Stillbirth in Nigeria: Rates and Risk Factors Based on 2013 Nigeria DHS

Abstract

Introduction: Stillbirth remains a public health problem with an estimate of 2.6 million stillbirths in 2015 of which 98% occurred in low- and middle-income countries and over three-quarters of these occurring in Sub-Saharan Africa (SSA) and south Asia. Further, only ten countries carry the burden of over 65% of total stillbirths in the world including Nigeria in the second position. The objective of this analysis is to estimate stillbirth rates and identify the determinants of stillbirth in Nigeria using the 2013 Nigeria DHS data. Methods: The study utilized the nationally-representative sample of women of reproductive age interviewed during the 2013 Nigeria DHS. Analysis was restricted to 31,671 women aged 15-49 years who had a pregnancy reaching at least seven months of gestation in the five-year period prior to the survey. Descriptive statistics and regression analysis were performed using Stata v13 to determine significant factors related to stillbirth. Incidence Risk Ratio (IRR) was used to assess strength of association between independent and dependent variables. Results: Overall stillbirth rate is 12.5 per 1000 pregnancies, with rates as high as 22 per 1000 (among women aged 15-19 years) and as low as 6.4 per 1000 (among women who received skilled ANC). Age, household wealth, higher birth order, facility delivery, Caesarean delivery, rural residence and ever use of contraceptive are consistent determinants of stillbirth in both the bivariate and multivariate models. Women in rich households have lower IRR of stillbirth (0.60; 95% CI: 0.45-0.59) as well as women who had ever used modern contraception (IRR = 0.72; 95% CI: 0.63-0.81). However, health facility deliveries as well as deliveries through a C-section, rural residence and age older than 20 years all carry increased risk of stillbirth (IRR = 1.81; 95% CI: 1.05-1.33), (IRR = 2.46; 95% CI: 2.03-2.98), (IRR = 1.41; 95% CI: 1.24-1.59), and (IRR = 2.23; 95% CI: 1.75-2.59) respectively. Conclusions: The study revealed that there are several factors responsible for stillbirth in Nigeria. Age, household wealth, higher birth order, facility delivery, Caesarean delivery, rural residence and ever use of contraceptive are consistent determinants of stillbirth in both the bivariate and multivariate models. There is urgent need by the National government to improve quality of maternal health care services and interventions to improve utilization and quality of prenatal care.