title: Determinants of stillbirth in Zambia.
abstract: OBJECTIVE
  The objective of this study was to estimate the rates and determinants of stillbirth in an urban African obstetric population.
  
  
  METHODS
  In this retrospective cohort study, we reviewed vital outcomes of newborns whose mothers received antenatal care, delivery care, or both antenatal and delivery care in the Lusaka, Zambia, public sector between February 2006 and March 2009. We excluded newborns weighing less than 1,000 g, those whose mothers died before delivery, and those born outside Lusaka.
  
  
  RESULTS
  There were 100,454 deliveries that met criteria for inclusion. The median maternal age at the initial visit was 24 years (interquartile range 21-29) and the median gestational age was 22 weeks (interquartile range 19-26). The median gestational age at birth was 38 weeks (interquartile range 36-40), and the median neonatal birth weight was 3,000 g (interquartile range 2,750-3,300). A total of 2,109 fetuses were stillborn (crude rate, 21 per 1,000 live births, 95% confidence interval 20.1 per 1,000 to 21.9 per 1,000). This included 1,049 (49.7%) stillbirths classified as "recent" (presumed to have occurred within 12 hours of delivery) and 1,060 (50.3%) classified as "macerated" (presumed to have occurred more than 12 hours before delivery). In adjusted analysis, increasing maternal age, baseline body mass index greater than 26, history of stillbirth, placental abruption, maternal untreated syphilis, cesarean delivery, operative vaginal delivery, assisted breech delivery, and extremes of neonatal birth weight were all significantly associated with stillbirth.
  
  
  CONCLUSIONS
  Stillbirth is a major contributor to poor perinatal outcomes in Lusaka. Many deaths appear avoidable through investment in antenatal screening and better labor monitoring. Stillbirth should be adopted as a routine health indicator by the World Health Organization.
authors.affiliation: From the University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; the University Teaching Hospital, Ministry of Health Zambia, Lusaka, Zambia; the Ministry of Health Zambia, Ndeke House, Lusaka, Zambia; Brown University, Providence, Rhode Island; and Drexel University, Philadelphia, Pennsylvania.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Stringer
authors.forename: Bellington
authors.initials: B
authors.lastname: Vwalika
authors.forename: William P
authors.initials: WP
authors.lastname: Killam
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Giganti
authors.forename: Reuben
authors.initials: R
authors.lastname: Mbewe
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
authors.forename: Namwinga
authors.initials: N
authors.lastname: Chintu
authors.forename: Dwight
authors.initials: D
authors.lastname: Rouse
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: Jeffrey S A
authors.initials: JSA
authors.lastname: Stringer
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D018743:Perinatal Care; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*; D014504:Urban Health / Q000706:statistics & numerical data; D015024:Zambia / Q000453:epidemiology