Community-based stillbirth rates and risk factors in rural Sarlahi, Nepal

Document Type

Journal Article

Publication Date

1-1-2011

Journal

International Journal of Gynecology and Obstetrics

Volume

113

Issue

3

DOI

10.1016/j.ijgo.2010.12.015

Keywords

Low-income country; Nepal; Risk factors; Stillbirth

Abstract

Objective: To assess stillbirth rates and antepartum risk factors in rural Nepal. Methods: Data were collected prospectively during a cluster-randomized, community-based trial in Sarlahi, Nepal, from 2002 to 2006. Multivariate regression modeling was performed to calculate adjusted relative risk estimates. Results: Among 24 531 births, the stillbirth rate was 35.4 per 1000 births (term stillbirth rate 21.2 per 1000 births). Most births occurred at home without a skilled birth attendant. The majority (69%) of intrapartum maternal deaths resulted in stillbirth. The adjusted RR (aRR) of stillbirth was 2.74 among nulliparas and 1.47 among mothers with history of a child death. Mothers above the age of 30 years carried a 1.59-fold higher risk for stillbirth than mothers who were 20-24 years old. The stillbirth risk was lower among households where the father had any formal education (aRR 0.70). Land ownership (aRR 0.85) and Pahadi ethnicity (aRR 0.67; reference: Madhesi ethnicity) were associated with significantly lower risks of stillbirth. Conclusion: Stillbirth rates were high in rural Nepal, with the majority of stillbirths occurring at full-term gestation. Nulliparity, history of prior child loss, maternal age above 30 years, Madhesi ethnicity, and socioeconomic disadvantage were significant risk factors for stillbirth. Clinicaltrials.gov NCT00 109616. © 2011 International Federation of Gynecology and Obstetrics. Publishedby Elsevier Ireland Ltd. All rights reserved.

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