Factors associated with preterm births at Mulago Hospital, Kampala

Abstract

Introduction: Preterm birth is one of the leading causes of neonatal mortality worldwide. It accounts for 35 percent of all neonatal deaths worldwide and underlies the other causes of neonatal deaths especially infections. Similarly, in Uganda, preterm birth contributes directly to 25 percent of all neonatal deaths. Uganda is the 28th country worldwide with the highest preterm births rate estimated at 13.6 per 1000 live births. In order to realise a reduction in pre-term births, interventions that target the risk factors are paramount thus the need for this study. Objective: This study aimed at identifying the socio-demographic, reproductive and pregnancy-related factors associated with preterm birth in Mulago Hospital. Methodology: This was a case control study among postpartum women in Mulago hospital, Kampala. Ninety nine women who had delivered preterm newborns were recruited as cases and 193 with full term babies were the controls. A semi-structured questionnaire was used to collect data. Data was entered into Epidata and exported to STATA 11 software for analysis. Descriptive statistics were computed and then bivariate analysis done to compute case control odds ratios. Multivariate analysis was done using a logistic regression model. Results: Maternal age of participants was comparable among the cases and controls. Socio-demographic factors associated with preterm birth included height less than 1.5 meters [aOR=131.08, 95% CI: 20.35- 844.02] and rural residence [aOR=6.56, 95%CI: 2.68-16.10]. Unemployment among the participants was a protective factor against preterm birth [aOR=0.36, 95%CI: 0.15-0.86]. Women who did not attend antenatal at all were more likely to have preterm births [aOR=8.88, 95%CI: 1.44-54.67]. Pregnancy related factors associated with preterm birth included PPROM [aOR= 287.11, 95%CI: 49.26-1673.28], antepartum haemorrhage [aOR=7.33, 95%CI: 1.23-43.72] and preeclampsia/eclampsia [aOR=16.24, 95%CI: 3.11-84.70]. Medical conditions in pregnancy were in higher proportions among cases than controls although not statistically significant. Conclusion: Preterm birth is more likely to occur in women of short stature, living in rural areas and those who do not attend antenatal clinic. Also the preterm birth risk is higher for women who get PPROM, APH and preeclampsia/eclampsia in the index pregnancy. Women who attend atleast four antenatal visit and those who are unemployed are less likely to have a preterm birth. Appropriate antenatal care, recognition and management of high risk conditions among pregnant women may lead to a reduction in preterm birth rates. Key words: Preterm birth, postpartum, risk factors for pre-term birth, newborn, Uganda.