Predictors of perinatal mortality in the seven major hospitals of Lusaka Zambia: A case control study

In 2023, approximately 2.3 million babies globally were lost before birth or within the first week of life, primarily due to preventable causes. Global perinatal mortality declined from 5.7 million in 2000 to 4.1 million by the end of 2015. However, despite this progress, for example 45% of all stillbirths were reported from high-income countries, which contribute less than 2% of the global burden of stillbirths. Perinatal mortality rates for sub-Saharan Africa and Zambia are at 37.4 and 33/1000 live births, respectively. The aim of this study was to determine the predictors of perinatal mortality at the seven major hospitals of Lusaka, Zambia.

This was a multifacility unmatched case control study from September 2023 to January 2024. Cases included perinatal death (≥22 weeks gestation or ≥500g stillborn and death of neonate within seven days of life) and controls were live births. Stepwise multivariate logistic regression analysis with Stata version 14 determined predictors using adjusted odd ratios and p-values.

This study included 630 participants, with 210 cases and 420 controls, analysed in a 1:2 ratio. Antenatal care booking after 12 weeks gestation had almost three times odds of experiencing perinatal mortality (AOR 2.91, 95% CI: 1.97-4.29), p < 0.001) compared to early booking (<12 weeks). Walking as a means of reaching the healthcare facility had over three times the odds of perinatal mortality (AOR3.48, 95% CI: 1.87-6.49, p < 0.012) compared to using personal transport. Anaemia in pregnancy carried a three-and-a-half-fold increased the risk of perinatal death (AOR 3.58, 95% CI: 1.72-7.44, p < 0.001) compared to mothers without anaemia. History of previous pregnancy loss was associated with a five-fold increased risk of perinatal death (AOR 5.05, 95% CI: 2.99-8.51, p < 0.001) compared to those without such a history.

This study revealed that late antenatal care booking, walking as means of transport to access health facility, anaemia in pregnancy, and previous history of loss of baby before birth perinatal death were the main predictors with statistical significance of perinatal death experience. The study findings highlight the need for policies that promote early antenatal care, prevent anaemia in pregnancy, improve transport access to hospitals, and further research into context-specific barriers and effective interventions.