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dc.contributor.authorChristou, Aliki
dc.contributor.authorDibley, Michael J.
dc.contributor.authorRasooly, Mohammad Hafiz
dc.contributor.authorMubasher, Adela
dc.contributor.authorHofiani, Sayed Murtaza Sadat
dc.contributor.authorRashidi, Mohammad Khakerah
dc.contributor.authorKelly, Patrick J.
dc.contributor.authorRaynes-Greenow, Camille
dc.date.accessioned2021-02-02T02:51:45Z
dc.date.available2021-02-02T02:51:45Z
dc.date.issued2018en_AU
dc.identifier.urihttps://hdl.handle.net/2123/24402
dc.description.abstractBackground: Stillbirth rates in Afghanistan have declined little in the past decade with no data available on key risk factors. Health care utilisation and maternal com- plications are important factors influencing pregnancy outcomes but rarely captured for stillbirth in national surveys from low‐ and middle‐income countries. The 2010 Afghanistan Mortality Survey (AMS) is one of few surveys with this information. Methods: We used data from the 2010 AMS that included a full pregnancy history and verbal autopsy. Our sample included the most recent live birth or stillbirth of 13 834 women aged 12‐49 years in the three years preceding the survey. Multivariable Poisson regression was used to identify sociodemographic, maternal, and health care utilisation risk factors for stillbirth. Results: The risk of stillbirth was increased among women in the Central Highlands (aRR: 3.01, 95% CI 1.35, 6.70) and of Nuristani ethnicity (aRR: 9.15, 95% CI 2.95, 28.74). Women who did not receive antenatal care had three times increased risk of stillbirth (aRR: 3.03, 95% CI 1.73, 5.30), while high‐quality antenatal care was impor- tant for reducing the risk of intrapartum stillbirth. Bleeding, infection, headache, and reduced fetal movements were antenatal complications strongly associated with stillbirth. Reduced fetal movements in the delivery period increased stillbirth risk by almost seven (aRR: 6.82, 95% CI 4.20, 11.10). Facility births had a higher risk of still- births overall (aRR: 1.55, 95% CI 1.12, 2.16), but not for intrapartum stillbirths. Conclusions: Targeted interventions are needed to improve access and utilisation of services for high‐risk groups. Early detection of complications through improved quality of antenatal and obstetric care is imperative. We demonstrate the potential of household surveys to provide country‐specific evidence on stillbirth risk factors for LMICs where data are lacking.en_AU
dc.language.isoenen_AU
dc.publisherWileyen_AU
dc.relation.ispartofPaediatric and Perinatal Epidemiologyen_AU
dc.subjectstillbirthen_AU
dc.subjectfetal deathen_AU
dc.subjectperinatal deathen_AU
dc.subjectAfghanistanen_AU
dc.subjectrisk factorsen_AU
dc.subjecthousehold surveyen_AU
dc.subjectlow- and middle-income countryen_AU
dc.subjectdemographic and health surveyen_AU
dc.titleUnderstanding country-specific determinants of stillbirth using household surveys: The case of Afghanistanen_AU
dc.typeArticleen_AU
dc.identifier.doi10.1111/ppe.12530
dc.rights.other"This is the peer reviewed version of the following article: Christou, A, Dibley, MJ, Rasooly, MH, et al. Understanding country‐specific determinants of stillbirth using household surveys: The case of Afghanistan. Paediatr. Perinat. Epidemiol.. 2019; 33: 28– 44, which has been published in final form at https://doi.org/10.1111/ppe.12530. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions."en_AU
usyd.facultySeS faculties schools::Faculty of Medicine and Health::Sydney School of Public Healthen_AU
usyd.citation.volume33en_AU
usyd.citation.spage28en_AU
usyd.citation.epage44en_AU
workflow.metadata.onlyNoen_AU


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