Title : Factors associated with stillbirths among women giving birth in four hospitals of Eswatini - A multi-centre study
Background: Stillbirth, a component of perinatal mortality, remains a global burden, with approximately 2 million occurring annually worldwide and mostly in low- and middle-income countries (LMICs). There is a dearth of studies on stillbirth in some LMICs, such as Eswatini. The purpose of this study was to assess the prevalence and associated factors for stillbirths among women delivering in four selected hospitals in Eswatini.
Methods: A quantitative unmatched case-control study was conducted using records of stillbirths (cases) and live births (controls) from July 1 to December 31, 2021. Consecutive sampling and systematic random sampling were used to select the cases and controls, respectively. Data extraction was performed using a piloted tool, and descriptive statistics summarized maternal and fetal factors. Statistical significance was determined using chi-square or Fisher's test. Univariable and multivariable binary logistic regression analyses were conducted to identify factors associated with stillbirths at p < .05 and 95% confidence interval. Ethical and administrative approval was obtained before the study.
Results: The overall stillbirth rate among 10,025 births was 28.8 per 1000 births. However, the sample data analysis revealed a stillbirth rate of 18.9% (95% CI: .169 - .210). The average age in years of women who experienced stillbirths and live births were 28.3(±6.9) and 26.9 (±6.6), respectively. Factors significantly associated with stillbirths included residing in the Hhohho region, alcohol consumption, syphilis, not taking IFAS, use of traditional remedies, hypertensive disorders, abnormal amniotic fluid volume (AFV), MSL II/III, antepartum haemorrhage (APH), birth before arrival (BBA), referral from another hospital, vaginal delivery, and fetal complications. Protective factors against stillbirths included abstaining from alcohol, birth intervals of more than 24 months, and timely rupture of membranes.
Conclusion: The proportion of stillbirths is significantly high. Several modifiable and nonmodifiable factors associated with stillbirth and protective factors were identified. The findings highlight the need for planning and implementing a targeted intervention to address the identified factors as well as the development of policies and further research.
Keywords: prevalence stillbirth, factors associated, women, birth, hospitals, Eswatini, multi-centre