Determinants of Stillbirths at the Ghana Police Hospital, Accra 2024

Abstract

Background: Stillbirth refers to the death of a baby before birth, with no evidence of life at delivery, and characterized by a birthweight of at least 1,000 grams, a gestational age of at least 28 weeks, or a length of 35 centimeters. It is a critical indicator of perinatal care quality and a significant contributor to neonatal mortality. The Ghana Police Hospital, a secondary-level facility in Accra, serves predominantly the urban poor and vulnerable populations, including those in police or prison custody. Many of these patients cannot afford expensive healthcare options and often do not attend antenatal care or present late for services. This study was conducted to determine stillbirth rates, identify maternal, foetal, demographic, and facility-based determinants of stillbirths, and evaluate the impact of antenatal care (ANC) on stillbirth outcomes. Methods: The study employed a 1:3 unmatched case-control design at the Ghana Police Hospital, involving 352 participants: 88 cases (stillbirths) and 264 controls (live births). Cases were defined as singleton stillbirths delivered at or after 28 weeks of gestation from 1st January 2021 to 31st December 2023, while controls were singleton live births during the same period. Data were collected from birth records and maternal medical records. Crude and adjusted odds ratios with 95% confidence intervals were calculated, with p-values < 0.05 considered statistically significant. Both bivariate and multivariate logistic and linear regression models were used to determine significant associations. Generalized linear regression models was used to assess the influence of ANC on stillbirth outcomes. Results: A total of 353 women participated in this study: comprising 88 cases and 264 controls. The mean age was 32.2+-5.7 SD for cases and 30.8+-5.1 SD years for controls (range: 14-46 years). Stillbirth rates were 22.4, 16.8, and 19.5 per 1000 live birth for 2021, 2022, and 2023, respectively. Significant factors associated with stillbirths were maternal haemoglobin levels ≤9.6 v University of Ghana http://ugspace.ug.edu.gh g/dL (aOR = 2.14, p < 0.018), obstetric complications (aOR = 3.92, p < 0.001), pre-existing medical conditions (aOR = 3.11, p < 0.002), being a trader (aOR = 4.01, p < 001), birth weight <2.5 kg (aOR = 6.02, p < 0.001), and preterm birth ≤37 weeks (aOR = 3.41, p < 0.001). Women with fewer than eight ANC visits had higher odds of stillbirth (aOR = 3.03, p < 0.016) while an increase in ANC attendance showed 30% decrease in the odds of stillbirths aOR = 0.7 (95% CI 0.61-0.70). There was no significant association between stillbirth and parity, maternal age, or education. Conclusion: Maternal haemoglobin, obstetric complications, being a trader and pre-existing medical condition were maternal determinants. Birth weight less than 2.5kg and birth under 37 weeks were foetal determinants. Antenatal care was a facility related determinant of stillbirths. Improving ANC utilization and early detection of high-risk pregnancies will improve pregnancy outcomes.