Background: Perinatal mortality is a major public health problem, particularly in developing countries where three quarters of neonatal deaths happen in the first week of life. Therefore, it is crucial to understand factors associated with perinatal mortality in order to design strategies and interventions that will improve newborn outcomes. Methods: A prospective cohort study was carried out, whereby pregnant women with gestational age ≥ 28 weeks were enrolled. Interviews were conducted during antenatal booking using structured questionnaire. Follow-up visits were made within 48 hours after delivery and on seventh day post delivery. Results: A total of 959 pregnant women were enrolled; 38 were lost to follow-up prior delivery. The remaining 921 participants, resulting in PMR of 45.5 per 1000 births. Over half of the deaths were stillbirths (SBR 29.6 per 1000 births) and early neonatal deaths (ENMR 16.8 per 1000 live births). Using Generalized Linear Model (GLM), risk factors associated with perinatal mortality included: maternal age ≥ 35 years (ARR 3.0, 95% CI: 1.0 to 9.0), nulliparous women (ARR 4.2, 95% CI: 1.6 to 11.1), assisted vaginal delivery (ARR 5.1, 95% CI: 1.4 to 19.0), home delivery (ARR 3.3, 95% CI: 1.6 to 6.6), previous newborn death (ARR 4.0, 95% CI: 1.5 to 10.1), pregnancy-induced hypertension (ARR 4.8, 95% CI: 2.4 to 9.4), herbal use during labour (ARR 2.4, 95% CI: 1.2 to 5.1) and newborn asphyxia (ARR 5.9, 95% CI: 1.3 to 26.5). Conclusions: Perinatal mortality was found to be high in Zanzibar. Healthcare providers should pay special attention to women with pregnancy-induced hypertension and nulliparous women throughout pregnancy and delivery. However, home delivery and use of herbs during labour should be discouraged.
KeywordsPerinatal MortalityStillbirthEarly Neonatal Death
United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME) (2015) Levels & Trends in Child Mortality. Report 2015. United Nations Children’s Fund, New York.
United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME) (2014) Levels & Trends in Child Mortality. Report 2014. United Nations Children’s Fund, New York.
Ministry of Health and Social Welfare (2008) The National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania 2008-2015. Ministry of Health and Social Welfare, Dar es Salaam.
National Bureau of Statistics and ICF Macro (2016) Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) 2015-16. National Bureau of Statistics and ICF, Dar es Salaam.
Lund, S., Rasch, V., Hemed, M., Boas, I.M., Said, A., Said, K., et al. (2014) Mobile Phone Intervention Reduces Perinatal Mortality in Zanzibar: Secondary Outcomes of a Cluster Randomized Controlled Trial. Journal of Medical Internet Research—JMIR Mhealth Uhealth, 2, e15. https://doi.org/10.2196/mhealth.2941
Ministry of Health and Social Welfare (MoHSW) (2008) Road Map to Accelerate the Reduction of Maternal, Newborn and Child Mortality in Zanzibar (2008-2015). Ministry of Health and Social Welfare, Zanzibar.
National Bureau of Statistics (NBS) (2013) The 2012 Population and Housing Census, Age and Sex Distribution Report. National Bureau of Statistics, Dar es Salaam.
Schmiegelow, C., Minja, D., Oesterholt, M., Pehrson, C., Suhrs, H.E., Bostrom, S., et al. (2012) Factors Associated with and Causes of Perinatal Mortality in Northeastern Tanzania. Acta Obstetricia et Gynecologica Scandinavica, 91, 1061-1068. https://doi.org/10.1111/j.1600-0412.2012.01478.x
Mmbaga, B.T., Lie, R.T., Olomi, R., Mahande, M.J., Olola, O. and Daltveit, A.K. (2012) Causes of Perinatal Death at a Tertiary Care Hospital in Northern Tanzania 2000-2010: A Registry Based Study. BMC Pregnancy Childbirth, 12, 139.
Yerebasmaz, N., Akdag, D.C., Ozdemirci, S., Erturk, S. and Kayikcioglu, F. (2016) Does Advanced Maternal Age Increase the Risk of Adverse Perinatal Outcomes? Acta Medica, 5, 23-29.
Muganyizi, P.S. and Balandya, B. (2013) Pregnancy Outcomes in the Extremes of Reproductive Age: A Seven-Year Experience in Tanzania. Open Journal of Obstetrics and Gynecology, 3, 51-57. https://doi.org/10.4236/ojog.2013.31012
Mutz-Dehbalaie, I., Scheier, M., Jerabek-Klestil, S., Brantner, C., Windbichler, G.H., Leitner, H., et al. (2014) Perinatal Mortality and Advanced Maternal Age. Gynecologic and Obstetric Investigation, 77, 50-57. https://doi.org/10.1159/000357168
Nankabirwa, V., Tumwine, J.K., Tylleskar, T., Nankunda, J. and Sommerfelt, H. (2011) Perinatal Mortality in Eastern Uganda: A Community Based Prospective Cohort Study. PLoS ONE, 6, e0019674. https://doi.org/10.1371/journal.pone.0019674
Bashir, A.O., Ibrahim, G.H., Bashier, I.A. and Adam, I. (2013) Neonatal Mortality in Sudan: Analysis of the Sudan Household Survey, 2010. BMC Public Health, 13, 287. https://doi.org/10.1186/1471-2458-13-287
Kozuki, N., Lee, A.C.C., Silveira, M.F., Sania, A., Vogel, J.P., Adair, L., et al. (2013) The Associations of Parity and Maternal Age with Small-for-Gestational-Age , Preterm, and Neonatal and Infant Mortality: A Meta-Analysis. BMC Public Health, 13, S2. https://doi.org/10.1186/1471-2458-13-S3-S2
Onwudiegwu, U. and Awowole, I. (2012) Current Trends in Perinatal Mortality in Developing Countries: Nigeria as a Case Study, Perinatal Mortality. https://doi.org/10.5772/32328 https://www.intechopen.com/books/perinatal-mortality/current-trends-in-perinatal-mortality-in-developing-countries-nigeria-as-a-case-study
Tachiweyika, E., Gombe, N., Shambira, G., Chadambuka, A., Mufuta, T., Zizhou, S., et al. (2011) Determinants of Perinatal Mortality in Marondera District, Mashonaland East Province of Zimbabwe, 2009: A Case Control Study. Pan African Medical Journal, 8, 7. https://doi.org/10.4314/pamj.v8i1.71054
Nakimuli, A., Mbalinda, S.N., Nabirye, R.C., Kakaire, O., Nakubulwa, S., Osinde, M.O., et al. (2015) Still Births, Neonatal Deaths and Neonatal near Miss Cases Attributable to Severe Obstetric Complications: A Prospective Cohort Study in Two Referral Hospitals in Uganda. BMC Pediatrics, 15, 44.
Musooko, M., Kakaire, O., Nakimuli, A., Nakubulwa, S., Nankunda, J., Osinde, M.O., et al. (2014) Incidence and Risk Factors for Early Neonatal Mortality in Newborns with Severe Perinatal Morbidity in Uganda. International Journal of Gynecology & Obstetrics, 127, 201-205. https://doi.org/10.1016/j.ijgo.2014.05.017
Berhan, Y. and Berhan, A. (2014) A Meta-Analysis of Social-Demographic Factors for Perinatal Mortality in Developing Countries: A Subgroup Analysis of the National Surveys and Small Scale Studies. Ethiopian Journal of Health Scie, 24, 41-54. https://doi.org/10.4314/ejhs.v24i0.5S
National Bureau of Statistics and ICF Macro (2011) Tanzania Demographic and Health Survey 2010. National Bureau of Statistics and ICF Macro, Dar es Salaam.
Mahande, M.J., Daltveit, A.K., Mmbaga, B.T., Obure, J., Masenga, G., Manongi, R., et al. (2013) Recurrence of Perinatal Death in Northern Tanzania: A Registry Based Cohort Study. BMC Pregnancy Childbirth, 13, 166. https://doi.org/10.1186/1471-2393-13-166
Mpembeni, R., Jonathan, R. and Mughamba, J. (2014) Perinatal Mortality and Associated Factors among Deliveries in Three Municipal Hospitals of Dar Es Salaam, Tanzania. Journal of Pediatrics and Neonatal Care, 1, 4.
Yirgu, R., Molla, M., Sibley, L. and Gebremariam, A. (2016) Perinatal Mortality Magnitude, Determinants and Causes in West Gojam: Population-Based Nested Case-Control Study. PLoS ONE, 11, e0159390. https://doi.org/10.1371/journal.pone.0159390
Allanson, E., Muller, M. and Pattinson, R. (2015) Causes of Perinatal Mortality and Associated Maternal Complications in a South African Province: Challenges in Predicting Poor Outcomes. BMC Pregnancy Childbirth, 15, 37. https://doi.org/10.1186/s12884-015-0472-9
Chinkhumba, J., Allegri, M., Muula, A. and Robberstad, B. (2014) Maternal and Perinatal Mortality by Place of Delivery in Sub-Saharan Africa: A Meta-Analysis of Population-Based Cohort Studies. BMC Public Health, 14, 1014. https://doi.org/10.1186/1471-2458-14-1014
Habte, F. and Demissie, M. (2015) Magnitude and Factors Associated with Institutional Delivery Service Utilization among Childbearing Mothers in Cheha District, Gurage Zone, SNNPR, Ethiopia: A Community Based Cross Sectional Study. BMC Pregnancy Childbirth, 15, 299. https://doi.org/10.1186/s12884-015-0716-8
Ramasubramaniam, S., Renganathan, L., Vijayalakshmi, G. and Mallo-Banatao, M. (2015) Use of Herbal Preparations among Parturient Women: Is There Enough Evidence—A Review of Literature. International Journal of Herbal Medicine, 2, 20-26.
Mothupi, M. (2014) Use of Herbal Medicine during Pregnancy among Women with Access to Public Healthcare in Nairobi, Kenya: A Cross-Sectional Survey. BMC Complementary and Alternative Medicine, 14, 432. https://doi.org/10.1186/1472-6882-14-432
Rasch, V., Sorensen, P., Wang, A., Tibazarwa, F. and Jager, A. (2014) Unsafe Abortion in Rural Tanzania—The Use of Traditional Medicine from a Patient and a Provider Perspective. BMC Pregnancy Childbirth, 14, 419.
Ernst, E. (2002) Herbal Medicinal Products during Pregnancy: Are They Safe? BJOG: An International Journal of Obstetrics & Gynaecology, 109, 227-235. https://doi.org/10.1111/j.1471-0528.2002.t01-1-01009.x
Mmbaga, B.T., Lie, R.T., Olomi, R., Mahande, M.J., Kvale, G. and Daltveit, A.K. (2012) Cause-Specific Neonatal Mortality in a Neonatal Care Unit in Northern Tanzania: A Registry Based Cohort Study. BMC Pediatrics, 12, 116. https://doi.org/10.1186/1471-2431-12-116
Yego, F., Williams, J.S., Byles, J., Nyongesa, P., Aruasa. W. and D’Este, C. (2013) A Retrospective Analysis of Maternal and Neonatal Mortality at a Teaching and Referral Hospital in Kenya. Reproductive Health, 10, 13.
Siddalingappa, H., Murthy, N., Kulkarni, P. and Ashok, N. (2013) Prevalence and Factors Influencing Perinatal Mortality in Rural Mysore, India. Journal of Clinical and Diagnostic Research, 7, 2796-2799.