Predictors of Stillbirth at Tema General Hospital: A Registry–Based Retrospective Study

Abstract Background: In 2015, the global incidence of stillbirths reached 2.6 million, equating to more than 7,178 deaths daily. The stillbirth rate in Ghana during this period was recorded at 22.7 per 1,000 births. While extensive research has been undertaken in high-income countries to document stillbirth rates and elucidate the associated risk factors, there is a notable paucity of similar studies in Ghana. This study therefore determined the predictors of stillbirth in a Ghanaian referral hospital. Methods: We conducted a facility-based 1:1 retrospective case-control study comparing data of women who had stillbirths to those who had live births at the Tema General Hospital in 2019. Data were obtained from the hospital records using a data extraction form that was specifically designed for this purpose. We extracted and entered data into Microsoft Excel 2013, cleaned, and analyzed using STATA 15. Frequency and percentage distributions were used to describe the characteristics of respondents. Bivariate and logistic regression analyses were carried out to examine predictors of stillbirth. Results: A total of 552 mothers were included in the study. The mean age of mothers with and without stillbirths was 31.4 (SD±6.1) years, and 28.8 (SD±6.0) years respectively. Mothers aged 40 years and older exhibited significantly higher odds of experiencing stillbirth (adjusted Odds Ratio [aOR] = 5.54; 95% Confidence Interval [CI] = 1.14-26.99; p = 0.034). Relative to individuals without formal education, the odds of stillbirth were lower among those with primary education (aOR = 0.40; 95% CI = 0.18-0.86; p = 0.019), and lowest among women with tertiary education (aOR = 0.22; 95% CI = 0.10-0.50; p < 0.001). Maternal employment was associated with a significantly increased likelihood of stillbirth compared to unemployment (adjusted Odds Ratio [aOR] = 2.55; 95% Confidence Interval [CI] = 1.23 - 5.28; p = 0.012). Conversely, mothers who attended four or more antenatal care (ANC) visits exhibited significantly lower odds of experiencing stillbirth compared to those with fewer visits (aOR = 0.57; 95% CI = 0.33 - 0.98; p = 0.043). Furthermore, delivery by Caesarean section was significantly associated with higher odds of stillbirth relative to vaginal delivery (aOR = 1.91; 95% CI = 1.26 - 2.89; p = 0.002). Hypertensive mothers had a significantly increased risk of stillbirth compared to those with normotensive blood pressure (aOR = 1.87; 95% CI = 1.24 - 2.82; p = 0.003). Finally, infants with low birth weight were significantly more likely to be stillborn compared to those with normal birth weight (aOR = 8.75; 95% CI = 5.21 - 14.71; p < 0.001). Conclusion: A combination of socio-demographic, maternal, and foetal variables predicted stillbirth at Tema General Hospital in 2019. Recommendations for improving birth outcomes at the hospital entail persistent community awareness initiatives targeting the impact of pivotal risk factors, timely stratification of pregnancies based on risk assessment, and the establishment of specialized Antenatal Care (ANC) services tailored for high-risk cohorts.