Pregnancy-related morbidity and risk factors for fatal foetal outcomes in the Taabo health and demographic surveillance system, Côte d'Ivoire

• Published in: BMC pregnancy and childbirth Vol. 18; no. 1; p. 216
• Main Authors: Koné, Siaka, Hürlimann, Eveline, Baikoro, Nahoua, Dao, Daouda, Bonfoh, Bassirou, N'Goran, Eliézer K, Utzinger, Jürg, Jaeger, Fabienne N
• Format: Journal Article
• Language: English
• Published: England BioMed Central 07.06.2018; BMC
• Subjects: Abortion, Spontaneous - epidemiology; Abortion, Spontaneous - etiology; Adult; Childbirth & labor; Childrens health; Costs; Cote d'Ivoire - epidemiology; Côte d’Ivoire; Demography; Early neonatal death; Epidemiology; Female; Foetal health; Health and demographic surveillance system; Health facilities; Humans; Infant, Newborn; Low income groups; Malaria; Midwifery; Miscarriage; Morbidity; Mortality; Mother and child health; Mothers; Newborn babies; Obstetrics; Odds Ratio; Population Surveillance; Poverty - statistics & numerical data; Pregnancy; Pregnancy complications; Pregnancy Complications - epidemiology; Pregnancy Complications - etiology; Pregnancy Outcome - epidemiology; Prenatal care; Prenatal Care - statistics & numerical data; Risk Factors; Rural areas; Rural Population - statistics & numerical data; Stillbirth; Surveillance; Womens health; Young Adult; Cote d'Ivoire; Africa; Ivory Coast; Pregnancy; Stillbirth; Health and demographic surveillance system; Perinatal mortality; Mother and child health; Foetal health; Miscarriage; Early neonatal death; Côte d’Ivoire
• ISSN: 1471-2393; 1471-2393
• DOI: 10.1186/s12884-018-1858-2

Reliable, population-based data on pregnancy-related morbidity and mortality, and risk factors for fatal foetal outcomes are scarce for low- and middle-income countries. Yet, such data are essential for understanding and improving maternal and neonatal health and wellbeing. Within the 4-monthly surveillance rounds of the Taabo health and demographic surveillance system (HDSS) in south-central Côte d'Ivoire, all women of reproductive age identified to be pregnant between 2011 and 2014 were followed-up. A questionnaire pertaining to antenatal care, pregnancy-related morbidities, delivery circumstances, and birth outcome was administered to eligible women. Along with sociodemographic information retrieved from the Taabo HDSS repository, these data were subjected to penalized maximum likelihood logistic regression analysis, to determine risk factors for fatal foetal outcomes. A total of 2976 pregnancies were monitored of which 118 (4.0%) resulted in a fatal outcome. Risk factors identified by multivariable logistic regression analysis included sociodemographic factors of the expectant mother, such as residency in a rural area (adjusted odds ratio (aOR) = 2.87; 95% confidence interval (CI) 1.31-6.29) and poorest wealth tertile (aOR = 1.79; 95% CI 1.02-3.14), a history of miscarriage (aOR = 23.19; 95% CI 14.71-36.55), non-receipt of preventive treatment such as iron/folic acid supplementation (aOR = 3.15; 95% CI 1.71-5.80), only two doses of tetanus vaccination (aOR = 2.59; 95% CI 1.56-4.30), malaria during pregnancy (aOR = 1.94; 95% CI 1.21-3.11), preterm birth (aOR = 4.45; 95% CI 2.82-7.01), and delivery by caesarean section (aOR = 13.03; 95% CI 4.24-40.08) or by instrumental delivery (aOR = 5.05; 95% CI 1.50-16.96). Women who paid for delivery were at a significantly lower odds of a fatal foetal outcome (aOR = 0.39; 95% CI 0.25-0.74). We identified risk factors for fatal foetal outcomes in a mainly rural HDSS site of Côte d'Ivoire. Our findings call for public health action to improve access to, and use of, quality services of ante- and perinatal care.