Upper West Regional Health Directorate, Ghana Health Service, Wa, Ghana
National Public Health Institute of Liberia, Monrovia, Liberia.
BMJ Open. 2024 Feb 27;14(2):e080661. doi: 10.1136/bmjopen-2023-080661.
Perinatal mortality remains a pressing concern, especially in lower and middle-income nations. Globally, 1 in 72 babies are stillborn. Despite advancements, the 2030 targets are challenging, notably in sub-Saharan Africa. Post-war Liberia saw a 14% spike in perinatal mortality between 2013 and 2020, indicating the urgency for in-depth study.
The study aims to investigate the predictors of perinatal mortality in Liberia using 2013 and 2019-2020 Liberia Demographic and Health Survey datasets.
In a two-stage cluster design from the Liberia Demographic and Health Survey, 6572 and 5285 respondents were analysed for 2013 and 2019-2020, respectively. Data included women aged 15-49 with pregnancy histories. Descriptive statistics was used to analyse the sociodemographic characteristics, the exposure to media and the maternal health services. Bivariate and multivariate logistic regressions were used to examine the predictors of perinatal mortality at a significance level of p value ≤0.05 and 95% CI. The data analysis was conducted in STATA V.14.
Perinatal mortality rates increased from 30.23 per 1000 births in 2013 to 42.05 in 2019-2020. In 2013, increasing age of respondents showed a reduced risk of perinatal mortality rate. In both years, having one to three children significantly reduced mortality risk (2013: adjusted OR (aOR) 0.30, 95% CI 0.14 to 0.64; 2019: aOR 0.24, 95% CI 0.11 to 0.54), compared with not having a child. Weekly radio listenership increased mortality risk (2013: aOR 1.36, 95% CI 0.99 to 1.89; 2019: aOR 1.86, 95% CI 1.35 to 2.57) compared with not listening at all. Longer pregnancy intervals (p<0.0001) and receiving 2+ tetanus injections (p=0.019) were protective across both periods. However, iron supplementation showed varied effects, reducing risk in 2013 (aOR 0.90, 95% CI 0.48 to 1.68) but increasing it in 2019 (aOR 2.10, 95% CI 0.90 to 4.92).
The study reports an alarming increase in Liberia's perinatal mortality from 2013 to 2019-2020. The findings show dynamic risk factors necessitating adaptable healthcare approaches, particularly during antenatal care. These adaptable approaches are crucial for refining health strategies in line with the Sustainable Development Goals, with emphasis on the integration of health, education, gender equality, sustainable livelihoods and global partnerships for effective health outcomes.
围产期死亡率仍然是一个紧迫的问题，特别是在中低收入国家。全球范围内，每 72 个婴儿中就有 1 个仍然是死胎。尽管取得了进展，但 2030 年的目标仍然具有挑战性，特别是在撒哈拉以南非洲。利比里亚在 2013 年至 2020 年间经历了 14%的围产期死亡率飙升，表明需要深入研究。
本研究旨在利用 2013 年和 2019-2020 年利比里亚人口与健康调查数据集，调查利比里亚围产期死亡率的预测因素。
采用利比里亚人口与健康调查的两阶段聚类设计，分别对 2013 年和 2019-2020 年的 6572 和 5285 名受访者进行分析。数据包括有妊娠史的 15-49 岁妇女。使用描述性统计分析方法分析社会人口特征、媒体接触和产妇保健服务。使用双变量和多变量逻辑回归在 p 值≤0.05 和 95%置信区间（CI）的显著性水平下检查围产期死亡率的预测因素。数据分析在 STATA V.14 中进行。
围产期死亡率从 2013 年的每 1000 例活产 30.23 例上升到 2019-2020 年的每 1000 例活产 42.05 例。在 2013 年，受访者年龄的增加显示出降低围产期死亡率的风险。在这两年中，生育一到三个孩子显著降低了死亡率风险（2013 年：调整后的比值比（aOR）为 0.30，95%CI 为 0.14 至 0.64；2019 年：aOR 为 0.24，95%CI 为 0.11 至 0.54），与没有孩子的情况相比。每周收听广播增加了死亡率风险（2013 年：aOR 为 1.36，95%CI 为 0.99 至 1.89；2019 年：aOR 为 1.86，95%CI 为 1.35 至 2.57），与完全不收听相比。较长的妊娠间隔（p<0.0001）和接受 2 次以上破伤风注射（p=0.019）在两个时期都是保护性的。然而，铁补充剂的作用不同，2013 年降低了风险（aOR 为 0.90，95%CI 为 0.48 至 1.68），但在 2019 年增加了风险（aOR 为 2.10，95%CI 为 0.90 至 4.92）。
本研究报告了利比里亚 2013 年至 2019-2020 年围产期死亡率的惊人增长。研究结果表明，需要采取动态的风险因素来适应医疗保健方法，特别是在产前保健期间。这些适应性方法对于根据可持续发展目标制定和完善卫生战略至关重要，重点是将卫生、教育、性别平等、可持续生计和全球伙伴关系纳入其中，以实现有效的卫生成果。
