Determinants of preterm survival in a tertiary hospital in Ghana: A ten-year review

Abstract

Background Prematurity (gestational age <37 completed weeks) accounts for the majority of neonatal deaths worldwide and most of these occur in the low-resource countries. Understanding factors that determine the best chances of preterm survival is imperative in order to enhance the care of neonates and reduce adverse outcomes in such complicated births. Aim This was to find out the proportions of preterm babies who survived at the Special Care Baby Unit (SCBU) in the Cape Coast Teaching Hospital (CCTH) and the factors which influenced their survival. Method This was a retrospective review of data on all the live preterm babies seen at the SCBU of CCTH from 2010 to 2019. Data on 2,254 babies that met the inclusion criteria were extracted. Descriptive statistics were generated and tests of association done with chi-square and multivariable logistic regression. Outcome The main outcome measure was the proportion of live preterm neonates who were discharged after SCBU admissions. Results The CCTH had a total of 27,320 deliveries from 2010 to 2019. Of these, 1,282 were live preterm births, giving a prevalence of live preterm babies over the ten-year period of 4.7% (1,282/27,320). An increasing trend in prevalence was observed with 2019 recording the highest at 9% (271/3027). Most (48.8%) of the deliveries were vaginal, 39.2% were by caesarean section (CS); the mode of birth for 12% of the women were not documented. The mean gestational age was 31.8 (±2.77) weeks. Of the birth weights documented, <1000g babies accounted for 11.9%, 1000–1499g babies made up 34.8%, while 1500g to 2499g babies accounted for 42.6%. The babies with weights >2500g made up only 3.7%. The average length of hospital stay was 8.3 (±9.88) days. Regarding the main outcome variable, 67.6% were discharged alive, 27.6% died and 4.9% were unaccounted for due to incomplete documentation. Factors which influenced survival were: birth weight (p <0.001); gestational age (p <0.001); mode and place of delivery (p <0.001 for both); APGAR scores at 1st and 5th minutes (p <0.001); and length of stay at the SCBU (p <0.001). No association was found for sex of the baby, maternal age and parity. Conclusion This study shows the possibility of achieving good preterm survival rates through the provision of specialised neonatal care, even in resource-constrained countries. This provides an updated benchmark for clinical decision-making and antenatal counselling. It also highlights the problem of inadequate data capture in our part of the world, which needs considerable improvement.

RETRACTED ARTICLE: Mothers’ experiences of caring for preterm babies at home: qualitative insights from an urban setting in a middle-income country

“…This is entirely not surprising because although Ghana has community health services, the manpower is lacking, and so routine follow-up visits are not done. Given that the survival rate for preterm babies in Ghana declines after discharge [15], the importance of long term follow-up cannot be undervalued.…”

“…In Ghana, about 15 % of births are preterm, occur in the community, and about half of these babies die before a month [14,15]. Normally healthy newborns are discharged home within 24 h after delivery.…”

“…Preterm babies are either managed alongside other infants in general wards or the NICU located in a higher-level facility. There are several challenges with in-hospital care [15,16] which influences survival rates however the care quality for preterm babies reduces significantly post-discharge largely due to socio-cultural and economic factors. Parents face an enormous cost burden [17] coupled with having to conform to popular sector beliefs and harmful practices propelled by Ghanaian culture and religion [18].…”

“…Premature babies are frowned upon and so mothers may not seek for or receive adequate support for fear of stereotypical attitudes [18,19]. Often many preterm babies are readmitted in a critical state and particularly those born extremely preterm die at home [15]. It is not surprising that the experiences of mothers who deliver preterm babies remain largely undocumented and this negatively impacts management [14,18].…”

“…Previous scholarly work has focused on obstetric determinants [20], outcomes of preterm delivery, and associated factors [15,21] using mostly quantitative methods. Few qualitative studies emphasized the experiences of parents of preterm babies in birth settings [1], and the experiences of mothers as primary carers [6].…”