Factors associated with stillbirth in four selected hospital maternity units: an unmatched case-control study in Eswatini.

BACKGROUND: Stillbirth is a substantially under-recognized adverse pregnancy outcome that predominantly occurs in low-middle-income countries. In 2019, Eswatini's stillbirth rate was 13.2 per 1,000 births, higher than global targets. However, there is limited research on stillbirths in Eswatini. This study analyzed factors associated with stillbirths among women giving birth in four selected hospitals. METHODS: A multi-center unmatched case-control study was conducted using secondary data sources from July 1 to December 31, 2021. Birth records of 268 stillbirths (cases) and 1,151 live births (controls) were selected using consecutive and systematic random sampling, respectively. A piloted data extraction tool was used to extract data. Logistic regression (p < .05, 95% CI) was used to estimate crude and adjusted odds ratios for factors associated with stillbirths, with the final model developed through backward selection. RESULTS: Factors highly significant and strongly associated with stillbirths (p ˂0.001) included lack of iron and folic acid supplementation (aOR = 2.32; CI = 1.50-3.5), positive rapid plasma regain test (aOR = 7.30; CI = 2.39-22.29), hypertensive disorders of pregnancy (aOR = 3.49; CI = 1.99-6.09), antepartum hemorrhage (aOR = 17.04; CI = 4.53-64.09) birth before arrival (aOR = 1.87; CI = 1.75-2.51), meconium-stained liquor grade II (aOR = 11.42; CI = 4.30-30.35), and fetal complications (aOR = 3.17; CI = 1.99-5.11). Other significant factors include alcohol consumption, having eight or more antenatal care visits, abnormal amniotic fluid volume, use of traditional remedies, gestational diabetes, and anemia. CONCLUSION: Stillbirth remains a significant public health burden in Eswatini, with key associated factors that are preventable, highlighting critical gaps in antenatal care. Therefore, strengthening routine screening, and integrated maternal health services offers a cost-effective strategy to reduce stillbirth rates and improve outcomes.