Understanding the complexities of unexplained stillbirth in sub-Saharan Africa: a mixed-methods study

Area of Science:

• Perinatal health
• Obstetrics
• Public health

Background:

• Unexplained stillbirth poses a significant challenge in low-resource settings.
• Previous estimates of stillbirth rates in Tanzania and Zambia may underestimate the true burden.

Purpose of the Study:

• To investigate the complexities of unexplained stillbirth in Tanzania and Zambia.
• To inform the development of culturally acceptable interventions for stillbirth care.

Main Methods:

• A mixed-methods study was conducted in tertiary, secondary, and primary care facilities in Zambia and Tanzania.
• Quantitative data included 1997 births, and qualitative data involved interviews with 48 women and 19 partners.
• Case record reviews of 2000 consecutive records were also performed.

Main Results:

• Stillbirth rates were 16% in Tanzania and 10% in Zambia, significantly higher than prior estimates.
• A history of stillbirth increased the risk (RR 1.86).
• In 28% of cases, the cause of stillbirth remained unexplained, hindering maternal grieving due to poor communication from healthcare professionals.

Conclusions:

• Stillbirth risk is substantially higher in the studied facilities than national data suggest.
• Women desire knowledge about the cause of stillbirth, necessitating further investigation.
• Enhanced training and support for healthcare professionals are vital for improving care and communication for bereaved families.