The Psychosocial Burden And Quality Of Life Of Mothers With Preterm Birth Versus Term Birth At Kenyatta National Hospital (a Mixed Methods Study)

Abstract

Background: Globally there are 13 million premature babies born annually. Prematurity comes with an increased demand in care, neonatal morbidity and mortality as well as attendant long term sequelae. These pose a burden to the baby, the mother, the community and the health system. Locally there is paucity of data on the psychosocial burden experienced by women who have had preterm delivery compared to their counterparts with term deliveries and how that may consequently affect their quality of life. Objective: This study evaluated the psychosocial burden and quality of life of women with preterm birth compared to those with term birth in Kenyatta National Hospital (KNH). Methodology: The study adopted a mixed method design: Descriptive cross-sectional study and Qualitative methods using Focused Group Discussions for aspects not captured in the quantitative assessment tools. The study recruited 267 mothers with preterm birth and 814 mothers with term birth from the labour and post natal wards of KNH. The Zarit Burden Interview and WHOQOL-BREF tools were administered to assess the psychosocial burden and Quality of life respectively. The participants were then subjected to focused group discussions in groups of 5-10 where their reported subjective burden was assessed. The data was cleaned and analyzed into frequencies, odds ratios, percentages, tables, charts and bar graphs. Linear regression using proportional odds and multivariate analysis was used for adjusting and analyzing confounders and associated factors. The level of significance was set at P < 0.05 for comparisons of the two groups. Results: Mothers with preterm birth had lower education levels (primary/no education in 30.7% vs. 18.8% and tertiary education 27.7% vs. 39.4%) in preterm vs. term birth mothers respectively (p < 0.0001). Mothers with preterm birth were more likely to be unemployed with a smaller proportion on formal employment compared to the term mothers (14.2% vs. 24.7%, p < 0.0002). They had a 12% chance of suffering greater burden (OR 1.12; C.I. 0.81, 1.53) compared to term mothers. The preterm birth mothers’ quality of life was lower in the physical (52.30% vs. 50.12%, P = 0.0187) and environmental domains (65.03% vs. 62.30%, P= 0.0014) the preterm birth mothers who were breastfeeding their neonates also had a better quality of life. The Focused Group Discussions revealed the greater burden resulted from physical pain and referral, emergency nature of the deliveries, newborn care routine and separation strain, strenuous accommodation as well as poor communication and support from health workers. Conclusion: Preterm birth mothers in Kenyatta National Hospital have high levels of psychosocial burden with a poorer quality of life in early postpartum period. Structured patient-focused psychological counseling and support may help mitigate this burden and improve the quality of life of the preterm birth mothers. Keywords: Preterm birth; Psychosocial burden; Quality of life; Focused Group Discussion