Factors associated with perinatal mortality in Umguza and Bubi rural areas, 2015- the effect of maternal human immunodeficiency virus status.
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Introduction: The perinatal mortality rate (PMR) is used as a proxy for the quality of maternal and child health care services accessible to women during pregnancy, delivery and the postnatal period. The PMR increased from 8.9 to 33 deaths and 21to 23 deaths per 1000 live births in Umguza and Bubi districts between the years 2010- 2014. The study seeks to understand the determinants of perinatal mortality in the two districts so that appropriate measures can be put in place. Methods: An unmatched 1:2 case control study was conducted using a pretested interviewer administered questionnaire. A total of 73 cases and 146 controls were recruited in the study. A case was a woman who resided in Umguza and Bubi districts who had a perinatal death from January 2014 to June 2015. A control was a woman who resided in Umguza and Bubi Districts whose baby survived the early neonatal period from January 2014 to June 2015. Two focused group discussions (FGD) were done one in each district using the FGD guide. The FGD consisted of 12 women for Bubi and nine women for Umguza district. Results: The median age of cases and controls was 22years (Q1=19; Q3=29) and 23 years (Q1=19.5; Q3=28) respectively.Gestational age of < 36 weeks OR 8.28 (3.67; 96.6), having a male baby OR 1.4 (1.09; 2.88), low birth weight of <2500g OR 1.37 (1.27; 6.96) and no antenatal care booking OR 24.6 (2.67;226.3) were independent risk factors for perinatal mortality. Antenatal booking OR 0.30 (0.14; 0.65) and secondary education were protective factors against perinatal deaths. Women’s cultural believes and poor nurse attitudes, resource shortages and patient delays were cited as contributory to perinatal mortality. Conclusion: Gestational age of less than 36 weeks, not attending antenatal care, having a male baby and low birth weight were risk factors. The majority of perinatal deaths were macerated. Having early neonatal deaths occurring during the first 24 hours after delivery might be indicative of the quality of neonatal care provided.