Association Between Select Factors With Spontaneous Preterm Birth Kisumu, Kenya. A Case Control Study.at Jaramogi Oginga Odinga Teaching and Referral Hospital

Abstract

Introduction: Preterm birth is the main cause of neonatal mortality and morbidity globally. The WHO estimates the global preterm birth prevalence to be between 5% and 18% with an upward trend in almost all the countries with consistent data. In Kenya the prevalence of preterm birth is 14.8% with majority occurring during the moderate and late preterm period. The burden of preterm birth threatens the achievement of the global development goals proposed in the SDG 3.2. Kisumu county is a malaria-endemic area and has the 2nd highest HIV prevalence with rising teenage pregnancy, JOOTRH is the largest hospital in Kisumu County, attending to mothers with high-risk pregnancy with outcomes including PTB, despite this, there is limited data on the risk factors of PTB in the region. Objective: To determine association between selected factors with spontaneous PTB among pregnant women in JOOTRH, 2023. Methodology: This was a hospital based un-matched case control study in which cases and controls were recruited in a ratio of 1:1. Data was collected using an interviewer administered pretested questionnaire, and patients’ medical records. Data was cleaned and analyzed using SPSS (version 26). Categorical data is presented as frequencies and percentage, while continuous data is presented as mean with standard deviation. Outcome of preterm and term births were summarized and presented as frequencies and proportions. A p-value of <0.05 was considered statistically significant. Results: The mean maternal age was 26.4 years (SD 4.9). Majority of the women were married (71.3%) and had attained secondary level education (39.4%). Most women were para 2-3 (56.3%). Among preterm births, 6% were very preterm (28+0 – 31+6 weeks), 23.4% were moderate preterm (32+0 – 33+6 weeks) and 71.6% were late preterm (34+0 – 36+6 weeks). In bivariate analysis, teenage pregnancy was associated with increased odds of preterm births (OR = 8.4, 95% CI: 2.89 – 24.50; p <0.035) HIV infection increased the odds of PTB (OR = 1.9, 95% CI: 1.01-3.65 p <0.035) those who had anemia during the pregnancy were highly likely to result in preterm births (OR = 2.9, 95% CI: 2.9– 6.09; p < 0.004) Malaria infection in pregnancy was not statistically associated with preterm birth (OR = 2.1, 95% CI: 0.92-4.83; p 0.108). Independent determinant of preterm birth was teenage pregnancy (aOR 3, 95% CI 1.54-16.81; p < 0.008). HIV infection, malaria, and anemia were found not to be associated with preterm birth, after multivariate analysis. Conclusion: We found teenage pregnancy the only factor significantly associated with preterm birth. We did not find significant association between Anemia, Malaria infection and HIV infection with PTB Recommendation: all pregnant teenagers should attend high risk clinic, Future research on the causes of preterm birth among teenage mothers and longitudinal studies with a large sample size to be able to confirm association.