Determinants of Preterm Birth at the Postnatal Ward of Kenyatta National Hospital, Nairobi, Kenya

Abstract

Background: Preterm birth, delivery prior to 37 completed weeks or 259 days gestation, is a worldwide maternal and perinatal challenge and is a leading cause of neonatal morbidity and mortality. Preterm birth remains the leading cause of perinatal and postnatal mortality and morbidity especially in devel oping countries where the health care services are suffering from limited re sources. Premature babies usually suffer from both immediate and long term consequences. Right after birth, they have difficulties in breathing, tempera ture regulation, bleeding, infection and other problems due to organ imma turity. Their growth and developmental milestones will also be affected lead ing poor physical, mental, educational and psychosocial problems as a long term consequences. Preterm deliveries were responsible for 1 million out of the 6.3 million deaths of children under 5 in 2013 [1]. In Kenyatta National hospital, few studies have been carried out to determine the prevalence and factors associated with preterm birth. Hence the aim of this study is to deter mine the prevalence and factors associated with preterm birth at Kenyatta na tional hospital (KNH), Nairobi, Kenya. Materials and Methods: This was a hospital based descriptive cross-sectional study involving randomly selected respondents (N = 183) from post natal ward of Kenyatta National Hospital. Systematic random sampling method was applied to recruit the study res pondents. A pre-tested semi-structured questionnaire was employed to collect information on the possible determinants of Preterm birth. Data was analysed using SPSS software version 22.0. Descriptive analysis was done using mean and frequency proportion. Inferential analysis using chi-square test was used to establish association different variables. The ethical approval to conduct the study was obtained from KNH-University of Nairobi Ethical Review Com mittee (KNH-UoN ERC). Permission to collect data was sought from the KNH and consent was obtained from the selected respondents before administering the questionnaire. Result: The prevalence rate of preterm birth was 20.2%. History of urinary tract infection during pregnancy [AOR = 4.62; 95% CI = 1.56 - 4.67; P = 0.013], history of preterm birth [AOR = 5.8; 95% CI = 1.18 - 10.30; P = 0.001], history of abortion [AOR = 3.54; 95% CI = 1.18 - 10.41; P = 0.016], history of hypertension during pregnancy [AOR = 2.04; 95% CI = 1.14 - 3.64; P = 0.012], maternal age (≥31 years) [AOR = 2.81; 95% CI = 1.24 - 5.87; P = 0.012] and alcohol consumption during pregnancy [AOR = 2.56; 95% CI = 0.68 - 9.64; P = 0.014] were determined as significant risk fac tors for preterm birth. Conclusion and recommendation: The determinants of preterm birth are multifactorial including history of abortion, preterm birth, urinary tract infection, hypertension and alcohol consumption during pregnancy. Most of these risk factors of preterm birth are controllable if re productive age mothers are educated properly. It is very important for ante natal mothers to adhere to the guidelines of antenatal visits so that those at risk are spotted and close monitoring can done in order to reduce this high rate of preterm birth and its negative consequences. Strategies to avert the high prevalence of preterm birth and its associated morbidity and mortality must be given priority at national, regional and international levels, so that the Millennium Development Goal (MDG) 4 can be achieved