title: Risk factors for stillbirths in Tete, Mozambique.
abstract: OBJECTIVE
  To evaluate known risk factors for stillbirth and identify local priorities for stillbirth prevention among institutional deliveries in Tete, Mozambique.
  
  
  METHODS
  A case-control study was conducted among 150 women who experienced stillbirths and 300 women who experienced live deliveries at three health facilities between December 1, 2009, and April 30, 2011. Case and control individuals were matched for health facility, age, and parity. Sociodemographic, pregnancy, and delivery characteristics (including HIV and syphilis serology) were assessed. Bivariate associations and a conditional logistic regression model identified variables contributing to fetal outcome.
  
  
  RESULTS
  No between-group differences were recorded in the frequency of infection with HIV (25 [16.7%] cases vs 55 [18.3%] controls; P=0.663) or syphilis (6 [4.0%] vs 16 [5.3%]; P=0.536) at delivery. Multivariate analysis revealed that stillbirth was associated with direct obstetric complications (mutually adjusted odds ratio [OR] 6.7; 95% confidence interval [CI] 3.6-12.1), low socioeconomic status (mutually adjusted OR 1.8; 95% CI 1.1-3.1), and referral during childbirth (mutually adjusted OR 3.2; 95% CI 1.7-6.1).
  
  
  CONCLUSIONS
  Stillbirths in Tete, Mozambique, were predominantly caused by direct obstetric complications requiring referral among women of low socioeconomic status. Prenatal management of HIV and syphilis limited effects on fetal outcome. Emergency obstetric care and referral systems should be the focus of interventions aimed at stillbirth prevention.
authors.affiliation: International Centre for Reproductive Health-Mozambique, Maputo, Mozambique. Electronic address: icrh.moz@tdm.co.mz.
authors.forename: Diederike
authors.initials: D
authors.lastname: Geelhoed
authors.affiliation: Institute for Tropical Medicine, Antwerp, Belgium.
authors.forename: Jocelijn
authors.initials: J
authors.lastname: Stokx
authors.affiliation: Faculty of Health Science, Zambeze University, Tete, Mozambique.
authors.forename: Xavier
authors.initials: X
authors.lastname: Mariano
authors.affiliation: Tete Provincial Health Directorate-Mozambique, Tete, Mozambique.
authors.forename: Carla
authors.initials: C
authors.lastname: Mosse Lázaro
authors.affiliation: Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Kristien
authors.initials: K
authors.lastname: Roelens
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D009073:Mozambique / Q000453:epidemiology; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011295:Prenatal Care; D012017:Referral and Consultation; D012307:Risk Factors; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology*; D013587:Syphilis / Q000150:complications / Q000453:epidemiology; D055815:Young Adult
keywords: Emergency obstetric care; Mozambique; Risk factors; Stillbirths