Analysis of Spatial Patterns and Associated Factors of Stillbirth in Pakistan, PDHS (2017-18): A Spatial and Multilevel Analysis

Globally, 2.6 million stillbirths had been predicted annually. Approximately 77% of stillbirths occurred in South Asia and sub-Saharan Africa. Pakistan is among the top 10 countries with the highest burden of stillbirths. Pakistan ranked third among the countries with a high stillbirth rate. Although stillbirth is a major public health problem, it remains a negligible issue in many countries including Pakistan. There are no studies in Pakistan that determine the spatial distribution of stillbirth. Therefore, the objective of the study is to carry out the spatial analysis and to determine the associated factors of stillbirth in Pakistan. We have used the Pakistan Demographic and Health Survey data for the years 2017-18. The Bernoulli model is fitted using SatScan V.9.6 and the ArcGIS V.10.6 to discover the spatial distribution of stillbirth. Multilevel binary logistic regression model is also used to explore the determinants of stillbirths using STATA V.15 software. Significant spatial variation of stillbirth was found across the country Pakistan. Region, Sindh, and Northern and Northwestern Punjab were the hotspot areas of stillbirth. Wealth status, maternal age, and preceding birth interval were significantly associated with stillbirth. Maternal age (30 + years) and birth interval (48 + months) are significant risk factors of stillbirth. The government should launch campaigns to promote optimal birth spacing and also take effective public health interventions to reduce the risk of stillbirth in the hotspot areas of Pakistan.