Abstract
Access to quality emergency obstetric and newborn care (EmONC); having a skilled attendant at birth (SBA); adequate antenatal care; and efficient referral systems are considered the most effective interventions in preventing stillbirths. We determined the influence of travel time from mother's area of residence to a tertiary health facility where women sought care on the likelihood of delivering a stillbirth. We carried out a prospective matched case-control study between 1st January 2019 and 31st December 2019 at the Federal Teaching Hospital Gombe (FTHG), Nigeria. All women who experienced a stillbirth after hospital admission during the study period were included as cases while controls were consecutive age-matched (ratio 1:1) women who experienced a live birth. We modelled travel time to health facilities. To determine how travel time to the nearest health facility and the FTHG were predictive of the likelihood of stillbirths, we fitted a conditional logistic regression model. A total of 318 women, including 159 who had stillborn babies (cases) and 159 age-matched women who had live births (controls) were included. We did not observe any significant difference in the mean travel time to the nearest government health facility for women who had experienced a stillbirth compared to those who had a live birth [9.3 mins (SD 7.3, 11.2) vs 6.9 mins (SD 5.1, 8.7) respectively, p = 0.077]. However, women who experienced a stillbirth had twice the mean travel time of women who had a live birth (26.3 vs 14.5 mins) when measured from their area of residence to the FTHG where deliveries occurred. Women who lived farther than 60 minutes were 12 times more likely of having a stillborn [OR = 12 (1.8, 24.3), p = 0.011] compared to those who lived within 15 minutes travel time to the FTHG. We have shown for the first time, the influence of travel time to a major tertiary referral health facility on the occurrence of stillbirths in an urban city in, northeast Nigeria.
Highlights
An estimated 2.6 million stillbirths are recorded globally every year, with the majority disproportionately occurring in low-and middle-income countries (LMIC), in sub-Saharan Africa [1]
We have shown for the first time, the influence of travel time to a major tertiary referral health facility on the occurrence of stillbirths in an urban city in, northeast Nigeria
This study was conducted at the Federal Teaching Hospital, Gombe (FTHG), a major tertiary health facility located in Gombe City, the capital of Gombe State, northeast Nigeria
Summary
An estimated 2.6 million stillbirths are recorded globally every year, with the majority disproportionately occurring in low-and middle-income countries (LMIC), in sub-Saharan Africa [1]. In 2014, the World Health Assembly-backed Every Newborn Action Plan (ENAP) acknowledged the need to reduce stillbirths occurring in LMICs thereby setting a global target to reduce SBR to 12 or fewer stillbirths per 1000 births in all countries by 2030 [3]. To achieve this ambitious ENAP stillbirth target by 2030, evidence-based and data-driven policy interventions targeted at the individual level, the broader health system and socioeconomic disadvantages which determine overall health in the first instance must be prioritised
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