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Risk factors for stillbirths: how much can a responsive health system prevent?

BACKGROUND: The stillbirth rate is an indicator of quality of care during pregnancy and delivery. Good quality care is supported by a functional heath system. The objective of this study was to explore the risk factors for stillbirths, particularly those related to a health system. METHODS: This cas...

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Autores principales: Neogi, Sutapa Bandyopadhyay, Sharma, Jyoti, Negandhi, Preeti, Chauhan, Monika, Reddy, Siddharth, Sethy, Ghanashyam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774063/
https://www.ncbi.nlm.nih.gov/pubmed/29347930
http://dx.doi.org/10.1186/s12884-018-1660-1
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author Neogi, Sutapa Bandyopadhyay
Sharma, Jyoti
Negandhi, Preeti
Chauhan, Monika
Reddy, Siddharth
Sethy, Ghanashyam
author_facet Neogi, Sutapa Bandyopadhyay
Sharma, Jyoti
Negandhi, Preeti
Chauhan, Monika
Reddy, Siddharth
Sethy, Ghanashyam
author_sort Neogi, Sutapa Bandyopadhyay
collection PubMed
description BACKGROUND: The stillbirth rate is an indicator of quality of care during pregnancy and delivery. Good quality care is supported by a functional heath system. The objective of this study was to explore the risk factors for stillbirths, particularly those related to a health system. METHODS: This case-control study was conducted in two districts of Bihar, India. Information on cases (stillbirths) were obtained from facilities as reported by Health Management Information System; controls were consecutive live births from the same population as cases. Data were collected from 400 cases and 800 controls. The risk factors were compared using a hierarchical approach and expressed as odds ratio, attributable fractions and population attributable fractions. RESULTS: Of all the factors studied, 22 risk factors were independently associated with stillbirths. Health system-related factors were: administration of two or more doses of oxytocics to augment labour before reaching the facilities (OR 1.6; 95% CI 1.2–2.1), any complications during labour (OR 2.3;1.7–3.1), >30 min to reach a facility from home (OR 1.4;1.05–1.8), >10 min to attend to the pregnant woman after reaching the facility (OR 2.8;1.7–4.5). In the final regression model, modifiable health system-related risk factors included: >10 min taken to attend to women after they reach the facilities (AOR 3.6; 95% CI 2.5–5.1), untreated hypertension during pregnancy (AOR 2.9; 95% CI 1.5–5.6) and presence of any complication during labour, warranting treatment (AOR 1.7; 95% CI 1.2–2.4). Among mothers who reported complications during labour, time taken to reach the facility was significantly different between stillbirths and live births (2nd delay; 33.5 min v/s 25 min; p < 0.001). Attributable fraction for any complication during labour was 0.56 (95% CI 0.42–0.67), >30 min to reach the facility 0.48 (95% CI 0.31–0.60) and institution of management 10 min after reaching the facility 0.68 (95% CI 0.58–0.75). Reaching a facility within 30 min, initiation of management within 10 min of reaching the facility and timely management of complications during labour could have prevented 17%, 37% and 20% of stillbirths respectively. CONCLUSION: A pro-active health system with accessible, timely and quality obstetric services can prevent a considerable proportion of stillbirths in low and middle income countries. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12884-018-1660-1) contains supplementary material, which is available to authorized users.
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spelling pubmed-57740632018-01-26 Risk factors for stillbirths: how much can a responsive health system prevent? Neogi, Sutapa Bandyopadhyay Sharma, Jyoti Negandhi, Preeti Chauhan, Monika Reddy, Siddharth Sethy, Ghanashyam BMC Pregnancy Childbirth Research Article BACKGROUND: The stillbirth rate is an indicator of quality of care during pregnancy and delivery. Good quality care is supported by a functional heath system. The objective of this study was to explore the risk factors for stillbirths, particularly those related to a health system. METHODS: This case-control study was conducted in two districts of Bihar, India. Information on cases (stillbirths) were obtained from facilities as reported by Health Management Information System; controls were consecutive live births from the same population as cases. Data were collected from 400 cases and 800 controls. The risk factors were compared using a hierarchical approach and expressed as odds ratio, attributable fractions and population attributable fractions. RESULTS: Of all the factors studied, 22 risk factors were independently associated with stillbirths. Health system-related factors were: administration of two or more doses of oxytocics to augment labour before reaching the facilities (OR 1.6; 95% CI 1.2–2.1), any complications during labour (OR 2.3;1.7–3.1), >30 min to reach a facility from home (OR 1.4;1.05–1.8), >10 min to attend to the pregnant woman after reaching the facility (OR 2.8;1.7–4.5). In the final regression model, modifiable health system-related risk factors included: >10 min taken to attend to women after they reach the facilities (AOR 3.6; 95% CI 2.5–5.1), untreated hypertension during pregnancy (AOR 2.9; 95% CI 1.5–5.6) and presence of any complication during labour, warranting treatment (AOR 1.7; 95% CI 1.2–2.4). Among mothers who reported complications during labour, time taken to reach the facility was significantly different between stillbirths and live births (2nd delay; 33.5 min v/s 25 min; p < 0.001). Attributable fraction for any complication during labour was 0.56 (95% CI 0.42–0.67), >30 min to reach the facility 0.48 (95% CI 0.31–0.60) and institution of management 10 min after reaching the facility 0.68 (95% CI 0.58–0.75). Reaching a facility within 30 min, initiation of management within 10 min of reaching the facility and timely management of complications during labour could have prevented 17%, 37% and 20% of stillbirths respectively. CONCLUSION: A pro-active health system with accessible, timely and quality obstetric services can prevent a considerable proportion of stillbirths in low and middle income countries. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12884-018-1660-1) contains supplementary material, which is available to authorized users. BioMed Central 2018-01-18 /pmc/articles/PMC5774063/ /pubmed/29347930 http://dx.doi.org/10.1186/s12884-018-1660-1 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Neogi, Sutapa Bandyopadhyay
Sharma, Jyoti
Negandhi, Preeti
Chauhan, Monika
Reddy, Siddharth
Sethy, Ghanashyam
Risk factors for stillbirths: how much can a responsive health system prevent?
title Risk factors for stillbirths: how much can a responsive health system prevent?
title_full Risk factors for stillbirths: how much can a responsive health system prevent?
title_fullStr Risk factors for stillbirths: how much can a responsive health system prevent?
title_full_unstemmed Risk factors for stillbirths: how much can a responsive health system prevent?
title_short Risk factors for stillbirths: how much can a responsive health system prevent?
title_sort risk factors for stillbirths: how much can a responsive health system prevent?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774063/
https://www.ncbi.nlm.nih.gov/pubmed/29347930
http://dx.doi.org/10.1186/s12884-018-1660-1
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