Prevalence and factors associated with preterm birth at Kenyatta national hospital
Abstract
Background: The World Health Organization (WHO) estimates the prevalence of preterm birth
to be between 5 and 18% across 184 countries. Most countries lack reliable data on the burden of
preterm birth with only 65 countries having had such data in 2010. Of the estimated 3 million
neonatal deaths occurring globally each year, about 1 million are directly related to prematurity.
The burden of prematurity has further hindered the achievement of Millennium Development
Goal (MDG)-4. Kenyatta National Hospital (KNH) is the largest referral and teaching hospital in
Kenya and handles many high risk pregnancies whose outcomes include preterm birth. Despite
this, few studies have been carried out locally to determine the prevalence of as well as factors
associated with preterm delivery.
Objective: To determine the prevalence and the factors associated with preterm birth at Kenyatta
National Hospital.
Design: A hospital based cross-sectional descriptive study.
Setting: Maternity unit, Kenyatta National Hospital, Nairobi.
Methods: All mothers who had live births at Kenyatta National Hospital and their newborns
were included in the study. Mothers were interviewed using a standard pretested questionnaire to
identify factors associated with preterm birth. Additional data was also extracted from maternal
records. The mothers’ nutritional status was assessed using MUAC measured on the left.
Gestational age was assessed clinically using the Finnstrom Score.
Results: A total of 322 mother-baby pairs were enrolled into the study. The mean maternal age
(± standard deviation) was 26±5 while most mothers (83%) were married and had attained postprimary
education (85%). There was no difference between the socio-demographic
preterm deliveries was 39±3 and 33±3 weeks respectively while the mean weight was 3059 ±538
grams and 2031±585 grams respectively. The prevalence of preterm birth in KNH was found to
be 18.3% (95% CI of 14.1-22.5). Parity ≥ 4, previous preterm birth, multiple gestation,
pregnancy induced hypertension (PIH), antepartum hemorrhage (APH), prolonged preterm
prelabor rupture of membranes (PPROM) and urinary tract infection (UTI) in pregnancy were all
significantly associated with preterm birth (p=<0.05). On logistic regression, only PIH, APH and
prolonged PPROM remained significant. Marital status, maternal level of education, smoking,
alcohol use in pregnancy, maternal occupation, ANC attendance, HIV status, anaemia, low
maternal MUAC and interpregnancy interval were not associated with preterm birth. APH and
parity ≥ 4 were more associated with early than late preterm (OR=4.7 versus 1.7 and OR=6.2
versus 3.9 respectively) while those who had multiple gestation had an almost 7 fold risk of
delivering late preterms (OR=6.7).
Conclusion: The prevalence of preterm birth in KNH was 18.3%. Parity ≥ 4, previous preterm
birth, twin pregnancy, PIH, APH, preterm PROM and UTI were associated with preterm birth.
PIH, APH and prolonged PPROM were independent determinants of preterm birth. APH and
parity were predictors of early preterm birth while multiple gestation and UTI were strongly
associated with late preterm delivery. At-risk mothers should receive intensified antenatal care to
mitigate preterm birth.
Citation
Masters of Medicine in Paediatrics and child health, University of Nirobi, 2014Publisher
University of Nairobi