Do Biomass Fuel Use and Consumption of Unsafe Water Mediate Socioeconomic Differences in Stillbirth Risk? An Analysis of the 2007 Ghana Maternal Health Survey

Abstract

Do Biomass Fuel Use and Consumption of Unsafe Water Mediate Socioeconomic Differences in Stillbirth Risk? An Analysis of the 2007 Ghana Maternal Health SurveyAbstract Number:2446 Adeladza Kofi Amegah* and Jouni Jaakkola Adeladza Kofi Amegah* University of Oulu, Finland, E-mail Address: [email protected] Search for more papers by this author and Jouni Jaakkola University of Oulu, Finland, E-mail Address: [email protected] Search for more papers by this author AbstractBackground: Stillbirth is a major public health problem in developing countries with 98% of the global stillbirth cases found in these countries. Previous studies have provided evidence of several environmental and hereditary determinants of stillbirth, but clearly socioeconomic factors seem to play a very important role. Numerous studies have explored the association between socioeconomic characteristics and stillbirth but most have failed to explain how low socioeconomic status (SES) leads to an increased risk of stillbirth. We hypothesized that household use of biomass fuels and unsafe drinking water resources related to low SES could explain the stillbirth burden in Ghana attributable to socioeconomic disadvantage. Method: Data from the 2007 Ghana Maternal Health Survey, a nationally representative population-based survey were analyzed for this study. A total of 10,370 women age 15-49 years were interviewed, with information on the household and socioeconomic characteristics, and a wide range of maternal health-related issues collected from both mothers and household heads in structured questionnaires. We used maternal education as a proxy for SES.Results: Applying generalized linear models adjusting for potential confounders, lower maternal primary education was associated with a 51% (Prevalence ratio [PR] = 1.51; 95% CI: 1.00, 2.27) increased lifetime risk of stillbirth with biomass fuel use and consumption of unsafe water mediating 18% and 8% of the observed socioeconomic effects. Jointly these two exposures explained 24% of the observed effects. In an adjusted multinomial logistic regression analysis, low educational attainment was found not to be risk factor for two or more stillbirth experiences in a woman’s lifetime.Conclusions: Our results show the importance of addressing socioeconomic inequalities in developing countries so as to ensure household choices that curtail environmental exposures, and ultimately improve pregnancy outcomes.