Indian J l'ediatr 1992; 59 : 455-4(71

Risk Factors for Stillbirths in a Rural Community Rajesh Kumar and Sunit Singhi*

Dq)amnozt oJ"Community Mcdichze and *Pediatrics, Post Graduate hlstitute of Medical Education and Research, Cl~andigarh To determine the risk factors for stillbirth, a case-control study was carried out in a rural community of Haryana. Stillbirths (cases) were identified retrospectively from a household survey, while the controls, matched individually with each case for the month of birth, were live born infants from the same neighbourhood as the case. The stillbirth rate in the study population was 26.8 per 1000 (68/2539) births. The distribution of socio-economic and environmental factors was similar in the cases and the controls (P > 0.05). Multivariate analysis indicated higher risk of stillbirth for first order births (Odds Ratio [OR] 7.9, Confidence Interval [CI] 2.1-29.2, P 0.002), history of prior stillbirths/child deaths (OR 15.2, CI 2.3-98.2, P 0.004), and absence of antenatal care (OR 3.3, CI 0.9-14.3, P 0.07). Mothers' age, birth interval ( 28 weeks) of gestation 15. A total of 2,539 live births and 68 stillbirths were reported in the one year period (stillbirth rate 26.8/1000 births). Parents of 64 cases were available for the detailed study. Controls, individually matched with the cases for the month of birth, were selected from the live born infants in the same neighbourhood as that of the case. A detailed structured questionnaire was prepared on various socio-economic, environmental, maternal and health care practices which were considered as likely risk factors for stillbirlh, and was pre-tested. The parents of the case and control infant were interviewed by medical doctors who were trained in the method of conducting interview and in filling the questionnaire in actual field sclling. One of the authors (SS) accompanied each interviewer at random to ensure quality control. Statistical metbods as applicable to matched case-control studies were used ~6. Odds ratio (OR) were estimated by using the discordant pairs of the case-control set (ratio of the number of 'exposed' cases with 'unexposed' controls and the number of 'unexposed' cases with 'exposed' controls). Exact 95% Confidence Interval (CI) for OR

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are based on binomial probabilities. For hypothesis testing normal approximate to binomial distribution (McNemar's test for matched pairs) was used when number of discordant pairs was 20 or more, otherwise exact test based upon binomial distribution was used. Multivariate analysis was carried out by using Epidemiological Graphics Estimation and Testing (EGRET) package ~7. Conditional logistic model was used to estimate effect of the variable of primary interest. The model was extended to include other potential confounding variables, one at a time. Likelihood ratio test was used to test the statistical significance of the model. The variables which did not vary the estimate significantly were excluded from the model. RESULTS As shown in Table 1, majority of the cases and controls were from lower caste and lived in 'kutcha' house. Parental illiteracy was common. Most of them were labourers. About three quarters of the families had access to safe drinking water and about two third used soap for personal cleanliness. None of these socio-economic and environmental variables had a significant influence on the risk of stillbirth (Table 1). The distribution of maternal and health care factors and their odds ratio for stillbirth are presented in Table 2. The odds for stillbirth were significantly higher among women aged more than 29 years as compared to 20-29 year olds, butrisk was not significantly higher in women below 20 years. The risk was also significantly higher in first order (p

Risk factors for stillbirths in a rural community.

To determine the risk factors for stillbirth, a case-control study was carried out in a rural community of Haryana. Stillbirths (cases) were identifie...
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