Determinants of stillbirths in sub‐Saharan Africa: A systematic review

Mukherjee, Ankita, Di Stefano, Lydia, Blencowe, Hannah and Mee, Paul Determinants of stillbirths in sub‐Saharan Africa: A systematic review. BJOG: An International Journal of Obstetrics & Gynaecology . ISSN 1470-0328

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Determinants of stillbirths in sub‐Saharan Africa: A systematic review
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Sub-Saharan African (SSA) countries have high stillbirth rates compared with high-income countries, yet research on risk factors for stillbirth in SSA remain scant.

To identify the modifiable risk factors of stillbirths in SSA and investigate their strength of association using a systematic review.

Search Strategy
CINAHL Plus, EMBASE, Global Health and MEDLINE databases were searched for literature.

Selection Criteria
Observational population- and facility-level studies exploring stillbirth risk factors, published in 2013–2019 were included.

Data Collection and Analysis
A narrative synthesis of data was undertaken and the potential risk factors were classified into subgroups.

Main Results
Thirty-seven studies were included, encompassing 20 264 stillbirths. The risk factors were categorised as: maternal antepartum factors (0–4 antenatal care visits, multiple gestations, hypertension, birth interval of >3 years, history of perinatal death); socio-economic factors (maternal lower wealth index and basic education, advanced maternal age, grand multiparity of ≥5); intrapartum factors (direct obstetric complication); fetal factors (low birthweight and gestational age of <37 weeks) and health systems factors (poor quality of antenatal care, emergency referrals, ill-equipped facility). The proportion of unexplained stillbirths remained very high. No association was found between stillbirths and body mass index, diabetes, distance from the facility or HIV.

The overall quality of evidence was low, as many studies were facility based and did not adjust for confounding factors. This review identified preventable risk factors for stillbirth. Focused programmatic strategies to improve antenatal care, emergency obstetric care, maternal perinatal education, referral and outreach systems, and birth attendant training should be developed. More population-based, high-quality research is needed.

Keywords:Spontaneous; Miscarriage; Stillbirth, Gynecology and obstetrics, Systematic Review
Subjects:A Medicine and Dentistry > A100 Pre-clinical Medicine
A Medicine and Dentistry > A900 Others in Medicine and Dentistry
A Medicine and Dentistry > A300 Clinical Medicine
Divisions:COLLEGE OF ARTS, SOCIAL SCIENCES AND HUMANITIES > College of Arts, Social Sciences and Humanities Executive Office
ID Code:56292
Deposited On:19 Sep 2023 14:36

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