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Abate M, Arefaynie M, Muche A, Molla A, Wodajo S, Temesgen K, Fentaw Z, Tefera Z, Habtewold TD. The effect of maternal age on still birth in Africa: A systematic review and meta-analysis. Health Sci Rep 2024; 7:e2105. [PMID: 38784246 PMCID: PMC11111610 DOI: 10.1002/hsr2.2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024] Open
Abstract
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.
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Affiliation(s)
- Mengistu Abate
- Department of Midwifery, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Amare Muche
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Asressie Molla
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Shambel Wodajo
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Kibir Temesgen
- Department of Midwifery, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Zinabu Fentaw
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Zenebe Tefera
- Department of Midwifery, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Tesfa D. Habtewold
- Department of EpidemiologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
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Abriham AA, Shitie E, Melese S, Dessie AM, Bizuneh AD. Determinants of stillbirth among women who delivered in hospitals of North Wollo Zone, Northeast Ethiopia: A case-control study. PLoS One 2024; 19:e0301602. [PMID: 38603732 PMCID: PMC11008825 DOI: 10.1371/journal.pone.0301602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Stillbirth is a silent tragedy that shatters the lives of women, families, and nations. Though affecting over 2 million infants globally in 2019, it remains overlooked, with no specific targets dedicated to its reduction in the sustainable development goals. Insufficient knowledge regarding the primary risk factors contributing to stillbirths hinders efforts to reduce its occurrence. Driven by this urgency, this study focused on identifying the determinants of stillbirth among women giving birth in hospitals across North Wollo Zone, Northeast Ethiopia. METHODOLOGY This study employed an institution-based unmatched case-control design, involving a randomly selected sample of 412 women (103 cases and 309 controls) who gave birth in hospitals of North Wollo Zone. Data were collected using a structured data extraction checklist. Data entry was conducted using Epi-data version 3.1, and analysis was performed using SPSS version 25.0. Employing a multivariable logistic regression model, we identified independent predictors of stillbirth. The level of statistical significance was declared at a p-value < 0.05. RESULTS Our analysis revealed several critical factors associated with an increased risk of stillbirth. Women who experienced premature rupture of membranes (AOR = 5.53, 95% CI: 2.33-9.94), induced labor (AOR = 2.24, 95% CI: 1.24-4.07), prolonged labor exceeding 24 hours (AOR = 3.80, 95% CI: 1.94-7.45), absence of partograph monitoring during labor (AOR = 2.45, 95% CI: 1.41-4.26) were all significantly associated with increased risk of stillbirth. Preterm birth (AOR = 3.46, 95% CI: 1.87-6.39), post-term birth (AOR = 3.47, 95% CI: 1.35-8.91), and carrying a female fetus (AOR = 1.81, 95% CI: 1.02-3.22) were at a higher risk of stillbirth. CONCLUSION These findings highlight the importance of early intervention and close monitoring for women experiencing premature rupture of membranes, prolonged labor, or induced labor. Additionally, consistent partograph use and enhanced prenatal care for pregnancies at risk of preterm or post-term birth could potentially contribute to reducing stillbirth rates and improving maternal and neonatal outcomes. Further research is needed to investigate the underlying mechanisms behind the observed association between fetal sex and stillbirth risk.
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Affiliation(s)
- Atnaf Alem Abriham
- Gubalafto Health Office, North Wollo Zonal Health Department, Woldia, Amhara Region, Ethiopia
| | - Eyob Shitie
- School of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Sisay Melese
- CDC Project HIV Case Detection, Linkage, Care and Treatment Coordinator, Woldia, Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asmamaw Demis Bizuneh
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
- Monash Center for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Erega BB, Ferede WY. A cohort study of maternal near-miss events and its adverse perinatal outcomes: an obstetrical finding in Northwest Ethiopia. AJOG GLOBAL REPORTS 2024; 4:100311. [PMID: 38356725 PMCID: PMC10865472 DOI: 10.1016/j.xagr.2024.100311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Globally, various studies have reported that most adverse perinatal outcomes were associated with maternal near-misses. In Ethiopia, studies on adverse perinatal outcomes from maternal near-miss are scarce. OBJECTIVE This study aimed to assess the incidence, determinants, and maternal near-miss effects on perinatal outcomes among women at public hospitals in the South Gondar zone in 2021. STUDY DESIGN A facility-based prospective cohort study was conducted from January 10, 2021, to May 10, 2021. The chi-square test, multivariable logistic regression methods, and SPSS software were used. The strength of associations and significance level were examined using P values and odds ratios with 95% confidence intervals, respectively. In addition, multicollinearity and model fitness were checked. RESULTS A total of 304 respondents (76 exposed and 228 unexposed) were included in the study with a response rate of 100.0%. The incidence rates of adverse perinatal outcomes among exposed and unexposed groups were 71.1% (95% confidence interval, 60.0-73.8) and 21.1% (95% confidence interval, 15.8-28.8), respectively. Multivariable logistic regression showed that short interbirth interval (adjusted odds ratio, 8.39; 95% confidence interval, 5.36-16.08), lower household income (adjusted odds ratio, 3.61; 95% confidence interval, 1.12-6.54), rural residence (adjusted odds ratio, 2.54; 95% confidence interval, 1.21-4.07), previous stillbirth (adjusted odds ratio, 4.24; 95% confidence interval, 1.04-17.31), absence of antenatal care (adjusted odds ratio, 9.84; 95% confidence interval, 4.89-17.51), and anemia (adjusted odds ratio, 4.19; 95% confidence interval, 1.01-17.46) were significantly associated with increased odds of adverse perinatal outcomes. CONCLUSION This study revealed that the incidence of adverse perinatal outcomes was significantly higher among exposed groups than unexposed groups. The result signified the need for improving the health of mothers by all stakeholders to improve perinatal outcomes.
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Affiliation(s)
- Besfat Berihun Erega
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debra Tabor, Ethiopia
| | - Wassie Yazie Ferede
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debra Tabor, Ethiopia
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Mukherjee A, Di Stefano L, Blencowe H, Mee P. Determinants of stillbirths in sub-Saharan Africa: A systematic review. BJOG 2024; 131:140-150. [PMID: 37272228 DOI: 10.1111/1471-0528.17562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/07/2023] [Accepted: 05/13/2023] [Indexed: 06/06/2023]
Abstract
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.
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Affiliation(s)
- Ankita Mukherjee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Monitoring, Evaluation and Research, New Delhi, India
| | | | - Hannah Blencowe
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Mee
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Lincoln International Institute for Rural Health, College of Social Science, University of Lincoln, Lincoln, UK
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Kasa GA, Woldemariam AY, Adella A, Alemu B. The factors associated with stillbirths among sub-saharan African deliveries: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:835. [PMID: 38049743 PMCID: PMC10696713 DOI: 10.1186/s12884-023-06148-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Globally, more than 2.6 million stillbirths occur each year. The vast majority (98%) of stillbirths occur in low- and middle-income countries, and over fifty percent (55%) of these happen in rural sub-Saharan Africa. METHODS This is a systematic review and meta-analysis developed using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. A literature search was performed using PubMed, the Cochrane Library, Google Scholar, EMBASE, Scopus, the Web of Sciences, and gray literature. Rayyan`s software was used for literature screening. A random effects meta-analysis was conducted with STATA version 17. Heterogeneity was checked by using Cochran's Q and I2 tests. Funnel plots and Egger's test were used to examine the risk of publication bias. The protocol of the study was registered in PROSPERO with a registration number of CRD42023391874. RESULTS Forty-one studies gathered from eight sub-Saharan countries with a total of 192,916 sample sizes were included. Nine variables were highly linked with stillbirth. These include advanced maternal age (aOR: 1.43, 95% CI: 1.16, 1.70), high educational attainment (aOR: 0.55, 95% CI: 0.47, 0.63), antenatal care (aOR: 0.45, 95% CI: 0.35, 0.55), antepartum hemorrhage (aOR: 2.70, 95% CI: 1.91, 3.50), low birth weight (aOR: 1.72, 95% CI: 1.56-1.87), admission by referral (aOR: 1.55, 95% CI: 1.41, 1.68), history of stillbirth (aOR: 2.43, 95% CI: 1.84, 3.03), anemia (aOR: 2.62, 95% CI: 1.93, 3.31), and hypertension (aOR: 2.22, 95% CI: 1.70, 2.75). CONCLUSION A significant association was found between stillbirth and maternal age, educational status, antenatal care, antepartum hemorrhage, birth weight, mode of arrival, history of previous stillbirth, anemia, and hypertension. Integrating maternal health and obstetric factors will help identify the risk factors as early as possible and provide early interventions.
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Affiliation(s)
- Getachew Adela Kasa
- School of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | | | - Alemayehu Adella
- West Shoa Zone Health Bureau, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Bezatu Alemu
- School of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Wolde J, Haile D, Paulos K, Alemayehu M, Adeko AC, Ayza A. Prevalence of stillbirth and associated factors among deliveries attended in health facilities in Southern Ethiopia. PLoS One 2022; 17:e0276220. [PMID: 36512623 PMCID: PMC9746959 DOI: 10.1371/journal.pone.0276220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/03/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Stillbirth is an unfavorable outcome of pregnancy, which is still prevalent in many countries despite remarkable efforts made to improve the care of pregnant women. While producing estimates consistent with other national reports, all are hindered by limited data and important causes of death are likely to be missed. However; there is a scarcity of data on stillbirth in Ethiopia particularly in the Wolaita zone. OBJECTIVE To assess the prevalence and associated factors of stillbirth among women giving birth at public hospitals in the Wolaita zone, southern Ethiopia. METHODS A facility-based cross-sectional study was conducted in public hospitals in the Wolaita zone. A stratified sampling technique was used to select 737 women. A pre-tested interviewer-administered questionnaire was used for data collection. Data were entered using Epidata version 3.1 and analyzed using SPSS version 20. Bivariate and multiple logistic regression analysis were used and the crude and adjusted odds ratios at a 95% confidence interval with P-value <0.05 were considered to declare the result as statistically significant. RESULT This study reported an 8.7% [95% CI: 6.5-10.8] prevalence of stillbirth. Women who lived in rural areas, had pregnancy and labor complications, a high number of pregnancies, a prior history of stillbirth, and a complicated delivery were associated with stillbirth. When compared to urban residents, being a rural resident increased the risk of stillbirth by 2.57 fold [adjusted OR = 2.57, 95% CI: 1.23, 5.40]. When compared to their counterparts, women who experienced complications during pregnancy and labor increased 6.23 fold [AOR = 6.23, 95% CI: 2.67-14.58], having a previous history of stillbirth increased 6.89 fold [AOR = 6.89, 95% CI: 2.57-13.57], and the type of delivery increased 7.13 fold the risk of stillbirth [AOR = 7.13, 95% CI: 2.71-18.73]. CONCLUSION AND RECOMMENDATION The prevalence of stillbirth among women who gave birth in public hospitals in the Wolaita zone was found to be high compared to national and regional figures. Therefore, the federal and regional governments should strengthen inter-sectoral collaboration with health facilities to promote the maternal and health care services utilization. The zonal health department and other concerned bodies should focus on the implementation of the strategies and policies that address and reduce the causes of stillbirth.
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Affiliation(s)
- Jegnaw Wolde
- Wolaita Zone Health Department, Wolaita Sodo, Ethiopia
| | - Dereje Haile
- Department of Public Health, College of Health and Medical Sciences, Wolaita Sodo University, Sodo, Ethiopia
- * E-mail:
| | - Kebreab Paulos
- Department of Midwifery, College of Health and Medical Sciences, Wolaita Sodo University, Sodo, Ethiopia
| | - Mihiretu Alemayehu
- Department of Public Health, College of Health and Medical Sciences, Wolaita Sodo University, Sodo, Ethiopia
| | - Asrat Chernet Adeko
- Department of Public Health, College of Health and Medical Sciences, Wolaita Sodo University, Sodo, Ethiopia
| | - Asaminew Ayza
- Wolaita Zone Health Department, Wolaita Sodo, Ethiopia
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Leta M, Assefa N, Tefera M. Obstetric emergencies and adverse maternal-perinatal outcomes in Ethiopia; A systematic review and meta-analysis. Front Glob Womens Health 2022; 3:942668. [PMID: 36386434 PMCID: PMC9643843 DOI: 10.3389/fgwh.2022.942668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Obstetric emergencies are life-threatening medical problems that develop during pregnancy, labor, or delivery. There are a number of pregnancy-related illnesses and disorders that can endanger both the mother's and the child's health. During active labor and after delivery, obstetrical crises can arise (postpartum). While the vast majority of pregnancies and births proceed without a hitch, all pregnancies are not without risk. Pregnancy can bring joy and excitement, but it can also bring anxiety and concern. Preterm birth, stillbirth, and low birth weight are all adverse pregnancy outcomes, leading causes of infant illness, mortality, and long-term physical and psychological disorders. Purpose The purpose of this study is to assess the magnitude and association of obstetric emergencies and adverse maternal-perinatal outcomes in Ethiopia. Method We used four databases to locate the article: PUBMED, HINARI, SCIENCE DIRECT, and Google Scholar. Afterward, a search of the reference lists of the identified studies was done to retrieve additional articles. For this review, the PEO (population, exposure, and outcomes) search strategy was used. Population: women who had obstetric emergencies in Ethiopia. Exposure: predictors of obstetric emergencies. Outcome: Women who had an adverse perinatal outcome. Ethiopian women were the object of interest. The primary outcome was the prevalence of adverse maternal and perinatal outcomes among Ethiopian women. Obstetrical emergencies are life-threatening obstetrical conditions that occur during pregnancy or during or after labor and delivery. The Joanna Briggs Institute quality assessment tool was used to critically appraise the methodological quality of studies. Two authors abstracted the data by study year, study design, sample size, data collection method, and study outcome. Individual studies were synthesized using comprehensive meta-analysis software and STATA version 16. Statistical heterogeneity was checked using the Cochran Q test, and its level was quantified using the I 2 statistics. Summary statistics (pooled effect sizes) in an odd ratio with 95% confidence intervals were calculated. Result A total of 35 studies were used for determining the pooled prevalence of adverse maternal and perinatal outcomes; twenty-seven were included in determining the odd with 95% CI in the meta-analysis, from which 14 were cross-sectional, nine were unmatched case-control studies, and 14 were conducted in the south nation and nationality Peoples' Region, and eight were from Amhara regional states, including 40,139 women who had an obstetric emergency. The magnitude of adverse maternal and perinatal outcomes following obstetric emergencies in Ethiopia was 15.9 and 37.1%, respectively. The adverse maternal outcome increased by 95% in women having obstetric emergencies (OR 2.29,95% CI 2.43-3.52), and perinatal deaths also increased by 95% in women having obstetric emergencies (OR 3.84,95% CI 3.03-4.65) as compared with normotensive women. Conclusion This review demonstrated the high prevalence of perinatal mortality among pregnant women with one of the obstetric emergencies in Ethiopia. Adverse maternal and perinatal outcomes following obstetric emergencies such as ICU admission, development of PPH, giving birth via CS, maternal death, NICU admission, LBW, and perinatal death were commonly reported in this study.
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Affiliation(s)
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Maleda Tefera
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Asim M, Karim S, Khwaja H, Hameed W, Saleem S. The unspoken grief of multiple stillbirths in rural Pakistan: an interpretative phenomenological study. BMC Womens Health 2022; 22:45. [PMID: 35193576 PMCID: PMC8864776 DOI: 10.1186/s12905-022-01622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pakistan has the highest rate of stillbirth (30.6 stillbirths per 1000 total births) as compared to other South Asian countries. The psychological impact of stillbirths on bereaved women is well documented; however, there is a dearth of literature on lived experiences of women with multiple stillbirths in Pakistan. Objective The purpose of this research is to understand the lived experiences of women who had multiple stillbirths in Thatta, Pakistan. Methods An interpretative phenomenological study was conducted in district Thatta with eight women who experienced more than one stillbirth. A semi-structured in-depth interview guide was used for data collection. The data were analyzed by using thematic analysis approach. Results The results of this study show that experiencing multiple stillbirths has a devastating impact on women’s mental and social wellbeing. The women who experienced multiple stillbirths are stigmatized as “child-killer” or cursed or being punished by God. They are avoided in social gatherings within the families and community, because of these social pressures these women seek spiritual and religious treatment, and struggle to conceive again to deliver a live baby. It was observed that the psycho-social and medical needs of these bereaved women remain unaddressed not only by the healthcare system but also by the society at large. Conclusions The physical, social and mental well-being of women who experience multiple stillbirth are at stake. These women are being considered social outcast. Health care providers including physicians, lady health workers, and traditional birth attendants should be trained on provision of psychosocial support along with the routine care that they provide in communities and health facilities. The health care providers should also inform the bereaved women about the biomedical causes of stillbirths that would be helpful to mitigate the stigma associated with stillbirths. Moreover, the health care providers should also counsel family members especially in-laws of these sorrowful women about the biomedical causes of stillbirths that would also be helpful to mitigate the stigma associated with stillbirths.
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Affiliation(s)
- Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Sehrish Karim
- Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Hajra Khwaja
- Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
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Jena BH, Biks GA, Gete YK, Gelaye KA. The effect of inter-pregnancy interval on stillbirth in urban South Ethiopia: a community-based prospective cohort study. BMC Pregnancy Childbirth 2021; 21:847. [PMID: 34965870 PMCID: PMC8715581 DOI: 10.1186/s12884-021-04325-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/10/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Stillbirth is an invisible and poorly understood adverse pregnancy outcome that remains a challenge in clinical practice in low-resource settings. It is also a key concern in Ethiopia where more than half of pregnancies occur shortly after preceding childbirth. Whether the interval between pregnancies has an effect on stillbirth or not is unclear. Therefore, we aimed to assess the effect of inter-pregnancy interval on stillbirth in urban South Ethiopia. METHODS A community-based prospective cohort study was conducted among 2578 pregnant women and followed until delivery. Baseline data were collected at the household level during registration and enrolment. End-line data were collected from hospitals during delivery. Exposed groups were pregnant women with inter-pregnancy intervals < 18 months and 18-23 months. Unexposed group contains women with inter-pregnancy intervals 24-60 months. A generalized linear model for binary outcome was applied, using R version 4.0.5 software. Relative risk (RR) was used to estimate the effect size with a 95% confidence level. Attributable fraction (AF) and population attributable fraction (PAF) were used to report the public health impact of exposure. RESULTS The overall incidence of stillbirth was 15 per 1000 total births, (95% CI: 11, 20%). However, the incidence was varied across months of inter-pregnancy intervals; 30 (< 18 months), 8 (18-23 months) and 10 (24-60 months) per 1000 total births. The risk of stillbirth was nearly four times (ARR = 3.55, 95%CI: 1.64, 7.68) higher for women with inter-pregnancy interval < 18 months as compared to 24-60 months. This means, about 72% (AF = 72, 95%CI: 39, 87%) of stillbirth among the exposed group (inter-pregnancy interval < 18 months category) and 42% (PAF = 42, 95%CI: 23, 50%) of stillbirth in the study population were attributed to inter-pregnancy interval < 18 months. These could be prevented with an inter-pregnancy interval that is at least 18 months or longer. CONCLUSIONS Inter-pregnancy interval under 18 months increases the risk of stillbirth in this population in urban South Ethiopia. Interventions targeting factors contributing to short inter-pregnancy intervals could help in reducing the risk of stillbirth. Improving contraceptive utilization in the community could be one of these interventions.
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Affiliation(s)
- Belayneh Hamdela Jena
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Gashaw Andargie Biks
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigzaw Kebede Gete
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Desta M, Akalu TY, Alamneh YM, Talie A, Alemu AA, Tessema Z, Yibeltal D, Alamneh AA, Ketema DB, Shiferaw WS, Getaneh T. Perinatal mortality and its association with antenatal care visit, maternal tetanus toxoid immunization and partograph utilization in Ethiopia: a meta-analysis. Sci Rep 2021; 11:19641. [PMID: 34608180 PMCID: PMC8490438 DOI: 10.1038/s41598-021-98996-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/20/2021] [Indexed: 02/08/2023] Open
Abstract
Despite remarkable progress in the reduction of under-five mortality; perinatal mortality is the major public health problem in Africa. In Ethiopia, the study findings on perinatal mortality and its predictors were inconsistent. Therefore, this systematic review and meta-analysis estimated the pooled perinatal mortality, and its association with antenatal care visit, maternal tetanus toxoid immunization, and partograph monitoring. International databases like PubMed, SCOPUS, Google Scholar and Science Direct were systematically searched. I squared statistics was used to determine the levels of heterogeneity across studies and the pooled estimate was computed using a random-effect model. The meta-analysis showed that a pooled prevalence of perinatal mortality in Ethiopia was 6.00% (95% CI 5.00%, 7.00%). The highest proportion of perinatal mortality was a stillbirth, 5.00% (95% CI 4.00%, 7.00%). Women who had antenatal care visit [OR = 0.20 (95% CI 0.12, 0.34)], maternal tetanus toxoid immunization [OR = 0.43 (95% CI 0.24, 0.77)] and partograph monitoring [POR = 0.22 (95% CI 0.06, 0.76)] reduced the risk of perinatal mortality. Whereas, previous history of perinatal mortality [POR = 7.95 (95% CI 5.59, 11.30)] and abortion history (POR = 2.02 (95% CI 1.18, 3.46)) significantly increased the risk of perinatal mortality. Therefore, antenatal care visit, maternal tetanus toxoid vaccination uptake, and partograph utilization should be an area of improvements to reduce perinatal mortality.
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Affiliation(s)
- Melaku Desta
- grid.449044.90000 0004 0480 6730Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tadesse Yirga Akalu
- grid.449044.90000 0004 0480 6730Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Yoseph Merkeb Alamneh
- grid.449044.90000 0004 0480 6730Department of Biomedical Sciences, College of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Asmare Talie
- grid.449044.90000 0004 0480 6730Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Addisu Alehegn Alemu
- grid.449044.90000 0004 0480 6730Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Zenaw Tessema
- grid.449044.90000 0004 0480 6730Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Desalegn Yibeltal
- grid.449044.90000 0004 0480 6730Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Alehegn Aderaw Alamneh
- grid.449044.90000 0004 0480 6730Department of Human Nutrition and Food Science, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Daniel Bekele Ketema
- grid.449044.90000 0004 0480 6730Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Wondimeneh Shibabaw Shiferaw
- grid.464565.00000 0004 0455 7818Department of Nursing, College of Health Science, Debre Berhan University, Debre Markos, Ethiopia
| | - Temesgen Getaneh
- grid.449044.90000 0004 0480 6730Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Liyew AD, Molla M, Azene ZN. Risk Factors of Stillbirth Among Women Who Gave Birth in Amhara Region Referral Hospitals, Ethiopia, in 2019: A Case-Control Study. Int J Womens Health 2021; 13:557-567. [PMID: 34149288 PMCID: PMC8205615 DOI: 10.2147/ijwh.s305786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022] Open
Abstract
Background Worldwide, 2.6 million stillbirths occur annually and more than three-quarters of them are recorded in South Asia and Sub-Saharan Africa. Thus, the aim of this study was to identify risk factors of stillbirth among women who gave birth in Amhara region referral hospitals found in northwest and northcentral, Ethiopia in 2019. Methods A multi-center institution-based unmatched case-control study was conducted among 456 mothers who gave birth in Amhara region referral hospitals from October 1 to December 30, 2019. Consecutive and simple random sampling was used to select the cases and controls, respectively. A semi-structured, interviewer-administered questionnaire and patient chart reviews were used to collect the data. Epidemiological (Epi) data version 4.4.2.1 and Statistical Package for the Social Sciences (SPSS) version 25.0 were used for data entry and analysis, respectively. Binary logistic regression was employed. An adjusted odds ratio with a 95% confidence interval was used to declare statistically significant variables on the basis of p-value<0.05 in the multivariable binary logistic regression model. Results Alcohol drinking (adjusted odds ratio (AOR)=3.02, 95% confidence interval (CI)=1.24–7.35), antepartum hemorrhage (AOR=5.74, 95% CI=2.67–12.33), premature rupture of membrane (AOR=2.21, 95% CI=1.09–4.44), meconium-stained amniotic fluid (AOR=8.18, 95% CI=4.29–15.60), non-use of partograph for labor follow-up (AOR=3.89, 95% CI=2.12–7.17), induction of labor (AOR=2.12, 95% CI=1.09–4.11), previous history of stillbirth (AOR=2.15, 95% CI=1.08–4.26), and birthweight less than 2,500 grams (AOR=7.36, 95% CI=3.43–15.81) increase the odds of stillbirth. Conclusion Stillbirth was higher among women who drank alcohol during their pregnancy, experienced antepartum hemorrhage, premature rupture of membrane, meconium-stained amniotic fluid, induction of labor, labor not followed by partograph, previous history of stillbirth, and birthweight less than 2,500 grams. As such, education to stop alcohol drinking during pregnancy, monitoring the progress of labor with partograph, and improving the quality of care for mothers and newborns at the time of pregnancy and childbirth will contribute to preventing stillbirth.
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Affiliation(s)
| | - Mihretu Molla
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zelalem Nigussie Azene
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Gizaw W, Feyisa M, Hailu D, Nigussie T. Determinants of stillbirth in hospitals of North Shoa Zone, Oromia region, Central Ethiopia: A case control study. Heliyon 2021; 7:e07070. [PMID: 34041408 PMCID: PMC8141871 DOI: 10.1016/j.heliyon.2021.e07070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/04/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND World Health Organization defined stillbirth as birth of fetus at 28 weeks or above gestation with a birth weight of ≥1000 g or body length of ≥35 cm. Majority of stillbirths occur in low and middle income nations. Efforts made in Ethiopia to improve maternal and child health are showing encouraging results, even though the magnitude didn't reach the expected level. Identification of determinants of stillbirth is quite substantial to apply further meaningful actions. OBJECTIVE To assess the determinants of stillbirth in hospitals of North Shoa Zone, Oromia region, Central Ethiopia. METHOD Institution based unmatched Case control study was conducted from March 01 to May 30/2019 among 342 women who gave birth in Fitche, Kuyu, Gundomeskel, and Muketurihospitals. Sample size was calculated by using Epi-info version 7.1.1 software package. Statistical Package for Social Sciences version 25 was used to analyze the data. Descriptive statistics, bivariate and multivariate logistic regression analysis were conducted. Variables having P-value ≤ 0.05 in multivariable logistic regression were considered as statistically significant. RESULT Type of labor (AOR = 3.79, 95%CI = 1.53, 9.38), duration of labor (AOR = 3.59, 95% CI = 1.53, 8.33), mal-presentation (AOR = 3.45, 95%CI = 1.99, 9.8), preeclampsia/eclampsia (AOR = 4.58, 95%CI = 1.45, 14.48) and birth defect (AOR = 3.05, 95%CI = 1.31, 7.1) were found to be the determinants of stillbirth. CONCLUSION AND RECOMMENDATION Causes of still birth in more than two third of the cases were identified. Type of labor, duration of labor, mal presentation, preeclampsia/eclampsia were identified as determinants of stillbirth from mothers' side while birth defect was found to be determinant of stillbirth from fetal side. Heath care providers, policy makers, and other stakeholders, should focus on identified factors to combat problems associated with still birth.
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Affiliation(s)
- Workineh Gizaw
- Department of Midwifery, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Mulugeta Feyisa
- Department of Midwifery, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Dejene Hailu
- Department of Nursing, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Tadesse Nigussie
- Department of Public Health, College of Health Sciences, Mizan Tepi University, Mizan Aman, Ethiopia
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Fikre R, Ejeta S, Gari T, Alemayhu A. Determinants of stillbirths among women who gave birth at Hawassa university comprehensive specialized hospital, Hawassa, Sidama, Ethiopia 2019: a case-control study. Matern Health Neonatol Perinatol 2021; 7:10. [PMID: 33597030 PMCID: PMC7888129 DOI: 10.1186/s40748-021-00128-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/14/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Globally over 2.6 million pregnancy ends with stillbirth annually. Despite this fact, only a few sherds of evidence were available about factors associated with stillbirth in Ethiopia. Therefore, the study aimed to spot factors related to stillbirth among women who gave birth at Hawassa University Comprehensive Specialized Hospital Hawassa, Sidama Ethiopia, 2019. METHODS Facility-based unmatched case-control study was conducted at Hawassa University Comprehensive Specialized Hospital. Cases were selected using simple random sampling technique and controls were recruited to the study consecutively after every case selection with case to control ratio of 1 to 3. Data were coded and entered into Epi-data version 3.1 and exported to SPSS version 24 for analysis. RESULTS A total of 106 cases and 318 controls were included in the study. Number of antenatal care visit [AOR = 0.38, 95% CI (0.15, 0.95)], lack of partograph utilization [AOR = 4.1 95% CI (2.04, 10.5)], prolonged labor [AOR = 6.5, 95% CI (2.9, 14.4)], obstructed labor [AOR = 3.5, 95% CI (1.5, 9.4)], and congenital defect [AOR = 9.7, 95% CI (4.08, 23.0)] were significantly associated with stillbirth. CONCLUSION Absence of partograph utilization, prolonged labor, obstructed labor, antepartum hemorrhage and congenital anomaly were found to have positive association with stillbirth.
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Affiliation(s)
- Rekiku Fikre
- Mettu University, College of Health Science, P.O. Box 2156, Mettu, Ethiopia.
| | - Samuel Ejeta
- Mettu University, College of Health Science, P.O. Box 2156, Mettu, Ethiopia.
| | - Taye Gari
- Mettu University, College of Health Science, P.O. Box 2156, Mettu, Ethiopia
| | - Akalewold Alemayhu
- Hawassa University, College of Medicine and Health Science, School of public health, P.O. Box 1560, Awassa, Ethiopia
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Ahinkorah BO, Seidu AA, Ameyaw EK, Budu E, Bonsu F, Mwamba B. Beyond counting induced abortions, miscarriages and stillbirths to understanding their risk factors: analysis of the 2017 Ghana maternal health survey. BMC Pregnancy Childbirth 2021; 21:140. [PMID: 33593319 PMCID: PMC7885363 DOI: 10.1186/s12884-021-03633-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 02/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background Inasmuch as induced abortions, miscarriages and stillbirths constitute common adverse pregnancy outcomes contributing to poor maternal health, there is paucity of literature about these in Ghana. We investigated the factors associated with induced abortions, miscarriages and stillbirths in Ghana. Methods Data derived from the 2017 Ghana Maternal Health Survey was used in this study. Women aged 15–49 constituted the target for the study. This study examined the relationship between socio-demographic characteristics and induced abortions, stillbirths and miscarriages. Subsequently, multivariable binary logistic regression models were fitted to investigate the factors associated with induced abortions, stillbirths and miscarriages at 95 % confidence interval (CI). Results The prevalence of miscarriages, induced abortions and stillbirths in Ghana in 2017 were 10.8 %, 10.4 % and 2 % respectively. Induced abortions (12.9 %) and miscarriages (11.1 %) were found to be higher among urban residents whiles rural residents had more of stillbirths (2.1 %). Compared to women aged 15–24, those in all age categories had lower odds of experiencing induced abortions, with the lowest odds occurring among women aged 35–49 (AOR = 0.26, 95 % CI = 0.21-32). Conversely, women of all age categories had higher odds of experiencing miscarriages compared to those aged 15–24 with the highest odds among those aged 25–34 (AOR = 1.62, 95 % CI = 1.39–1.89). Women with at least primary education were more likely to experience miscarriages than those with no formal education, with those with higher level of education having the highest odds (AOR = 1.42, 95 % CI = 1.13–1.78). While the likelihood of induced abortions was lower among Muslims, compared to Christians (AOR = 0.65, 95 % CI = 0.52–0.82), the odds of miscarriages were higher among Muslims, compared to Christians (AOR = 1.31, 95 % CI = 1.13–1.52). Women with parity 1 or more were less likely to experience induced abortions, miscarriages and stillbirths compared to those with parity 0. Conclusions Our study indicates that efforts to limit induced abortions, miscarriages and stillbirths in Ghana need to focus on the disparities in socio-demographic characteristics of women. Synergy between government health institutions and the private sector cannot be left out if much success can be achieved in efforts to subside the current prevalence of induced abortions, stillbirths and miscarriages confronting the country.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, PMB University Private Mail Bag, Cape Coast, Ghana. .,College of Public Health, Medical and Veterinary Sciences, James Cook University, 4811, Townsville, Queensland, Australia.
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Eugene Budu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, PMB University Private Mail Bag, Cape Coast, Ghana
| | - Freda Bonsu
- Asutifi South District Health Directorate, Hwidiem, Ghana
| | - Bupe Mwamba
- Centre for Midwifery, Family and Child Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Mekonnen Dagne H, Takele Melku A, Abdurkadir Abdi A. Determinants of Stillbirth Among Deliveries Attended in Bale Zone Hospitals, Oromia Regional State, Southeast Ethiopia: A Case-Control Study. Int J Womens Health 2021; 13:51-60. [PMID: 33447092 PMCID: PMC7802824 DOI: 10.2147/ijwh.s276638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/05/2020] [Indexed: 12/14/2022] Open
Abstract
Background Stillbirth is one of the adverse outcomes of pregnancy, and it is among the major public health problems in developing countries including Ethiopia. Stillbirth has wide-reaching consequences for parents, care providers, community and society at large. Purpose To assess the determinant of stillbirth among deliveries attended in Bale zone hospitals Southeast Ethiopia. Methods An institution-based unmatched case-control study was conducted. Cases were deliveries whose birth outcome was stillbirth and controls were deliveries with live birth. A pretested and structured checklist was used to collect data from a sample of 402 (134 cases and 268 controls). Systematic random sampling was used to recruit samples from a list of charts in the delivery registration book. Data were entered into EpiData version 4.2 and exported to SPSS version 20 for analysis. Crude and adjusted odds ratio with 95%CI was calculated and P-value <0.05 was used to declare statistical significance. Results A total of 402 charts of mothers (134 cases and 268 controls) were included in the analysis. Preceding birth interval <24 months (AOR: 2.991; 95%CI: 1.351-6.621), antenatal visit started at third trimester (AOR: 2.739; 95%CI: 1.048-7.158), referred from other health facility (AOR: 3.215; 95%CI: 1.430-7.229), labor length ≥24 h (AOR: 3.169; 95%CI: 1.241-8.091), presence of meconium stained amniotic fluid (AOR: 2.670; 95%CI: 1.082-6.592) and giving birth to a baby <2500 g (AOR: 3.155; 95%CI: 1.235-8.07) were determinants of stillbirth. Conclusion Preceding birth interval of <24 months, antenatal visit started at third trimester, referred from other health facility, presence of meconium stained amniotic fluid, labor length ≤24 h and giving birth to a baby <2500 g were found the determinants of stillbirth. Intrapartum care, early identification of labor complications and referral system are required.
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Affiliation(s)
| | | | - Adem Abdurkadir Abdi
- Department of Public Health, Madda Walabu University Goba Referral Hospital School of Health Science, Bale Goba, Ethiopia
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Shiferaw K, Mengiste B, Gobena T, Dheresa M. The effect of antenatal care on perinatal outcomes in Ethiopia: A systematic review and meta-analysis. PLoS One 2021; 16:e0245003. [PMID: 33444374 PMCID: PMC7808692 DOI: 10.1371/journal.pone.0245003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/18/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The estimated annual global perinatal and neonatal death is four million. Stillbirths are almost equivalent to neonatal mortality, yet they have not received the same attention. Antenatal care is generally thought to be an effective method of improving pregnancy outcomes, but its effectiveness as a means of reducing perinatal mortality has not been evaluated in Ethiopia. Therefore, we will identify the pooled effect of antenatal care on perinatal outcomes in Ethiopia. METHODS Medline, Embase, Cinahl, African journal online and Google Scholar was searched for articles published in English language between January 1990 and May 2020. Two independent assessors selected studies and extracted data from eligible articles. The Risk of Bias Assessment tool for Non-Randomized Studies was used to assess the quality of each included study. Data analysis was performed using RevMan 5.3. Heterogeneity and publication bias were assessed using I2 test statistical significance and Egger's test for small-study effects respectively. The random effect model was employed, and forest plot was used to present the risk ratio (RR) with 95% confidence interval (CI). RESULTS Thirteen out of seventeen included studies revealed antenatal care utilization had a significant association with perinatal outcomes. The pooled risk ratio by the random-effects model for perinatal death was 0.42 (95% CI: 0.34, 0.52); stillbirth 0.34 (95% CI: 0.25, 0.46); early neonatal death 0.85 (95% CI: 0.21. 3.49). CONCLUSION Women who attended at least one antenatal care visit were more likely to give birth to an alive neonate that survives compared to their counterpart. Therefore, the Ethiopian Ministry of health and other stakeholders should design tailored interventions to increase antenatal care utilization since it has been shown to reduce perinatal mortality.
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Affiliation(s)
- Kasiye Shiferaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bizatu Mengiste
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tesfaye Gobena
- Department of Environmental Health Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Desta M, Admas M, Yeshitila Y, Meselu B, Bishaw K, Assemie M, Yimer N, Kassa G. Effect of Preterm Birth on the Risk of Adverse Perinatal and Neonatal Outcomes in Ethiopia: A Systematic Review and Meta-Analysis. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211064125. [PMID: 34907788 PMCID: PMC8802133 DOI: 10.1177/00469580211064125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite remarkable progress in the reduction of under-five mortality, the rate of perinatal and neonatal mortality is still high especially in developing countries. The adverse outcome associated with preterm birth is one of the major public health challenges in Africa. However, there are limited and inconsistent studies conducted on the effect of preterm birth on adverse perinatal and neonatal outcomes in Ethiopia. Therefore, this systematic review and meta-analysis aimed to investigate the association between preterm birth and its adverse perinatal and neonatal outcomes in Ethiopia. We systematically searched several electronic databases like PubMed, Web of Science, SCOPUS, CINAHL, Google Scholar, African Journals Online databases and Science Direct. All identified observational studies were included. The I1 statistics were used to assess the heterogeneity among the studies. A random-effects model was computed to estimate the pooled effect of preterm birth on adverse perinatal and neonatal outcomes. Thirty-three studies with a total of 20 109 live births were included in the final meta-analysis. Our meta-analysis showed that preterm birth increased the odds of perinatal mortality by 10-folds [POR = 9.56 (95% CI: 5.47, 19.69)] and there was a 5.44-folds risk of stillbirth [Odds Ratio = 5.44 (95% CI: 3.57, 8.28)] among women who gave birth before 37 weeks of gestation. In addition, preterm birth was significantly associated with neonatal hypothermia [OR=3.54 (95% CI: 2.41, 5.21)], neonatal mortality [OR= 3.16 (95% CI: 1.57, 6.34). The sub-group analysis of this meta-analysis showed that there was an increased risk of neonatal sepsis [OR=2.33 (95% CI: 1.15, 4.71)] among preterm babies. Preterm births significantly increased the risk of adverse perinatal and neonatal outcomes in Ethiopia. Therefore, scale-up strategies and improving the quality of maternal and child health care providers should be an area of intervention to reduce adverse outcomes associated with preterm birth. The Federal Ministry of Health and concerned bodies should work towards the prevention of preterm birth and its adverse outcomes.
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Affiliation(s)
- Melaku Desta
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | - Melaku Admas
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | - Yordanos Yeshitila
- Departments of Nursing, College of Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Belsity Meselu
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | - Keralem Bishaw
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | - Moges Assemie
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | - Nigus Yimer
- Department of Midwifery, Woldia University, Woldia, Ethiopia
| | - Getachew Kassa
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
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Tesema GA, Gezie LD, Nigatu SG. Spatial distribution of stillbirth and associated factors in Ethiopia: a spatial and multilevel analysis. BMJ Open 2020; 10:e034562. [PMID: 33115888 PMCID: PMC7594361 DOI: 10.1136/bmjopen-2019-034562] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Although the rate of stillbirth has decreased globally, it remains unacceptably high in developing countries. Today, only 10 countries share the burden of more than 65% of the global rate of stillbirth and these include Ethiopia. Ethiopia ranks seventh in terms of high rate of stillbirths. Exploring the spatial distribution of stillbirth is critical to developing successful interventions and monitoring public health programmes. However, there is no study on the spatial distribution and the associated factors of stillbirth in Ethiopia. Therefore, this study aimed to explore the spatial distribution and the associated factors of stillbirth. METHODS Secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey data. A total weighted sample of 11 375 women were included in the analysis. The Bernoulli model was fitted using SaTScan V.9.6 to identify hotspot areas and ArcGIS V.10.6 to explore the spatial distribution of stillbirth. For associated factors, a multilevel binary logistic regression model was fitted using STATA V.14 software. Variables with a p value of less than 0.2 were considered for the multivariable multilevel analysis. In the multivariable multilevel analysis, adjusted OR (AOR) with 95% CI was reported to reveal significantly associated factors of stillbirth. RESULTS The spatial analysis showed that stillbirth has significant spatial variation across the country. The SaTScan analysis identified significant primary clusters of stillbirth in the Northeast Somali region (log likelihood ratio (LLR)=13.4, p<0.001) and secondary clusters in the border area of Oromia and Amhara regions (LLR=8.8, p<0.05). In the multilevel analysis, rural residence (AOR=4.83, 95% CI 1.44 to 16.19), primary education (AOR=0.39, 95% CI 0.20 to 0.74), no antenatal care (ANC) visit (AOR=2.77, 95% CI 1.70 to 4.51), caesarean delivery (AOR=5.07, 95% CI 1.65 to 15.58), birth interval <24 months (AOR=1.95, 95% CI 1.20 to 3.10) and height <150 cm (AOR=2.73, 95% CI 1.45 to 4.97) were significantly associated with stillbirth. CONCLUSION AND RECOMMENDATION In Ethiopia, stillbirth had significant spatial variations across the country. Residence, maternal stature, preceding birth interval, caesarean delivery, education and ANC visit were significantly associated with stillbirth. Therefore, public health interventions that enhance maternal healthcare service utilisation and maternal education in hotspot areas of stillbirth are crucial to reducing stillbirth in Ethiopia.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Solomon Gedlu Nigatu
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Simegn A, Azale T, Addis A, Dile M, Ayalew Y, Minuye B. Youth friendly sexual and reproductive health service utilization among high and preparatory school students in Debre Tabor town, Northwest Ethiopia: A cross sectional study. PLoS One 2020; 15:e0240033. [PMID: 32997712 PMCID: PMC7526918 DOI: 10.1371/journal.pone.0240033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Youth continue to fall victim to sexual and reproductive health problems. Despite, reproductive health needs of youth had been supported by different organizations, utilization of those services is low. All efforts have not been felt across the Ethiopian learning institutions as is evidenced by persistent reproductive health problems. Therefore, this study aimed to assess the magnitude of youth friendly sexual and reproductive health service utilization and associated factors among high and preparatory school youths in Debre Tabor town, Northwest Ethiopia. METHODS An institution based cross- sectional study was conducted from March 1 to 28, 2016. The data were collected using a pre-tested and structured self-administered questionnaire. Multistage cluster sampling method was used to select the study participants. The data were entered into Epi-data version 4.2.0.0 and analyzed using SPSS version 20. Binary logistics regression was used for analysis. Odds ratio along with 95%CI was estimated to measure the strength of the association. Level of statistical significance was declared at p value ≤0.05. RESULTS Overall utilization of reproductive health service was 28.8%. Being male (AOR = 1.54, 95% CI: 1.05, 2.25), prior discussion on reproductive health issues (AOR = 6.33, 95% CI: 4.22, 9.51), and previous sexual intercourse within the past one year (AOR = 1.95, 95% CI: 1.10, 3.44) were significantly associated with youth friendly health service utilization. CONCLUSIONS Youth friendly health service utilization among high school and preparatory students in Debre Tabor town was low. Ensuring gender empowerment and advocating sexual and reproductive service discussion among themselves and with others might be important in improving reproductive health utilization and health. Future researcher should address segment of population who does not enter school.
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Affiliation(s)
- Amare Simegn
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Telake Azale
- College of Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebaw Addis
- College of Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Dile
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yitayal Ayalew
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biniam Minuye
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Worede DT, Dagnew GW. Determinants of stillbirth in Felege-Hiwot comprehensive specialized referral hospital, North-west, Ethiopia, 2019. BMC Res Notes 2019; 12:579. [PMID: 31521188 PMCID: PMC6744638 DOI: 10.1186/s13104-019-4621-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/07/2019] [Indexed: 01/16/2023] Open
Abstract
Objective The objective of this study was to identify determinants of stillbirth in Felege Hiwot comprehensive specialized referral hospital, North-west, Ethiopia: 2019. To conduct this study an institutional-based unmatched case–control study was used among 84 cases and 336 controls. Pretested, structured questioner with face to face interview was conducted and some data were also extracted from medical records using a checklist. The data were analyzed by using binary logistics regression. A p-value of < 0.05 was considered as significant at 95% confidence level and the strength of association was measured using odds ratio. Results Illiteracy (AOR 3.8, 95% CI 1.4–10.2), sexually transmitted infection (AOR 5.7, 95% CI 1.1–29.7), Premature rupture of membrane (AOR 4.0, 95% CI 1.4–11.3), congenital anomaly (AOR 10.4, 95% CI 2.0–11.2) and history of perinatal death (AOR 10.4, 95% CI 3.7–29.2) were the determinants of stillbirth that increase risk of fetal death. Whereas taking at least two doses of tetanus toxoid vaccine (AOR 0.5, 95% CI 0.2–0.9) and partograph use (AOR 0.2, 95% CI 0.1–0.4) were found to be protective factors for stillbirth. To overcome this problem; empowering female education, facilitating women in taking tetanus toxoid vaccine, sexually transmitted infection prevention, and encourage health professionals to use partograph during labour follow up highly strongly recommended.
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Affiliation(s)
- Daniel Tarekegn Worede
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizachew Worku Dagnew
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
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