Factors associated with fresh stillbirths and low apgarscore in selected health units in Kiboga district, Uganda.

Abstract

Each year, thousands of new born babies arebeing born in the world with low apgarscore while others are fresh stillbirths. These two conditions are among the contributors of perinatal mortality and poor pregnancy outcomes in developing countries and especially rural communities like Kiboga district. In rural areas where service delivery is not adequate, the prevelance of fresh stillbirths and low apgarscore is expected to be high. The prevalence of fresh stillbirths is high in developing countires than developed countries and should therefore be declared a public health problem. Factors associated with these conditions can be individual to the mother or institutional or health system failure. An intervention now will lead to reduction in the deaths of newborn babies. OBJECTIVE: The aim was to determine the factors associated with fresh stillbirths and low apgarscore in selected health units in kiboga district. STUDY DESIGN: Case control study, among mothers who delivered in selected health units in kiboga district. The ratio of cases to controls was 1.2. A total of 300 mothers were enrolled in the study. They included 38 FSBs with and controls and 62 low apgarscore with 124 controls. The selected health units included Kiboga hospital, Bukomero H/C IV, Ntwetwe H/C IV, Lwamata H/C III, Nabwendo H/C III, Butemba H/C III, St. Balikuddembe H/C III and Kyankwanzi H/C III. RESULTS: The mean age of the participants was 24 years. There was no age difference between the cases and the controls. The major factors associated with FSB and Low A/S included; duration of labour more than 24 hours, OR 3.26 (95% C1 0.98-10.82), No partograph use OR 3.09 (95% C1 1.35-7.04), outcome of the previous pregnancy OR 0.30 (95% C1 0.10-0.91), Low birth weight of less than 2.5 kgs, OR 5.64 (95% C1 1.08-29.38), distance of the mothers from the health units (of more than 5km), OR 2.06 (95% C1 0.87-4.99), booking for antenatal OR 8.95 (95%C1 0.96-83.51), Lack of financial support from the spouse, OR 0.4 (95%C1 0.13-0.96), Level of education of the mother (primary or less), OR 2.1 (95%C1 1.11-3.92), single motherhood, OR 0.52 (95% C1 0.27-0.97) and carde of the person who conducted the delivery (doctor) OR 3.26 (95%C1 1.26-8.41). CONCLUSION: Both FSB and Low A/S in selected health units in Kiboga district were found to be associated with multiple risk factors operating at different levels; socio demographic, health facility and obstetric factors. They include; duration of labour of more than 24 years , outcome of the last pregnancy, low birthweight, distance of mothers from the health units of more than 5km, booking status (unbooked mothers were more affected than booked mothers), level of education of the mother (primary or less), deliveries conducted by doctors, single motherhood and lack of financial support from the spouse. RECOMMENDATION: Greater attention needs to be given to the strategies that focus on improving the quality of obstetric care provided in the whole of kiboga district and other areas.  There is need to emphasize the use of partographs in all health units and set up a perinatal audit in the area.  Extend EMOC services to lower health units by operationalising and equipping the already existing health units.  Promote girl child education by embracing the universal primary and secondary education.