INVESTIGATING FACTORS CONTRIBUTING TO STILLBIRTHS AMONG RURAL DWELLERS (A CASE STUDY OF GENERAL HOSPITAL ALADE IDANRE, IDANRE LOCAL GOVERNMENT

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Product Code: 00005981

No of Pages: 58

No of Chapters: 5

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TABLE OF CONTENTS
Title Page
Front page i
Title page ii
Declaration iii
Certification iv
Abstract v
Dedication vi
Acknowledgements vii
Table of Contents viii
List of tables x
List of figures xi

CHAPTER ONE
1.0 Introduction 1
1.1 Background of the study 3
1.2 Statement of the problem 5
1.3 Objectives of the study                                                                                               6
1.4       Research questions                 6
1.5 Significance of the study 7
1.6 Definition of terms 8

CHAPTER TWO
2.0 Literature review 10
2.1 Definition of stillbirth 11
2.2 Factors associated with Stillbirth                         12
2.3       Causes of still birth                                                                                                     15
2.4 Food to avoid during pregnancy                                                                                 16
2.5 Symptoms of still birth              20
2.6 Prevention of still birth                                                       21
2.7 Management of still birth cases                               21

CHAPTER THREE
3.0 Research methodology 23
3.1.     Description of the study area 24
3.2 Study design                               25
3.3 Sampling technique             25
3.4 Instrument of data collection 25
3.5 Sample size determination      25
3.6.1 Method of data collection                         26
3.6.2 Method of data analysis 26 

CHAPTER FOUR
4.0 Data analysis and presentation of results          27-36

CHAPTER FIVE
5.0 Discussion of findings, conclusions and recommendations 37
5.1 Discussion of findings 37
5.2 Conclusions               38
5.3 Recommendations 38
References 40
Appendix 46

LIST OF TABLES
Table Page
1. Age of respondents                                                 27
2. Marital Status of respondents               29
3. Level of education of respondents               30
4. There factors contributing to stillbirth in this community            31
5. Factors contributing to stillbirth in this community                        32
6. Women with stillbirth being properly taken care of in this area                        33
7. There any measures being taken by the women in the study area to prevent still birth  34
8. Measures being taken by the women in the study area to prevent still birth                      35
9. Hospital record of still birth in Oda Town                                                                           36


LIST OF FIGURES
Figure Page
1. Map showing Oda town the study area 24



CHAPTER ONE
1.0. INTRODUCTION
Nigeria has the second highest rate of stillbirths in the world at 42.9 per 1,000 total births as well as the second highest absolute number of stillbirths, estimated at 314,000 in 2015. While the whole country faces challenges, these are particularly stark in the northern regions. Demographic and Health Surveys (DHS) in Nigeria repeatedly show large discrepancies in access to health services between the southern and northern regions of the country. For example, the 2013 DHS reported that 55% of pregnant women in the North-West region receive no antenatal care, compared to just 4% in the South-East region. Similarly, 87.5% of women in the North-West region deliver their babies at home, while in the South-East region, 20% of deliveries occur at home (NPC, 2011).

Every day more than 7,300 babies are stillborn. A death occurs just when parents expect to welcome a new life. Ninety-eight percent of stillbirths occur in low and middle-income countries. Wealthier nations are not immune with 1 in 200 pregnancies resulting in a stillbirth two thirds occurring in the last trimester of pregnancy, a rate that has stagnated in the last decade. The five main causes of stillbirths are childbirth complications, maternal infections in pregnancy, maternal disorders (especially pre-eclampsia and diabetes), fetal growth restriction and congenital abnormalities. The number of stillbirths worldwide has declined by only 1.1 percent per year, from 3 million per year in 1995 to 2.6 million in 2009. This is slower than reductions for child and maternal mortality (De Bernis et. al., 2016).

An African woman has a 24 times higher chance of having a stillbirth at the time of delivery than a woman in a high-income country. Two-thirds of stillbirths happen in rural areas, where skilled birth attendants, in particular midwives and physicians, are not always available for essential care during childbirth and for obstetric emergencies, including caesarean sections. The major causes of stillbirths in a hospital study in Nigeria included antepartum haemorrhage, hypertensive disorders of pregnancy, uterine rupture, low birth weight, and congenital fetal malformations. Globally, infections and other intrapartum-related complications are additional important causes. As many of these conditions are preventable, it is extremely important for pregnant women to have access to antenatal care and skilled assistance at birth. A deeper analysis of the 2013 DHS concluded that there is an urgent need for the national government to improve the quality of maternal health care services and interventions to help improve utilization and quality of prenatal care. However, in northern Nigeria this is a serious challenge as there is a severe shortage of female health workers, with some rural communities having no health workers at all. Even where health workers are present, cultural traditions deter many women from accessing services offered by men. And poor schooling in rural areas means that girls often cannot gain entry into local training centres to become health workers (Suleiman and Ibrahim, 2015).

1.1 BACKGROUND OF THE STUDY
Annually, an estimated 2.6 million stillbirths occur worldwide (Lawn et. al., 2016), making it the fifth leading global cause of death when compared with leading global causes of death in all age categories, outranking diarrhoea, HIV/AIDS, tuberculosis, road traffic accidents and any form of cancer (Froen et. al., 2011). Every stillbirth is a tragedy and a potential life lost. There are, in addition, many psycho-social consequences for parents including anxiety, long-term depression, post-traumatic stress disorder and stigmatisation (Froen et. al., 2011). Sadly, women who have experienced a stillbirth are more likely to experience this again in subsequent pregnancies than those who have not (Kupka et. al., 2019; Ouyang et. al., 2013; Stringer et. al., 2011; Watson-Jones et. al., 2007; Yatich et. al., 2010). 

The vast majority (98%) of stillbirths occur in low- and middle-income countries (LMIC), and more than half (55%) of these happen in rural sub-Saharan Africa (Lawn et. al., 2011). While some developed countries report a stillbirth rate (SBR) of 3 per 1,000 births (McClure et. al., 2011; Stanton et. al., 2006), a ten-fold increase is noted in some settings in sub-Saharan Africa and Southeast Asia with reported stillbirth rates of 30 per 1,000 births and over (McClure et. al., 2011; Lawn et. al., 2011; McClure et. al., 2017). 

Nigeria account for one of the highest stillbirth rates in African continent. It is one of six countries that bears the burden of all stillbirths globally, together with India, Pakistan, the Democratic Republic of Congo, China and Ethiopia. Nigeria, unhappily, has the second highest rate of stillbirths in the world with 42.9 per 1,000 births as well as the second absolute number of stillbirths, estimated at 314,000 in 2015. It is crucial that we understand the causes of and factors which have led to a stillbirth and develop interventions with a focus on high-risk groups (George et. al., 2011). However, for many cases of stillbirths the cause of death is currently never established (McClure et. al., 2016; Edmond et. al., 2018; Baqui et. al., 2011). Causes of death are very often not recorded accurately or not recorded at all; training of healthcare providers is required to improve understanding of causes of stillbirth and factors contributing to it (Cockerill et. al., 2012). 

Data suggests that most of these deaths could be prevented (Lawn et. al., 2011; Stanton et. al., 2016). A systematic review of perinatal audit in low- and middle-income countries, showed that if audit is conducted at health facility level by healthcare providers, this has the potential to improve the quality of care (Pattinson et. al., 2019). When they meta-analysed seven before-and-after studies, they observed a reduction in perinatal mortality of 30% (95% confidence interval: 21%–38%) after introduction of perinatal audit. 

In Nigeria, child delivery in rural areas could be an ordeal. Left largely to poorly-trained and ill-equipped traditional health attendants, the outcome is often unpredictable. Health centres, in the few places where they exist, lack the right calibre of manpower needed for such delicate health matters. Some mothers do not even know what antenatal care means and could go into labour while on their way to the farm or market, relying only on providence for safe delivery; doubtlessly a game of chance.Available systems for classifying the underlying cause of stillbirth differ in their approach and even when applied there is a high proportion of unclassified stillbirths (Gardosi et. al., 2015; Flenady et. al., 2019).

1.2 STATEMENT OF THE PROBLEM
Every year, an estimated quite numbers of stillbirths do occur most especially among low- and middle-income countries. Two-thirds of stillbirths happen in rural areas, where skilled birth attendants, in particular midwives and physicians, are not always available for essential care during childbirth and for obstetric emergencies, including caesarean sections. The major causes of stillbirths included antepartum haemorrhage, hypertensive disorders of pregnancy, uterine rupture, low birth weight, and congenital fetal malformations. Understanding the cause of and factors associated with stillbirth will be of great importance in helping to inform the design and implementation of interventions aimed at reducing preventable stillbirths in the area. The reason why some mothers still experiencing still birth could be as a result of lack of knowledge about the risk factors and prevention. Therefore, this study aimed to investigate the factors contributing to still birth among rural dwellers using Alade Idanre as a case study.

1.3 OBJECTIVES OF THE STUDY
The objectives of the study are to;
determine the prevalence of stillbirths in the study area
investigate factors contributing to still birth in Alade Idanre
evaluate strategies to prevent high occurrence of still birth in the study area.

1.4 RESEARCH QUESTIONS
Are there increase or decrease in cases of still birth in the study area?
Are there factors contributing to still birth in Alade Idanre Local Government, Ondo State?
Are there strategies to prevent high occurrence of still birth in the study area?
1.5 SIGNIFICANCE OF THE STUDY 
This study is aimed at providing deeper knowledge of the causes of stillbirth among rural dwellers, providing up-to-date data upon which programmes could rely to focus interventions targeting reduction of stillbirth in Alade, Idanre Local Government. It will also add to the existing body of knowledge.

1.6 DEFINITIONS OF TERMS 
Stillbirth: Stillbirth is the birth of a baby at ≥ 22 weeks of gestation or with birth weight of ≥ 500g or body length of ≥ 25cm who died before or during labour and birth. For international comparisons, stillbirth is a baby born dead at ≥ 28 weeks of gestation, or birth weight of ≥ 1000 g, or a body length of ≥ 35cm (WHO, 2014; Froen et. al., 2011).  

Pregnancy: is the term used to describe the period in which a fetus develops inside a woman's womb or uterus.

Immunity: the ability of an organism to resist a particular infection or toxin by the action of specific antibodies or sensitized white blood cells.

Stillbirth Rate: Stillbirth rate is the number of stillbirths per every 1,000 total births (live births + stillbirths). 

Factor Associated with Stillbirth: A maternal/paternal characteristic is considered to be a risk factor for stillbirth when it is associated with stillbirth but without an obvious causal relationship with the stillbirth (McClure et. al., 201). 

Cause of Stillbirth: A cause of stillbirth is “any condition with a plausible mechanism likely to lead to the death of the fetus” (McClure et. al., 2011). 

Low-Income Country: A country with gross national income (GNI) per capita of $1,025 or less (World Bank, 2017). 

Lower Middle-Income Country: A country with GNI per capita of $1,026 - $4,035 (World Bank, 2017). 

Upper Middle-Income Country: A country with GNI per capita of $4,036 - $12,475 (World Bank, 2017). 

High-Income Country: A country with GNI per capita of $12,476 or more (World Bank, 2017).



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