causes of death were set by pediatricians and medical residents. EpiData 3.1 and Statistical Package for Social Sciences Version 25 software were used for data entry and analysis, respectively. Multivariable logistic regression was used to identify the predictors of facility-based neonatal mortality.

Results

The proportion of facility-based neonatal mortality was 20% (95% CI:16.7–23.8%). The causes of death were complications of preterm birth (28.58%), birth asphyxia (22.45%), neonatal infection (18.36%), meconium aspiration syndrome (9.18%), respiratory distress syndrome (7.14%), and congenital malformation (4.08%). Low birth weight, preterm births, length of stay of the neonatal intensive care unit, low 5 min APGAR score, hyperthermia, and initiation of feeding were predictors of neonatal death among infants admitted to the neonatal intensive care units of public hospitals in eastern Ethiopia.

Conclusions

The proportion of facility-based neonatal deaths was unacceptably high. The main causes of death were preventable and treatable. Hence, improving the timing and quality of antenatal care is essential for early detection, anticipating high-risk newborns, and timely interventions. Furthermore, early initiation of feeding and better referral linkage to tertiary health facilities could lead to a reduction in neonatal death in this setting.

Determinants of birth asphyxia among newborns in Ethiopia: A systematic review and meta-analysis

OBJECTIVE

The aim of this systematic review and meta-analysis was to estimate the pooled magnitude of birth asphyxia and its determinants in Ethiopia.

METHODS

The databases, including PubMed, Medline, CINAHL, EMBASE, and other relevant sources, were used to search relevant articles. Both published and unpublished studies, written in English and carried out in Ethiopia, were included in the study. Quality of evidence was assessed by the relevant of the Joanna Briggs Institute tool. RevMan v5.3 statistical software was used to undertake the meta-analysis using a Mantel-Haenszel random-effects model. Heterogeneity was evaluated using the Cochran Q test, and I2 statistics was considered to assess its level. The outcome was measured using a 95% confidence interval (CI).

RESULTS

The pooled prevalence of birth asphyxia was 22.8% (95% CI: 13-36.8%]. Illiterate mothers (adjusted odds ratio [AOR]; 1.96, 95% CI: 1.44-2.67), antepartum hemorrhage (APH) (AOR; 3.43, 95% CI: 1.74-6.77), cesarean section (AOR; 3.66, 95% CI: 1.35-9.91), instrumental delivery (AOR; 2.74, 95% CI: 1.48-5.08), duration of labor (AOR; 3.09, 95% CI: 1.60-5.99), pregnancy induced hypertension (AOR; 4.35, 95% CI: 2.98-6.36), induction of labor (AOR; 3.69, 95% CI: 2.26-6.01), parity (AOR; 1.29, 95% CI: 1.03-1.62), low birth weight (LBW) (AOR; 5.17, 95% CI: 2.62-10.22), preterm (AOR; 3.98, 95% CI: 3.00-5.29), non-cephalic presentation (AOR; 4.33, 95% CI: 1.97-9.51), and meconium staining (AOR; 4.59, 95% CI: 1.40-15.08) were significantly associated with birth asphyxia.

CONCLUSION

The magnitude of birth asphyxia was very high. Maternal education, APH, mode of delivery, prolonged labor, induction, LBW, preterm, meconium-staining, and non-cephalic presentation were determinants of birth asphyxia. Hence, to reduce birth asphyxia and associated neonatal mortality, attention should be directed to improve the quality of intrapartum service and timely communication between the delivery team. In addition, intervention strategies aimed at reducing birth asphyxia should target the identified determinants.

Association between time of delivery and poor perinatal outcomes -An evaluation of deliveries in a tertiary hospital, South-east Nigeria

OBJECTIVES

Nigeria account for a significant proportion of adverse perinatal outcome. Nigerian studies assessing impact of time of delivery on perinatal outcome are scarce. This study evaluates any associations between time of delivery and perinatal outcome.

METHODS

This was a cross-sectional study at the Federal Teaching Hospital, Abakaliki from 01 January 2016 to 30 June 2018. Data were analysed with IBM SPSS version 25.0.

RESULTS

A total of 4,556 deliveries were analysed. Majority (72.2%) delivered on week days and 27.8% on weekends. Over 90% had 1st and 5th minutes Apgar scores ≥7. There was statistical difference in NICU admission between morning and evening hours (p = 0.009) but not between morning and night hours (p = 0.795). ENND during evening was twice higher (1.2%) than morning (0.5%); p = 0.047 and night hours (0.6%); p = 0.623.There was no difference in the risk of fresh stillbirths between morning and evening (p = 0.560), as well as morning and night hours (p = 0.75), there was also no difference in fresh stillbirths between week days and weekends (p = 0.895). There was no difference in low Apgar scores at 1st minute between morning and evening (p = 0.053) and night (p = 0.221), and between weekdays and weekends (p = 0.524). Similarly, there was no difference in low 5th minute Apgar scores between morning and evening (p = 0.165) and night (p = 0.944), as well as between week days and weekends (p = 0.529). However, ENND was twice (p = 0.085) and 1.3 times higher (p = 0.526) for evening and night hours respectively, while there was no difference between weekends and week days (p = 0.652).

CONCLUSION

NICU admission and ENND were commoner during evening hours. However, work hours did not affect the rate of stillbirth and low Apgar scores during weekdays and weekends. It is pertinent for each obstetric unit to identify and modify factors responsible for unfavourable outcomes during various shifts, with the aim of improving perinatal health.

Adverse pregnancy outcomes, 'stillbirths and early neonatal deaths' in Mutare district, Zimbabwe (2014): a descriptive study

Background

Perinatal deaths account for 7% of the global burden of disease, with developing countries contributing about 98% of deaths. The aim of this study was to describe the prevalence and factors contributing to adverse pregnancy outcomes, particularly perinatal death, among women at Sakubva hospital, Mutare district, Zimbabwe from January to June 2014.

Methods

We conducted a retrospective review of 346 patient records, of women who delivered at Sakubva hospital and those referred from Mutare district facilities to Mutare Provincial Hospital, between January and June 2014. Descriptive statistics was used to explore the contributors to stillbirths and early neonatal deaths in Mutare.

Results

Of the 346 women, 54 (15.61%) experienced an adverse pregnancy outcome (stillbirth or early neonatal death). Contributing factors to adverse pregnancy outcomes included birthweight, gestational age, delivery complications and delivery methods. These factors are preventable if quality focused antenatal care, intrapartum care is provided. Identification of pregnancy complications and facilitation of proper method of delivery is key to improve quality of care. Caesarean section provision to all women who need it improves outcomes.

Conclusions

High prevalence of adverse pregnancy outcomes in Mutare district could be reduced through the provision of quality antenatal care throughout the continuum of care, pre-, intra and postpartum. Further studies to explore risk factors associated with high adverse outcomes are recommended.

Maternal and fetal risk factors for stillbirth in Northern Tanzania: A registry-based retrospective cohort study

Background

Stillbirth is a major cause of perinatal mortality and occurs disproportionately in developing countries including Tanzania. However, there is scant information regarding the predictors of this condition in Tanzania. This study aimed to determine maternal and fetal risk factors for stilbirth in northen Tanzania.

Methodology

A retrospective cohort study was performed using maternally-linked data from the Kilimanjaro Christian Medical Centre birth registry. A total of 47681 women who had singleton delivery at KCMC between 2000 and 2014 were analyzed. Women with multiple gestations were excluded. Descriptive statistics were summarized using proportions and frequency. Chi-square test was used to determine risk factors for stillbirth in bivariate analysis. A multivariable regression model was used to estimate adjusted odds ratios (AOR) with 95% confidence intervals for maternal and fetal factors associated with stillbirth. A p-value of less than 0.05 was considered statistically significant.

Results

The frequency of stillbirth was 3.5%. Pre-eclampsia (AOR 3.99; 95% CI: 3.31–4.81) and placental abruption (AOR 22.62; 95% CI: 15.41–33.19) were the strongest maternal risk factors associated with still birth. While non-cephalic presentation (AOR 6.05; 95% CI: 4.77–7.66) and low birth weight (AOR 9.66; 95%CI: 8.66–10.77) were the fetal factors with the greatest impact on stillbirth.

Conclusion

The rate of stillbirth in our study was consistent with past studies of developing countries. Numerous maternal and fetal factors risk factors were identified. Early identification of at risk pregnancies and appropriate intervention may help to reduce the occurrence of stillbirth.

Determinants of stillbirths in Ghana: does quality of antenatal care matter?

BACKGROUND

Each year, over two million babies die before they are born. Like maternal deaths, the great majority of these stillbirths occur in developing countries, with about a third of all cases worldwide in sub-Saharan Africa (SSA). Few studies have, however, examined the determinants of stillbirths in SSA. In addition, the emphases on promoting deliveries by skilled birth attendants and/or in health facilities to prevent maternal deaths, though important, may have undermined efforts to provide good quality antenatal care (ANC), which may have an additional role in preventing stillbirths. This study examines the factors associated with stillbirths in Ghana, focusing on the role of ANC quality.

METHODS

Data are from the Ghana Maternal Health Survey (N = 4,868)-a national survey of women of reproductive age. The main analysis includes women who had a pregnancy ending in a live birth or stillbirth in the five years preceding the survey and who received ANC at least once. ANC quality is measured by an index based on receipt (or otherwise) of nine antenatal services during the last pregnancy, including education about pregnancy complications; with receipt of at least of eight services classified as higher quality ANC. Stillbirths refer to babies born dead at seven or more months of pregnancy. Analytic techniques include multilevel logistic regression, with moderation and mediation analysis to examine conditional and intervening effects respectively.

RESULTS

Higher quality ANC decreases the odds of a stillbirth by almost half after accounting for other factors, including the type of delivery provider and facility. Educating pregnant women about pregnancy complications contributes significantly to this difference by ANC quality. The type of delivery facility and provider account for a small proportion (14 %) of the ANC quality effect on stillbirths and a larger proportion of the rural/urban difference (27 %) in stillbirths. Completing the recommended four antenatal visits decreases the odds of a stillbirth. Having a pregnancy complication, a multiple gestation, a past stillbirth, or a sister who died from pregnancy complications increases the odds of a stillbirth.

CONCLUSIONS

Good quality ANC can improve birth outcomes in two ways: directly through preventative measures, and indirectly through promoting deliveries in health facilities where complications can be better managed. Targeted programs and policies to increase ANC quality, including adequately educating women on pregnancy complications, will help improve birth outcomes in Ghana, and in SSA as a whole.

Linear trends and seasonality of births and perinatal outcomes in Upper East Region, Ghana from 2010 to 2014

BACKGROUND

Seasonal variations greatly influence birth patterns differently from country to country. In Ghana, there is paucity of information on birth seasonal patterns. This retrospective study described the trends and seasonality of births and perinatal outcomes in Upper East Region of Ghana.

METHODS

Births occurring in each month of the calendar years (2010-2014; inclusive) were extracted from the District Health Information Management System (DHIMS2) database of the Bolgatanga Municipal Health Directorate and exported into Microsoft Excel spread sheet and Epi Ifo for analysis. Analysis was carried out by calculating average number of births per month correcting for unequal month length using 30 days. A Chi-square test for trend was performed to check for statistical significance (p < 0.05) in trends and seasonality of birth and perinatal outcomes.

RESULTS

There were 24,171 health facility deliveries, of which 97.7% were singleton deliveries and 2.3% were multiple (two or three) deliveries. There was a consistent rise in the annual health facility deliveries controlled for the number of fertile women, from 4169 in 2010 to 5474 in 2014 (p < 0.0001). Monthly birth distribution displayed a periodic pattern with peaks in May, September and October and troughs during the months of January, February and July (p < 0.0001). Women were likely to give birth during the raining season than the dry season. Caesarean Section (CS) rate showed a steady rise over the years (124 per 1000 births in 2010 to 185 per 1000 births in 2014 (p < 0.0001) with overall rate of 14.6%. Stillbirth (SB) rate, however decreased slightly over the years from 29 per 1000 births to 23 per 1000 births (p = 0.197) with overall SB rate of 2.6%. Similarly, Low Birth Weight (LBW) declined from 77 per 1000 live births to 71 per 1000 live births from 2010 to 2014 (p < 0.0001). Seasonal (rainy and dry) distributions did not show a clear difference in birth frequencies.

CONCLUSION

Health facility delivery was persistently high in the Bolgatanga Municipality with birth peaking in May, September and October. Despite the rising rate of caesarean section, stillbirth rate did not significantly improved over the years. A prospective study may reveal the reasons for the increasing caesarean section rate. Additionally, understanding the factors that affect the decreasing trends of low birth weight in the municipality is crucial to public health policy makers in Ghana.