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Determinants of premature births in two central hospital Harare, Zimbabwe, 2011
Insights
Previous premature delivery and pregnancy complications increase preterm birth risk in Zimbabwe. Longer birth intervals and good maternal nutrition significantly reduce this risk, highlighting areas for intervention.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Health
- Public Health
Background:
- Prematurity is a leading cause of neonatal mortality in Zimbabwe, accounting for 33% of deaths despite representing 8-10% of deliveries.
- Identifying local risk factors is crucial for developing targeted prevention and intervention strategies.
Purpose of the Study:
- To identify independent risk factors associated with premature delivery in Zimbabwean women.
- To inform local strategies for reducing neonatal morbidity and mortality due to prematurity.
Main Methods:
- A 1:1 unmatched case-control study was conducted.
- Data was collected from 188 mothers of premature infants (cases) and 188 mothers of term infants (controls) at Harare and Parirenyatwa central hospitals.
- Statistical analysis identified independent risk factors.
Main Results:
- Previous premature delivery (AOR 3.15) and medical complications during pregnancy (AOR 2.15) were significant risk factors.
- Birth intervals greater than 24 months (AOR 0.26) and adequate maternal nutrition (BMI ≥20kg/m², MUAC ≥23cm) were protective.
- HIV infection was not associated with premature delivery (p≤0.001).
Conclusions:
- Factors such as short birth intervals, prior premature birth, limited antenatal care, and maternal undernutrition are associated with premature delivery.
- Maternal undernutrition requires targeted interventions, including food supplementation.
- No association was found between HIV infection and premature delivery in this study population.
Introduction:
Prematurity is a major determinant of neonatal morbidity and mortality in Zimbabwe. Although 8-10% of deliveries are premature , prematurity contributes 33% of neonatal deaths. Identifying local risk factors for prematurity could help incoming up with local intervention and prevention strategies.
Design:
1:1 unmatched case control study.
Setting:
Harare and Parirenyatwa central hospitals maternity units.
Subjects:
All mothers who delivered in the units June to July 2011. Acase was a mother who had delivered a premature baby and control was a mother who delivered a term baby.
Results:
We interviewed 188 cases and 188 controls. Independent risk factors for premature delivery were -A previous premature delivery [AOR 3.15 95% CI 1.17 8.49, 4.61] being admitted with a medical complication in pregnancy[AOR 2.15 95% CI 1.18-3.92]. Birth interval > 24 months [AOR 0.26 95% CI 0.12 0.59] being well nourished evidenced by BMI ≥20kg/m [ AOR 0.926 95% CI 0.88 0.97] and MUAC ≥23cm [AOR 0.95 95% CI 0.91 0.95] reduced the risk of premature delivery. HIV test was done on 87% of participants, 12% were positive (66% controls, 33% cases) (p≤0.001).
Conclusion:
Birth interval < 24 months, previous premature delivery, only one ANC attendance, maternal under nutrition and being hospitalized with complications in pregnancy were associated with premature delivery. There was no association with HIV infection. Efforts should be made to give food supplements to pregnant undernourished women.
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