Perinatal mortality in rural Burkina Faso: a prospective community-based cohort study

Abdoulaye Hama Diallo, Nicolas Meda, Emmanuel Zabsonré, Halvor Sommerfelt, Simon Cousens, Thorkild Tylleskär, PROMISE-EBF Study Group, Abdoulaye Hama Diallo, Nicolas Meda, Emmanuel Zabsonré, Halvor Sommerfelt, Simon Cousens, Thorkild Tylleskär, PROMISE-EBF Study Group

Abstract

Background: There is a scarcity of reliable data on perinatal mortality (PNM) in Sub-Saharan Africa. The PROMISE-EBF trial, during which we promoted exclusive breastfeeding, gave us the opportunity to describe the epidemiology of PNM in Banfora Health District, South-West in Burkina Faso.

Study objectives: To measure the perinatal mortality rate (PNMR) in the PROMISE-EBF cohort in Banfora Health District and to identify potential risk factors for perinatal death.

Methods: We used data collected prospectively during the PROMISE-EBF-trial to estimate the stillbirth rate (SBR) and early neonatal mortality rate (ENMR). We used binomial regression with generalized estimating equations to identify potential risk factors for perinatal death.

Results: 895 pregnant women were enrolled for data collection in the EBF trial and followed-up to 7 days after birth. The PNMR, the SBR and the ENMR, were 79 per 1000 (95% CI: 59-99), 54 per 1000 (95% CI: 38-69) and 27 per 1000 (95% CI: 9-44), respectively. In a multivariable analysis, nulliparous women (RR = 2.90, 95% CI: 1.6-5.0), primiparae mothers (RR = 2.20, 95% CI: 1.2-3.9), twins (RR = 4.0, 95% CI: 2.3-6.9) and giving birth during the dry season (RR = 2.1 95% CI: 1.3-3.3) were factors associated with increased risk of perinatal death. There was no evidence that risk of perinatal death differed between deliveries at home and at a health centre

Conclusion: Our study observed the highest PNMR ever reported in Burkina. There is an urgent need for sustainable interventions to improve maternal and newborn health in the country.

References

    1. World Health Organization. WHO Publications. Geneva: WHO; 2006. Neonatal and Perinatal mortality: Country, Regional and Global estimates; p. 69.
    1. World Health Organization a. WHO Publications. Geneva: WHO; 2007. Neonatal and Perinatal mortality: Country, Regional and Global estimates 2004.
    1. Lawn JE, Yakoob MY, Haws RA, Soomro T, Darmstadt GL, Bhutta ZA. 3.2 million stillbirths: epidemiology and overview of the evidence review. BMC Pregnancy Childbirth. 2009;9(Suppl 1):S2. doi: 10.1186/1471-2393-9-S1-S2.
    1. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where? Why? Lancet. 2005;365(9462):891–900. doi: 10.1016/S0140-6736(05)71048-5.
    1. The World Bank. World Development Report 2009: Reshaping Economic Geography. The World Bank Publications, Washington DC; 2009. pp. 349–360.
    1. Burkina Faso INSD. Claverton, MD, macro International Inc, 2000. Ouagadougou: MEF/INSD; 2000. Demographic Health Survey 1998-1999.
    1. Burkina Faso INSD. INSD et ORC Macro. Ouagadougou: MEF/INSD; 2004. Demographic Health Survey 2003; p. 343.
    1. Fjeld E, Siziya S, Katepa-Bwalya M, Kankasa C, Moland KM, Tylleskar T. 'No sister, the breast alone is not enough for my baby' a qualitative assessment of potentials and barriers in the promotion of exclusive breastfeeding in southern Zambia. Int Breastfeed J. 2008;3:26. doi: 10.1186/1746-4358-3-26.
    1. Wandera M, Engebretsen IM, Okullo I, Tumwine JK, Astrom AN. Socio-demographic factors related to periodontal status and tooth loss of pregnant women in Mbale district, Uganda. BMC Oral Health. 2009;9:18. doi: 10.1186/1472-6831-9-18.
    1. Burkina Faso INSD. DR/Hauts-Bassins, BF. Ouagadougou: MEF/INSD; 2008. Annuaire Statistique 2008 de la Region des Cascades (Statistics of the Cascades Region in 2008) p. 96.
    1. World Health Organization b. WHO Publications. Geneva: WHO; 2007. International statistical classification of diseases and related health problem, 10th revision (ICD-10)
    1. Filmer D, Pritchett LH. Estimating wealth effects without expenditure data--or tears: an application to educational enrollments in states of India. Demography. 2001;38(1):115–132.
    1. Kolenikov S, Angeles G. Socioeconomic status measurement with discrete proxy variables: is principal component analysis a reliable answer? The Review of Income and Wealth 2009. 2009;Series 55:128. doi: 10.1111/j.1475-4991.2008.00309.x.
    1. Roberfroid D, Huybregts L, Lanou H, Henry MC, Meda N, Menten J, Kolsteren P. Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso. Am J Clin Nutr. 2008;88(5):1330–1340.
    1. Hounton S, Byass P, Brahima B. Towards reduction of maternal and perinatal mortality in rural Burkina Faso: communities are not empty vessels. Glob Health Action. 2009;2
    1. Gies S, Coulibaly SO, Ouattara FT, Ky C, Brabin BJ, D'Alessandro U. A community effectiveness trial of strategies promoting intermittent preventive treatment with sulphadoxine-pyrimethamine in pregnant women in rural Burkina Faso. Malar J. 2008;7:180. doi: 10.1186/1475-2875-7-180.
    1. Chalumeau M. Identification des facteurs de risque de mortalite perinatale en Afrique de l'Ouest:consultation prenatale ou surveillance de l'accouchement. J Gynecol Obstet Biol Reprod. 2002;31:63–69.
    1. Bell JS, Ouedraogo M, Ganaba R, Sombie I, Byass P, Baggaley RF, Filippi V, Fitzmaurice AE, Graham WJ. The epidemiology of pregnancy outcomes in rural Burkina Faso. Trop Med Int Health. 2008;13(Suppl 1):31–43. doi: 10.1111/j.1365-3156.2008.02085.x.
    1. Filippi V, Ganaba R, Baggaley RF, Marshall T, Storeng KT, Sombie I, Ouattara F, Ouedraogo T, Akoum M, Meda N. Health of women after severe obstetric complications in Burkina Faso: a longitudinal study. Lancet. 2007;370(9595):1329–1337. doi: 10.1016/S0140-6736(07)61574-8.
    1. Graham WJ, Conombo SG, Zombre DS, Meda N, Byass P, De Brouwere V. Undertaking a complex evaluation of safe motherhood in rural Burkina Faso. Trop Med Int Health. 2008;13(Suppl 1):1–5. doi: 10.1111/j.1365-3156.2008.02081.x.
    1. Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet. 2005;365(9463):977–988. doi: 10.1016/S0140-6736(05)71088-6.
    1. Edmond KM, Quigley MA, Zandoh C, Danso S, Hurt C, Owusu Agyei S, Kirkwood BR. Aetiology of stillbirths and neonatal deaths in rural Ghana: implications for health programming in developing countries. Paediatr Perinat Epidemiol. 2008;22(5):430–437. doi: 10.1111/j.1365-3016.2008.00961.x.
    1. Engmann C, Matendo R, Kinoshita R, Ditekemena J, Moore J, Goldenberg RL, Tshefu A, Carlo WA, McClure EM, Bose C. et al.Stillbirth and early neonatal mortality in rural Central Africa. Int J Gynaecol Obstet. 2009;105(2):112–117. doi: 10.1016/j.ijgo.2008.12.012.
    1. Spector JM, Daga S. Preventing those so-called stillbirths. Bull World Health Organ. 2008;86(4):315–316. doi: 10.2471/BLT.07.049924.
    1. Greenwood A. A prospective survey of the outcome of pregnancy in a rural area of the gambia. World Health Org Bull. 1987;65(5):635–643.
    1. McDermott J, Steketee R, Wirima J. Perinatal mortality in rural Malawi. Bull World Health Organ. 1996;74(2):165–171.
    1. Burkina Faso INSD. Statistiques sanitaires. Ouagadougou: MEF/INSD; 2009. Annuaire Statistique (Statistics book)-Edition 2008; p. 356.
    1. Hounton SH, Newlands D, Meda N, De Brouwere V. A cost-effectiveness study of caesarean-section deliveries by clinical officers, general practitioners and obstetricians in Burkina Faso. Hum Resour Health. 2009;7:34. doi: 10.1186/1478-4491-7-34.
    1. Habib NA, Lie RT, Oneko O, Shao J, Bergsjo P, Daltveit AK. Sociodemographic characteristics and perinatal mortality among singletons in North East Tanzania: a registry-based study. J Epidemiol Community Health. 2008;62(11):960–965. doi: 10.1136/jech.2007.062828.
    1. Darmstadt GL, Yakoob MY, Haws RA, Menezes EV, Soomro T, Bhutta ZA. Reducing stillbirths: interventions during labour. BMC Pregnancy Childbirth. 2009;9(Suppl 1):S6. doi: 10.1186/1471-2393-9-S1-S6.
    1. Haws RA, Yakoob MY, Soomro T, Menezes EV, Darmstadt GL, Bhutta ZA. Reducing stillbirths: screening and monitoring during pregnancy and labour. BMC Pregnancy Childbirth. 2009;9(Suppl 1):S5. doi: 10.1186/1471-2393-9-S1-S5.
    1. Steketee RW, Nahlen BL, Parise ME, Menendez C. The burden of malaria in pregnancy in malaria-endemic areas. Am J Trop Med Hyg. 2001;64(1-2 Suppl):28–35.
    1. Steketee RW, Wirima JJ, Hightower AW, Slutsker L, Heymann DL, Breman JG. The effect of malaria and malaria prevention in pregnancy on offspring birthweight, prematurity, and intrauterine growth retardation in rural Malawi. Am J Trop Med Hyg. 1996;55(1 Suppl):33–41.
    1. Burkina Faso PNLP. PNLP/BF. Ouagadougou: MS/PNLP; 2007. Nouvelles recommandations pour le traitement et la prevention du paludisme chez les femmes enceintes au Burkina Faso.
    1. Habib NA, Dalveit AK, Mlay J, Oneko O, Shao J, Bergsjo P, Lie-Nielsen E, Lie RT. Birthweight and perinatal mortality among singletons and twins in north-eastern Tanzania. Scand J Public Health. 2008;36(7):761–768. doi: 10.1177/1403494808089559.
    1. E GdAR Fabre, de Augustin JL. et al.Perinatal mortality in twin pregnancy: an anlysis of birth weight-specific mortality rates and adjusted mortality rates for birth weight distributions. J Perinat Med. 1988;16(2):85–91. doi: 10.1515/jpme.1988.16.2.85.
    1. Becher H, Kauermann G, Khomski P, Kouyate B. Using penalized splines to model age- and season-of-birth-dependent effects of childhood mortality risk factors in rural Burkina Faso. Biom J. 2009;51(1):110–122. doi: 10.1002/bimj.200810496.
    1. Becher H, Muller O, Jahn A, Gbangou A, Kynast-Wolf G, Kouyate B. Risk factors of infant and child mortality in rural Burkina Faso. Bull World Health Organ. 2004;82(4):265–273.
    1. Hammer GP, Some F, Muller O, Kynast-Wolf G, Kouyate B, Becher H. Pattern of cause-specific childhood mortality in a malaria endemic area of Burkina Faso. Malar J. 2006;5:47. doi: 10.1186/1475-2875-5-47.

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