title: Predictors of stillbirths and neonatal deaths in rural western Uganda.
abstract: OBJECTIVE
  To explore pregnancy outcomes at a referral hospital in rural western Uganda.
  
  
  METHODS
  A retrospective study was undertaken using data for all deliveries at Virika Hospital, Fort Portal, Uganda, between July 1, 2009, and October 22, 2011. A detailed review of delivery logs was conducted. Categories were created for obstetric risk factors (e.g. grand multipara, history of hypertension), maternal delivery complications (e.g. eclampsia, hemorrhage), and neonatal complications (e.g. fetal distress, birth defects).
  
  
  RESULTS
  Overall, 4883 deliveries were included. Of the 517 neonates who did not survive, 430 (83.2%) had been stillborn. After controlling for parity, gestational age, obstetric risk factors, and neonatal complications, risk factors for stillbirth included maternal delivery complications (risk ratio [RR] 3.32, 95% confidence interval [CI] 2.34-4.71; P<0.001) and living 51-100km from the hospital (RR 3.37, 95% CI 2.41-4.74; P<0.001). Risk factors for neonatal death included neonatal complications (RR 5.79, 95% CI 2.49-13.46; P=0.001) and maternal delivery complications (RR 3.17, 95% CI 1.47-6.82; P=0.003).
  
  
  CONCLUSIONS
  Qualified providers need to be deployed to rural areas of Uganda to facilitate the prompt identification and management of pregnancy, delivery, and neonatal complications.
authors.affiliation: Global REACH and Departments of Learning Health Sciences and Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: camoyer@umich.edu.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Moyer
authors.affiliation: Office of Performance Assessment and Clinical Effectiveness, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Candace K
authors.initials: CK
authors.lastname: Kolars
authors.affiliation: Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Oppong
authors.affiliation: Ghana Health Service, Kumasi, Ghana.
authors.forename: Ashura
authors.initials: A
authors.lastname: Bakari
authors.affiliation: School of Public Health, University of Michigan, Ann Arbor, MI, USA.
authors.forename: April
authors.initials: A
authors.lastname: Bell
authors.affiliation: Department of Obstetrics and Gynecology, Virika Hospital, Fort Portal, Uganda.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Busingye
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D000013:Congenital Abnormalities / Q000453:epidemiology*; D003710:Demography; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010298:Parity; D054238:Perinatal Mortality / Q000639:trends*; D011247:Pregnancy; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D050497:Stillbirth / Q000453:epidemiology*; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
keywords: Complications; Neonatal death; Pregnancy outcomes; Stillbirth; Sub-Saharan Africa