Menu
Menu
Menu
Menu
Background: The World Health Organization estimates the prevalence of preterm birth to be 5-18% across 184 countries of the world. Statistics from countries with reliable data show that preterm birth is on the rise. About a third of neonatal deaths are directly attributed to prematurity and this has hindered the achievement of Millennium Development Goal-4 target. Locally, few studies have looked at the prevalence of preterm delivery and factors associated with it. This study determined the prevalence of preterm birth and the factors associated with preterm delivery at Kenyatta National Hospital in Nairobi, Kenya. Methods: A cross-sectional descriptive study was conducted at the maternity unit of Kenyatta National Hospital in Nairobi, Kenya in December 2013. A total of 322 mothers who met the eligibility criteria and their babies were enrolled into the study. Mothers were interviewed using a standard pretested questionnaire and additional data extracted from medical records. The mothers’ nutritional status was assessed using mid-upper arm circumference measured on the left. Gestational age was assessed clinically using the Finnstrom Score. Results: The prevalence of preterm birth was found to be 18.3%. Maternal age, parity, previous preterm birth, multiple gestation, pregnancy induced hypertension, antepartum hemorrhage, prolonged prelabor rupture of membranes and urinary tract infections were significantly associated with preterm birth (p=<0.05) although maternal age less 4, twin gestation, maternal urinary tract infections, pregnancy induced hypertension, antepartum hemorrhage and prolonged prelabor rupture of membranes were significantly associated with preterm birth. The latter 3 were independent determinants of preterm birth. At-risk mothers should receive intensified antenatal care to mitigate preterm birth.
A hospital based descriptive cross-sectional study was conducted using interviewer administered questionnaire. Additional information was obtained from medical records of the mothers and babies. KNH is the largest referral hospital in Kenya and Eastern and Central Africa and also serves as a teaching hospital for the University of Nairobi and the Kenya Medical Training College. It is located in Nairobi which is the capital city of Kenya with a population of about 4 million. The hospital has a busy maternity unit registering over 10,000 deliveries annually. It also has a busy newborn unit (NBU) which offers specialised neonatal care. Being a teaching and referral hospital, KNH handles many high risk pregnancies whose outcomes often include preterm birth. The study population comprised of all mothers who had live births at Kenyatta National Hospital and their newborns. A total of 322 mothers who met the eligibility criteria were enrolled into the study. These mothers delivered a total of 331 babies 18 of which were twins. All mothers who had live births at KNH in December 2013 were identified using the birth register within 24 h of delivery. Systematic sampling was used to recruit mother-baby pairs. Mothers were traced to the postnatal wards. Informed consent was obtained from the mothers and babies admitted to the newborn unit were also traced. A standard pretested questionnaire was administered to the mothers while additional data was obtained from the mothers’ and babies’ medical records as required. The records examined for additional data included the mothers’ antenatal and admission records and the babies’ medical records for those admitted in the NBU after delivery. Information collected from the mother included maternal age, marital status, level of education, occupation, smoking and alcohol use during pregnancy, parity, date of last normal menstrual period, date of current and preceding delivery (for calculation of interpregnancy interval) and history of previous preterm birth. Information obtained from medical records included antenatal clinic (ANC) attendance and number of visits, Human Immune Deficiency (HIV) status, hemoglobin level, mode of delivery, onset of labor (spontaneous or medically indicated), pregnancy outcome (singleton or multiple), birthweight (to nearest 10 g), baby’s gender, prelabor rupture of membranes (PROM) for > 18 h, pregnancy induced hypertension (PIH), antepartum hemorrhage (APH), history of burning sensation during pregnancy or treatment for urinary tract infection (UTI). Anemia was defined as hemoglobin level of 140/90 mmHg after 20 weeks of gestation with or without proteinuria and/or edema as diagnosed and documented by the attending clinician. APH was defined as any vaginal bleeding in the mother after 24 weeks of gestation as documented in the records by the attending clinician. UTI was defined as a documented clinical/laboratory diagnosis of UTI any time during the pregnancy and/or a positive history of treatment of burning sensation with micturition as reported by the mother. Maternal nutritional status was assessed by measuring the left mid-upper arm circumference (MUAC) using non-stretchable World Food Program MUAC tapes used for screening pregnant mothers. A low MUAC was defined as a measurement of less than 24 cm. Gestational age was calculated using a standard obstetric wheel based on menstrual dates and confirmed within 24 h of birth by clinical assessment using the Finnstrom Score. This method was developed by Finnstrom et al. in 1977. Seven (7) physical parameters which are scalp hair, skin opacity, length of fingernails, breast size, nipple formation, ear cartilage and plantar skin creases were used. This tool is not only easy to use but is also sensitive with an accuracy of +/− 2 weeks when administered within 24 h of birth [8, 9]. To limit observer bias, gestational assessment of all babies was done by only one research assistant trained by the principal investigator and aided by a printed pictorial scoring chart. For uniformity, gestational age used for analysis was based on Finnstrom score and not on menstrual dates. Preterm birth was defined as a gestation of less than 37 completed weeks. Prematurity was further categorized as extreme (less than 28 weeks), severe (28–31 weeks), moderate (32–33 weeks) and late preterm or near term (34–36 weeks). Data was entered into Microsoft Access database, cleaned and stored in a password protected external storage device. Data was analyzed using Stata 11.0. Mean, median, frequencies and percentages were reported to describe the variables and inferential statistics were used to establish associations between prematurity and the various risk factors using a chi-square analysis. Multivariate logistic regression was used to determine the factors independently associated with preterm birth.
N/A
