Predictors of perinatal mortality in Busoga region, Uganda: a case control study.

Abstract

Introduction Although 6 million perinatal deaths were saved in the last 2 decades, another 6 million continue to die in utero and shortly after birth. Eight out of ten neonates who die in Uganda are below 1 week and for 20% of all pregnancies end into still births (Waiswa et al., 2010; UNICEF, 2016a). Uganda has had a decline in perinatal mortality rates although the rate is still unacceptably high (UBOS, 2012, HMIS data). Objective To determine the socio- demographic, obstetric and fetal factors associated with perinatal mortality at Jinja Regional Referral and Iganga Hospitals in Busoga region between January to June 2017 with the aim of improving perinatal outcomes. Methodology A case- control study was conducted among mothers who delivered at Jinja and Iganga Hospitals in Busoga region. A sample size of 370 (74 cases and 296 controls) was attained by convenient, nonprobability sampling. All deliveries within the study period with complete records were included in the study. Files with incomplete records were excluded from the study. Cases were women who experienced a perinatal death while controls were women with a live birth and neonatal survival until discharge. Four controls were selected for each case and day of delivery was used for matching. Data were extracted from the delivery register using a checklist and analysed using SPSS version 15. Descriptive analysis for participant characteristics was done using frequencies. Logistic regression was used to detect predictors of perinatal mortality. Confounding was assessed if the difference between Crude Odds ratio and Adjusted Odds ratio was ≥ 10%. Results After controlling for obstetric related variables and possible socioeconomic confounding variables, three variables showed to be independently associated with perinatal mortality. Key predictors of perinatal mortality included; gestation age below 37 weeks (OR=4.32; 95% CI: 1.87–9.99) and being a referral (AOR= 4.53; 95% CI: 2.37- 8.66). Babies with normal birth weight (2500g- 3500g) were 0.23 times less likely to die during the perinatal period. Conclusion Predictors of perinatal mortality in this region include prematurity, low birth weight and referral in labour. Urgent attention is needed to improve referral care, management of premature labour and low birth weight births.