Maternal, Fetal and Service-Related Risk Factors for Stillbirths During Conflict Situation, Yemen, 2015-2016


  • Ahmed Hamood Al-Shahethi National Center for Epidemiology and Diseases Surveillance, Ministry of Public Health and Population, Yemen
  • Rafdzah Ahmad Zaki Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
  • Abdulwahed Abdulgabar Al-Serouri Department of Community Medicine, University of Medicine and Health Sciences, Sana
  • Awang Bulgiba Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia



Background: Stillbirth is a silent traumatic canker, which is a major concern to individuals, health institutions countries worldwide and continues to be a major global problem responsible for nearly three million deaths each year. To estimate the stillbirth rate (SBR) and to identify the potential risk factors for stillbirth.

Subjects and Method: A community-based prospective cohort study was undertaken between August 2015 and December 2016 in which 980 pregnant women in Sana’a city of Yemen were identified. A multi-stage cluster sampling was used to select participants from community households. The independent variables were socio-demographic, prenatal and past obstetric, special habit, birth and fetal. The dependent variable was stillbirth. The data collection of this study used a questionnaire. Binomial regression together with generalized linear models, were employed in this study.

Results: The results identified that the stillbirth rate (SBR) was presently between 46.2 per 1000 and 45.2 per 1000 cases. The multivariable analysis identified teenage mothers aged < 20 years, with their first childbirth, had a (aOR= 3.70; 95% CI= 1.76 to 7.76; p<0.001) women with anemia (aOR = 2.23; 95% CI= 1.67 to 2.98; p<0.001), smoking snuff (aOR = 4.27; 95% CI= 1.17 to 15.55; p= 0.028), prolonged labor (> 24 hours) (aOR= 2.02; 95% CI= 1.38 to 2.96; p< 0.001), prolonged rupture of membranes (≥ 24 hours) (aOR= 2.22; 95% CI= 1.66 to 2.98; p<0.001), fetal mal-position (aOR= 4.60; 95% CI= 2.97 to 7.12; p<0.001), low birth weight (aOR= 14.90; 95% CI= 4.30 to 51.75; p<0.001) and fetal gestational age (in weeks) (aOR = 5.60; 95% CI= 2.52 to 12.41; p<0.001). These factors were associated with an increased risk of stillbirths.

Conclusion: This study is encouraging pregnant women to deliver at health facilities, providing better management of obstetrical complications, proper antenatal care, and prompt referral services are essential for the reduction of stillbirths in Yemen.

Keywords: stillbirth, risk factors, community-based study, cohort study, Sana’a city, Yemen

Correspondence:Ahmed H. Al-Shahethi. National Center for Epidemiology and Diseases Surveillance, Ministry of Public Health and Population, Yemen. P.O. box: 299. Fax: +9671564720. Phone: +967771922712. Email:,


Alosaimi AN, Luoto R, Al Serouri AW, Nwaru BI, Mouniri H (2016). Measures of maternal socioeconomic status in yemen and association with maternal and child health outcomes. Matern Child Health J. 20(2):386-97. doi: 10.1007/s1099501518374.

AlSeaidan M, Al Wotayan R, Christophi CA, Al-Makhseed M, Abu Awad Y, Nassan F, Ahmed A, et al. (2016). Birth outcomes in a prospective pregnancy-birth cohort study of environmental risk factors in Kuwait: The TRACER Study. Paediatr Perinat Epidemiol. 30(4): 408-17. doi: 10.1111/ppe.12296

Anker M, et al. (1999). A standard verbal autopsy method for investigating causes of death in infants and children. doi:

Assaf S, Khawaja M, DeJong J, Mahfoud Z, Yunis K (2009). Consanguinity and reproductive wastage in the Palestinian Territories. Paediatr Perinat Epidemiol. 23(2):107-15. doi: 10.1111/j.1365-3016.2008.00988.x.

Banajeh SM, Al-Rabee AM, Al-Arashi IH (2005). Burden of perinatal conditions in Yemen: a 12-year hospital-based study. East Mediterr Health J. 11(4): 680-9.

Bhattacharya S, Prescott GJ, Black M, Shetty A (2010). Recurrence risk of stillbirth in a second pregnancy. BJOG. 117(10): 1243-7. doi: 10.1111/j.14710528.2010.02641.x.

Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, Hogan D, Shiekh S, et al. (2016). Lancet stillbirth epidemiology investigator group. national, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health. 4(2):e98-e108. doi: 10.1016/S2214109X(15)002752. Epub 2016 Jan 19. Erratum in: Lancet Glob Health. 4(3):e164.

Central Statistical Organization (2004). Population and housing census 2004. Retrieved from: last/frame_gov_13.pdf.

Flenady V, Koopmans L, Middleton P, Frøen JF, Smith GC, Gibbons K, Coory M, et al. (2011). Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet. 377(9774):1331-40. doi: 10.1016/S01406736(10)622337.

Ghazi A, Ali T, Jabbar S, Siddiq NM, Lata S, Noren S, Mansoor M (2009). Perinatal mortality contributors in singleton gestation. J Coll Physicians Surg Pak. 19(11):711-3. PMID: 19889268.

Jammeh A, Vangen S, Sundby J (2010). Stillbirths in rural hospitals in the gambia: a cross-sectional retrospective study. Obstet Gynecol Int. 2010;2010: 186867. doi: 10.1155/2010/186867.

Laughon SK, Berghella V, Reddy UM, Sundaram R, Lu Z, Hoffman MK (2014). Neonatal and maternal outcomes with prolonged second stage of labor. Obstet Gynecol. 124(1):57-67. doi: 10.1097/AOG.0000000000000278. Erratum in: Obstet Gynecol.124(4):842.

McClure EM, Saleem S, Pasha O, Goldenberg RL (2009). Stillbirth in developing countries: a review of causes, risk factors and prevention strategies. J Matern Fetal Neonatal Med. 22(3): 183-90. doi: 10.1080/14767050802559129.

Reinebrant HE, Leisher SH, Coory M, Henry S, Wojcieszek AM, Gardener G, Lourie R, et al. (2018). Making stillbirths visible: a systematic review of globally reported causes of stillbirth. BJOG. 125 (2):212-224. doi: 10.1111/14710528.14971.

Sebayang SK, Dibley MJ, Kelly PJ, Shankar AV, Shankar AH, SUMMIT Study Group (2012). Determinants of low birthweight, small-for-gestational-age and preterm birth in Lombok, Indonesia: analyses of the birthweight cohort of the SUMMIT trial. Trop Med Int Health. 17(8):938-50. doi: 10.1111/j.1365-3156.2012.03039.x.

Sen J, Roy A, Mondal N (2010). Association of maternal nutritional status, body composition and socio-economic variables with low birth weight in India. J Trop Pediatr. 56(4):254-9. doi: 10.1093/tropej/fmp102.

Siza JE (2008). Risk factors associated with low birth weight of neonates among pregnant women attending a referral hospital in northern Tanzania. Tanzan J Health Res. 10(1):1-8. doi: 10.4314/thrb.v10i1.14334.

Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT) Study Group; Shankar AH, Jahari AB, Sebayang SK, Aditiawarman, Apriatni M, Harefa B, et al. (2008). Effect of maternal multiple micronutrient supplementation on fetal loss and infant death in Indonesia: a double-blind cluster-randomised trial. Lancet. 371 (9608): 215-27. doi: 10.1016/S01406736(08)601336.

Unfpa (January 2017). Key figures, UNFPA response in Yemen monthly situation report.

UNICEF (2015). Levels and trends in child mortality. Report 2015. Estimates developed by the UN Interagency Group for Child Mortality Estimation. Retrieved from:

UNICEF and WHO (2009). Mid-Upper arm circumference (MUAC) measuring tapes.

Weissmann-Brenner A, O'Reilly-Green C, Ferber A, Divon MY (2009). Values of amniotic fluid index in cases of preterm premature rupture of membranes. J Perinat Med. 37(3):232-5. doi: 10.1515/JPM.2009.078.

WHO (2010). World health statistics. Retrieved from: tics/EN_WHS10_Full.pdf.

WHO (2012). Verbal autopsy standards: the 2012 WHO verbal autopsy instrument. Retrieved from: RC1_Instrument.pdf?ua=1.

WHO (2015). Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and United Nations Population Division. Retrieved from: toring/maternalmortality2015/en/.

Willis D, Popovech M, Gany F, Zelikoff J (2012). Toxicology of smokeless tobacco: implications for immune, reproductive, and cardiovascular systems. J Toxicol Environ Health B Crit Rev. 15(5):317-31. doi: 10.1080/10937404.2012.689553.

Yakoob MY, Lawn JE, Darmstadt GL, Bhutta ZA (2010). Stillbirths: epidemiology, evidence, and priorities for action. Semin Perinatol. 34(6):387-94. doi: 10.1053/j.semperi.2010.09.010.

YMoPHP and CSO (2013). National health and demographic survey (YNDHS), 2013, final report. Retrieved from:




How to Cite

Al-Shahethi, A. H., Zaki, R. A., Al-Serouri, A. A., & Bulgiba, A. (2023). Maternal, Fetal and Service-Related Risk Factors for Stillbirths During Conflict Situation, Yemen, 2015-2016. Journal of Maternal and Child Health, 8(2), 217–226.