Introduction: globally, the leading cause of neonatal mortality is preterm birth which may hinder the achievement of Sustainable Development Goal 3.2 target. We aimed to determine the prevalence and factors associated with preterm delivery at Kabutare hospital, Rwanda. Methods: a cross-sectional study was conducted between August and September 2020. Mothers were interviewed using a standard pretested semi-structured questionnaire and additional data were extracted from medical records of obstetric files. Gestational age was assessed using the Ballard score. Adjusted Odds Ratios and their 95% confidence intervals were calculated for multivariable logistic regression analysis to take care of all potential confounders. Results: the prevalence of preterm birth was 17.5% (95% CI: 12.9% – 22.9%). The independent factors associated with preterm birth after considering multiple logistic regression were husband being a smoker (adjusted Odds Ratio (aOR) = 5.9; 95% CI; 1.9-18; p= 0.002), antenatal care (ANC) attendance ≤ 3 visits (aOR=3.9; 95% CI; 1.1-13.8; p=0.04) and low mother’s Mid Upper Arm Circumference (MUAC) < 23cm (aOR=5.6, 95% CI; 1.8-18.9; p=0.004). Conclusion: preterm delivery was high in Huye district. Thus, we recommend ANC sessions to emphasize on maternal nutritional education which is of good quality and quantity, discourage maternal alcohol consumption as well as passive smoking.
Study design and setting: this was a facility based cross-sectional study done among preterm babies delivered at Kabutare hospital, Huye district, Rwanda. Study variables included maternal socio-demographic characteristics, pregnancy lifestyle factors by preterm birth, antenatal and obstetric factors associated with preterm birth. Kabutare hospital is a district hospital which receives many high-risk pregnancies referred from 12 health centers of which some are preterm babies. It has a busier maternity department and registers about 300 births every month. It equally has a busy neonatal unit that provides specialized neonatal care (SNC) services. The hospital SNC is comprised of medical staffs: paediatricians (2), medical officers (2) and 12 nurses (12). Kabutare district hospital is located in Huye district, southern province of Rwanda, at 126 km from the capital Kigali. Huye district has a population of 328,605 inhabitants covering an area of 581.5 km2. Its density population is 510.3 inhabitants per km2. Study population: the study population comprised of postnatal women who delivered preterm babies between August and September 2020. The sample size was determined using single population proportion formula by considering confidence level (95%), margin of error = 0.04 and proportion of preterm rate in Rwanda being 10% [7]. By adding 10% non-response rate, the final sample size was 240. Inclusion/exclusion criteria: consenting postnatal women aged between 18 and 49 years who had delivered a singleton preterm baby within the study period were included. On the other hand, non-consenting postnatal women, mentally unstable, those who had memory loss or those who were sick thus unable to participate were excluded from the study. Study variables: the dependent variable was spontaneous preterm birth. The independent variables were as follows: (i) maternal socio-demographic characteristics (age, residence, marital status, religion, level of education, family size, occupation and Mid-Upper Arm Circumference [MUAC]); (ii) maternal pregnancy lifestyle factors (smoking during pregnancy, alcohol consumption, husband being cigarette smoker, husband drinks alcohol; (iii) antenatal care (ANC)-related factors (frequency of ANC visits, gestational age of first visit, prior pregnancy danger signs and maternal HIV status) and obstetric-related factors (parity, inter-delivery interval, onset of labour, gestational age, previous preterm birth, anaemia during pregnancy). Operational definitions: preterm birth was the commencement of labor with an intact or pre-labor rapture of the membrane and birth before 37 weeks of gestational age. The inter-delivery was defined as the number of months since the previous birth. It was considered as either being short or optimal if the birth interval was ≤ 24 months or ≥ 25 months, respectively. Study procedure: we conducted a systematic sampling which enabled us recruit all mothers who had delivered within 24 hours at Kabutare hospital from August to September 2020. Informed consent was obtained from the mothers whose babies had been admitted to the newborn care unit (NBU). A semi-structured pre-test questionnaire was administered to the mothers while additional data were obtained from the mothers' and babies' obstetric and neonatal records for those admitted as required, respectively. Data were collected from medical records by two trained research assistants who were supervised by the principal investigator. For every case, information was collected regarding socio-demographic characteristics, medical history, antenatal care attendance (ANC), medical conditions diagnosed before or during current pregnancy and details of lifestyle and anthropometric measurements and maternal and perinatal outcome including complications. Maternal nutritional status was assessed by measuring the left mid-upper arm circumference (MUAC) using non-stretchable MUAC tapes used for screening pregnant mothers. A low MUAC was defined as a measurement of less than 23 cm. While, gestational age was calculated using last menstrual period and confirmed within 24 hours of birth by clinical assessment using the Ballard Score. Ethical considerations: ethical approval was obtained from Mount Kenya University Kigali, Rwanda The School of Postgraduate studies, Mount Kenya University, Kigali first approved the research proposal and ethical clearance was obtained from the Institutional Research and Ethics committee of Mount Kenya University (N°: MKU04/DVCARA/2019-2020/077). After obtaining ethical approval, permission was obtained from the director general of Kabutare district hospital for authorization to proceed with the data collection. The participants were told about the study objectives and that their participation was voluntary and they could withdraw at any time, without giving any reason. Written informed consent was obtained for participation in the study. No inducements or rewards were given to participants to join the study. Confidentiality was maintained at all times. Data collected as part of the study were not linked to individual or personal identifiers and was reported in accordance with the STROBE guidelines. Data analysis: data were entered into Microsoft Access database, cleaned and uploaded into a password protected android tablet. The outcome variables were dichotomized and coded as 0 and 1, representing those that did not have a preterm birth and those that had a preterm birth, respectively. Data were analyzed using Stata version 17 Univariate analysis was done to include frequencies and proportions that was displayed in form of tables and figures. Bivariate analysis using Chi-square test was conducted to identify the association between the independent and dependent variables. Adjusted Odds Ratios, and their 95% confidence intervals were deliberated for multivariable logistic regression analysis to take care of all potential confounders. The goodness of fit was assessed using Hosmer-Lemeshow test with Chi-square value 1.74 and p-value of 0.884 which indicated that the fitted model was adequate.
N/A