Term stillbirths in Eastern Uganda: a community-based prospective cohort study

Area of Science:

• Obstetrics and Gynecology
• Global Health
• Epidemiology

Background:

• Stillbirths represent a significant global health challenge, with 1.9 million cases annually worldwide.
• Sub-Saharan Africa (SSA) and Southeast Asia bear a disproportionate burden, accounting for 1.5 million stillbirths each year.

Purpose of the Study:

• To determine the incidence and risk factors of term stillbirths in Eastern Uganda.
• To describe the underlying causes of term stillbirths in this region.

Main Methods:

• A cohort study involving pregnant women at 34 weeks of gestation or more, followed through delivery between January 2021 and January 2024.
• Community-based enrollment and follow-up by trained midwives using structured questionnaires to collect data on maternal health, pregnancy, and birth outcomes.
• Analysis of data from 5496 participants for incidence and 5296 for risk factors of term stillbirth.

Main Results:

• The incidence of term stillbirth in Eastern Uganda was 18.4 per 1000 births.
• Prolonged or obstructed labor (31.7%) and malaria (19.8%) were the most common causes of stillbirth.
• Risk factors identified include caesarean birth (aRR 3.3), intimate partner violence (aRR 1.8), and maternal age over 35 years (aRR 2.2).

Conclusions:

• Eastern Uganda experiences a high rate of term stillbirths, with over half occurring during labor.
• Urgent interventions are required to enhance the quality of intrapartum care.
• Preventing intimate partner violence is essential to mitigate stillbirth risk in the region.