BMJ open · 2025
Exploring multilevel determinants of stillbirth: a comprehensive analysis across sub-Saharan African countries.
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Adeleye Khadijat, Ogungbe Oluwabunmi, Yeboah-Kordieh Yvette, Gresh Ashley, Iradukunda Favorite
Аннотация
BACKGROUND: Stillbirths and associated outcomes remain a significant concern in sub-Saharan Africa (SSA), with approximately 41% of global stillbirths.
DESIGN: Our cross-sectional analysis included a weighted sample of women aged 15-49 years who had given birth or experienced stillbirth.
SETTING: Sub-Saharan African Countries.
THE MAIN OUTCOME MEASURES: Determinants of stillbirth among women in 29 SSA countries.
RESULT: Among a sample of 197 328, stillbirth prevalence was 8.4/1000 live births. Among individual-level factors, the risk increased with age. Higher maternal educational levels were significantly associated with decreased stillbirth risk (aOR=0.62, 95%CI: 0.44 to 0.89, higher versus no education). Single women had significantly lower odds of stillbirth compared with those who no longer lived together or were separated from their partners (aOR=0.38, 95%CI: 0.25 to 0.60). Contextually, women with a job had an increased risk compared with women without a job (aOR=1.19, 95%CI: 1.06 to 1.34), and living in a rural residential area was a significant factor (aOR=1.30, 95%CI: 1.13 to 1.50).
CONCLUSION: The complex interplay between individual-level and contextual factors continues to influence stillbirth outcomes in SSA. Cross-sector integrative care approaches to maternal and neonatal health are needed to address the multifaceted determinants of stillbirths.
DESIGN: Our cross-sectional analysis included a weighted sample of women aged 15-49 years who had given birth or experienced stillbirth.
SETTING: Sub-Saharan African Countries.
THE MAIN OUTCOME MEASURES: Determinants of stillbirth among women in 29 SSA countries.
RESULT: Among a sample of 197 328, stillbirth prevalence was 8.4/1000 live births. Among individual-level factors, the risk increased with age. Higher maternal educational levels were significantly associated with decreased stillbirth risk (aOR=0.62, 95%CI: 0.44 to 0.89, higher versus no education). Single women had significantly lower odds of stillbirth compared with those who no longer lived together or were separated from their partners (aOR=0.38, 95%CI: 0.25 to 0.60). Contextually, women with a job had an increased risk compared with women without a job (aOR=1.19, 95%CI: 1.06 to 1.34), and living in a rural residential area was a significant factor (aOR=1.30, 95%CI: 1.13 to 1.50).
CONCLUSION: The complex interplay between individual-level and contextual factors continues to influence stillbirth outcomes in SSA. Cross-sector integrative care approaches to maternal and neonatal health are needed to address the multifaceted determinants of stillbirths.