Risk factors for stillbirth and early neonatal death: a case-control study in tertiary hospitals in Addis Ababa, Ethiopia

Abstract Background Ethiopia is a Sub-Saharan country that has made significant improvements in maternal mortality and under-five mortality over the past 15 years. However, the nation continues to have one of the highest rates of perinatal mortality in the entire world with current estimates at 33 deaths per 1000 live births. Methods This case-control study was conducted between October 2016 and May 2017 at Tikur Anbessa Hospital and Gandhi Memorial Hospital. All women who had a stillbirth or early neonatal death (i.e. death within 7 days) during this period willing to participate were included as cases. A systematic random sample of women delivering at the hospital were approached for recruitment as controls to generate a 2:1 ratio of controls to cases. Data on risk factors were retrieved from medical records including delivery records, and treatment charts. Statistical differences in background and social characteristics of cases and controls were determined by t-test and chi-squared (or fisher’s exact test) for quantitative and categorical variables respectively. Binary logistic regression analysis was completed to determine any associations between risk factors and stillbirth/early neonatal death. Results During the study period, 366 women delivering at the hospitals were enrolled as cases and 711 women delivering at the hospitals were enrolled as controls. Records from both hospitals indicated that the estimated stillbirth and neonatal mortality rates were 30.7 per 1000. Neonatal causes (43.4%) were the most common, followed by antepartum (32.5%) and intrapartum (24.5%). Risk factors for stillbirths and early neonatal death were low maternal education (aOR 1.747, 95%CI 1.098–2.780), previous stillbirth (aOR 9.447, 95%CI 6.245–14.289), previous preterm birth (aOR 3.620, 95%CI 2.363–5.546), and previous child with congenital abnormality (aOR 2.190, 95% 1.228–3.905), and antepartum hemorrhage during pregnancy (aOR 3.273, 95% 1.523–7.031). Conclusion Antepartum hemorrhaging is the only risk factor in our study amenable for direct intervention. Efforts should be maximized to improve patient education and antenatal and obstetric services. Moreover, the most significant cause of mortality was asphyxia-related causes. It is imperative that obstetric capacity in rehabilitation services are strengthened and for further studies to investigate the high burden of asphyxia at these tertiary hospitals to better tailor interventions.http://deepblue.lib.umich.edu/bitstream/2027.42/173657/1/12884_2021_Article_4025.pd

Obstetric capacity strengthening in Ghana results in wide geographic distribution and retention of certified Obstetrician/Gynaecologists: A quantitative analysis

ObjectivesTo determine the cumulative retention of Obstetricians/Gynaecologists (Ob/Gyns) since the inception of the Ghana postgraduate Ob/Gyn programmes, to determine the demographic and practice characteristics of all Ob/Gyns who have been trained, and to compare the geographic distribution of Ob/Gyns throughout Ghana between 2010, when a previous study was conducted, and the current practice locations of all graduates in 2017.DesignCross- sectional, quantitative investigation.SettingFieldwork for this study was conducted in Ghana between 21 June 2017 and 20 August 2017.MethodsA roster of certified Ob/Gyns, year certified and email contact information was obtained from the Ghana College of Physicians and Surgeons, a roster of practice locations was obtained from Ghana Medical Board.Main outcome measuresRetention of Ob/Gyns, geographic distribution of providers and comparison of geographic spread between 2010 and 2017 practice locations.ResultsSignificant geographic spread and increase in in- country medical programmes have occurred over the 7- year period. In recent years, Ob/Gyn certifications through the Ghana College of Physicians and Surgeons have significantly increased.ConclusionThe establishment of the Ghana College of Physicians and Surgeons created a national certification opportunity that made Ob/Gyn certification more accessible. This provides a cadre of certified Ob/Gyns that can be trained and retained in low- income settings, and allows for long- term commitment in multiple relevant sectors that may serve to establish a comprehensive obstetric and gynaecology capacity beyond urban centres.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/174755/1/bjo17121.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/174755/2/bjo17121_am.pd