Factors Associated with Stillbirths in Achimota Hospital- A Case-Control Study

Abstract

Background: it is estimated that 2.6 million stillbirths occur worldwide and about 98% of these occur in low and middle income countries mainly sub-Saharan Africa and parts of Asia. Most of the stillbirths occurring in these low resource settings are intrapartum stillbirths occurring at post viable gestations. These are largely preventable through improved intrapartum surveillance and access to caesarean sections. Data on stillbirths in less developed countries is scanty and it is only when risk factors are identified that tailored interventions can be developed to ameliorate them. Objective: The objective of this study was to determine the factors associated with stillbirths in the Achimota hospital. Methodology: An unmatched 1:4 hospital based case-control study was carried out among women who delivered at the Achimota hospital between 1st January 2018 and 31st December 2019. Cases were selected using consecutive sampling and appropriate controls selected by simple random sampling and data extracted from the maternal records to determine the exposures; socio-demographic, fetal, obstetric, maternal and health facility factors that are associated with stillbirths. Trained field assistants assisted with the data collection. Data was entered into Microsoft Excel 2016 and univariate and multivariate logistic regression was done using STATA 16 to determine the exposures that were significantly associated with stillbirths. Level of significance was set at p < 0.05. Results: Three hundred and ten (310) participants (62 cases and 248 controls) were recruited for this study. The multivariate logistic model showed that still births were more likely among women who resided in rural area (aOR=4.46, 95% CI 2.05-9.68), those with obstetric complications (aOR=15.88, 95% CI 5.72-44.07), low birth weight (aOR=3.83, 95% CI 1.43-10.26), congenital anomalies (aOR=7.60, 95% CI 1.69-34.32), medical illness and those delivered by caesarean section (aOR=2.38, 95% CI 1.11-5.12). Maternal education (aOR=0.13, 95% CI 0.03-0.54) and term delivery (aOR=0.13, 95% CI 0.05-0.35) were found to be associated with reduced odds for stillbirths. Conclusion: No maternal education, rural residence, preterm delivery, low birth weight, obstetric complications, congenital anomalies, maternal medical illness and delivery by caesarean section were significantly associated with still births among women delivering at the Achimota hospital. Improving fetal surveillance for women with high risk pregnancies as well as screening and optimal management of medical illnesses are essential for reducing the incidence of stillbirths in the hospital.