RISK FACTORS FOR STILLBIRTH IN THE KINTAMPO MUNICIPAL HOSPITAL, BRONG AHAFO REGION OF GHANA

ABSTRACT

Introduction: Stillbirth remains a serious public health problem globally with an estimated annual death of 2.6 million. Although stillbirth rates have declined especially in the developed countries, Africa and south Asia have the slowest rate of decline. In 2015, the rate of stillbirth in Ghana was 22.7 per 1000 births. However, in Kintampo the stillbirth rate was 24 per 1000 births. The actual causes of stillbirth remain unknown. This study was conducted to assess the socio-demographic, maternal, fetal and health facility risk factors for stillbirth.

Method: The study was a review of delivery records in the Kintampo Municipal Hospital, a primary referral facility in the Municipality from May 2016-October 2018. The proportion of stillbirth was determined by reviewing the summary data of stillbirth and total deliveries from the health information unit of the hospital. A 1:2 unmatched case control study design was used to review data from the delivery register in the hospital. Sample size of 300 participants; a census of 100 cases were selected using consecutive sampling method and 200 controls were selected using systematic random sampling method. A case was a woman who delivered a stillborn and a control was a woman who delivered a live baby. Data collection was done by reviewing data from the delivery register using a structured data extraction tool. Univariate analysis of categorical variables was expressed as Frequencies, percentages and proportions. Bivariate data analysis was performed for independent variables. Pearson Chi squared/Fisher’s exact analysis was done to establish associations between independent variables and stillbirth. Simple and Multiple logistic regressions were performed to determine the strength of the association between the independent and the dependent variables with odds ratio at 95% confidence interval and their respective statistical significance.

Results In all, 100 stillbirths and 200 live births were studied. Proportion of stillbirth was 16.6 per 1000 births. Odds ratio for mother’s place of residence 2.4 (95% CI 1.4-4.1), obstetric complication 3.1 (95% CI 1.6-5.9), low birth weight 3.8 (95% CI 1.7-8.2), and preterm 2.5 (95% CI 1.2-4.23) were found to be factors that were associated with stillbirth. Odds Ratios for tertiary education 0.1(95% CI 0.0-0.8), high number of ANC visits 0.4 (0.1-0.6), use of partograph 0.2 (95% CI 0.1-0.3), taking 4 or more of SP 0.4 (95% CI 0.16-0.88) and monitoring of maternal haemoglobin 0.4 (95% CI 0.22-0.89) were found to be protective of stillbirth.

Conclusion: The proportion of stillbirth is high, Use of patograph, ANC visits, and high level of maternal education as well as receiving SP is protective. However, place of residence, obstetric complications, prematurity, and none dosing of SP are possible risk factors for stillbirth. Education of women and expansion of ANC services may help reduce stillbirth.