ORIGINAL

Niger J Paed 2014; 41 (2):125 –128

Alkali YS

Jalo I

El –Nafaty AU

Bode-Thomas F

Causes of stillbirth in a community

survey in Gombe State

DOI:http://dx.doi.org/10.4314/njp.v41i2,9

Accepted: 12th December 2013

Abstract: Background: Perinatal

Results: Five hundred and two

parturient mothers were recruited.

They delivered a total of 520

babies, amongst whom were

eighteen sets of twins; five

hundred of these were live births.

There were 20 still births, giving a

stillbirth rate of 38.5/1000. Causes

of stillbirth include unbooked and

early pregnanacies as well as

deliveries unattended to by trained

health personnel.

Conclusion: Lack of antenatal

Care, home delivery and teenage

pregnancy were important factors

contributing to high still birth rate

in Dukku LGA of Gombe State.

mortality rate is very high in North

Eastern Nigeria mainly due to a

large number of still births. The

causes and factors related need to

be identified so as to proffer

solutions with a view to improving

obstetric practice and perinatal

survival.

Objectives: To identify the causes

and factors related to stillbirths in

Dukku Local Government Area of

Gombe state.

Methodology: A prospective study

that was both hospital and

community based, in which

parturients were recruited in their

last trimester and followed up till

delivery. The fetal outcome was

(

⁾Jalo I

Alkali YS

Department of Paediatrics,

El –Nafaty AU

Department of Obstetrics and

Gynaecology,

Federal Medical Centre Gombe

P M B 0037 Gombe

Nigeria.

Email: ysalkali@yahoo.com

Tel: +2348024279967

Bode-Thomas F

Department of Paediatrics,

Jos University Teaching Hospital

Jos, Nigeria.

Key Words: Stillbirth, Perinatal,

Mortality,

recorded and

calculated.

still birth rate

Introduction

In North-eastern Nigeria, there are very fewer studies on

perinatal mortalty as₁₅c_,₁o₆mpared to other parts of the

,

Perinatal morbidity/mortality in the north-east region of

country in particular

and the rest of the world in

1

17, 18

Therefore this study was set out to identify

Nigeria is high . This is due to ineffective health care

general.

2

services resulting in many stillbirths. A stillbirth is a

the causes of stillbirths and also to determine the

differences in the causes and rates of stillbirths at the

community level and hospital based data in Dukku

Local Government Area of Gombe state.

product of conception delivered after 28 weeks of

gestation without any sign of life after separation from

3

the mother. Among the many causes of stillbirths in

developing countries are adverse environmental

conditions, poorly treated_-₇maternal complications and

4

harmful home practices. Most of the deliveries in

developing₈countries still take place without skilled

attendance. In fact, home deliveries attended to by

traditional birth attendants (₉TBAs) account for up to 60-

Subjects and Methods

Study Area: Dukku Local Government Area [LGA] is

located in the Savannah belt of North-eastern Nigeria,

8

0% of all deliveries. In these nations, low

0

socioeconomic background and lack of organized

between latitudes 10 49’N a₁n₉ d 10 46’E, with a land

antenatal and perinatal healthcare system₀ s contribute to

area of 181,600 hectares. It has an estimated

1

the poor utilisation of health facilities. Women living

population of 207,658 as at March 2006, with 33%

(68527) m_O ade of women of childbearing age (15–

in the rural areas in developing countries have less

educational opportunities, uncontrolled fertility and too

frequent pregnancies too early or too₁ late in life,

2

49years). The LGA is divided into six health districts,

namely: Du₂k₁ku, Gombe-Abba, Hashidu, Jamari, Malala

and Zange. Many of the communities have little or

no access to maternal and child health care services

because of poor road network.

The main occupations of the people are subsistence

farming and trading; majority of the inhabitants are

Muslims of Hausa/Fulani descent, while the minority are

Bolewa, Tera and Kanuri. There is an uneven

1

resulting in high perinatal mortality rate. Mothers and

infants in such countries are still caught in the cycle of

illiteracy, poverty, malnutrition, infection and ill health,

making the₂m very vulnerable to morbidities and

1

mortalities. This means that maternal and child health

strategies are either not accepted in affected cou₁₃n_,₁t₄ries or

not yet available to those who need them most.

1

26

distribution of the health facilities; each health district

has only one maternity unit which is part of a Primary

Health Centre (PHC) headed by a Nurse/Midwife, three

to four Community Health Extension Workers

Results

Five hundred and two parturients were recruited; they

delivered 520 babies, amongst whom were 18 sets of

twins. One hundred and eighty five (37.0%) deliveries

took place in health facilities and 317 (63%) took place

either in family homes or Traditional Birth Attendants`

place. Five hundred of these deliveries were live births;

there were 20 still births, giving a stillbirth rate of

38.5/1000. There was no delivery in a Church, Mosque

or en route the hospital. Table 1 shows the demographic

profiles of the parturients.

(

CHEWs) and five to six unskilled workers serving as

support staff.

Study Procedure: This was a prospective study carried

out between January and September 2005. It was both

hospital- and community-based. Two of the six Health

Districts in Dukku LGA, namely Dukku and Hashidu,

were selected by random sampling. The nature of the

study was explained in the local dialect weekly, to all

pregnant women attending the antenatal clinics as well

as those who went to Traditional Birth Attendants`

homes. All the women needed to obtain permission from

their spouses before giving their consent which was

indicated by appending their signatures/thumbprints on

the proforma. The General Hospital, the Primary Health

Centre and the Town Maternity in Dukku district as well

as the Comprehensive Health Centre in Hashidu and the

traditional birthing places (run by TBAs who were regis-

tered with the PHC Department of the LGA) were used

as recruitment and study centres.

Table 1: Socio-demographic profiles of the 502 parturients

Variable

Age group (years)

Number of Parturients (%)

<

2

>

20

0-35

35

68 (14.0)

400 (80.0)

34 (6.0)

Parity

Nulliparous

Para 1-4

Para 5 and above

Socioeconomic Status

Upper

Middle

Lower

Place of Delivery

Hospital

Home

108 (22.0)

241 (48.0)

153 (30.0)

32 (6.0)

70 (14.0)

400 (80.0)

All booked pregnant women who lived in the selected

districts, who were in their last trimester and gave their

consent, as well as those who were not booked but gave

their consent within 24 hours of delivery were recruited

for the study. The socio-economic status of the study

participants was₂ determined using the classification by

185 (37.0)

200 (40.0)

117 (23.0)

TBA

2

Olusanya et al . Biodata were obtained and recorded,

measurements were also taken of maternal height,

weight, blood pressure and fundal height. Gestational

age estimation was largely based on uterine size and

lunar calendar at the first hospital visit. The mothers`

blood was analyzed for haemoglobin concentration and

Table 2 shows that the stillbirth rate among teenagers

and those 35 years and above was significantly higher

than for the age group of 20-35 years (p = 0.0001). Also,

booked mothers were significantly less likely to have

stillbirths than non-booked ones (p = 0.007), while those

who had a history of previous stillbirths and those with

prolonged labour were respectively more likely to have

stillbirths than their counterparts (p = 0.003 in each

case). Six hospital deliveries resulted in stillbirths

compared to 14 deliveries which occurred outside

orthodox facilities. This difference was not statistically

®

urinalysis carried out_r_dusing Multistiks . Those women

enrolled in their 3 trimester of pregnancy were

followed up fortnightly and similar procedures repeated

until delivery. Those who booked elsewhere or who

were not booked but delivered within the two health

districts were also enrolled within 24 hours of delivery if

they consented to participate in the study.

2

significant (3.2% versus 4.4%, χ = 0.042, p > 0.5).

All stillbirths were examined within twenty four hours

of delivery by the principal researcher. A note was made

of whether the stillbirth was fresh or macerated; the

presence or absence of dysmorphic features and gross

malformations was also recorded on the proforma.

However most stillbirths were buried almost

immediately and relevant information could only be

obtained from the nurse/midwife or the TBAs. This

information was subsequently recorded on the proforma

too.

The relationship between maternal parity and stillbirth is

represented graphically in Fig 1. It can be seen that there

is an inverse relationship between parity and number of

stillbirths; the lower the parity, the higher the still birth

rate.

Fig 1:

Stillbirt/Maternal Parity

relationship

between

maternal

parity and

stillbirths

7

6

5

4

3

2

1

0

Data entry and analysis

Series1

®

Data was recorded on SPSS Version 15 spreadsheet and

analysed using Epi-info 2002. Chi-square test was used

and statistical significance was set at a p-value of <0.05.

A multivariate analysis was carried out to eliminate

confounding factors.

1

2

3

4

5

6

7

Maternal Parity

1

27

Table 2: Obstetric factors associated with stillbirths

urban settings with more health personnel available,

who did not consider the other birthing places. The

result of this study is also much higher than the WHO

Still Births

Live Births

no (%)

Total

no (%)

Factors

no (%)

estimated average for Sub-Saharan Africa, which is

Age (yrs)

1

3

0/1000, and about ten times₁h₇i_,₁g₈her than what is

<

20 or >35

14 (14.0)

6 (1.5)

88 (86.0)

394 (98.5)

102 (100.0)

400 (100.0)

reported for the developed nations.

This may be due

2

0 to 35

X2

to differences in settings and environments even in

Africa with more awareness and available facilities in

developed nations. Such facilities need to be developed

and/or imroved generally in the area of this study. The

association between teenage pregnancy and high

stillbirthrate as seen in this study may be due to too

early marriages as well as unavailability of family

planning facilities until when the parturients are

physicaly matured for parturition. Lack of antenatal care

may be an indication of lack of facilities and awareness

of the importance of that. These may all result in high

stillbirth rates with a negative impact on the affected

women as well as their families and the community in

general. There is therefore a need to improve both the

availability and awareness of maternal and child health

facilities in the communities so that members can avail

themselves of these services.

=

31.69, RR = 9.15, p-value = 0.0001

Booking Status

Unbooked

B_X₂ooked

16 (6.0)

4 (1.6)

7.20, RR = 3.91, p-value = 0.007

238 (94.0)

244 (98.4)

254 (100.0)

248 (100.0)

=

History of past stillbirths

No

Y_X₂es

=

6 (12.0)

14 (3.0)

8.98, RR = 3.79, p-value = 0.003

45 (88.0)

437 (97.0)

51 (100.0)

451 (100.0)

Labour duration

Prolonged

10 (8.5)

10 (3.0)

107 (91.5)

375 (97.0)

117 (100.0)

385 (100.0)

N_X₂ormal

=

8.30, RR = 3.79, p-value = 0.003

Discussion

The stillbirth Rate in Dukku LGA₄_,₁w₇_,₁a₈s 38.5/1000 births;

this is higher than other studies, which are strictly

hospital based. The findigs are however simila₆_,r₇_. to

Conclusion

hospital based reports from other parts of Nigeria as

1

1,13

well as from outside Nigeria . These similarities may

be attributed to similar socio-economic conditions and

the fact that those studies outside Nigeria were

community based. Maternal factors significantly

associated with still birth in this study are teenage

pregnancy, lack of ante-natal care, prolonged labour and

history of previous stillbirths. Fetal factors associated

with stillbirth included low birth weight and multiple

fetuses. ₁₅_,T₁₆his also agrees₁₄ with other reports in

Adolescent pregnancy and parturition was very common

in the study area. This is associated with lack of

antenatal care and prolonged labour which may explain

the high stillbirth rate. Hospital based studies report a

lower rate of perinatal mortality than community based

studies of this type.

Conflict of interest: None

Funding: None

Nigeria,

and Tanzania. However the Nigerian

studies were all carried out in tertiary health centres in

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