WHO, stillbirths and 60% occurred in rural

WHO, for international comparison defines Stillbirth as a baby born with no signs of life at or after 28 weeks’ gestation. Stillbirths are  more  common than the  death of a  baby  after birth  and remains a  serious public  health issue  in the  developing  world. In 2015 there were 2.6 million stillbirths globally, with more than 7178 deaths a day. The greater part of these deaths occurred in developing countries with ninety-eight percent occurring in low- and middle-income countries. South Asia and sub-Saharan Africa accounted for three-fourths of the stillbirths and 60% occurred in rural families from these areas(Two-thirds of the 2.6 million stillbirths, were in Africa). This mirrors a similar distribution of maternal deaths with stillbirth rate in sub-Saharan Africa roughly 10 times that of developed countries (29 vs. 3 per 1000 births).The estimated 2·6 million yearly stillbirths (WHO definition: foetal death at ?1000 g or ?28 weeks’ gestation) were however, excluded in the MDGs and remain invisible. These stillborn babies are also not included in global tracking mechanisms, for example ,the Global Burden of Disease study, routinely reported to the UN from vital registration, or routinely measured in Demographic and Health Surveys or UNICEF’s Multiple Indicator Cluster Survey. Inability to count stillbirths ignores their impact on women and families, and prompts underestimation of the advantages of investments in maternity care. As the MDG era comes to an end, the health policy focus beyond 2015, is widening beyond survival to include wellbeing and human capital, the increasing importance of disability, non-communicable diseases (NCDs) and mental health, and the links between environment and health. Neither stillbirths nor neonatal deaths surprisingly , are mentioned in post-2015 documents.Recent estimates demonstrate that stillbirths pose an immense burden to countries and health systems, especially in developing countries. The estimated numbers of stillbirths are reported to be greater than that for many other conditions high on the global agenda, including HIV/AIDS; intrapartum stillbirths alone exceed global child deaths resulting from malaria.Lawn (2011) listed maternal infections in pregnancy notably syphilis, maternal conditions especially hypertension and diabetes, as part of the global “big five” causes of stillbirths with other diverse causes and risk factors existing in different geographical locations.  In Africa, Nigeria, The Democratic Republic of Congo, Ethiopia and Tanzania are amongst the countries with high still birth rates of about 180 per 1000 deliveries (Okeudo et al., 2012).Stillbirths are not routinely and adequately recorded and monitored in Ghana. Evaluation of stillbirth rates from various reviews in Ghana range from around 14 to 22 per 1000 births (Cousens et al., (2009), with higher rates from demographic surveillance and health facility data in different parts of the country—e.g., 23 stillbirths ?1000 births for Navrongo and its environs in the Upper East region, 32 stillbirths/1000 births for a rural district in the Brong Ahafo region, to 59 stillbirths/1000 vaginal deliveries in a tertiary health facility. Engmann et al., (2012) found high rate of stillbirth among perinatal mortalities in the Upper East of Ghana using the Navrongo Health and Demographic Surveillance System (NHDSS) Database. Tamale Metropolitan area, within Northern Ghana recorded a sharp increase in stillbirth rates in the past four years with Kumbungu District ranking first (DHIS2, Northern Region, Ghana Health Service, 2012). Not very many studies have analysed factors associated with birth outcomes in Ghana, and none depended on national data. These studies also, while speculating that quality of maternal health services may be contributing to differential outcomes for birth, mostly do not examine these effects. The rate of stillbirth increased from 1.9% in 2011 to 2% in 2012 (Ghana Health Service Annual Report, 2012) with stillbirth rates prevalent in northern Ghana as a result of inequitable distribution of health resources. Although, the causes are to a great extent unknown, majority of these causes are believed to be preventable and a strong knowledge based foundation of the causes of stillbirths will reduce the high rates in the Tamale Metropolitan area.In any case, Stillbirth are  a huge burden to women and their families. The grief and distress experienced by women with stillbirths is alarming, and depression or despondency felt by mothers and families when a stillbirth occurs may surpass that associated with a neonatal death. Social taboos, particularly in developing settings like Ghana, may however prevent women from openly grieving the loss of a foetus. Notwithstanding the grief and stigma attached to a stillbirth, there are other costs to parent(s), families and society. These costs are both direct – a stillbirth costs 10-70% more than a live birth with funeral costs generally being passed on to parent(s) and lost income from time taken off work; and indirect due to significantly reduced work productivity. (Lancet, 2016)Around the world, the number of stillbirths has declined by 19.4% between 2000 and 2015, speaking to a yearly rate of reduction of 2%. This decrease noted for stillbirths is lower than that noted for maternal mortality ratio  and under 5 death rate for the same period.Generally,the cause of stillbirth remains unknown but about half of all stillbirths occur in the intrapartum period, representing the greatest time of risk and about Half of stillbirths happen during labor as a result of preventable conditions, notably syphilis and malaria. Also maternal factors such as smoking, alcohol use, diabetes, multi-parity ,extreme maternal age, placental abruption, antepartum haemorrhage and infection during pregnancy have been cited as risk factors for stillbirths. Foetal factors like congenital malformation, birth asphyxia, growth restriction, and prolonged/ obstructed labor. Accordingly, certain interventions have been reported to reduce the incidence of stillbirth, such as antenatal ultrasound, infection management, and micronutrient supplementation to mention a few. At present rates of progress, it will be 160 years until a woman in Africa and Ghana for that matter,to have the same chance of her baby being born alive as a woman in a high-income country