The factors associated with stillbirths among sub-saharan African deliveries: a systematic review and meta-analysis

Abstract

Background: Globally, more than 2.6 million stillbirths occur each year. The vast majority (98%) of stillbirths occur in low- and middle-income countries, and over fifty percent (55%) of these happen in rural sub-Saharan Africa.

Methods: This is a systematic review and meta-analysis developed using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. A literature search was performed using PubMed, the Cochrane Library, Google Scholar, EMBASE, Scopus, the Web of Sciences, and gray literature. Rayyan`s software was used for literature screening. A random effects meta-analysis was conducted with STATA version 17. Heterogeneity was checked by using Cochran's Q and I2 tests. Funnel plots and Egger's test were used to examine the risk of publication bias. The protocol of the study was registered in PROSPERO with a registration number of CRD42023391874.

Results: Forty-one studies gathered from eight sub-Saharan countries with a total of 192,916 sample sizes were included. Nine variables were highly linked with stillbirth. These include advanced maternal age (aOR: 1.43, 95% CI: 1.16, 1.70), high educational attainment (aOR: 0.55, 95% CI: 0.47, 0.63), antenatal care (aOR: 0.45, 95% CI: 0.35, 0.55), antepartum hemorrhage (aOR: 2.70, 95% CI: 1.91, 3.50), low birth weight (aOR: 1.72, 95% CI: 1.56-1.87), admission by referral (aOR: 1.55, 95% CI: 1.41, 1.68), history of stillbirth (aOR: 2.43, 95% CI: 1.84, 3.03), anemia (aOR: 2.62, 95% CI: 1.93, 3.31), and hypertension (aOR: 2.22, 95% CI: 1.70, 2.75).

Conclusion: A significant association was found between stillbirth and maternal age, educational status, antenatal care, antepartum hemorrhage, birth weight, mode of arrival, history of previous stillbirth, anemia, and hypertension. Integrating maternal health and obstetric factors will help identify the risk factors as early as possible and provide early interventions.

Keywords: Fetal death; Intrauterine death; Intrauterine fetal death; Prenatal death.

Fig. 1

Framework of the factors associated with stillbirth, SSA, November 2022 to May 2023

Fig. 2

Flow chart describing the selection of studies on factors linked with stillbirth, SSA, 2012–2022

Fig. 3

Subgroup analysis of the association between sociodemographic characteristics and stillbirth, SSA, 2012–2022: a maternal age, > 34/20–34 years, (b) mothers’ educational level

Fig. 4

Forest plot for the association between sociodemographic characteristics and stillbirth, SSA, 2012–2022: a maternal age (< 20 years/20–34 years), (b) maternal age (> 34 years/20–34 years), (c) mothers’ educational level

Fig. 5

Funnel plot to assess the publication bias of the included sub-Saharan studies on factors associated with stillbirths, 2012–2022: a maternal age (< 20/20–34 years), (b) maternal age (> 34/20–34 years), (c) mothers’ educational level, (d) ANC, (e) APH, (f) birth weight, (g) mode of arrival, (h) history of previous stillbirth(s), (i) anemia, (j) hypertension

Fig. 6

Forest plot for the association between pregnancy-related characteristics and stillbirth, SSA, 2012–2022: a ANC, (b) APH, (c) birth weight, (d) mode of arrival, (e) history of previous stillbirth

Fig. 7

Forest plot for the association between maternal health-related characteristics and stillbirth, SSA, 2012–2022: a anemia and (b) hypertension