title: Trends and risk factors of stillbirths and neonatal deaths in Eastern Uganda (1982-2011): a cross-sectional, population-based study.
abstract: To identify mortality trends and risk factors associated with stillbirths and neonatal deaths 1982-2011.
  
  
  
  Population-based cross-sectional study based on reported pregnancy history in Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda. A pregnancy history survey was conducted among women aged 15-49 years living in the HDSS during May-July 2011 (n = 10 540). Time trends were analysed with cubic splines and linear regression. Potential risk factors were examined with multilevel logistic regression with adjusted odds ratios (AOR) and 95% confidence intervals (CI).
  
  
  
  34 073 births from 1982 to 2011 were analysed. The annual rate of decrease was 0.9% for stillbirths and 1.8% for neonatal mortality. Stillbirths were associated with several risk factors: multiple births (AOR 2.57, CI 1.66-3.99), previous adverse outcome (AOR 6.16, CI 4.26-8.88) and grand multiparity among 35- to 49-year-olds (AOR 1.97, CI 1.32-2.89). Neonatal deaths were associated with multiple births (AOR 6.16, CI 4.80-7.92) and advanced maternal age linked with parity of 1-4 (AOR 2.34, CI 1.28-4.25) and grand multiparity (AOR 1.44, CI 1.09-1.90). Education, marital status and household wealth were not associated with the outcomes.
  
  
  
  The slow decline in mortality rates and easily identifiable risk factors calls for improving quality of care at birth and a rethinking of how to address obstetric risks, potentially a revival of the risk approach in antenatal care.
authors.affiliation: Department of Public Health Sciences - Global Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Sanni
authors.initials: S
authors.lastname: Kujala
authors.affiliation: Department of Public Health Sciences - Global Health, Karolinska Institutet, Stockholm, Sweden.|Maternal and Newborn Centre of Excellence, Makerere University School of Public Health, Kampala, Uganda.|The INDEPTH Network Maternal and Newborn Working Group, Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda.
authors.forename: Peter
authors.initials: P
authors.lastname: Waiswa
authors.affiliation: The INDEPTH Network Maternal and Newborn Working Group, Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda.|Mental Health Program, Clinical Services Division, Ministry of Health, Kampala, Uganda.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kadobera
authors.affiliation: Maternal and Newborn Centre of Excellence, Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Akuze
authors.affiliation: The INDEPTH Network Maternal and Newborn Working Group, Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda.|Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: George
authors.initials: G
authors.lastname: Pariyo
authors.affiliation: Department of Public Health Sciences - Global Health, Karolinska Institutet, Stockholm, Sweden.|Faculty of Infectious & Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Claudia
authors.initials: C
authors.lastname: Hanson
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D016015:Logistic Models; D008423:Maternal Age; D008875:Middle Aged; D016017:Odds Ratio; D010298:Parity; D066087:Perinatal Death; D011247:Pregnancy; D011272:Pregnancy, Multiple; D012307:Risk Factors; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology*; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
keywords: Ouganda; Uganda; décès périnatal; embarazo; epidemiologic factors; facteurs épidémiologiques; factores epidemiológicos; grossesse; histoire de la reproduction; historia reproductiva; mortinaissance; mortinato; muertes perinatales; perinatal death; pregnancy; reproductive history; stillbirth