School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia.
School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia.
PLoS One. 2018 Aug 29;13(8):e0202603. doi: 10.1371/journal.pone.0202603. eCollection 2018.
The aim of this study was to estimate the rate and predisposing factors associated with stillbirth in the African Great Lakes region (Burundi, Congo Democratic Republic, Kenya, Rwanda, Tanzania and Uganda).
Cross-sectional data from the most recent Demographic and Health Surveys (DHS) of countries in the African Great Lakes region were used in this study. DHS from Congo Democratic Republic was not included in the analyses because data was not collected for stillbirth in the country survey. A pooled sample of 57046 pregnancies of 7+ months' duration and 1002 stillbirths were included in the final analysis. The analyses were restricted to stillbirths reported in the 5 years preceding the surveys. Stillbirth was defined as foetal death in the third trimester (≥ 28 weeks' gestation). Multilevel logistic regression analyses that adjusted for cluster and survey weights were used to determine the factors associated with stillbirth in the Africa Great Lakes region. Health service variables and maternal medical condition variables were not included in the analysis because DHS do not collect data on these variables for pregnancies that did not result in a live birth. Burundi had the highest stillbirth rate per 1000 births [23% (95% CI: 20, 25)] within the region. Factors associated with stillbirth across the region were: no schooling [1.85 (95%Cl: 1.44, 2.38)] and primary education [1.64 (1.32, 2.05)], advanced maternal age [2.39 (95% CI: 1.59, 3.59)], smoking [1.99 (95% CI: 1.19, 3.32)] and drinking water from unimproved sources [1.18 (95% CI: 1.01, 1.37)].
To achieve Every Newborn Action Plan (ENAP) stillbirth target of 12 per 1000 births or less by 2030, policy interventions to prevent stillbirth should focus on promoting community-based socio-educational programmes which encourages a healthy lifestyle especially among uneducated women in the advanced age spectrum.
本研究旨在估计非洲大湖区（布隆迪、刚果民主共和国、肯尼亚、卢旺达、坦桑尼亚和乌干达）的死胎发生率和相关危险因素。
本研究使用了非洲大湖区最新的人口与健康调查（DHS）的横断面数据。刚果民主共和国的 DHS 未纳入分析，因为该国的国家调查未收集死胎数据。最终分析纳入了 57046 例妊娠 7 个月以上和 1002 例死胎的汇总样本。分析仅限于调查前 5 年报告的死胎。死胎定义为妊娠 28 周后（≥第三 trimester）的胎儿死亡。采用多水平逻辑回归分析，调整了聚类和调查权重，以确定非洲大湖区与死胎相关的因素。由于 DHS 不为未导致活产的妊娠收集这些变量的数据，因此未将卫生服务变量和产妇医疗状况变量纳入分析。该地区的死胎率最高的国家是布隆迪，每 1000 例活产中有 23%（95%CI：20，25）。整个地区与死胎相关的因素包括：未接受学校教育[1.85（95%Cl：1.44，2.38）]和小学教育[1.64（1.32，2.05）]，高龄产妇[2.39（95%CI：1.59，3.59）]，吸烟[1.99（95%CI：1.19，3.32）]和饮用未改良水源的水[1.18（95% CI：1.01，1.37）]。
为了实现 2030 年每 1000 例活产中死胎数 12 例或更少的《每个新生儿行动计划》（ENAP）目标，预防死胎的政策干预措施应侧重于促进以社区为基础的社会教育方案，鼓励特别是在高龄未受教育的妇女中养成健康的生活方式。
