An Observational Review Of Determinants Of Perinatal Deaths In Kwahu East, West And South Districts

Abstract

Background: Perinatal deaths, largely occurring in full-term pregnancy1, are usually of unknown causes even with statutory routine autopsy performance. Autopsies reveal causes in only 40%4. Data paucity remains a major challenge in developing countries.Objective: The study aimed to identify determinants of perinatal deaths in three Kwahu Districts and assess their preventability.Methodology: An observational study with an unmatched case control design using Health Facilitybased data.Results: Most perinatal deaths occurred at term. Mean gestational age at delivery was 37 and 38.8 weeks for cases and controls respectively. Cases were mainly rural residents with informal occupations and comparatively higher gravidity and parity. Controls hadhigher educational backgrounds. Factors associated with perinatal deaths were Rural residence, OR - 2.7 (95% CI = 2.02 - 3.6), grandmultiparity OR - 2.0 (95% CI = 1.3 - 3.2), mal presentation OR - 2.5 (95% CI = 1.4 - 4.4), Low Birth Weight OR - 2.3 (95% CI = 1.4 -3.8), delayed second stage OR - 8.4 (95% CI = 2 - 27), Hypertensive disease OR - 3.0 (95% CI = 1.8 - 3.6), uterine rupture OR - 2.0 (95% CI = 1.8 - 2.1) and prematurity OR - 3.8 (95% CI = 2.7 - 5.3). Formal occupations OR - 0.4 (95% CI = 0.3 - 0.7), referrals OR - 0.6 (95% CI = 0.4 - 0.7), tertiary education OR - 0.3 (95% CI = 0.2 - 0.5) and adequate ANC OR - 0.5 (0.3 - 0.6) significantly reduced odds of deaths.Conclusions: Perinatal deaths remain preventable with accessible quality ANC, delivery and postnatal services supported by comprehensive, sustainably funded surveillance. The Human Rights Based Approach to programming must be prioritized.