Abstract
ABSTRACT Background: Perinatal mortality in Uganda remains high at 38 deaths/1,000 births, an estimate greater than the every newborn action plan (ENAP) target of ≤24/1,000 births by 2030. To improve perinatal survival, there is a need to understand the persisting risk factors for death. Objective: We determined the incidence, risk factors, and causes of perinatal death in Lira district, Northern Uganda. Methods: This was a community-based prospective cohort study among pregnant women in Lira district, Northern Uganda. Female community volunteers identified pregnant women in each household who were recruited at ≥28 weeks of gestation and followed until 50 days postpartum. Information on perinatal survival was gathered from participants within 24 hours after childbirth and at 7 days postpartum. The cause of death was ascertained using verbal autopsies. We used generalized estimating equations of the Poisson family to determine the risk factors for perinatal death. Results: Of the 1,877 women enrolled, the majority were ≤30 years old (79.8%), married or cohabiting (91.3%), and had attained only a primary education (77.7%). There were 81 perinatal deaths among them, giving a perinatal mortality rate of 43/1,000 births [95% confidence interval (95% CI: 35, 53)], of these 37 were stillbirths (20 deaths/1,000 total births) and 44 were early neonatal deaths (23 deaths/1,000 live births). Birth asphyxia, respiratory failure, infections and intra-partum events were the major probable contributors to perinatal death. The risk factors for perinatal death were nulliparity at enrolment (adjusted IRR 2.7, [95% CI: 1.3, 5.6]) and maternal age >30 years (adjusted IRR 2.5, [95% CI: 1.1, 5.8]). Conclusion: The incidence of perinatal death in this region was higher than had previously been reported in Uganda. Risk factors for perinatal mortality were nulliparity and maternal age >30 years. Pregnant women in this region need improved access to care during pregnancy and childbirth.
Highlights
Perinatal mortality in Uganda remains high at 38 deaths/1,000 births, an estimate greater than the every newborn action plan (ENAP) target of ≤24/1,000 births by 2030
A recent meta-analysis of data from sub-Saharan Africa reported an overall perinatal mortality rate of 34.7 per 1,000 births [3]. This is higher than the global estimate of 26.7 deaths per 1,000 births [1] and doubles the perinatal mortality rate of 13.6 per 1,000 births reported in Georgia, a country with the highest perinatal mortality in Europe [4]
There were 81 perinatal deaths, resulting in perinatal mortality rate of 43 per 1,000 pregnancies, constituted by 37 stillbirths (20 per/1,000 total births) and 44 early neonatal deaths (23 per/ 1,000 live births)
Summary
Perinatal mortality in Uganda remains high at 38 deaths/1,000 births, an estimate greater than the every newborn action plan (ENAP) target of ≤24/1,000 births by 2030. Perinatal mortality is a major public health concern worldwide with estimated 2 million stillbirths and 1.8 million early neonatal deaths reported in 2019 [1]. Most of these deaths (98%) occur in low- and middle-income countries (LMIC), with sub-Saharan Africa and South Asia being the most affected [2]. A recent meta-analysis of data from sub-Saharan Africa reported an overall perinatal mortality rate of 34.7 per 1,000 births [3]. Most of these studies were hospital-based or in an urban/peri-urban setting, excluding home births
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