Christou Aliki, Dibley Michael J, Rasooly Mohammad Hafiz, Mubasher Adela, Hofiani Sayed Murtaza Sadat, Rashidi Mohammad Khakerah, Kelly Patrick J, Raynes-Greenow Camille
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Afghanistan National Public Health Institute, Ministry of Public Health, Kabul, Afghanistan.
Paediatr Perinat Epidemiol. 2019 Jan;33(1):28-44. doi: 10.1111/ppe.12530.
BACKGROUND: Stillbirth rates in Afghanistan have declined little in the past decade with no data available on key risk factors. Health care utilisation and maternal complications are important factors influencing pregnancy outcomes but rarely captured for stillbirth in national surveys from low- and middle-income countries. The 2010 Afghanistan Mortality Survey (AMS) is one of few surveys with this information. METHODS: We used data from the 2010 AMS that included a full pregnancy history and verbal autopsy. Our sample included the most recent live birth or stillbirth of 13 834 women aged 12-49 years in the three years preceding the survey. Multivariable Poisson regression was used to identify sociodemographic, maternal, and health care utilisation risk factors for stillbirth. RESULTS: The risk of stillbirth was increased among women in the Central Highlands (aRR: 3.01, 95% CI 1.35, 6.70) and of Nuristani ethnicity (aRR: 9.15, 95% CI 2.95, 28.74). Women who did not receive antenatal care had three times increased risk of stillbirth (aRR: 3.03, 95% CI 1.73, 5.30), while high-quality antenatal care was important for reducing the risk of intrapartum stillbirth. Bleeding, infection, headache, and reduced fetal movements were antenatal complications strongly associated with stillbirth. Reduced fetal movements in the delivery period increased stillbirth risk by almost seven (aRR: 6.82, 95% CI 4.20, 11.10). Facility births had a higher risk of stillbirths overall (aRR: 1.55, 95% CI 1.12, 2.16), but not for intrapartum stillbirths. CONCLUSIONS: Targeted interventions are needed to improve access and utilisation of services for high-risk groups. Early detection of complications through improved quality of antenatal and obstetric care is imperative. We demonstrate the potential of household surveys to provide country-specific evidence on stillbirth risk factors for LMICs where data are lacking.
背景:在过去十年中,阿富汗的死产率几乎没有下降,且缺乏关于关键风险因素的数据。医疗保健利用情况和孕产妇并发症是影响妊娠结局的重要因素,但在低收入和中等收入国家的全国性调查中,很少收集死产方面的相关信息。2010年阿富汗死亡率调查(AMS)是少数包含此类信息的调查之一。 方法:我们使用了2010年AMS的数据,其中包括完整的妊娠史和死因推断。我们的样本包括调查前三年中13834名年龄在12至49岁之间的妇女的最近一次活产或死产情况。采用多变量泊松回归分析来确定死产的社会人口统计学、孕产妇和医疗保健利用方面的风险因素。 结果:中部高地的妇女(风险比:3.01,95%置信区间1.35,6.70)和努里斯坦族妇女(风险比:9.15,95%置信区间2.95,28.74)的死产风险增加。未接受产前护理的妇女死产风险增加两倍(风险比:3.03,95%置信区间1.73,5.30),而高质量的产前护理对于降低产时死产风险很重要。出血、感染、头痛和胎动减少是与死产密切相关的产前并发症。分娩期胎动减少使死产风险增加近七倍(风险比:6.82,95%置信区间4.20,11.10)。总体而言,在医疗机构分娩的死产风险较高(风险比:1.55,95%置信区间1.12,2.16),但产时死产情况并非如此。 结论:需要采取有针对性的干预措施,以改善高危人群获得和利用服务的情况。必须通过提高产前和产科护理质量来早期发现并发症。我们证明了家庭调查在为缺乏数据的低收入和中等收入国家提供关于死产风险因素的国别证据方面的潜力。
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