The University of Dodoma University of Dodoma Institutional Repository http://repository.udom.ac.tz Health Sciences Master Dissertations 2020 Predictors of stillbirths among post- delivery mothers in Pwani region. Simtowe, Predicanda Mzurikwao The University of Dodoma Simtowe, P. M. (2020). Predictors of stillbirths among post- delivery mothers in Pwani region (Master dissertation). The University of Dodoma, Dodoma. http://hdl.handle.net/20.500.12661/2844 Downloaded from UDOM Institutional Repository at The University of Dodoma, an open access institutional repository. PREDICTORS OF STILLBIRTHS AMONG POST- DELIVERY MOTHERS IN PWANI REGION PREDICANDA MZURIKWAO SIMTOWE MASTER OF SCIENCE IN MIDWIFERY THE UNIVERSITY OF DODOMA COLLEGE OF HEALTH DECEMBER, 2020 PREDICTORS OF STILLBIRTHS AMONG POST-DELIVERY MOTHERS IN PWANI REGION BY PREDICANDA MZURIKWAO SIMTOWE A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS OF THE DEGREE OF MASTERS OF SCIENCE IN MIDWIFERY THE UNIVERSITY OF DODOMA COLLEGE OF HEALTH DECEMBER, 2020 DECLARATION AND COPY RIGHT I, Predicanda Mzurikwao Simtowe, declare that this dissertation is my original work and that it has not been presented and will not be presented elsewhere in a similar way for either award or as a research project. No part of this dissertation may be reproduced, stored in any retrieval system, or transmitted in any form or by any means without prior written permission of the author or the University of Dodoma. If transformed for publication in any other format shall be acknowledged that, “this work has been submitted for degree award at the University of Dodoma”. i CERTIFICATION The undersigned certify that they have read and hereby recommend for acceptance by the University of Dodoma thesis/dissertation entitled “Predictors of stillbirths among post-delivery mothers in Pwani Region” in fulfillments of the requirements for the Degree of Masters of Science in Midwifery of the University of Dodoma. Dr Secilia K. Ng‟weshemi (Supervisor) ii ACKNOWLEDGMENTS First I would like to thank God the Almighty, for giving me this opportunity and strength, which enabled me to complete this study. I am very grateful to my supervisors Dr. Secilia K. Ng‟weshemi for her exceptional support, constructive comments and guidance, from the beginning to the end of this dissertation. I would also sincerely express my deepest gratitude to my adored lovely husband Mr. Edwin Steven Alfred Nguma for his support, as well as the Regional Administrative Secretary Pwani for granting me a permission to collect data. Again, I would like to thank my family, Mzurikwao‟s family especially my mum Annastazia Mzurikwao and my sister Leticia as well as my children Nazareth, Maureen, and Paularose who missed my care while undertaking this study. I would like to acknowledge and thank the Tanzania Ministry of Health for sponsoring the entire study and all research assistants and other staff, for their support during data collection and entry. Last but not least, I would like to thank all those who have responded to my questionnaires. However, it should be noted that, any shortcomings on this research are entirely belong to me. iii DEDICATION Dedicated to the compassionate souls of the silent babies at birth iv ABSTRACT Background: Stillbirth is a silent traumatic canker that is a major concern of various individuals, health institutions, and the country as a whole. All over the world researchers are fighting tooth and nail to unravel the mystery surrounding the high prevalence of stillbirths. This study was carried out in Pwani region with the aim of finding the predictors associated with stillbirth among post-delivery mothers. Methods: A matched case-control study with a ratio of 1:2, conducted in Pwani region from May to early of August 2020 of which 65 post-delivery mothers faced stillbirths (Cases), and 130 postdelivery mothers with live borns (Controls) were enrolled. Interviewer-administered questionnaires and documentary reviews were used for data collection. Data were analyzed by using SPSS version 20. Results: All post-delivery mothers were enrolled, including 65 post-delivery mothers with stillbirths, and 130 post-delivery mothers with live borns, during the study. Post-delivery with high parity above 4 para, and women with less access to antenatal care were at increased risk of stillbirth. Mothers who were anaemic during admission to labour ward were more likely to have stillbirth compared to those who were not anaemic (AOR=4.690, p value=0.000). Furthermore, post-delivery mothers, who had not received a dose of sulfadoxine pyrimethamine, malaria in pregnancy, folic acid intake were more likely to have stillbirths, compared to live births, stillbirths were more likely to be preterm (AOR=4.024 95%, p value= 0.001), and post-delivery mothers taken local herbs during pregnancy as association with stillbirths (AOR=4.738, p value=0.000). Fetal presentation none other than cephalic was associated with stillbirth (AOR=12.591, p value= 0.000), birth weight <2.5kgand >4kg, and cord around the neck (AOR=15.326, p value=0.000). In addition, Obstetric factors associated with stillbirths were observed as post- delivery mothers who were referred from another facility (AOR=17.716, p value=0.000), history of cord prolapse was relatively more likely to be associated with stillbirths (AOR=13.656, p value=0.001). Furthermore, post-delivery mothers with a history of early rupture of membrane (before labour) more likely to be associated with stillbirth compared with rupture of the membrane during labour (AOR=29.819, p value=0.000). v Conclusion: Based on the results of the study, Stillbirth rate is still existing in Pwani Region hence is a major concern, appeared to be mostly associated with maternal factors, fetal factors, and obstetric factors. Recommendation; Improve uptake of ANC among pregnant mothers and reproductive age, empowering girls to prevent teenage pregnancy as stated by Sustainable development goal 5,improve health care provision and Hospital readiness for pregnancy emergencies. Key words: Stillbirth, Predictors, Pwani, Post delivery mother, Tanzania vi TABLE OF CONTENTS DECLARATION AND COPY RIGHT ........................................................................ i CERTIFICATION ....................................................................................................... ii ACKNOWLEDGMENTS .......................................................................................... iii DEDICATION ............................................................................................................ iv ABSTRACT ................................................................................................................. v TABLE OF CONTENTS ........................................................................................... vii LIST OF TABLES ....................................................................................................... x LIST OF FIGURES .................................................................................................... xi LIST OF APPENDEX ............................................................................................... xii LIST OF ABBREVIATIONS AND ACRONYMS .................................................. xiii OPERATIONAL DEFINITIONS .............................................................................. xv CHAPTER ONE ........................................................................................................ 1 1.0 INTRODUCTION ................................................................................................ 1 1.1 Background information ....................................................................................... 1 1.2 Statement of the problem ..................................................................................... 4 1.3 Study Objectives ................................................................................................... 5 1.3.1 Broad Objectives ................................................................................................ 5 1.3.2 Specific Objectives ............................................................................................. 5 1.4 Study Questions .................................................................................................... 5 1.5 Significance Of the Study .................................................................................... 5 CHAPTER TWO ....................................................................................................... 7 2.0 LITERATURE REVIEW .................................................................................... 7 2.1 Overview of the chapter ......................................................................................... 7 2.2 Theoretical Literature Review................................................................................ 7 2.2.1 Triple Risk Model ............................................................................................... 7 2.2.2 Conceptual Model for Causal Pathways to Stillbirths ........................................ 9 2.3 Empirical Review ................................................................................................... 9 2.3.1 Socio-demographic characteristics associated with stillbirths .......................... 10 2.3.2 Maternal Factors................................................................................................ 10 2.3.3 Fetal Factors .....................................................................................................