Determinants of fresh still births at public health facilities in Mubende District, rural Western Uganda: unmatched case control study

Abstract

Background/Objective: Global still birth rate is at 18.9 per 1000 live births of which 98% are from low income countries and half of them are Fresh Still Births (FSB). Uganda’s still birth rate is at 21per 1000 live births with FSB at 10 per 1000 live births. FSBs contribute to the high national perinatal mortality of 70 per 1000 live births. Mubende district has relatively poor newborn outcomes with an FSB rate of 19 per 1000 births and these remain under researched despite their far reaching consequences. The study established the determinants of Fresh Still Births in Mubende District. Methods: Unmatched facility-based case control study with 364 respondents was conducted from March to April 2018 in Mubende district. Cases were single Fresh Still Births as recorded in the maternity registers at health facilities in the last 12 months. Controls were single live babies as recorded in the same period. Data were extracted from maternity registers and in-depth interviews conducted with purposively selected cases using a data extraction form and an in-depth interview guide. Variables extracted included age of mother, parity, referral status, and reason for referral, place of referral, complications, and weight of baby, ANC attendance, residence, and HIV status among others. Using logistic regression, Crude and adjusted odds ratios with 95% confidence intervals at p<0.05 were used to determine associations between the independent variables and fresh stillbirths. Results: Almost all respondents (98%) resided in rural areas and their mean age was 24.8 years ± 6 (mean ± standard deviation) with an average parity of 2.9 ± 2.59 times (mean ± standard deviation). Most referrals were from HCIII (66.29%). Being admitted in second stage of labor and being referred were significant determinants of fresh still births (AOR= 3.2, 95% CI: 1.96-5.37) and AOR=3.42, 95% CI: 1.83-6.39) respectively. Female babies were less likely to be FSBs, (AOR= 0.47, 95% CI: 0.29-0.76) Conclusion: Being admitted in second stage of labor and being referred were the key determinants of Fresh Still Births in Mubende district. Community sensitization drives need to be implemented to stress the importance of timely seeking of obstetric care on the onset of labor. The district also needs to ensure that HCIII are well equipped to handle obstetric emergencies.