Introduction
Stillbirth is a significant global public health issue, with an
estimated 2.6 million women affected every year. 1-3Approximately 98% of stillbirths occur in low-and middle-income
countries (LMICs), with this burden most heavily felt in South-Asian and
African countries. 2-5 Many stillbirths in LMICs are
thought to be preventable. Despite this, little progress has been made
in reducing these numbers compared to other perinatal outcomes.
The Solomon Islands is a Pacific LMIC with a population of approximately
700,000, spanning across 993 islands. The country faces significant
geographical, socioeconomic and cultural barriers to achieving health
equity. The National Referral Hospital, situated on the main island of
Guadalcanal, is the only tertiary hospital in the country. Despite this,
there are limited midwifery staff, only 4 consultant obstetricians and
just one or two working cardiotocograph machines at any given time. Like
many of its counterparts in the Asia-Pacific, the Solomon Islands has
poor perinatal outcomes, with a recent study showing a high rate of
preventable maternal mortality6 and an estimated
stillbirth rate of 17.6 per 1000 births in 2015 from World Health
Organization data. 7 In contrast, the rate of
stillbirth in Australia, one of the nation’s closest neighbours, has a
stillbirth rate of 6.8 per 1000 births. 8 Despite
this, there has been little research into improving perinatal outcomes,
and in particular, no previous targeted research investigating causes of
stillbirth in the Solomon Islands.
In order to reduce the global burden of stillbirths, accurate recording
of cause of death and preventable risk factors is required. This could
help direct where to place scarce resources to have maximal impact in
reducing rates of stillbirth. However, in many LMICs this is a
significant challenge due to a lack of health worker training and
diagnostic tools. 9 Furthermore, many countries do not
have a national registration system for perinatal deaths, particularly
in the Asia-Pacific region. 2, 10 While there is also
no national registry or classification of stillbirths in the Solomon
Islands, they are audited at National Referral Hospital. This recording
of cases creates an opportunity to investigate the causes of stillbirth
and identify those that may be preventable, as well as identifying gaps
in information with the current data collection system. Such an
investigation would assist in directing scarce resources towards the
most effective clinical service with the aim of ultimately reducing
stillbirth in the Solomon Islands and other similar Pacific Island
nations. Thus, we undertook a retrospective cohort study investigating
the incidence of stillbirth and associated risk factors in the Solomon
Islands.