Spatiotemporal Trend and Hotspot Analysis of Stillbirth Prevalence in Ghana

Stillbirth, although a preventable health outcome, remains a silent contributor to global mortality. Stillbirths have also been deemed to be one of the most significant, albeit least known and reported adverse pregnancy consequences. The regional variations of stillbirth and its risk factors at the district level have not been well studied in Ghana. This study examined the spatiotemporal distribution, hotspots, and determinants of stillbirth in Ghana over 5 years (2017 - 2021).

This study is an ecological, observational analysis using district-level aggregated stillbirth data from 2017 to 2021. The main analyses used trend analysis, Moran's I, Gi*, and OLS regression. Global Moran's Index was used to determine spatial autocorrelation. Getis Ord G* was used to determine spatial hotspots, clusters and outliers. An Ordinary Least Squares analysis was performed to determine the association between the stillbirth rate and other risk factors.

The findings showed that the highest stillbirth rates throughout the 5 years were observed in districts in the Greater Accra region (Tema with SBR between 30.0 and 34.5) and Volta region (Akatsi North (SBR = 45.2)). There were persistent hotspot districts throughout the 5 years. These occurred in the Northern and Greater Accra regions. The regression analysis revealed that age of mothers, number of health facilities in the district, and number of beds per facility in the district are significant risk factors for stillbirth in Ghana.

The findings of this study reveal a persistently high stillbirth burden across several districts in Ghana over the 5-year period, with districts such as Tema, Akatsi North, and La-Dade-Kotopon consistently recording the highest stillbirth rates. These high-burden districts require urgent and targeted quality improvement initiatives, including strengthening emergency obstetric care, improving skilled birth attendance, and enhancing antenatal care coverage.