Using a Health and Demographic Surveillance System to Assess Stillbirths Trends and Risk Factors in Siaya County, Kenya between 2008 and 2019

Abstract

INTRODUCTION: Every year, about 4 million stillbirths occur, most of which are in the developing countries. Although stillbirths are more prevalent in developing countries, they are least studied and hence their rates remain unknown. It is imperative to track trends and identify determinants of stillbirths to inform interventions. METHODS: We used data collected by the Kenya Medical Research Institute’s Health and Demographic Surveillance System to analyze trends and risk factors for stillbirths in Siaya County, Kenya in the period between 2008 and 2019. The Health and Demographic Surveillance System’s staff collect data on pregnancy status for all women of reproductive age (13 - 49 years) twice a year. Once a pregnancy is registered, its outcome is monitored in the subsequent visits and the outcome type is reported. Using the pregnancy outcome records plus demographic and social attributes of the observed women, we calculated trend and assessed risk factors for stillbirths using logistic regression models at 95% confidence interval. RESULTS: In total, we analyzed 59,028 records out of which 1,250 (2.1%) were stillbirths. Across the years, the prevalence of stillbirths reduced from 3.69% to 1.77% from 2008 to 2019. The trend was irregular especially in Gem sub-County. Risk factors included mother’s age >36 years, having no formal education, living in Rarieda sub-County, low wealth index and year of pregnancy, particularly in 2008 and 2012. CONCLUSION: A reducing trend of stillbirths suggests that the existing interventions are effective. However, health care providers should pay attention to the identified risk factors including advanced maternal age, those without formal education, women who have had more than three pregnancies. In addition, more interventions should prioritize Rarieda sub-County over Gem and Karemo.