Gwacham-Anisiobi Uchenna, Opondo Charles, Cheng Tuck Seng, Kurinczuk Jennifer J, Anyaegbu Geoffrey, Nairl Manisha
Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLOS Glob Public Health. 2024 Oct 24;4(10):e0003771. doi: 10.1371/journal.pgph.0003771. eCollection 2024.
Despite Nigeria's stillbirth rate reducing from 28.6 to 22.5 per 1,000 births from 2000-2021, progress trails comparable indicators and regional variations persist. We assessed stillbirth incidences and associated risk factors in 20 secondary hospitals in Imo state, to generate essential local evidence to inform policymaking to reduce mortality. The total numbers of births and their outcomes were determined through hospital maternity registers. An unmatched case-control study was conducted. We collected retrospective data about 157 antepartum and 193 intrapartum stillbirths, and from 381 livebirths (controls). Potential risk factors were categorised into sociodemographic, obstetric and maternity care and biological determinants using a theoretical framework. Independent multivariable logistic regression models were used to investigate the association of risk factors with each stillbirth type. The overall stillbirth rate was 38 per 1,000 total births. The rate of antepartum and intrapartum stillbirths were 16 and 19 per 1,000 respectively. The risk factors independently associated with antepartum stillbirths were nulliparity (adjusted odds ratio (aOR) 1.87, 95%CI 1.04-3.36); preterm birth (aOR 14.29, 95%CI 6.31-32.38); being referred from another facility (aOR 3.75, 95%CI 1.96-7.17); unbooked pregnancy (aOR 2.58, 95%CI 1.37-4.85); and obstetric complications (aOR 4.04, 95%CI 2.35-6.94). For intrapartum stillbirths, associated factors were preterm birth (aOR 11.28, 95%CI 4.66-27.24); referral (aOR 2.50, 95%CI 1.19-5.24); not using a partogram (aOR 2.92, 95%CI 1.23-6.95) and obstetric complications (aOR 10.71, 95%CI 5.92-19.37). The findings highlight specific risk factors associated with antepartum and intrapartum stillbirths, shedding light on potential areas for targeted interventions.
尽管尼日利亚的死产率在2000年至2021年间从每1000例出生28.6例降至22.5例，但进展落后于可比指标，地区差异依然存在。我们评估了伊莫州20家二级医院的死产发生率及相关风险因素，以生成重要的本地证据，为降低死亡率的政策制定提供依据。通过医院产科登记册确定出生总数及其结局。进行了一项非匹配病例对照研究。我们收集了157例产前死产和193例产时死产以及381例活产（对照）的回顾性数据。使用理论框架将潜在风险因素分为社会人口学、产科和孕产妇保健以及生物学决定因素。采用独立多变量逻辑回归模型研究风险因素与每种死产类型的关联。总死产率为每1000例出生38例。产前和产时死产率分别为每1000例16例和19例。与产前死产独立相关的风险因素为空产史（调整优势比（aOR）1.87，95%置信区间1.04 - 3.36）；早产（aOR 14.29，95%置信区间6.31 - 32.38）；从另一家机构转诊（aOR 3.75，95%置信区间1.96 - 7.17）；未登记妊娠（aOR 2.58，95%置信区间1.37 - 4.85）；以及产科并发症（aOR 4.04，95%置信区间2.35 - 6.94）。对于产时死产，相关因素为早产（aOR 11.28，95%置信区间4.66 - 27.24）；转诊（aOR 2.50，95%置信区间1.19 - 5.24）；未使用产程图（aOR 2.92，95%置信区间1.23 - 6.95）和产科并发症（aOR 10.71，95%置信区间5.92 - 19.37）。研究结果突出了与产前和产时死产相关的特定风险因素，为有针对性干预的潜在领域提供了线索。
