Still birth in a tertiary health facility in Enugu state South-East Nigeria: a hidden tragedy


  • Hope O. Nwoga Department of Community Medicine, Enugu State University Teaching Hospital Parklane, Enugu, Nigeria
  • Miriam O. Ajuba Department of Community Medicine, Enugu State University College of Medicine, Enugu, Nigeria
  • Chukwuma P. Igweagu Department of Community Medicine, Enugu State University College of Medicine, Enugu, Nigeria



Nigeria, Pregnancy outcome, Prevalence, Still birth


Background: Stillbirth is one of the common adverse outcomes of pregnancy that occur worldwide. The prevalence differs in different continents of the world and even within different localities in the same country. The objective of this study was to determine the prevalence and social determinants of health that affect still birth in Enugu state, Nigeria.

Methods: The study was a prospective hospital-based study conducted at the obstetrics and gynecology department of a tertiary health facility in Nigeria. All the data were retrieved from the ante natal and delivery card of all the women that delivered at the unit within the time of data collection. Data was analyzed using SPSS version 25 and variables were presented as frequencies, percentages, means, and standard deviation. Bivariate analysis was done using chi-square test. The level of significance was set at p value≤0.05.

Results: The mean age of the mothers was 29.76±4.69 while most of them were aged 21-30 years 431(56.0%). Majority of them were employed 529 (68.7%) and had tertiary education 484 (62.9%). The prevalence of still birth was 40.3 per 1000 births. Maternal age, marital status, educational levels and booking status affected the prevalence of still birth.

On logistic regression, un-booked mothers had 25 times odds of having still birth when compared to those that booked after 28 weeks gestation

Conclusions: The prevalence of still birth is high in Enugu state with un-booked mothers contributing about 88.6%. Early booking helps to detect possible complications early with timely interventions.


Ouyang F, Zhang J, Betran AP, Yang Z, Souza JP, Merialdi M. Recurrence of adverse perinatal outcomes in developing countries. Bull World Health Organ. 2013;91(5):357-67.

WHO. International Classification of Disease 10th Revision (ICD-10) 2010, 2021. Available at: 2010.pdf?ua-1. Accessed on 12 April 2021.

Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, Flenady V, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016;387(10018):587-603.

Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet. 2011;377(9774):1319-30.

Clure EM, Pasha O, Goudar SS, Chomba E, Garces A, Tshefu A, Althabe F, et al. Epidemiology of stillbirth in low-middle income countries: a Global Network Study. Acta Obstet Gynecol Scand. 2011;90(12):1379-85.

Tukur D, Alhaji AA. Stillbirth in Nigeria: Rates and Risk factors based on 2013 Nigeria DHS. Open Access Library J. 2016;3:1-12.

Goldenberg RL, Saleem S, Pasha O, Harrison MS, Mcclure EM. Reducing stillbirths in low-income countries. Acta Obstet Gynecol Scand. 2016;95(2):135-43.

Aminu M, Unkels R, Mdegela M, Utz B, Adaji S, Broek N. Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review. BJOG. 2014;121(4):141-53.

Flenady V, Koopmans L, Middleton P, Froen JF, Smith GC, Gibbons K, et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet. 2011; 377(9774):1331-40.

Manasyan A, Saleem S, Koso TM, Althabe F, Pasha O, Chomba E, Goudar SS, et al. Assessment of obstetric and neonatal health services in developing country health facilities. Am J Perinatol. 2013;30(9):787-94.

Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I, et al. Stillbirths: Where? When? Why? How to make the data count?. Lancet. 2011;377(9775):1448-63.

Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, Hogan D, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health. 2016;4(2):98-108.

Turton P, Evans C, Hughes P. Long-term psychosocial sequelae of stillbirth: phase II of a nested case-control cohort study. Arch Womens Ment Health. 2009;12(1):35-41.

Lamont K, Scott NW, Jones GT, Bhattacharya S. Risk of recurrent stillbirth: systematic review and meta-analysis. BMJ. 2015;350:3080.

WHO. Every newborn: an action plan to end preventable deaths, 2014. Available at: Accessed on 10 April 2021.

UNICEF. Hidden tragedy: Nigeria accounts for one of the highest stillbirth rates in Africa, 2020. Available at: Accessed on 16 April 2021.

Anyichie NE, Nwagu EN. Prevalence and maternal socio-demographic factors associated with stillbirth in health facilities in Anambra, South-East Nigeria. Afr Health Sci. 2019;19(4):3055-62.

Bhusal M, Gautam N, Lim A, Tongkumchum P. Factors Associated With Stillbirth Among Pregnant Women in Nepal. J Prev Med Public Health. 2019;52(3):154-60.

WHO, UNICEF, UNFPA, World Bank Group, UN Population Division. Trends in Maternal Mortality: 1990 to 2015, 2015. Available at Accessed on 21 March 2021.

Ashish KC, Nelin V, Wrammert J, Ewald U, Vitrakoti R, Baral GN, Malqvist M. Risk factors for antepartum stillbirth: a case-control study in Nepal. BMC Pregnancy Childbirth. 2015;15:146.

Asiki G, Baisley K, Newton R, Marions L, Seeley J, Kamali A, Smedman L. Adverse pregnancy outcomes in rural Uganda (1996-2013): trends and associated factors from serial cross sectional surveys. BMC Pregnancy Childbirth. 2015;15:279.

Igwegbe AO, Nwosu BO, Ugboaja JO, Monago NE. Stillbirth in a Nigerian Tertiary Hospital. Nigerian Med J. 2008; 49:74-8.

Lofwander M. Stillbirths and associations with maternal education. A registry study from a regional hospital in north eastern Tanzania. Epidemiol Commun Health. 2012;66(7):240-6.

Alhassan A, Ayikai LA, Alidu H, Yakong VN. Stillbirth and associated factors in a Peri-urban District in Ghana. J Med Biomed Sci. 2016;5(1):23-31.

Auger N, Delezire P, Harper S, Platt RW. Maternal education and stillbirth: estimating gestational-age-specific and cause-specific associations. Epidemiology. 2012;23(2):247-54.

Clure EM, Saleem S, Goudar SS, Moore JL, Garces A, Esamai F, et al. Stillbirth rates in low-middle income countries 2010- 2013: a population-based, multi-country study from the Global Network. Reprod Health. 2015;12(2):7.

Ugwa EA, Ashimi A. An assessment of stillbirths in a tertiary hospital in northern Nigeria. J Matern Fetal Neonatal Med. 2015;28(13):1585-8.

Mutihir JT, Eka PO. Stillbirths at the Jos University Teaching Hospital: incidence, risk, and etiological factors. Niger J Clin Pract. 2011;14(1):14-8.

Silver RM, Varner MW, Reddy U, Goldenberg R, Pinar H, Conway D, et al. Work-up of stillbirth: a review of the evidence. Am J Obstet Gynecol. 2007;196(5):433-44.

Goldenberg RL, Clure EM, Bann CM. The relationship of intrapartum and antepartum stillbirths rates to measures of obstetric care in developed and developing countries. Acta obstetricia et gynecologica Scandinavica. 2007;86:1303-9.






Original Research Articles