Koné S, et al. - Researchers sought to provide reliable, population-based data on pregnancy-related morbidity and mortality, and risk factors for fatal foetal outcomes for low- and middle-income countries. Risk factors for fatal foetal outcomes were identified in a mainly rural health and demographic surveillance system (HDSS) site of Côte d’Ivoire. Public health action is required to improve access to, and use of, quality services of ante- and perinatal care.

Methods

• Researchers followed-up all women of reproductive age identified to be pregnant between 2011 and 2014 within the 4-monthly surveillance rounds of the Taabo health and demographic surveillance system (HDSS) in south-central Côte d’Ivoire.
• To eligible women, they administered a questionnaire pertaining to antenatal care, pregnancy-related morbidities, delivery circumstances, and birth outcome.
• To determine risk factors for fatal foetal outcomes, these data were subjected to penalized maximum likelihood logistic regression analysis along with sociodemographic information retrieved from the Taabo HDSS repository.

Results

• A total of 2976 pregnancies were monitored of which 118 (4.0%) resulted in a fatal outcome.
• Multivariable logistic regression analysis identified risk factors which 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).
• A significantly lower odds of a fatal foetal outcome was observed for women who paid for delivery (aOR = 0.39; 95% CI 0.25–0.74).