{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:58:40Z","timestamp":1787774320175,"version":"build-2784847793"},"reference-count":42,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,1,6]],"date-time":"2024-01-06T00:00:00Z","timestamp":1704499200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","award":["Horizon 2020 (No 847824)"],"award-info":[{"award-number":["Horizon 2020 (No 847824)"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Birth asphyxia is a leading cause of neonatal mortality in sub\u2010Saharan Africa. The relationship to grand multiparity (GM), a controversial pregnancy risk factor, remains largely unexplored, especially in the context of large multinational studies. We investigated birth asphyxia and its association with GM and referral in Benin, Malawi, Tanzania and Uganda.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>This was a prospective cross\u2010sectional study. Data were collected using a perinatal e\u2010Registry in 16 hospitals (four per country). The study population consisted of 80\u2009663 babies (&gt;1000\u2009g, &gt;28\u2009weeks\u2019 gestational age) delivered between July 2021 and December 2022. The primary outcome was birth asphyxia, defined by 5\u2010minute appearance, pulse, grimace, activity and respiration score &lt;7. A multilevel and stratified multivariate logistic regression was performed with GM (parity \u22655) as exposure, and birth asphyxia as outcome. An interaction between referral (none, prepartum, intrapartum) and GM was also evaluated as a secondary outcome. All models were adjusted for confounders. Clinical Trial: Pan African Clinical Trial Registry 202006793783148.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Birth asphyxia was present in 7.0% (<jats:italic>n<\/jats:italic>\u2009=\u20095612) of babies. More babies with birth asphyxia were born to grand multiparous women (11.9%) than to other parity groups (\u22647.6%). Among the 76\u2009850 cases included in the analysis, grand multiparous women had a 1.34 times higher odds of birth asphyxia (95% confidence interval [CI] 1.17\u20131.54) vs para one to two. Grand multiparous women referred intrapartum had the highest probability of asphyxiation (13.02%, 95% CI 9.34\u201316.69). GM increased odds of birth asphyxia in Benin (odds ratio [OR] 1.37, 95% CI 1.13\u20131.68) and Uganda (OR 1.29, 95% CI 1.02\u20131.64), but was non\u2010significant in Tanzania (OR 1.44, 95% CI 0.81\u20132.56) and Malawi (OR 0.98, 95% CI 0.67\u20131.44).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is some evidence of an increased risk of birth asphyxia for grand multiparous women having babies at hospitals, especially following intrapartum referral. Antenatal counseling should recognize grand multiparity as higher risk and advise appropriate childbirth facilities. Findings in Malawi suggest an advantage of health systems configuration requiring further exploration.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14754","type":"journal-article","created":{"date-parts":[[2024,1,6]],"date-time":"2024-01-06T12:19:22Z","timestamp":1704543562000},"page":"590-601","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Birth asphyxia and its association with grand multiparity and referral among hospital births: A prospective cross\u2010sectional study in Benin, Malawi, Tanzania and Uganda"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0528-9838","authenticated-orcid":false,"given":"Greta","family":"Handing","sequence":"first","affiliation":[{"name":"Department of Global Public Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Straneo","sequence":"additional","affiliation":[{"name":"Department of Global Public Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Agossou","sequence":"additional","affiliation":[{"name":"Department of Statistics Center for Research in Human Reproduction and Demography  Cotonou Benin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Wanduru","sequence":"additional","affiliation":[{"name":"School of Public Health Makerere University College of Health Sciences  Mulago Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Kandeya","sequence":"additional","affiliation":[{"name":"Center for Reproductive Health Kamuzu University of Health Sciences  Chichiri Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muzdalifat S.","family":"Abeid","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Aga Khan University  Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristi S.","family":"Annerstedt","sequence":"additional","affiliation":[{"name":"Department of Global Public Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Hanson","sequence":"additional","affiliation":[{"name":"Department of Global Public Health Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Disease Control London School of Hygiene and Tropical Medicine  London England"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,6]]},"reference":[{"key":"e_1_2_14_2_1","unstructured":"UN Inter\u2010Agency Group for Child Mortality Estimation.Child Mortality and Stillbirth Estimates [Internet].ChildMortality.org.https:\/\/childmortality.org\/"},{"key":"e_1_2_14_3_1","unstructured":"World Health Organization.Guidelines on Basic Newborn Resuscitation [Internet].2012. 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