Incidence and risk factors for stillbirth in Kenya, Mozambique and the Gambia: the PRECISE cohort study.

BACKGROUND: Stillbirth is a critical public health challenge in sub-Saharan Africa, but prospective data on incidence and risk factors remain limited. We conducted a multi-country study in Kenya, Mozambique, and The Gambia to determine stillbirth rates and underlying risk factors. METHODS: We analysed pooled data from 5772 women aged 16-49 with birth outcomes enrolled from seven health facilities in Mozambique, Kenya, and The Gambia participating in the PRECISE (PREgnancy Care Integrating translational Science, Everywhere) cohort (2019-2022). We used bivariable and multivariable modified Poisson regression models to assess associations between maternal socio-demographic, environmental, medical, including obstetric, and health system factors with stillbirth (≥20 weeks gestation or weighing ≥500 g). FINDINGS: Overall stillbirth incidence was 29.2 per 1000 total births (95%CI 24.8-33.6): 17.5 (95% CI:12.5-22.5) in Kenya, 32.8 (95% CI:24.7-40.9) in Mozambique, and 49.8 (95%CI: 37.4-62.4) in The Gambia. The majority (89.1%) occurred at ≥28 weeks gestation. Significant risk factors were a history of previous stillbirth (attributable risk ratio (aRR) = 3.18, 95% CI: 1.85-5.46), Stage 2 hypertension (aRR = 3.25, 95% CI: 1.42-7.44), antepartum haemorrhage (aRR = 3.10, 95% CI: 1.77-5.42), Caesarean delivery aRR = 1.74 (95%CI:1.01-3.01), and small-for-gestational age (aRR = 2.05 (95%CI:1.34-3.12)). INTERPRETATION: Stillbirth rates remain unacceptably high across these settings, with country variations. Multifactorial determinants underscore the need for integrated antenatal and intrapartum care strategies addressing systemic barriers to early detection of risk, robust referral systems and timely access to high-quality emergency obstetric care towards ending preventable stillbirths in these contexts. FUNDING: The PRECISE Network was funded by the UK Research and Innovation Grand Challenges Research Fund GROW Award scheme (grant number: MR/P027938/1). The PRECISE cohort extension in Kenya after January 2022 was funded by the Office of the Director, National Institutes of Health, the National Institute of Biomedical Imaging and Bioengineering, the National Institute of Mental Health, and the Fogarty International Center AT THE NATIONAL INSTITUTES OF HEALTH under award number U54TW012089. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.