Community perceptions, knowledge, and attitudes on causes of stillbirths (CPKACS)

Eso-Obaleye, Olabisi Rosemary
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Background: Stillbirth can be defined as “an infant born with no sign of life at or after twenty eight weeks gestation. Stillbirth continues to be a major pregnancy outcome with its causes remaining a huge scientific mystery. The amount of stillbirth are mostly 10 times higher in third-world countries than in first-world countries. Ninety eight percent of the stillbirths happen in third-world nations, with more than 55% happening in remote sub-Saharan Africa. Consequently, every year the world loses an estimated 2.6 million babies to stillbirth. Causes of stillbirths remain mainly unknown and rarely investigated but some studies have shown that there are risk factors that contribute to stillbirths such as prior stillbirth, low socioeconomic status, low maternal education, advanced maternal age (>35), primiparity, obesity, smoking, alcohol, and recreational drug use. In addition, clinical studies have found that there are many causes of stillbirths including maternal disease, congenital anomalies, placenta conditions, intrapartum causes and trauma, umbilical causes, amniotic and uterine causes, and other unknown causes. However, despite an enormous amount of time and resources that have been invested in trying to prevent stillbirths, the problem continues to occur unabated. Literature reveals that there is a gap in knowledge regarding other unknown causes of stillbirths. Research on community perceptions, knowledge, and attitudes on the causes of stillbirths is hugely missing. This study gathered social science data by using a mixed-method approach, a qualitative and quantitative to understand community perceptions, knowledge, and attitudes on the causes of stillbirth, knowledge, and acceptance surrounding maternal immunization. Qualitative method involve key-informant interviews (KIIs). KIIs engaging 15 participants, captured the perspective, knowledge, and attitude towards the causes of stillbirth and knowledge and acceptance surrounding maternal vaccination, among participants and diverse social, ethnic, and religious groups. An open-ended and iteratively modified checklist was structured relatively to each key informant. The quantitative research includes a knowledge, attitude, and practice [KAP], survey, a cross-sectional face-to-face survey which was conducted within individuals and households of the communities, which included 192 males and 192 females. The questionnaire was used to capture information on their knowledge, and understanding of stillbirth, their practice about the prevention of stillbirth, and their attitude towards the causes of stillbirth. Method: A key informant interview KII for a qualitative data collection, was conducted among 15 participants which included mothers and fathers that have experienced stillbirth, traditional birth attendance and leaders, religious leaders and birth attendance health care workers. All participant are member of the community in Soweto, South Africa. For a quantitative data collection, a survey was filled among 192 males and 192 females members of the community of Soweto south Africa. Computer Assisted Qualitative Data Analysis Software (CAQDAS) Atlas. tic version 9 software with the use of electronic coding was used to code and analyse all the details given by the key informant participants. For the Quantitative analysis, a descriptive statistics was also utilize to connote the distribution of all variables with the use of IBM-SPSS 26. Findings: This study captured the understanding of stillbirth from the community’s perspective as the ‘death of an unborn baby. Factors such as abortion attempt, baby weight, comorbidities, health care worker negligence, being medically unfit to carry the child, poor antenatal care attendance, poor nutrition, being strangled by the umbilical cord, stress, witchcraft, and mother’s negligence have been stated as the possible causes of stillbirth by the study participants. Reactions to receiving the news of iv the stillbirths were mostly hurt, shocked, disappointed and some needed explanation as to why it happened. To most participants, it is still an unanswered question. Concerning coping mechanism, counselling, the presence and support of family and friends, and traditional medicine for cleansing, has been the responses from the participant but not in all cases. The findings have also shown practices done by participants in trying to prevent stillbirth, which includes, early antenatal care attendance, Health education for pregnant women, traditional concoction, and adequate medical attention. This study also captured participant knowledge of maternal immunization, understanding of maternal immunization benefits, and acceptance. It was found that the vast majority of participants were said to be unaware of the vaccines given to pregnant women to prevent stillbirths and confused them for supplements given during antenatal. It also indicates that most participant only has an average knowledge of the benefit of maternal immunization. Few of the participants were against maternal immunization due to religious and cultural beliefs, while others were in favour of it, claiming that they would recommend it to pregnant women, as it is a bit of medical advice to help protect the other and the baby. Conclusion: This study gives new information on the thoughts, understanding, and reaction towards stillbirth in a family and community after they have experienced a stillbirth. Clinically the information can be used to help improve health education to the community as regards to still birth causes, preventive measures, and maternal immunization. It will also help in policymaking as regards potential maternal vaccines that can prevent stillbirth-related diseases.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Science in Medicine to the Faculty of Health Sciences, School of Pathology, University of Witwatersrand, Johannesburg, 2022