Factors associated with adverse fatal outcomes in Busia District, Uganda : a case control study
Abstract
Introductions: Access to obstetric care services during pregnancy is an important factor in safeguarding both maternal and fetal outcome. Globally, 7,700 neonatal deaths occur each day as a result of complications during childbirth; 75% of them occur in the first week of life (early neonatal period), half of which are on the first day of life due to intra-partum causes. An addition, 7,300 women experience stillbirths in the postnatal period (Khan et al., 2006, Knight et al., 2013). Objective: The aim of this study was to determine the factors associated with adverse fetal outcomes in Busia district, Uganda. Methods: An unmatched community based case-control study with multistage sampling procedure was conducted in June 2020. A total of 327 participants, 109 cases and 219 controls were enrolled in the study. A case was a mother aged 15-49 years who delivered at a health facility in the 12 months preceding the study (June 2019-May 2020) and registered stillbirth or early neonatal death while a control was a mother aged 15-49 years who delivered at a health facility in the 12 months preceding the study and registered a live birth. Data entry and cleaning were done using Epi-data and analyzed with STATA version 14.0. Bivariate and multivariable analyses were done to examine the associations between the primary outcome variable (stillbirth early neonatal death) and its predictors. Results: The maternal factors significantly associated with perinatal death were maternal young age of 15-19 years [AOR= 4.29, 95% CI (1.94-9.46)], maternal advanced age of 35-49 years [AOR= 2.76, 95% CI:1.42-5.37], birth interval of less than 2 years [AOR 2.48, 95% CI (1.26-4.90)], previous birth history of stillbirth or early neonatal death [AOR= 11.21, 95% CI (4.05-31.0)], multiple pregnancy during current pregnancy[AOR= 8.77, 95% CI (1.10-69.82)], illness [AOR 3.49, 95% CI (1.77-6.86)], and less than 4 ANC visits [AOR=2.11, 95% CI:1.32-8.60]. The health facility factors that were associated with perinatal deaths' were; availability of required delivery care services [AOR 8.47, 95% CI:(2.31-31.03)], unaffordability of delivery care logistical requirements [AOR=1.81, 95% CI (1.10-2.99)]. The community factor significantly associated with perinatal death was absence of delivery plan [AOR=1.72, 95% CI. Conclusions: In this study, maternal young age of 15-19 years, advanced maternal age of 35-49, birth interval of less than 2 years, previous history of stillbirth or early neonatal death, multiple pregnancy, illness during current pregnancy, less ANC attendances, unavailability of required delivery care services, unaffordability of delivery care logistical requirements, and absence delivery care plan were statistically significant factors associated with perinatal death.