title: The effect of prenatal and intrapartum care on the stillbirth rate among women in rural Ethiopia.
abstract: OBJECTIVE
  To determine whether community-based prenatal and intrapartum care in Ethiopia results in a lower stillbirth rate.
  
  
  METHODS
  Between May and December 2014, a randomly selected sample of women in northern and eastern Ethiopia who had delivered a neonate in the preceding 12months completed a face-to-face survey about their experiences of maternal services and the fetal outcome for each delivery. The stillbirth rates among women delivering at home and at health facilities were compared.
  
  
  RESULTS
  Overall, 4442 women completed surveys. Stillbirth was reported by 42 (1.7%) of the 2437 women who had received prenatal care and 53 (2.8%) of the 1921 women who did not receive prenatal care (P=0.01). The stillbirth rate was similar among women who delivered in a health center (27/1417 [1.9%]), in a hospital (6/126 [4.8%]), and at home (62/2725 [2.3%]; P=0.13). However, women experiencing an intrapartum emergency were twice as likely to deliver in a health facility (odds ratio 2.6, 95% confidence interval 2.2-3.0). Satisfaction with health-center care was moderately good (median score 77.5/100).
  
  
  CONCLUSIONS
  The stillbirth rate was reduced among women receiving prenatal care, although delivering in a health facility did not reduce the risk of stillbirth. Improving the quality of health-center care could lead to their planned use for childbirth, which might reduce stillbirth rates.
authors.affiliation: Hamlin Fistula Ethiopia, Addis Ababa Fistula Hospital, Addis Ababa, Ethiopia. Electronic address: k.ballard@surrey.ac.uk.
authors.forename: Karen
authors.initials: K
authors.lastname: Ballard
authors.affiliation: Hamlin Fistula Ethiopia, Addis Ababa Fistula Hospital, Addis Ababa, Ethiopia.
authors.forename: Zelalem
authors.initials: Z
authors.lastname: Belete
authors.affiliation: Hamlin Fistula Ethiopia, Addis Ababa Fistula Hospital, Addis Ababa, Ethiopia.
authors.forename: Hirut
authors.initials: H
authors.lastname: Kinfu
authors.affiliation: Hamlin Fistula Ethiopia, Addis Ababa Fistula Hospital, Addis Ababa, Ethiopia.
authors.forename: Mebkyou
authors.initials: M
authors.lastname: Tadesse
authors.affiliation: Hamlin Fistula Ethiopia, Addis Ababa Fistula Hospital, Addis Ababa, Ethiopia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Amin
authors.affiliation: Hamlin Fistula Ethiopia, Addis Ababa Fistula Hospital, Addis Ababa, Ethiopia.
authors.forename: Habtamu
authors.initials: H
authors.lastname: Atnafu
mesh_terms: D000328:Adult; D003153:Community Health Services; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005002:Ethiopia; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Basic emergency obstetric and newborn care; Ethiopia; Health facility delivery; Prenatal care; Satisfaction with care; Stillbirth