Determinants of preterm birth among mothers who gave birth at public hospitals in the Amhara region, Ethiopia: A case-control study

Abstract

BackgroundPreterm birth (PTB) is a public health issue worldwide. In developing nations, like Ethiopia, PTB is under reported and underestimated. However, it is the leading cause of neonatal and under-five mortality in Ethiopia. Besides, limited and non-comparative research studies to date has been conducted in the country to address the prevalence of PTB. Therefore, this study aims to determine predictors of PTB.MethodsHospital-based unmatched case control study was employed on a sample of 139 cases and 278 controls from October 2017 to December 2017 in the Amhara region, Ethiopia. The cases and controls were proportionally allocated in each hospital based on the last one-year case flows. As soon as a case was identified, the respective two controls were enrolled until the required sample size was satisfied. The outcome variable was measured by using either last menstrual period (LMP), early ultrasound result, or Ballard maturity examination. Face-to-face interviews were conducted using a standardized, structured, and pre-tested questionnaire to collect data. The collected data was entered into Epi-data and exported into SPSS for analysis. Independent variables with p-values < 0.25 in the bivariate analysis were entered into multivariable logistic regression models with forward logistic regressions method to control the influence of covariates. Ethical clearance was ensured.ResultsA total of 134 cases and 268 controls participated with a response rate of 96.4%. After adjusting for covariates, the following variables were associated with PTB: residing in rural areas [AOR = 2.99: 95% CI 1.19, 7.48], low maternal age [AOR = 3.47: 95% CI 1.11, 10.83], being illiterate [AOR = 4.56: 95% CI 1.11,8.62], short birth spacing [AOR = 2.48: 95% CI 1.07, 5.75], no antenatal care visits for this index pregnancy [AOR = 10.78: 95% CI 4.43, 26.25], having a history of previous adverse birth outcomes [AOR = 3.47: 95% CI 1.51, 8.02], and exposure to medical problems during pregnancy [AOR = 13.94: 95% CI 4.39, 24.27].ConclusionThe study revealed maternal sociodemographic factors, short birth space, lack of antenatal care, exposure to previous adverse birth outcomes and facing medical illnesses during pregnancy were the predictors of PTB. Therefore, inclusive preventive and control interventions should be developed at regional, zonal and district levels to reduce the burden of PTB among women resided in rural areas such as integrating antenatal care services into the existing health extension packages. Study results suggest increasing the awareness of PTB, contraceptive utilization and counseling to enhance birth spacing, antenatal care visits, and accessibility to services among women in Ethiopia should be given due attention. Health care providers should focus on mothers with previous adverse birth outcomes and those exposed to medical problems during pregnancy. Additional community based longitudinal studies supplemented with qualitative methods are recommended.

Epidemiology of preterm birth in Ethiopia: systematic review and meta-analysis

“…Only one study [16] was excluded for its poor quality by critical appraisal. Finally, 22 studies [17,19,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] were included in this review.…”

“…Using results from two studies [39,42], the pooled effect shows that rural residents were 2.34 (AOR = 2.34, 95% CI: 1.35-4.05, I-squared = 0.0%) times likely to give birth before 37 week of gestation compared to urban residents. In contrast, one study shows that urban residents were more likely to give PTB [38].…”

Short birth interval predicts the risk of preterm birth among pregnant women in Sub-Saharan Africa: A systematic review and meta-analysis

“…A total of 10 studies that assessed the association of short birth interval with preterm birth in Sub-Saharan African countries were included in this review. Five of the included studies were conducted in Ethiopia (18)(19)(20)(21)(22), two in Tanzania (23,24), two in Kenya (25,26), and one in Ghana (27). Of the ten studies two were cohort study (20,24), ve case-control (18,(21)(22)(23)27) and three cross-sectional (19,25,26).…”

WITHDRAWN: Determinants of Adverse Birth Outcome in West Shewa Zone, Oromia Regional State, Ethiopia Hospital Based Unmatched Case-control Study

“…A structured, interview administered questionnaire was prepared in English and translated into local language, Afan Oromo by the translator, and then translated back to English by a third person to check for consistency. The tool adapted from previous literature in different parts of the world and modi ed according to the local context (7,(13)(14)(15)(16)(17). The data were collected from the mothers, measurements from neonates.…”

“…5%. Low birth weight and prematurity were the common adverse birth outcomes reported and antenatal care follow-up, rural in residency, pregnancy-induced hypertension, advanced maternal age, having current complication of pregnancy, anemia and multiple pregnancy were factors associated with adverse birth outcomes (11)(12)(13)(14)(15)(16). Though there are few studies conducted earlier in Ethiopia, those studies were cross sectional which is weak in identifying those factors and those studies were mainly conducted in single town or district.…”