Risk Factors Associated with Stillbirths in Kibogora District Hospital, Rwanda, 2015

  • Maternal and child health
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Background:
Stillbirths remain a major challenge in Kibogora district hospital (DH) catchment area, a largely rural setting of 240,000 people. Among 124 perinatal deaths reported in 2014-2015 in the area, 70.8% of them were stillbirths. We conducted this study to determine the rate of stillbirths in this rural community and identify associated factors.
Methods:
We conducted a hospital-based unmatched case-control study. We enrolled 133 stillbirths and 266 live births delivered at Kibogora DH from January to December 2015 as cases and controls respectively. Stillbirths were defined as fetal deaths occurring from 22 weeks’ gestation or a fetus born dead and weighing 500g or more. All stillbirths occurring during the period of study were enrolled as cases, while controls were two live births, one before and another after each stillbirth. We used a structured tool to abstract data from delivery and operating rooms’ registers and stillbirths audit reports. We conducted the univariate analysis and multivariate logistic regression. We computed adjusted odds ratios (AOR) and 95% Confidence Intervals (CI).
Results:
Of the 2,605 deliveries at the hospital, 133 were stillbirths giving a rate of 51 per 1000 births. Among the stillbirths, 71 (54%) were macerated and 62 (47%) were fresh stillbirths. The risk factors for stillbirths identified were preterm de- livery (AOR=2,08; 95% CI=1.38 – 20.57); inadequate monitoring of labor by midwives (AOR=3,25; p value<0.001 with 95% CI=2.07 – 6.79)and delay in referrals of high-risk pregnancies from the health centers (AOR=2,24; p value=0.037; 95% CI=1.04 – 4.79).
Conclusion
The risk factors for stillbirths in Kibogora are largely due to preventable health system associated challenges. Timely referral of high-risk pregnancies by health staff at health centers would help to reduce stillbirths in Kibogora. Further investigations on preterm delivery in the catchment area are required.

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