Effect of Socioeconomic Deprivation and Health Service Utilisation on Antepartum and Intrapartum Stillbirth Population Cohort Study from Rural Ghana 英文参考文献.docVIP

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Effect of Socioeconomic Deprivation and Health Service Utilisation on Antepartum and Intrapartum Stillbirth Population Cohort Study from Rural Ghana 英文参考文献.doc

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Effect of Socioeconomic Deprivation and Health Service Utilisation on Antepartum and Intrapartum Stillbirth Population Cohort Study from Rural Ghana 英文参考文献

EffectofSocioeconomicDeprivationandHealthService UtilisationonAntepartumandIntrapartumStillbirth: PopulationCohortStudyfromRuralGhana YoonheeP.Ha1,LisaS.Hurt1,CharlotteTawiah-Agyemang2,BettyR.Kirkwood1,KarenM.Edmond3* 1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom, 2Kintampo Health Research Centre, Kintampo,BrongAhafo,Ghana,3SchoolofPaediatricsandChildHealth,UniversityofWesternAustralia,Perth,WesternAustralia,Australia Abstract Background:Nostudieshaveexaminedtheeffectofsocioeconomicdeprivationonantepartumandintrapartumstillbirths inthepoorestwomeninlowincomecountries. Methodology/PrincipalFindings:Thisstudyuseddatafromaprospectivepopulationbasedsurveillancesysteminvolving allwomenofchildbearingageandtheirbabiesinruralGhana.Theprimaryobjectivewastoevaluateassociationsbetween householdwealthandrisk ofantepartum andintrapartum stillbirth.The secondaryobjective wastoassess whetherany differencesinriskweremediatedbyutilisationofhealthservicesduringpregnancy.Datawereanalysedusingmultivariable logistic regression. Random effect models adjusted for clustering of women who delivered more than one infant. There were80267babiesdeliveredfrom1July2003to30September2008:77666livebirthsand2601stillbirths.Ofthestillbirths 1367(52.6%)wereantepartum,989(38.0%)wereintrapartumand245(9.4%)hadnodataonthetimingofdeath.94.8%of thebabiesborninthestudy(76129/80267)hadcompletedataonallcovariatesandoutcomes.36878(48.4%)ofbabies were born to women in the two poorest quintiles and 3697 (4.9%) had no pregnancy care. There was no association betweenwealthandantepartumstillbirths.Therewasamarked‘doseresponse’ofincreasingriskofintrapartumstillbirth with increasing levels of socioeconomic deprivation (adjOR 1.09 [1.03–1.16] p value 0.002). Women in the poorest two quintileshadgreaterriskofintrapartumstillbirth(adjOR1.19[1.02–1.38]pvalue0.023)comparedtotherichestwomen. Adjustingforheathserviceutilisationandothervariablesdidnota