Stillbirths in Primary Level Hospitals in Sunyani, Ghana: A Retrospective Data Analysis

Main Article Content

Paulina C. Appiah
Kingsley Arhin-Wiredu
Michael R. Adjei
Charles L. Noora
Janet V. Baafi
Timothy S. Letsa
Alfred Edwin Yawson

Abstract

Aims: To determine prevalence and factors influencing stillbirth among deliveries.

Study Design: A facility-based cross-sectional analytical study.

Place and Duration of Study: Sunyani Municipal and Seventh Day Adventist (SDA) Hospitals in Bono Region, Ghana from January, 2014 and December, 2015.  

Methodology: Two thousand and twelve deliveries were analyzed. Outcome variable was stillbirth, explanatory variables were the sociodemographic, obstetric and clinical characteristics. Logistic regression (bivariate and multivariate) analysis reporting odds ratio at 95% confidence interval were calculated to identify factors associated with stillbirth. 

Results Stillbirth rate was 15/1000 births.  Mean age of mothers was 28.2 ±5.9 years and majority (75.1%) were aged 20-34 years. Prevalence of stillbirth was higher among women with no formal education (2.1%). Odds of stillbirth decreased with additional antenatal care (ANC) visits; 2-3times ANC visits (AOR=0.16, 95% CI:0.06 - 0.48), ANC 4+ times (AOR=0.017, 95% CI: 0.006 - 0.052). Women who received 3+ doses of intermittent prophylactic treatment (IPT) for malaria had 68% reduction in odds of stillbirth compared with those who had one (AOR=0.32, 95% CI: 0.009-0.103). Women with haemoglobin greater than 11.0 g/dl were more than 70% less likely of stillbirth outcome (AOR = 0.29, 95% CI: 0.11-0.73).

Conclusion: High number of ANC visits, optimal maternal haemoglobin (>11.0 g/dl) and 3+ IPT are associated with lower risk of stillbirth among deliveries.  Premium should be placed on quality of ANC to suit the specific needs of pregnant women whiles encouraging more visits.

Keywords:
Sunyani, primary level hospital, stillbirth, antenatal care

Article Details

How to Cite
C. Appiah, P., Arhin-Wiredu, K., R. Adjei, M., L. Noora, C., V. Baafi, J., S. Letsa, T., & Yawson, A. E. (2020). Stillbirths in Primary Level Hospitals in Sunyani, Ghana: A Retrospective Data Analysis. Asian Journal of Pregnancy and Childbirth, 2(3), 1-8. Retrieved from https://www.journalajpcb.com/index.php/AJPCB/article/view/30105
Section
Original Research Article

References

Cacciatore J. Psychological effects of stillbirth. Semin Fetal Neonatal Med. 2013; 18:76–82.

World Health Organization. Every newborn 1. WHO Reprod Heal Res. 2014;1–55.

De Bernis L, Kinney M V., Stones W, et al. Stillbirths: Ending preventable deaths by 2030. The Lancet; 2016.

Epub ahead of print 2016.
DOI: 10.1016/S0140-6736(15)00954-X.

Lawn JE, Blencowe H, Waiswa P, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016; 387: 587–603.

WHO | Stillbirths. WHO; 2016. Availbale:https://www.who.int/maternal_child_adolescent/epidemiology/stillbirth/en/ (Accessed 5 June 2019).

Saleem S, Tikmani SS, McClure EM, et al. Trends and determinants of stillbirth in developing countries: Results from the Global Network’s Population-Based Birth Registry. Reprod Health 2018;15:100.

Chaibva BV, Olorunju S, Nyadundu S, et al. Adverse pregnancy outcomes, ‘stillbirths and early neonatal deaths’ in Mutare district, Zimbabwe (2014): a descriptive study. BMC Pregnancy Childbirth. 2019;19:86.

Statistical Service Accra G. Ghana Maternal Health Survey; 2007.
Available:https://www.dhsprogram.com/pubs/pdf/FR227/FR227.pdf
(Accessed 13 June 2019).

Statistical Service Accra G. Ghana Maternal Health Survey; 2018.
Available: www.DHSprogram.com.
(Accessed 30 October 2019).

Ganle KK, Parker M, Fitzpatrick R, et al. A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition. BMC Pregnancy Childbirth; 2014.

Epub ahead of print 2014.
DOI: 10.1186/s12884-014-0425-8.

GSS, GHS, ICF I. Demographic and Health Survey 2014; 2015.

Dassah ET, Odoi AT, Opoku BK. Stillbirths and very low Apgar scores among vaginal births in a tertiary hospital in Ghana: A retrospective cross-sectional analysis. BMC Pregnancy Childbirth. 2014;14: 289.

Badimsuguru AB, Nyarko KM, Afari EA, et al. Determinants of stillbirths in Northern Ghana: A case control study. Pan Afr Med J. 2016;25:18.

Edmond KM, Quigley MA, Zandoh C, et al. Aetiology of stillbirths and neonatal deaths in rural Ghana: Implications for health programming in developing countries. Paediatr Perinat Epidemiol. 2008;22:430–437.

Der E, Sutaa F, Azongo T, et al. Stillbirths At the West Gonja Hospital in Northern Ghana. 2016;51–7.

Altijani N, Carson C, Choudhury SS, et al. Stillbirth among women in nine states in India: Rate and risk factors in study of 886,505 women from the annual health survey. BMJ Open. 2018;8.

Epub ahead of print 1 November 2018.
DOI: 10.1136/bmjopen-2018-022583.

Angell JN, Abdul‐Mumin AS, Gold KJ. Determining the cause of stillbirth in Kumasi, Ghana. Int J Gynecol Obstet. 2019;147:173–178.

Hirst J, Villar J, Victora C, et al. The antepartum stillbirth syndrome: Risk factors and pregnancy conditions identified from the Intergrowth-21 st Project. Bjog An Int J Obstet Gynaecol. 2018;125:1145–1153.

Asare M, Suuk Laar A. International Journal of Health Sciences and Research 2 Master of Public Health in Health Economics, Kybele/Program for Appropriate Technology in Health (PATH). 2016;6:341.

WHO Recommendations on antenatal care for a positive pregnancy experience 1 who recommendations on antenatal care for a Positive Pregnancy Experience: Summary; 2017.
DOI: 10.1016/S0140-6736(15):00838-7.

Lincetto O, Mothebesoane-Anoh, Gomez P, Munjanja S. Chapter 2: Antenatal care. In: Lawn J, Kerber K, editors. Opportunities for Africa’s Newborns: practical data, policy and programmatic support for newborn care in Africa. Geneva: World Health Organization; 2006;51–62.
Available:http://www.who.int/pmnch/ media/publications/aonsectionIII_2.pdf, (Accessed 5 December 2019)

Olayinka A, Joel A, Bukola D. Factors influencing utilization of antenatal care services among pregnant women in Ife Central Lga , Osun State Nigeria National Hospital Abuja , Nigeria. Adv Appl Sci Res 2012;3:1309–1315.

Nteta TP, Mokgatle-Nthabu M, Oguntibeju OO. Utilization of the Primary Health Care Services in the Tshwane Region of Gauteng Province, South Africa. PLoS One. 2010;5:e13909.

Kirkwood BR, Manu A, Ten Asbroek AHA, et al. Effect of the Newhints home-visits intervention on neonatal mortality rate and care practices in Ghana: A cluster randomised controlled trial. Lancet. 2013; 381:2184–2192.

Gage AD, Leslie HH, Bitton A, et al. Does quality influence utilization of primary health care? Evidence from Haiti. Global Health. 2018;14:59.

Chimatiro CS, Hajison P, Chipeta E, et al. Understanding barriers preventing pregnant women from starting antenatal clinic in the first trimester of pregnancy in Ntcheu District-Malawi. Reprod Health 2018;15:158.

Afulani PA. Determinants of stillbirths in Ghana: Does quality of antenatal care matter? BMC Pregnancy Childbirth. 2016; 16:132.

Pomerai KW, Field Epidemiology Z, Muchekeza M, et al. Pregnancy using Sulphadoxine-Pyrimethamine in Gokwe North, Midlands Province. Nur Prim Care 2018;2:1–6.

WHO | Intermittent preventive treatment in pregnancy (IPTp). WHO.

Nair M, Churchill D, Robinson S, et al. Association between maternal haemoglobin and stillbirth: A cohort study among a multi-ethnic population in England. Br J Haematol. 2017;179:829–837.

Nair M, Knight M, Robinson S, et al. Pathways of association between maternal haemoglobin and stillbirth: Path-analysis of maternity data from two hospitals in England. BMJ Open. 2018;8.

Epub ahead of print 1 April 2018.

DOI: 10.1136/bmjopen-2017-020149.