{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T23:12:34Z","timestamp":1785885154296,"version":"3.56.0"},"reference-count":79,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,6,4]],"date-time":"2023-06-04T00:00:00Z","timestamp":1685836800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Sub\u2010Saharan African (SSA) countries have high stillbirth rates compared with high\u2010income countries, yet research on risk factors for stillbirth in SSA remain scant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To identify the modifiable risk factors of stillbirths in SSA and investigate their strength of association using a systematic review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search Strategy<\/jats:title><jats:p>CINAHL Plus, EMBASE, Global Health and MEDLINE databases were searched for literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection Criteria<\/jats:title><jats:p>Observational population\u2010 and facility\u2010level studies exploring stillbirth risk factors, published in 2013\u20132019 were included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Collection and Analysis<\/jats:title><jats:p>A narrative synthesis of data was undertaken and the potential risk factors were classified into subgroups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Results<\/jats:title><jats:p>Thirty\u2010seven studies were included, encompassing 20\u2009264 stillbirths. The risk factors were categorised as: maternal antepartum factors (0\u20134 antenatal care visits, multiple gestations, hypertension, birth interval of &gt;3\u2009years, history of perinatal death); socio\u2010economic factors (maternal lower wealth index and basic education, advanced maternal age, grand multiparity of \u22655); intrapartum factors (direct obstetric complication); fetal factors (low birthweight and gestational age of &lt;37\u2009weeks) and health systems factors (poor quality of antenatal care, emergency referrals, ill\u2010equipped facility). The proportion of unexplained stillbirths remained very high. No association was found between stillbirths and body mass index, diabetes, distance from the facility or HIV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The overall quality of evidence was low, as many studies were facility based and did not adjust for confounding factors. This review identified preventable risk factors for stillbirth. Focused programmatic strategies to improve antenatal care, emergency obstetric care, maternal perinatal education, referral and outreach systems, and birth attendant training should be developed. More population\u2010based, high\u2010quality research is needed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17562","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T21:48:38Z","timestamp":1686174518000},"page":"140-150","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Determinants of stillbirths in sub\u2010Saharan Africa: A systematic review"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3129-8762","authenticated-orcid":false,"given":"Ankita","family":"Mukherjee","sequence":"first","affiliation":[{"name":"Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine  London UK"},{"name":"Monitoring, Evaluation and Research  New\u00a0Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Di\u00a0Stefano","sequence":"additional","affiliation":[{"name":"Mercy Hospital for Women  Heidelberg Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Blencowe","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Mee","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology London School of Hygiene and Tropical Medicine  London UK"},{"name":"Lincoln International Institute for Rural Health, College of Social Science, University of Lincoln  Lincoln UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,6,4]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"ICD\u201010 version: 2016 [Internet]. 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