Association between self-reported STI symptoms and stillbirth in sub-Saharan Africa using nationally representative household surveys

Stillbirths are a known outcome of untreated sexually transmitted infections (STIs). Sub-Saharan Africa (SSA) shares a disproportionate burden of both stillbirths (2015: 29/1000 births vs 3/1000 births in high income countries globally) and STIs. Nationally representative survey data can inform stillbirth prevention measures in multiple countries in the SSA region, with greater generalizability than clinic-based studies. We assessed the association between any self-reported STI symptoms (STI diagnosis, abnormal genital discharge, genital sore or ulcer) in the last 12 months and stillbirth in the prior five years, among women aged 15-49 years participating in nationally representative Demographic and Health Surveys (DHS) in 19 countries in SSA between 2015-2021 and reporting a pregnancy in the five years prior to interview. We used multivariable logistic regression models adjusting for maternal age, wealth index, education level of mother, cigarette smoking behaviors, health care utilization and country of residence. Among 160,995 SSA women who reported being pregnant at least once between 2011-2021, 18.0% (25,596) reported any STI symptom in the prior year and 1.9% (3,205) reported a stillbirth in the past five years. Women who self-reported STI symptoms in the past year had 1.30 (95% CI 1.16-1.47) times the odds of stillbirth in the prior five years compared to women who did not report STI symptoms. Women 35-49 years old had 1.17 (95% CI 1.04-1.33) times the odds of stillbirth compared to those 15-24 years old. The association found between self-reported STI symptoms and stillbirth highlights the need for increased screening for STI symptoms and subsequent treatment among pregnant women in SSA.