Community-based stillbirth rates and risk factors in rural Sarlahi, Nepal

Objective: To assess stillbirth rates and antepartum risk factors in rural Nepal. Methods: Data were collected prospectively during a cluster-randomized, community-based trial in Sarlahi. Nepal, from 2002 to 2006. Multivariate regression modeling was performed to calculate adjusted relative risk estimates. Results: Among 24 531 births, the stillbirth rate was 35.4 per 1000 births (term stillbirth rate 21.2 per 1000 births). Most births occurred at home without a skilled birth attendant. The majority (69%) of intrapartum maternal deaths resulted in stillbirth. The adjusted RR (aRR) of stillbirth was 2.74 among nulliparas and 1.47 among mothers with history-of a child death. Mothers above the age of 30 years carried a 1.59-fold higher risk for stillbirth than mothers who were 20-24 years old. The stillbirth risk was lower among households where the father had any formal education (aRR 0.70). Land ownership (aRR 0.85) and Pahadi ethnicity (aRR 0.67; reference: Madhesi ethnicity) were associated with significantly lower risks of stillbirth. Conclusion: Stillbirth rates were high in rural Nepal, with the majority of stillbirths occurring at full-term gestation. Nulliparity, history of prior child loss, maternal age above 30 years, Madhesi ethnicity, and socioeconomic disadvantage were significant risk factors for stillbirth. Clinicaltrials.gov NCT00 109616 (C) 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.