Abstract
BackgroundReliable, population-based data on pregnancy-related morbidity and mortality, and risk factors for fatal foetal outcomes are scarce for low- and middle-income countries. Yet, such data are essential for understanding and improving maternal and neonatal health and wellbeing.MethodsWithin the 4-monthly surveillance rounds of the Taabo health and demographic surveillance system (HDSS) in south-central Côte d’Ivoire, all women of reproductive age identified to be pregnant between 2011 and 2014 were followed-up. A questionnaire pertaining to antenatal care, pregnancy-related morbidities, delivery circumstances, and birth outcome was administered to eligible women. Along with sociodemographic information retrieved from the Taabo HDSS repository, these data were subjected to penalized maximum likelihood logistic regression analysis, to determine risk factors for fatal foetal outcomes.ResultsA total of 2976 pregnancies were monitored of which 118 (4.0%) resulted in a fatal outcome. Risk factors identified by multivariable logistic regression analysis included sociodemographic factors of the expectant mother, such as residency in a rural area (adjusted odds ratio (aOR) = 2.87; 95% confidence interval (CI) 1.31–6.29) and poorest wealth tertile (aOR = 1.79; 95% CI 1.02–3.14), a history of miscarriage (aOR = 23.19; 95% CI 14.71–36.55), non-receipt of preventive treatment such as iron/folic acid supplementation (aOR = 3.15; 95% CI 1.71–5.80), only two doses of tetanus vaccination (aOR = 2.59; 95% CI 1.56–4.30), malaria during pregnancy (aOR = 1.94; 95% CI 1.21–3.11), preterm birth (aOR = 4.45; 95% CI 2.82–7.01), and delivery by caesarean section (aOR = 13.03; 95% CI 4.24–40.08) or by instrumental delivery (aOR = 5.05; 95% CI 1.50–16.96). Women who paid for delivery were at a significantly lower odds of a fatal foetal outcome (aOR = 0.39; 95% CI 0.25–0.74).ConclusionsWe identified risk factors for fatal foetal outcomes in a mainly rural HDSS site of Côte d’Ivoire. Our findings call for public health action to improve access to, and use of, quality services of ante- and perinatal care.
Highlights
Reliable, population-based data on pregnancy-related morbidity and mortality, and risk factors for fatal foetal outcomes are scarce for low- and middle-income countries
We investigated the most important pregnancy-related morbidities and factors associated with fatal foetal outcomes in the Taabo health and demographic surveillance system (HDSS), including all pregnancies starting and ending between January 1, 2011 and December 31, 2014
Study sample and sociodemographic characteristics From a total of 3070 pregnancies registered in the Taabo HDSS over a 4-year period, 3009 were monitored from start to finish
Summary
Population-based data on pregnancy-related morbidity and mortality, and risk factors for fatal foetal outcomes are scarce for low- and middle-income countries. Such data are essential for understanding and improving maternal and neonatal health and wellbeing. While major progress has been made over the past 15 years to improve population health and wellbeing [1], maternal and neonatal mortality still remain high, in the poorest countries, where stillbirths occur frequently [2, 3]. Miscarriage is usually considered as pregnancy loss of a foetus that did not yet reach the gestational age of 23 weeks or a weight inferior to 500 g in case gestational age is unknown [6, 7]. Stillbirth and neonatal death come at a substantial direct, indirect, and tangible cost, to the mothers and fathers and their family, and staff who care for them and the society at large [8]
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