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Determinants of stillbirths in Sub Saharan Africa: a systematic review
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  • Ankita Mukherjee,
  • Lydia Di Stefano,
  • Hannah Blencowe,
  • Paul Mee
Ankita Mukherjee
London School of Hygiene & Tropical Medicine

Corresponding Author:[email protected]

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Lydia Di Stefano
Mercy Hospital for Women
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Hannah Blencowe
Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT
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Paul Mee
London School of Hygiene & Tropical Medicine
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Background: Sub-Saharan African (SSA) countries have high stillbirth rates compared to high-income countries, yet research on risk factors for stillbirth in SSA remain scant. Objectives: To identify the modifiable risk factors of stillbirths in SSA and investigate their strength of association using a systematic review. Search Strategy: EMBASE, MEDLINE, Global Health, and CINAHL Plus databases were searched for literature. Selection Criteria: Observational population- and facility-level studies exploring stillbirth risk factors, published between 2013-2019 were included. Data Collection and Analysis: Narrative synthesis of data was undertaken and the potential risk factors were classified into sub-groups. Main Results: Thirty-seven studies were included, encompassing 20,264 stillbirths. The risk factors were categorized as maternal antepartum (0-4 antenatal care visits, multiple gestations, hypertension, birth interval >3 years, history of perinatal death); socioeconomic factors (maternal lower wealth index and basic education, advanced maternal age, grand multiparity (≥5)); intrapartum (direct obstetric complication, non-vaginal delivery); fetal (low birthweight and gestational age <37weeks) and health systems (poor ANC quality, emergency referrals, ill-equipped facility). The proportion of unexplained stillbirths remained very high. No association was found between stillbirths and HIV, BMI, diabetes, and distance from the facility. Conclusion: The overall quality of evidence was low as many studies were facility-based and did not adjust for confounders. This review identified preventable risk factors for stillbirth. Focused programmatic strategies should be developed to improve antenatal care, emergency obstetric care, maternal perinatal education, referral and outreach systems, and birth attendant training. More population-based high-quality research is needed. Funding: Not externally funded
25 Oct 2022Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
07 Nov 2022Submission Checks Completed
07 Nov 2022Assigned to Editor
07 Nov 2022Review(s) Completed, Editorial Evaluation Pending
20 Nov 2022Reviewer(s) Assigned
20 Feb 2023Editorial Decision: Revise Major
07 Apr 20231st Revision Received
12 Apr 2023Submission Checks Completed
12 Apr 2023Assigned to Editor
12 Apr 2023Review(s) Completed, Editorial Evaluation Pending
13 May 2023Editorial Decision: Accept