title: Adverse pregnancy outcomes in rural Uganda (1996-2013): trends and associated factors from serial cross sectional surveys.
abstract: OBJECTIVE
  Community based evidence on pregnancy outcomes in rural Africa is lacking yet it is needed to guide maternal and child health interventions. We estimated and compared adverse pregnancy outcomes and associated factors in rural south-western Uganda using two survey methods.
  
  
  METHODS
  Within a general population cohort, between 1996 and 2013, women aged 15-49 years were interviewed on their pregnancy outcome in the past 12 months (method 1). During 2012-13, women in the same cohort were interviewed on their lifetime experience of pregnancy outcomes (method 2). Adverse pregnancy outcome was defined as abortions or stillbirths. We used random effects logistic regression for method 1 and negative binomial regression with robust clustered standard errors for method 2 to explore factors associated with adverse outcome.
  
  
  RESULTS
  One third of women reported an adverse pregnancy outcome; 10.8% (abortion = 8.4%, stillbirth = 2.4%) by method 1 and 8.5% (abortion = 7.2%, stillbirth = 1.3%) by method 2. Abortion rates were similar (10.8 vs 10.5) per 1000 women and stillbirth rates differed (26.2 vs 13.8) per 1000 births by methods 1 and 2 respectively. Abortion risk increased with age of mother, non-attendance of antenatal care and proximity to the road. Lifetime stillbirth risk increased with age. Abortion and stillbirth risk reduced with increasing parity.
  
  
  CONCLUSIONS
  Both methods had a high level of agreement in estimating abortion rate but were markedly below national estimates. Stillbirth rate estimated by method 1 was double that estimated by method 2 but method 1 estimate was more consistent with the national estimates.
  
  
  CONCLUSIONS
  Strategies to improve prospective community level data collection to reduce reporting biases are needed to guide maternal health interventions.
authors.affiliation: Department of women's and children's Health, Karolinska Institute, Stockholm, Sweden. gershim.asiki@mrcuganda.org.|Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, P.O Box 49, Entebbe, Uganda. gershim.asiki@mrcuganda.org.
authors.forename: Gershim
authors.initials: G
authors.lastname: Asiki
authors.affiliation: Technical Epidemiological Group, London School Hygiene and Tropical Medicine, London, UK.
authors.forename: Kathy
authors.initials: K
authors.lastname: Baisley
authors.affiliation: Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, P.O Box 49, Entebbe, Uganda.|Department of Health Sciences, University of York, York, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Newton
authors.affiliation: Department of women's and children's Health, Karolinska Institute, Stockholm, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Marions
authors.affiliation: Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, P.O Box 49, Entebbe, Uganda.|London School Hygiene and Tropical Medicine, London, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Seeley
authors.affiliation: Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, P.O Box 49, Entebbe, Uganda.|London School Hygiene and Tropical Medicine, London, UK.
authors.forename: Anatoli
authors.initials: A
authors.lastname: Kamali
authors.affiliation: Department of women's and children's Health, Karolinska Institute, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Smedman
mesh_terms: D000028:Abortion, Induced / Q000639:trends*; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008423:Maternal Age; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D011295:Prenatal Care / Q000639:trends; D012307:Risk Factors; D012424:Rural Population / Q000639:trends*; D050497:Stillbirth / Q000453:epidemiology*; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult