Makasa Musonda, Kaonga Patrick, Jacobs Choolwe, Makasa Mpundu, Vwalika Bellington
Department of Epidemiology and Biostatistics, University of Zambia School of Public Health, Lusaka, Zambia.
University Teaching Hospital, Women and Newborn Hospital, Lusaka, Zambia.
PLOS Glob Public Health. 2025 Aug 20;5(8):e0003326. doi: 10.1371/journal.pgph.0003326. eCollection 2025.
In 2023, approximately 2.3 million babies globally were lost before birth or within the first week of life, primarily due to preventable causes. Global perinatal mortality declined from 5.7 million in 2000 to 4.1 million by the end of 2015. However, despite this progress, for example 45% of all stillbirths were reported from high-income countries, which contribute less than 2% of the global burden of stillbirths. Perinatal mortality rates for sub-Saharan Africa and Zambia are at 37.4 and 33/1000 live births, respectively. The aim of this study was to determine the predictors of perinatal mortality at the seven major hospitals of Lusaka, Zambia.
This was a multifacility unmatched case control study from September 2023 to January 2024. Cases included perinatal death (≥22 weeks gestation or ≥500g stillborn and death of neonate within seven days of life) and controls were live births. Stepwise multivariate logistic regression analysis with Stata version 14 determined predictors using adjusted odd ratios and p-values.
This study included 630 participants, with 210 cases and 420 controls, analysed in a 1:2 ratio. Antenatal care booking after 12 weeks gestation had almost three times odds of experiencing perinatal mortality (AOR 2.91, 95% CI: 1.97-4.29), p < 0.001) compared to early booking (<12 weeks). Walking as a means of reaching the healthcare facility had over three times the odds of perinatal mortality (AOR3.48, 95% CI: 1.87-6.49, p < 0.012) compared to using personal transport. Anaemia in pregnancy carried a three-and-a-half-fold increased the risk of perinatal death (AOR 3.58, 95% CI: 1.72-7.44, p < 0.001) compared to mothers without anaemia. History of previous pregnancy loss was associated with a five-fold increased risk of perinatal death (AOR 5.05, 95% CI: 2.99-8.51, p < 0.001) compared to those without such a history.
This study revealed that late antenatal care booking, walking as means of transport to access health facility, anaemia in pregnancy, and previous history of loss of baby before birth perinatal death were the main predictors with statistical significance of perinatal death experience. The study findings highlight the need for policies that promote early antenatal care, prevent anaemia in pregnancy, improve transport access to hospitals, and further research into context-specific barriers and effective interventions.
2023年，全球约有230万婴儿在出生前或出生后第一周内夭折，主要原因是可预防的因素。全球围产期死亡率从2000年的570万降至2015年底的410万。然而，尽管取得了这一进展，但例如45%的死产报告来自高收入国家，而这些国家在全球死产负担中所占比例不到2%。撒哈拉以南非洲和赞比亚的围产期死亡率分别为每1000例活产37.4例和33例。本研究的目的是确定赞比亚卢萨卡七家主要医院围产期死亡的预测因素。
这是一项从2023年9月至2024年1月的多机构非匹配病例对照研究。病例包括围产期死亡（妊娠≥22周或死产≥500克以及新生儿在出生后七天内死亡），对照为活产。使用Stata 14版进行逐步多变量逻辑回归分析，通过调整后的比值比和p值确定预测因素。
本研究包括630名参与者，其中210例病例和420例对照，按1:2的比例进行分析。与早期预约（<12周）相比，妊娠12周后进行产前护理预约的围产期死亡几率几乎高出三倍（调整后的比值比为2.91，95%置信区间：1.97 - 4.29，p < 0.001）。与使用私人交通工具相比，步行前往医疗机构的围产期死亡几率高出三倍多（调整后的比值比为3.48，95%置信区间：1.87 - 6.49，p < 0.012）。与无贫血的母亲相比，孕期贫血使围产期死亡风险增加了三倍半（调整后的比值比为3.58，95%置信区间：1.72 - 7.44，p < 0.001）。与无此类病史的人相比，既往流产史使围产期死亡风险增加了五倍（调整后的比值比为5.05，95%置信区间：2.99 - 8.51，p < 0.001）。
本研究表明，产前护理预约延迟、步行作为前往医疗机构的交通方式、孕期贫血以及既往有过出生前婴儿夭折史是围产期死亡经历具有统计学意义的主要预测因素。研究结果强调需要制定政策，促进早期产前护理，预防孕期贫血，改善前往医院的交通条件，并进一步研究特定背景下的障碍和有效的干预措施。
