Abstract
Maternal and Child health remains at the core of global health priorities transcending the Millennium Development Goals into the current era of Sustainable Development Goals. Most low and middle-income countries including Ghana are yet to achieve the required levels of reduction in child and maternal mortality. This paper analysed the trends and the associated risk factors of stillbirths in a district hospital located in an impoverished and remote region of Ghana. Retrospective hospital maternal records on all deliveries conducted in the Navrongo War Memorial hospital from 2003-2013 were retrieved and analysed. Descriptive and inferential statistics were used to summarise trends in stillbirths while the generalized linear estimation logistic regression is used to determine socio-demographic, maternal and neonatal factors associated with stillbirths. A total of 16,670 deliveries were analysed over the study period. Stillbirth rate was 3.4% of all births. There was an overall decline in stillbirth rate over the study period as stillbirths declined from 4.2% in 2003 to 2.1% in 2013. Female neonates were less likely to be stillborn (Adjusted Odds ratio = 0.62 and 95%CI [0.46, 0.84]; p = 0.002) compared to male neonates; neonates with low birth weight (4.02 [2.92, 5.53]) and extreme low birth weight (18.9 [10.9, 32.4]) were at a higher risk of still birth (p<0.001). Mothers who had undergone Female Genital Mutilation had 47% (1.47 [1.04, 2.09]) increase odds of having a stillbirth compared to non FGM mothers (p = 0.031). Mothers giving birth for the first time also had a 40% increase odds of having a stillbirth compared to those who had more than one previous births (p = 0.037). Despite the modest reduction in stillbirth rates over the study period, it is evident from the results that stillbirth rate is still relatively high. Primiparous women and preterm deliveries leading to low birth weight are identified factors that result in increased stillbirths. Efforts aimed at impacting on stillbirths should include the elimination of outmoded cultural practices such as FGM.
Highlights
Maternal and Child health remains at the core of global health priorities transcending the Millennium Development Goals into the current era of Sustainable Development Goals
There was an overall decline in stillbirth rate over the study period as stillbirths declined from 4.2% in 2003 to 2.1% in 2013
Primiparous women and preterm deliveries leading to low birth weight are identified factors that result in increased stillbirths
Summary
Retrospective hospital maternal records on all deliveries conducted in the Navrongo War Memorial hospital from 2003–2013 were retrieved and analysed. This study used data collected from the Navrongo War Memorial Hospital (WMH) in the Kassena-Nankana Municipality of the Upper East Region of Northern Ghana. The WMH is located in Navrongo and is the only secondary referral facility in the Kassena-Nankana area offering emergency obstetric care, surgical and other public health services [19] It is a 123 bed facility serving a population of about 165,000 people and receives referrals from the many primary level health facilities in the area including private clinics as well as referrals from neighbouring districts and neighbouring towns in Burkina Faso [20]. The Kassena-Nankana Municipality which is home to the WMH lies within the Guinea Savannah ecological zone in the extreme north-eastern part of Ghana and occupies an area of about 1,675 square kilometres It borders the Bulisa and Sissala Districts to the South West and West respectively, Bongo and Bolgatanga Districts in East and North-East respectively, and Burkina Faso in the North-eastern corner. As a consequence of these circumstances, the region ranks among Ghana’s three most impoverished regions with a poverty prevalence of 55% [21]
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