Risk factors for stillbirth and early neonatal death: A case-control study in tertiary hospitals in Addis Ababa, Ethiopia
Background: Globally, Ethiopia is ranked seventh in the absolute number of stillbirths. Attempts to decrease this number have been obstructed by an inadequate understanding of the risk factors leading to stillbirth and early neonatal death in Ethiopia. This study was conducted in two tertiary hospitals in Addis Ababa, Ethiopia, to identify the risk factors for stillbirth and neonatal death in this setting.Methods: This case-control study was conducted between October 2016 and May 2017 at Tikur
... May 2017 at Tikur Anbessa Hospital (TAH) and Gandhi Memorial Hospital (GMH). All enrolled women who had a stillbirth or early neonatal death during this period were included as cases and a random sample of women delivering at the hospital was selected to enroll as controls for a 2:1 ratio of controls to cases. Data on potential risk factors were retrieved from medical records including health passports, delivery records, and treatment charts. Statistical differences in background and social characteristics of cases and controls were determined by t-test and chi-squared (or fisher's exact test) for quantitative and categorical variables, respectively. Binary logistic regression analysis was completed to determine any associations between risk factors and stillbirth/early neonatal death.Results: During the study period, 366 women delivering at the hospitals were enrolled as cases and 711 women delivering at the hospitals were enrolled as controls. During the study period, hospital records indicated that the estimated stillbirth and neonatal death rates were 30.7 per 1000. Neonatal causes (43.4%) were the most common, followed by antepartum (32.5%) and intrapartum (24.5%). Risk factors for stillbirths and early neonatal death were maternal education (aOR 1.747, 95%CI 1.098-2.780), parity (aOR 1.114, 95%CI .058- 2.484), previous stillbirth (aOR 9.447, 95%CI 6.245-14.289), previous preterm birth (aOR 3.620, 95%CI 2.363-5.546), and previous child with congenital abnormality (aOR 2.190, 95% 1.228-3.905), and antepartum hemorrhage during pregnancy (aOR 3.273, 95% 1.523-7.031).Conclusion: Antepartum hemorrhaging is the only risk factor in our study amenable for direct intervention. Efforts should be maximized to improve patient education and antenatal and obstetric services, particularly for women who have a history of obstetric complications identified as risk factors.