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In Ethiopia, the reduction in perinatal mortality rates is still falling short of national and global targets set for 2030. Additionally, accurate recording is challenging, as many births occur at home. This study aimed to assess the trends and determinants of perinatal mortality using population-based longitudinal data from 2009 to 2016 across three Health and Demographic Surveillance Systems (HDSS) in Ethiopia: Gelgel-Gibe, Dabat, and Kilite-Awlaelo. Data on vital events and pregnancies were continuously collected at these HDSS sites. The study utilized follow-up data from prospective linked pregnancy and birth cohorts from January 2009 to December 31, 2016. Perinatal mortality was defined as deaths occurring from 28 weeks of gestation until six days after birth, measured per 1000 live births. Relevant health, demographic, and socioeconomic data were included in the analysis. Poisson regression was employed to assess factors associated with perinatal mortality. Out of 38,691 pregnancies that led to births, there were 1214 perinatal deaths (456 stillbirths and 758 early neonatal deaths), resulting in a perinatal mortality rate of 31 deaths per 1000 total births. The early neonatal death rate was higher, at 19.6 deaths per 1000 total births, compared to the stillbirth rate of 11.8 per 1000 total births. The perinatal mortality rate declined from 40.6 in 2009 to 29.1 per 1000 total births in 2016, reflecting an average annual rate reduction of 2.4%. Determinants of perinatal mortality included being a male newborn, multiple births, first-time pregnancies (primi-gravidity), lack of antenatal care visits, absence of delivery services, and residing in tropical zones. The primary causes of death were asphyxia, sepsis, and preterm birth. Overall, perinatal mortality rates were high in the three HDSS sites, with slow reductions over time and significant variations between them. Addressing the issue of stillbirths and improving the availability and quality of emergency obstetric care are crucial. Continuous home visits in rural communities to prevent stillbirths and newborn deaths, are also essential.

Background Perinatal mortality remains a problem in Ethiopia. Findings of primary studies varied on level of perinatal mortality and its predictors including inter-pregnancy interval. The aim of this review was to estimate the pooled perinatal mortality rate, its trend overtime and verify the association with inter-pregnancy interval in Ethiopian context. Methods Studies were accessed through the electronic web-based search strategies from PubMed, ScienceDirect, Hinari for health via Research4Life, Google and Advanced Google search, and retrieving via relevant references using a combination of medical subject headings (MeSH terms) and key words related with inter-pregnancy interval. R version 3.4.3 software was used for the meta-analysis. A forest plot and I 2 test were done to assess heterogeneity. Sensitivity analysis and subgroup analysis were done to deal with heterogeneity. A weighted inverse variance random-effects model was applied to estimate pooled effect sizes. A funnel plot and Egger’s regression test were done to check publication bias. Results A total of 34 studies used to answer review questions (30 for perinatal mortality rate and its trend estimation from 1997 to 2019 and 8 for its relationship with inter-pregnancy interval). The pooled perinatal mortality rate was 51.3 per 1000 total births (95% CI: 40.8–62.8). The pooled stillbirth rate was 36.9 per 1000 births (95% CI: 27.3–47.8) and early neonatal mortality rate was 29.5 per 1000 live births (95% CI: 23.9–35.6). Increasing trend was seen in stillbirth rate (23.7 to 36.9 per 1000 births) while decreasing trend in early neonatal mortality rate (51 to 29.5 per 1000 live births). Slight reduction trend was observed in overall perinatal mortality rate (66 to 51.3 per 1000 births). An inter-pregnancy interval less than 15 months was found to be statistically significantly associated with perinatal mortality; pooled OR = 2.76 (95% CI: 2.1–3.62). Spacing pregnancy for at least 15 months was related with reducing perinatal mortality by 64% (95% CI: 52.38, 72.38%). Conclusions In Ethiopia, perinatal mortality rate remains high. Insignificant reduction trend was observed in overall perinatal mortality rate. Counseling couples about the importance of spacing pregnancy and intensifying long-acting contraceptive use will help in reducing perinatal mortality related to poor pregnancy spacing.

Introduction Perinatal mortality is a critical barometer of maternal and newborn health. In fragile states like Somalia, which grapple with prolonged conflict and systemic healthcare challenges, this indicator is particularly stark. Despite global progress, contemporary, localized data from this region remain scarce, hindering targeted public health initiatives. This study aimed to quantify the perinatal mortality rate (PMR) and identify key determinants within two major referral hospitals in Mogadishu. Methods We conducted a hospital-based, cross-sectional study with a seven-day prospective follow-up from January to April 2020, including 352 mother-newborn dyads. Data on maternal demographics, antenatal care, delivery mode, and neonatal outcomes were collected via structured questionnaires and medical records. Multivariate logistic regression was used to identify independent predictors of perinatal mortality. Results From 358 recorded deliveries, 62 perinatal deaths occurred, yielding an alarmingly high PMR of 173 per 1 , 000 total births . Stillbirths were the predominant component, accounting for 82% of these deaths. After multivariate adjustment, significant protective factors included maternal age of 22–29 years (Adjusted Odds Ratio [AOR]: 0.44; 95% CI: 0.21–0.94), primary or secondary education (AOR: 0.40; 95% CI: 0.16–0.95), and delivery via cesarean section (AOR: 0.33; 95% CI: 0.11–0.98). A history of previous stillbirth was a significant predictor in unadjusted but not in the final multivariate model. Conclusion This study reveals a severe, localized crisis of perinatal mortality in Mogadishu, driven overwhelmingly by stillbirths. The protective effects of maternal education and emergency obstetric care underscore the urgent need for systemic investments in maternal health services. Interventions must prioritize enhancing the quality of both antenatal and intrapartum care to avert these preventable tragedies.

Introduction The burden of adverse neonatal outcomes (ANOs), encompassing preterm birth(PTB), low birth weight(LBW), and early neonatal deaths, remain significant public health challenge globally, particularly in developing countries. The study aims to provide estimates of adverse birth outcomes and examine their correlates by using a multi-level model analysis at individual/household/community level. Methodology The study has chosen three ANOs such as preterm birth(PTB), low birth weight(LBW), and early neonatal deaths (based on available data) for constructing a combined indicator which is calculated by the presence of any one of these variables. We used National-Family-Health-Survey India data(2019–21). Multilevel(three-level) logistic regression model was used to find the probability of binary adverse neonatal outcomes with the effects of individual/household/community level variables among the recently delivered women. Result Between 2019–21, a total of 26.5% ANOs were reported from 1.7 million pregnant women surveyed, a rate that has increased since 2005–06 (20%). Final multilevel model asserts that women having higher education [OR 0.92, 95%CI 0.88, 0.96), and those registered for antenatal checkups (OR 0.95, 95%CI OR 0.9, 0.99) and know all components of birth-preparedness-and-complication-readiness (OR 0.88, 95%CI 0.84, 0.92) have a higher protective odd of having adverse outcomes. Difficulty in seeking medical help (OR 1.2, 95%CI 1.15, 1.25) and belonging to poor wealth status and no intention to become pregnant (OR 1.11 95% CI 1.05, 1.18) acts as a risk factor. Multilevel model with household, community and district level variables added to the null model showed a decline in the ICC values to 4.7%, 18.8% and 30.9% respectively across district, community, and household levels. Conclusion The study underscores that specific ANOs in India has shown an increase, prompting significant concern. There is need to institute a mechanism for generating knowledge amongst women to protect them from unwanted pregnancies and later adverse outcomes.

Background Ghana has consistently reported a high perinatal mortality rate. This has raised concerns regarding the country’s ability to achieve the Sustainable Development Goals 3 target 2 by 2030. This comprehensive review presents the pooled prevalence and predictors of perinatal mortalities in Ghana guided by the Anderson’s framework of healthcare utilization. Methods A comprehensive literature search was conducted mainly from four electronic databases; PubMed, Web of Science, Scopus and CINAHL as they collectively index > 90% of relevant maternal health journals in Africa and also eases the burden of screening. Eligible studies, published from 1st January 2010 to 30th June, 2024, were charted and synthesized, with focus on the three primary domains of Anderson’s framework: pre-disposing factors, enabling factors and need factors. Meta-analysis was conducted to estimate the pooled prevalence of perinatal mortality rate within each of the sub-regions. Significant heterogeneity was detected among the various surveys (I2 > 50%), hence a random effect model was reported. Sub-group and meta-regression were performed to identify the sources of heterogeneity observed in the study. Results A total of 2,184 articles were initially identified for review, but after multiple rounds of screening and deduplication, only 30 full-text articles were finally included. The most frequent study design was cross-sectional, accounting for 23.3% of the studies. The Pooled estimate of perinatal mortality is 44.8 (95%CI: 15.4–74.2) per 1000 births in Ghana, with very high heterogeneity (I 2  > 99.97, p  < 0.0001) among the studies. The predictors of perinatal mortality included advanced maternal age, pre-existing health conditions, poor quality ANC, access to healthcare facilities and environmental exposures. Conclusion This review presents the complex interplay of factors determining perinatal mortality in Ghana. In addition to the predictors identified, the review reveals gaps in literature particularly the lack of case-control studies in rural settings and inadequate focus on healthcare quality, socio-economic influences, and policy impacts. Future studies should address these gaps using a holistic approach that takes into account Ghana’s diverse social and geographical factors to better reduce perinatal mortality. Systematic Review Registration. The review protocol was registered in PROSPERO (CRD42024564968).

ObjectiveTo examine the effect of short (<36 months) and long (≥60 months) birth intervals on adverse pregnancy outcomes in Bangladesh.Design, setting and participantsWe analysed data from six Bangladesh Demographic and Health Surveys (1996–1997, 1999–2000, 2004, 2007, 2011 and 2014). We included all singleton non-first live births, most recently born to mothers within 5 years preceding each survey (n=21 382). We defined birth interval according to previous research which suggests that a birth interval between 36 and 59 months is the most ideal interval. Bivariate and multivariable analyses were conducted to obtain the crude and adjusted ORs (aOR) respectively to assess the odds of first-day neonatal death, early neonatal death and small birth size for both short (<36 months) and long (≥60 months) spacing between births.Main outcome measuresFirst-day neonatal death, early neonatal death and small birth size.ResultsIn the multivariable analysis, compared with births spaced 36–59 months, infants with a birth interval of <36 months had increased odds of first-day neonatal death (aOR: 2.11, 95% CI: 1.17 to 3.78) and early neonatal death (aOR: 1.58, 95% CI: 1.13 to 2.22). Compared with births spaced 36–59 months, infants with a birth interval of ≥60 months had increased odds of first-day neonatal death (aOR: 2.02, 95% CI: 1.10 to 3.73) and small birth size (aOR: 1.17, 95% CI: 1.02 to 1.34). When there was a history of any previous pregnancy loss, there was an increase in the odds of first-day and early neonatal death for both short and long birth intervals, although it was not significant.ConclusionsBirth intervals shorter than 36 months and longer than 59 months are associated with increased odds of adverse pregnancy outcomes. Care-providers, programme managers and policymakers could focus on promoting an optimal birth interval between 36 and 59 months in postpartum family planning.

Background Understanding the magnitude and clinical causes of maternal and perinatal mortality are basic requirements for positive change. Facility-based information offers a contextualized resource for clinical and organizational quality improvement. We describe the magnitude of institutional maternal mortality, causes of death and cause-specific case fatality rates, as well as stillbirth and pre-discharge neonatal death rates. Methods This paper draws on secondary data from 40 low and middle income countries that conducted emergency obstetric and newborn care assessments over the last 10 years. We reviewed 6.5 million deliveries, surveyed in 15,411 facilities. Most of the data were extracted from reports and aggregated with excel. Results Hemorrhage and hypertensive diseases contributed to about one third of institutional maternal deaths and indirect causes contributed another third (given the overrepresentation of sub-Saharan African countries with large proportions of indirect causes). The most lethal obstetric complication, across all regions, was ruptured uterus, followed by sepsis in Latin America and the Caribbean and sub-Saharan Africa. Stillbirth rates exceeded pre-discharge neonatal death rates in nearly all countries, possibly because women and their newborns were discharged soon after birth. Conclusions To a large extent, facility-based findings mirror what population-based systematic reviews have also documented. As coverage of a skilled attendant at birth increases, proportionally more deaths will occur in facilities, making improvements in record-keeping and health management information systems, especially for stillbirths and early neonatal deaths, all the more critical.

Abstract Background Invasive Group B Streptococcus (GBS) is a common cause of early-onset neonatal sepsis and is also associated with stillbirth. This study aimed to determine the proportion of stillborn infants and infants who died between 0 and 90 days attributable to GBS using postmortem minimally invasive tissue sampling (MITS) in 7 low- and middle-income countries (LMICs) participating in Child Health and Mortality Prevention Surveillance (CHAMPS). Methods Deaths that occurred between December 2016 and December 2021 were investigated with MITS, including culture for bacteria of blood and cerebrospinal fluid (CSF), multipathogen polymerase chain reaction on blood, CSF, and lung tissue and histopathology of lung, liver, and brain. Data collection included clinical record review and verbal autopsy. Expert panels reviewed all information and assigned causes of death. Results We evaluated 2966 deaths, including stillborn infants (n = 1322), infants who died during first day of life (0 to <24 hours, n = 597), early neonatal deaths (END) (1 day to <7 days; END; n = 593), and deaths from 7 to 90 days (n = 454). Group B Streptococcus was determined to be in the causal pathway of death for 2.7% of infants (79 of 2, 966; range, 0.3% in Sierra Leone to 7.2% in South Africa), including 2.3% (31 of 1322) of stillbirths, 4.7% (28 of 597) 0 to <24 hours, 1.9% (11 of 593) END, and 2.0% (9 of 454) of deaths from 7 to 90 days of age. Among deaths attributed to GBS with birth weight data available, 61.9% (39 of 63) of decedents weighed <2500 grams at birth. Group B Streptococcus sepsis was the postmortem diagnosis for 100% (31 of 31) of stillbirths. For deaths <90 days, postmortem diagnoses included GBS sepsis (83.3%, 40 of 48), GBS meningitis (4.2%, 2 of 48), and GBS pneumonia (2.1%, 1 of 48). Conclusions Our study reveals significant heterogeneity in the contribution of invasive GBS disease to infant mortality across different countries, emphasizing the need for tailored prevention strategies. Moreover, our findings highlight the substantial impact of GBS on stillbirths, shedding light on a previously underestimated aspect in LMICs.

Introduction Twin pregnancies are associated with significantly higher perinatal mortality (PM) rates compared to singletons, primarily due to complications like fetal growth restriction, preterm birth, and congenital anomalies. This study aimed to compare the characteristics associated with PM in twin pregnancies and compare maternal and obstetric factors and cause of death among twins and singletons in the Republic of Ireland. Materials and methods Data spanning 2011 to 2022 from the National Perinatal Epidemiology Centre’s annual perinatal mortality clinical audit included 4494 perinatal deaths. Maternal characteristics, antenatal care factors and cause of death were analysed with relative risk calculated using national Hospital In-Patient Enquiry data. Pearson’s chi-squared tests studied the difference between mortality in twins and singletons. Results Twins accounted for 10.4% of all perinatal deaths, despite representing only 3.6% of total births. The PM rate for twins was 17.3 per 1000 births, 3.1 times higher than for singletons. Early neonatal deaths (ENNDs) were more frequent in twins (54.2%), while stillbirths predominated among singletons (68.6%). Younger maternal age and lower BMI were associated with higher PM risks in twins. A considerable proportion of twin deaths with major congenital anomalies or birth before 28 weeks gestation occurred in non-tertiary hospitals, suggesting limitations in referral pathways to centres with appropriate neonatal expertise. Conclusion Twin pregnancies pose a higher risk of perinatal mortality, particularly among younger mothers and preterm births. The findings highlight the need for updated guidelines that prioritise early risk assessment, targeted interventions, and improved referral systems.

Background perinatal mortality is the sum of still birth (fetal death) and early neonatal death (ENND) i.e. death of live newborn before the age of 7 completed days. Perinatal mortality accounts three fourth of the deaths of the neonatal period and is one of the major challenges for under-five mortality. Therefore this study was conducted to better understand the common and avoidable factors that affect perinatal mortality in Addis Ababa, Ethiopia. Methods An unmatched case control study design using secondary data as a source of information was conducted. Cases were still births or early neonatal deaths and controls were live births and neonates who were discharged alive from the hospital and did not die before the age of 7 days. The study period was from 1st January up to 30th February 2015. Epi-Info version 7.0 and SPSS Version 21 were used for data entry and analysis. Descriptive statistics, frequencies, proportions and diagrams were used to check the distribution of outcome variable and describe the study population. Logistic regression model was used to identify the important factors that are associated with perinatal mortality. Results A total of 1113(376 cases and 737 controls) maternal charts were reviewed. The mean age of the mothers for cases and controls were 26.47 ± 4.87 and 26.95 ± 4.68 respectively. Five hundred ninety seven (53.6%) mothers delivered for the first time. Factors that are significantly associated with increased risk of perinatal mortality were birth interval less than 2 years, preterm delivery, anemia, congenital anomaly, previous history of early neonatal death and low birth weight. Use of partograph was also associated with decreased risk of perinatal mortality. Conclusion From factors that are associated with perinatal mortality, some of them can be prevented with early investigation of pregnant mothers on their antenatal care follow. Appropriate labor follow-up and monitoring with regular use of partograph, immediate newborn care and interventions to delay birth interval also minimize perinatal mortality.