Abstract
BackgroundNo studies have examined the effect of socioeconomic deprivation on antepartum and intrapartum stillbirths in the poorest women in low income countries.Methodology/ Principal FindingsThis study used data from a prospective population based surveillance system involving all women of childbearing age and their babies in rural Ghana. The primary objective was to evaluate associations between household wealth and risk of antepartum and intrapartum stillbirth. The secondary objective was to assess whether any differences in risk were mediated by utilisation of health services during pregnancy. Data were analysed using multivariable logistic regression. Random effect models adjusted for clustering of women who delivered more than one infant. There were 80267 babies delivered from 1 July 2003 to 30 September 2008: 77666 live births and 2601 stillbirths. Of the stillbirths 1367 (52.6%) were antepartum, 989 (38.0%) were intrapartum and 245 (9.4%) had no data on the timing of death. 94.8% of the babies born in the study (76129/80267) had complete data on all covariates and outcomes. 36 878 (48.4%) of babies were born to women in the two poorest quintiles and 3697 (4.9%) had no pregnancy care. There was no association between wealth and antepartum stillbirths. There was a marked ‘dose response’ of increasing risk of intrapartum stillbirth with increasing levels of socioeconomic deprivation (adjOR 1.09 [1.03–1.16] p value 0.002). Women in the poorest two quintiles had greater risk of intrapartum stillbirth (adjOR 1.19 [1.02–1.38] p value 0.023) compared to the richest women. Adjusting for heath service utilisation and other variables did not alter results.Conclusions/ SignificancePoor women had a high risk of intrapartum stillbirth and this risk was not influenced by health service utilisation. Health system strengthening is required to meet the needs of poor women in our study population.
Highlights
Over 98% of stillbirths occur in low and middle income countries and sub-Saharan Africa has the greatest risk [1]
There were 1367 (52.6%) antepartum stillbirths, 989 (38.0%) intrapartum stillbirths and 245 (9.4%) stillbirths did not have data on timing of death.76129 babies born in the study (94.8%) had complete data on all covariates and outcomes (Table 1). 36878 (48.4%) babies were born to women in the two poorest quintiles. 3959 (5.2%) babies were born to women who had delivered a previous stillbirth. 8146 (10.7%) were born to women under 20 years of age and 9440 (12.4%) were to primiparas. 3350 (4.4%) were multiple births
Recorded birthweight from the pregnancy card was only available for 40.3% (30 680) of all births and 12.0% (9135) of stillbirths. 33040 (43.4%) babies were born at home and 3697 (4.9%) had no pregnancy care (Table 1)
Summary
Over 98% of stillbirths occur in low and middle income countries and sub-Saharan Africa has the greatest risk [1]. No published studies have examined differentials in antepartum and intrapartum stillbirth risk in poor countries. Analyses from the Macro International Demographic and Health Surveys (DHS) are limited by small sample sizes and underreporting [8]. These surveys do not differentiate between antepartum and intrapartum stillbirths despite their substantially different determinants and pathogenesis [8]. No studies have examined the effect of socioeconomic deprivation on antepartum and intrapartum stillbirths in the poorest women in low income countries
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