Abstract
Background: Sub-Saharan African (SSA) countries have high stillbirth
rates compared to high-income countries, yet research on risk factors
for stillbirth in SSA remain scant. Objectives: To identify the
modifiable risk factors of stillbirths in SSA and investigate their
strength of association using a systematic review. Search Strategy:
EMBASE, MEDLINE, Global Health, and CINAHL Plus databases were searched
for literature. Selection Criteria: Observational population- and
facility-level studies exploring stillbirth risk factors, published
between 2013-2019 were included. Data Collection and Analysis: Narrative
synthesis of data was undertaken and the potential risk factors were
classified into sub-groups. Main Results: Thirty-seven studies were
included, encompassing 20,264 stillbirths. The risk factors were
categorized as maternal antepartum (0-4 antenatal care visits, multiple
gestations, hypertension, birth interval >3 years, history
of perinatal death); socioeconomic factors (maternal lower wealth index
and basic education, advanced maternal age, grand multiparity (≥5));
intrapartum (direct obstetric complication, non-vaginal delivery); fetal
(low birthweight and gestational age <37weeks) and health
systems (poor ANC quality, emergency referrals, ill-equipped facility).
The proportion of unexplained stillbirths remained very high. No
association was found between stillbirths and HIV, BMI, diabetes, and
distance from the facility. Conclusion: The overall quality of evidence
was low as many studies were facility-based and did not adjust for
confounders. This review identified preventable risk factors for
stillbirth. Focused programmatic strategies should be developed to
improve antenatal care, emergency obstetric care, maternal perinatal
education, referral and outreach systems, and birth attendant training.
More population-based high-quality research is needed. Funding: Not
externally funded