Individual and Community-level Determinants of Stillbirth in Southern Ethiopia: A Multi-level Mixed Effect Poisson Regression Analysis

Introduction: Ethiopia is one of just ten nations that currently bear the brunt of more than 65% of the stillbirth rate worldwide. Despite significant efforts by the Ministry of Health, the stillbirth rate has declined slowly, remaining substantially higher than the target. This study analyzed broader regional data on stillbirths revealed critical gaps and contributing factors, informing the effective interventions to improve outcomes.Objective: To assess individual and community-level determinants of stillbirth in southern EthiopiaMethods: A community-based quantitative cross-sectional study was conducted from October-November 2022. We included all randomly selected 1,130 women who gave live birth in the last 12 months. A multi-stage sampling method to select eligible women. The data were collected by using interviewer-guided structured questionnaire. After each questionnaire was carefully checked for completeness and validity, data were entered into Epi Data, then imported into SPSS software for analysis. The descriptive statistics and mixed effect-multilevel linear regression were performed. The presence and strength of a statistically significant association were assessed using APRs with 95% CIs. Results: In a multi-level mixed effect negative binomial analysis, women who had faced health problem during pregnancy had a 66% increased likelihood of stillbirth (APR = 1.66; 95% CI: 1.11-2.46) as compared to women who did not face health problem, the likelihood of stillbirth was 53% lower among women who had planned pregnancy (APR = 0.47; 95% CI: 0.31, 0.73) than their counterparts, the likelihood of stillbirth was 70% lower for those women who resided in high-literacy communities (APR = 0.30; 95% CI: 0.04-0.82) as compared to women who resided in low-literacy communities, one-year increase in women's age at first pregnancy (APR = 0.84; 95% CI: 0.75-0.94) decreased the likelihood of stillbirth by 16%, and one-child increase in women's childbirths (APR = 1.33; 95% CI: 1.21-1.46) led to 33% increase in the likelihood of stillbirth.Conclusions: The women facing health problems during the pregnancy, planning current pregnancy, community literacy, women's age at first pregnancy, and parity were significantly associated with stillbirth. The higher keeping good women’s health status during the pregnancy, planning for pregnancy, raising community literacy, raising the age of women at first pregnancy, and avoiding parity were recommended.