Abstract
Background:Stillbirths are a poignant representation of global inequality. Nigeria is documented to have the second highest rate; yet, the reporting system is inadequate in most Nigerian healthcare facilities. The aim was to identify the determinants of stillbirth among deliveries in the Murtala Muhammad Specialist Hospital (MMSH), Kano, Nigeria.Methods:Two study designs were used: a case-control study (S1) and a prospective cohort study (S2). Both studies were carried out at the MMSH. For S1, stillbirths were retrospectively matched to a livebirth by time (target of 24 hours' time variation) to establish a case-control study with a 1:1 ratio. Eligibility into S2 included all mothers who were presented at the MMSH in labour regardless of birth outcome. Both were based on recruitment durations, not sample sizes (3 months and 2 months, respectively, 2017–2018). The demographic and clinical data were collected through paper-based questionnaires. Univariable logistic regression was used. Multivariable logistic regression was used to explore relationships between area type and other specific factors.Findings:Stillbirth incidence in S2 was 180/1,000 births. Stillbirth was associated with the following factors; no maternal education, previous stillbirth(s), prematurity, living in both semi-rural and rural settings, and having extended time periods between rupture of membranes and delivery. Findings of the multivariable analysis (S1 and S2) indicated that the odds of stillbirth, for those living in a rural area, were further exacerbated in those mothers who had no education, lived in a shack, or had any maternal disease.Interpretation:This research identifies the gravity of this situation in this area and highlights the need for action. Further understanding of some of the findings and exploration into associations are required to inform intervention development.Funding:This collaboration was partially supported by funding from Health and Care Research Wales.
Highlights
Stillbirths are one of the most neglected tragedies in global health today; ∼2.6 million stillbirths occur each year with 98% occurring in low- and middle-income countries (LMICs) [1,2,3] and Nigeria is reported to account for 12% of the 2.6 million [4]
Data collection for controls ceased in December 2017, so cases born in this period were matched with controls born in late November 2017
The earliest report of stillbirths within Hausa communities was between 1974 and 1977 and reported an incidence of 113/1,000, suggesting that little has changed in 40 years [20]
Summary
Stillbirths are one of the most neglected tragedies in global health today; ∼2.6 million stillbirths occur each year with 98% occurring in low- and middle-income countries (LMICs) [1,2,3] and Nigeria is reported to account for 12% of the 2.6 million [4]. Other studies in Nigeria carried out between 2008 and 2012 show rates ranging from 22.4 to 127/1,000 births [13]. The aim of this study was to investigate the determinants of stillbirths among deliveries in the MMSH, Kano, Nigeria. The aim was to identify the determinants of stillbirth among deliveries in the Murtala Muhammad Specialist Hospital (MMSH), Kano, Nigeria
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