Globally, stillbirth is a concern for public health, particularly in Sub-Saharan Africa (SSA) [1]. The World Health Organisation defined stillbirth as foetal death in the third trimester (greater than or equal to 28 completed weeks of development) with birth weight greater than or equal to 1000 g or length greater than or equal to 35 cm. It also means that the child dies before the complete expulsion or extraction from its mother [2]. While institutional deliveries are on the rise, stillbirth rates in developing nations have not significantly declined [3].

Every year, there are an estimated 2.6 million stillbirths worldwide, with data avasilable showing that low and lower-middle-income countries account for 84% [4]. Despite this, there is a lot of proof that not all stillbirths that call for reporting are reported. In developing nations like Ghana, where stillbirths are not counted in routine mortality data gathering, the situation is worse [5][6].

Various studies have suggested diverse factors, including maternal age, occupation, and parity, to be associated with stillbirths in different settings [6][7]. According to the 2017 Ghana Maternal Health Survey, 20 stillbirths per 1000 live births, or 2% of pregnancies, resulted in stillbirth nationwide [8]. Earlier research has identified several significant predictors of stillbirth, which may be maternal or foetal [1][9].

The rate of stillbirth is a sensitive indicators of the healthcare system and a significant predictor of the standard of care received during pregnancy and childbirth. Initiatives launched after 2015 demonstrate that stillbirths remain a sustainable development goal and are part of a hidden global agenda. At the 2014 World Health Assembly, Ghana was one of 194 countries that supported the Every Newborn Action Plan’s goal of ending avoidable stillbirths. The plan’s objective was to lower the country’s rate of stillbirth to 12 or less per 1000 live births by 2030 [10].

Although there are various strategies and plans to improve the well-being of mothers and children, the level of stillbirth is a major public health problem in areas such as Tumu [8]. Consequently, the stillbirth rate has been 20 stillbirths per 1000 live births [8]. Despite global efforts to reduce stillbirths, progress remains uneven, particularly in Sub-Saharan Africa, where the burden is disproportionately high. In Ghana, the stillbirth rate remains elevated at 20 per 1000 live births [8], with concerns of underreporting in rural areas like the Tumu Municipality. Although various studies have identified factors such as maternal age, parity, and antenatal care as predictors of stillbirth, there is a lack of research focusing on these determinants within the rural northern Ghanaian context. Additionally, limited district-level data obscures local variations and hampers the development of targeted interventions. Understanding the specific maternal, fetal, and health system factors influencing stillbirths in Tumu is therefore crucial for informed policy-making and improved maternal and newborn outcomes.

In underdeveloped nations, where the majority of neonatal deaths are believed to occur [12], this phenomenon is still a serious issue [13] and in both developed and developing nations alike, neonatal deaths are reported more in rural than urban areas [14]. Therefore, solid strategic interventions that are based on a thorough understanding of the causes and variables associated with the incidence of stillbirths are necessary to achieve reductions in the worldwide burden of stillbirths [15]. There is however little evidence of this context in most rural poor communities in Ghana, hence the quest of this study to assess the prevalence and predictors of stillbirths following vaginal delivery at Tumu municipality of the Upper West Region of Ghana.

This study found the overall stillbirth rate to be 12.84 per 1000 total births. This is lower compared to the national rate of 17 stillbirths per 1000 live births [16] though there has been a decline in the stillbirth rates from 21 per 1000 live births to 17 per 1000 live births from 2013 to 2022, respectively. This finding and change witnessed over this period, though encouraging, is still high and a little over recommendations by the WHO. This finding is nonetheless lower than that in other developing countries outside Africa. For instance, a study in India found 62.0 per 1000 live births [17], another in Afghanistan found 37 per 1000 live births [18], and an increase from 24.8 to 38.1 per 1000 live births from 2017 to 2020 in Cambodia [19]. In other African countries, there was a comparatively higher stillbirth rate of 20.1 per 1000 live births in Burkina Faso [20], 61.8 per 1000 livebirths in Nigeria, a country that ranks second after India in neonatal deaths [21], and 22.0 per 1000 live births in Tanzania [22]. The low stillbirth rate seen in this study may be due to the gradual but sustained improvement in the health service delivery like the Community-based Health Planning Services (CHPS) system along with partnerships formed such as the Tumu Healthcare Initiative to improve the maternal healthcare and women’s healthcare services in Tumu [23]. Even so, health authorities in the region will need to sustain efforts and improve in the areas of ANC attendance and the use of partograph to monitor labour to further reduce the rate as observed in a study with 9.2 per 1000 livebirths found in Ethiopia [24].

Similar to the findings in this study which indicated that labours not monitored with the partograph had over 15-fold higher odds of resulting in neonatal deaths, the use of partographs for labour monitoring has been found in earlier studies conducted in Ghana, Angola, and Burkina Faso to be a useful tool for improving pregnancy outcomes through early referrals for interventions like augmentation and emergency surgery when necessary [25]. This gives credence to the fact that partograph use is the best tool for monitoring labour and an indicator for the timely use of the next intervention to avert a negative outcome. About 81% of labour in this study was monitored with the partograph. This might be as a result of the Upper West Regional Health Directorate’s continuous training of midwives as part of its audit of obstetric and newborn referrals in the area.

With recourse to the results, pregnant women who attended ANC 4 to 8 times had better prospects with stillbirths than their colleagues who attended fewer times or not at all. This aligns with the available literature [26]. The ANC visit is an embodiment of the aphorism ‘Be good to your baby before it’s born’. Because the foetal organs are actively growing throughout the first 12 weeks of pregnancy and subsequently developing through the rest of the pregnancy, this care is crucial [27].

The overall rate of neonatal mortality was 12.84 per 1000 live births among singleton pregnancies. The foetal outcomes of pregnant women who attended ANC 4 to 8 times were better than those of their colleagues who attended ANC less frequently or not at all. The likelihood of stillbirths in labours without partograph monitoring was equally high. It is recommended that all midwives and other auxiliary staff who support the labour force undergo refresher training on the importance of monitoring labour progress using a partograph. We also recommend that mothers be better educated about the importance of routinely attending ANC and arriving at the hospital early in the event of labour for proper monitoring. The address of frequent ANC attendance must involve a multi-sectoral collaboration.

The Committee on Human Research, Publications and Ethics, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, waived the need for informed consent and granted ethical permission for this work. The retrospective nature of the data without identifying patient information makes consent for participation irrelevant. Informed consent was not required. Because of the following, the research complied with the informed consent waiver requirements: it posed no more than a minimal risk to the patients; it did not negatively impact the patients’ rights or welfare; and it was practically impossible to conduct the research without the waiver. The reference number for this approval is CHRPE/AP/172/24. The Tumu Municipal Hospital’s management was consulted for approval.

All data are fully available without restriction.

Conception and design: MMB, PDAA, ES, RNA, AAS, ASDA & MHK; Acquisition of data: MMB, PDAA, ES & RNA; Analysis: MMB, PDAA, ES & RNA; Interpretation of data: MMB, PDAA, ES & RNA; Drafting the article: MMB, PDAA, ES, RNA, AAS, ASDA, MHK & BSM; Revising it critically for important intellectual content: MMB, PDAA, ES, RNA &BSM; Final approval of the version to be published: MMB, PDAA, ES, RNA &BSM.

We sincerely thank all of the mothers whose records were examined for this project. We express our gratitude to the maternity ward and ANC unit staff for their tireless efforts in saving lives, as well as for providing the documentation that made this study possible. We express our sincere gratitude to the hospital’s management and the District Director of Health Services for their endorsements and evaluations. Finally, we would like to express our gratitude to God for his protection, inspiration, and guidance during the study.

The VIF indicated that all the variable used in the multivariable regression had very low correlation and hence did not affect the outcome of the model.

AOR, Adjusted Odds Ratio; ANC, Antenatal care; CI, Confidence Interval; X²/F, Chi-Square or Fisher’s exact test; CHPS, Community-based Health Planning Services; HB, Haemoglobin; IPT, Intermittent Preventive Treatment; OR, Odds Ratio; SSA, SD, Standard deviation; Sub-Saharan Africa; VIS, Variance Inflation Factor.