Stillbirths in urban Guinea-Bissau: A hospital- and community-based study

Morten Bjerregaard-Andersen*, Najaaraq Lund, Anne Sofie Pinstrup Joergensen, Frida Starup Jepsen, Holger Werner Unger, Mama Mane, Amabelia Rodrigues, Staffan Bergström, Christine Stabell Benn

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Background Stillbirth rates remain high in many low-income settings, with fresh (intrapartum) stillbirths accounting for a large part due to limited obstetrical care. We aimed to determine the stillbirth rate and identify potentially modifiable factors associated with stillbirth in urban Guinea-Bissau. Methods The study was carried out by the Bandim Health Project (BHP), a Health and Demographic Surveillance System site in the capital Bissau. We assessed stillbirth rates in a hospital cohort consisting of all deliveries at the maternity ward at the National Hospital Simão Mendes (HNSM), and in a community cohort, which only included women from the BHP area. Stillbirth was classified as fresh (FSB) if fetal movements were reported on the day of delivery. Results From October 1 2007 to April 15 2013, a total of 38164 deliveries were registered at HNSM, among them 3762 stillbirths (99/1000 births). Excluding deliveries referred to the hospital from outside the capital (9.6%), the HNSM stillbirth rate was 2786/34490 births (81/1000). During the same period, 15462 deliveries were recorded in the community cohort. Of these, 768 were stillbirths (50/1000). Of 11769 hospital deliveries among women from Bissau with data on fetal movement, 866 (74/1000) were stillbirths, and 609 (70.3%) of these were FSB, i.e. potentially preventable. The hospital FSB rate was highest in the evening from 4 pm to midnight (P = 0.04). In the community cohort, antenatal care (ANC) attendance correlated strongly with stillbirth reduction; the stillbirth rate was 71/1000 if the mother attended no ANC consultations vs. 36/ 1000 if she attended 7 consultations (P<0.001). Conclusion In Bissau, the stillbirth rate is alarmingly high. The majority of stillbirths are preventable FSB. Improving obstetrical training, labour management (including sufficient intrapartum monitoring and timely intervention) and hospital infrastructure is urgently required. This should be combined with proper community strategies and additional focus on antenatal care.

OriginalsprogEngelsk
Artikelnummere0197680
TidsskriftPLOS ONE
Vol/bind13
Udgave nummer5
Antal sider18
ISSN1932-6203
DOI
StatusUdgivet - 2018

Fingeraftryk

Guinea-Bissau
Stillbirth
fetal death
Health
prenatal care
Prenatal Care
Fetal Movement
Personnel
Referral and Consultation
Monitoring
monitoring

Citer dette

Bjerregaard-Andersen, Morten ; Lund, Najaaraq ; Joergensen, Anne Sofie Pinstrup ; Jepsen, Frida Starup ; Unger, Holger Werner ; Mane, Mama ; Rodrigues, Amabelia ; Bergström, Staffan ; Benn, Christine Stabell. / Stillbirths in urban Guinea-Bissau : A hospital- and community-based study. I: PLOS ONE. 2018 ; Bind 13, Nr. 5.
@article{5337c721c2654d31a8de320c850e74db,
title = "Stillbirths in urban Guinea-Bissau: A hospital- and community-based study",
abstract = "Background Stillbirth rates remain high in many low-income settings, with fresh (intrapartum) stillbirths accounting for a large part due to limited obstetrical care. We aimed to determine the stillbirth rate and identify potentially modifiable factors associated with stillbirth in urban Guinea-Bissau. Methods The study was carried out by the Bandim Health Project (BHP), a Health and Demographic Surveillance System site in the capital Bissau. We assessed stillbirth rates in a hospital cohort consisting of all deliveries at the maternity ward at the National Hospital Sim{\~a}o Mendes (HNSM), and in a community cohort, which only included women from the BHP area. Stillbirth was classified as fresh (FSB) if fetal movements were reported on the day of delivery. Results From October 1 2007 to April 15 2013, a total of 38164 deliveries were registered at HNSM, among them 3762 stillbirths (99/1000 births). Excluding deliveries referred to the hospital from outside the capital (9.6{\%}), the HNSM stillbirth rate was 2786/34490 births (81/1000). During the same period, 15462 deliveries were recorded in the community cohort. Of these, 768 were stillbirths (50/1000). Of 11769 hospital deliveries among women from Bissau with data on fetal movement, 866 (74/1000) were stillbirths, and 609 (70.3{\%}) of these were FSB, i.e. potentially preventable. The hospital FSB rate was highest in the evening from 4 pm to midnight (P = 0.04). In the community cohort, antenatal care (ANC) attendance correlated strongly with stillbirth reduction; the stillbirth rate was 71/1000 if the mother attended no ANC consultations vs. 36/ 1000 if she attended 7 consultations (P<0.001). Conclusion In Bissau, the stillbirth rate is alarmingly high. The majority of stillbirths are preventable FSB. Improving obstetrical training, labour management (including sufficient intrapartum monitoring and timely intervention) and hospital infrastructure is urgently required. This should be combined with proper community strategies and additional focus on antenatal care.",
keywords = "Adolescent, Adult, Female, Guinea-Bissau/epidemiology, HIV Infections/complications, Hospitals, Humans, Pregnancy, Prenatal Care, Registries, Risk Factors, Stillbirth/epidemiology, Young Adult",
author = "Morten Bjerregaard-Andersen and Najaaraq Lund and Joergensen, {Anne Sofie Pinstrup} and Jepsen, {Frida Starup} and Unger, {Holger Werner} and Mama Mane and Amabelia Rodrigues and Staffan Bergstr{\"o}m and Benn, {Christine Stabell}",
year = "2018",
doi = "10.1371/journal.pone.0197680",
language = "English",
volume = "13",
journal = "P L o S One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "5",

}

Bjerregaard-Andersen, M, Lund, N, Joergensen, ASP, Jepsen, FS, Unger, HW, Mane, M, Rodrigues, A, Bergström, S & Benn, CS 2018, 'Stillbirths in urban Guinea-Bissau: A hospital- and community-based study', PLOS ONE, bind 13, nr. 5, e0197680. https://doi.org/10.1371/journal.pone.0197680

Stillbirths in urban Guinea-Bissau : A hospital- and community-based study. / Bjerregaard-Andersen, Morten; Lund, Najaaraq; Joergensen, Anne Sofie Pinstrup; Jepsen, Frida Starup; Unger, Holger Werner; Mane, Mama; Rodrigues, Amabelia; Bergström, Staffan; Benn, Christine Stabell.

I: PLOS ONE, Bind 13, Nr. 5, e0197680, 2018.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Stillbirths in urban Guinea-Bissau

T2 - A hospital- and community-based study

AU - Bjerregaard-Andersen, Morten

AU - Lund, Najaaraq

AU - Joergensen, Anne Sofie Pinstrup

AU - Jepsen, Frida Starup

AU - Unger, Holger Werner

AU - Mane, Mama

AU - Rodrigues, Amabelia

AU - Bergström, Staffan

AU - Benn, Christine Stabell

PY - 2018

Y1 - 2018

N2 - Background Stillbirth rates remain high in many low-income settings, with fresh (intrapartum) stillbirths accounting for a large part due to limited obstetrical care. We aimed to determine the stillbirth rate and identify potentially modifiable factors associated with stillbirth in urban Guinea-Bissau. Methods The study was carried out by the Bandim Health Project (BHP), a Health and Demographic Surveillance System site in the capital Bissau. We assessed stillbirth rates in a hospital cohort consisting of all deliveries at the maternity ward at the National Hospital Simão Mendes (HNSM), and in a community cohort, which only included women from the BHP area. Stillbirth was classified as fresh (FSB) if fetal movements were reported on the day of delivery. Results From October 1 2007 to April 15 2013, a total of 38164 deliveries were registered at HNSM, among them 3762 stillbirths (99/1000 births). Excluding deliveries referred to the hospital from outside the capital (9.6%), the HNSM stillbirth rate was 2786/34490 births (81/1000). During the same period, 15462 deliveries were recorded in the community cohort. Of these, 768 were stillbirths (50/1000). Of 11769 hospital deliveries among women from Bissau with data on fetal movement, 866 (74/1000) were stillbirths, and 609 (70.3%) of these were FSB, i.e. potentially preventable. The hospital FSB rate was highest in the evening from 4 pm to midnight (P = 0.04). In the community cohort, antenatal care (ANC) attendance correlated strongly with stillbirth reduction; the stillbirth rate was 71/1000 if the mother attended no ANC consultations vs. 36/ 1000 if she attended 7 consultations (P<0.001). Conclusion In Bissau, the stillbirth rate is alarmingly high. The majority of stillbirths are preventable FSB. Improving obstetrical training, labour management (including sufficient intrapartum monitoring and timely intervention) and hospital infrastructure is urgently required. This should be combined with proper community strategies and additional focus on antenatal care.

AB - Background Stillbirth rates remain high in many low-income settings, with fresh (intrapartum) stillbirths accounting for a large part due to limited obstetrical care. We aimed to determine the stillbirth rate and identify potentially modifiable factors associated with stillbirth in urban Guinea-Bissau. Methods The study was carried out by the Bandim Health Project (BHP), a Health and Demographic Surveillance System site in the capital Bissau. We assessed stillbirth rates in a hospital cohort consisting of all deliveries at the maternity ward at the National Hospital Simão Mendes (HNSM), and in a community cohort, which only included women from the BHP area. Stillbirth was classified as fresh (FSB) if fetal movements were reported on the day of delivery. Results From October 1 2007 to April 15 2013, a total of 38164 deliveries were registered at HNSM, among them 3762 stillbirths (99/1000 births). Excluding deliveries referred to the hospital from outside the capital (9.6%), the HNSM stillbirth rate was 2786/34490 births (81/1000). During the same period, 15462 deliveries were recorded in the community cohort. Of these, 768 were stillbirths (50/1000). Of 11769 hospital deliveries among women from Bissau with data on fetal movement, 866 (74/1000) were stillbirths, and 609 (70.3%) of these were FSB, i.e. potentially preventable. The hospital FSB rate was highest in the evening from 4 pm to midnight (P = 0.04). In the community cohort, antenatal care (ANC) attendance correlated strongly with stillbirth reduction; the stillbirth rate was 71/1000 if the mother attended no ANC consultations vs. 36/ 1000 if she attended 7 consultations (P<0.001). Conclusion In Bissau, the stillbirth rate is alarmingly high. The majority of stillbirths are preventable FSB. Improving obstetrical training, labour management (including sufficient intrapartum monitoring and timely intervention) and hospital infrastructure is urgently required. This should be combined with proper community strategies and additional focus on antenatal care.

KW - Adolescent

KW - Adult

KW - Female

KW - Guinea-Bissau/epidemiology

KW - HIV Infections/complications

KW - Hospitals

KW - Humans

KW - Pregnancy

KW - Prenatal Care

KW - Registries

KW - Risk Factors

KW - Stillbirth/epidemiology

KW - Young Adult

U2 - 10.1371/journal.pone.0197680

DO - 10.1371/journal.pone.0197680

M3 - Journal article

C2 - 29791501

AN - SCOPUS:85047555272

VL - 13

JO - P L o S One

JF - P L o S One

SN - 1932-6203

IS - 5

M1 - e0197680

ER -