A Scoping Review of Preterm Births in Sub-Saharan Africa: Burden, Risk Factors and Outcomes
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Published on: January 12, 2018
Adam Mabrouk1,2,3, Amina Abubakar1,3,4, Ezra Kipngetich Too3
1KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi P.O. Box 230-80108, Kenya.
Insights
Preterm birth (PTB) is a major cause of newborn deaths in Sub-Saharan Africa (SSA). Addressing modifiable risk factors is crucial to reduce the high burden of PTB and improve infant outcomes.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Neonatology
Background:
- Preterm birth (PTB) is the leading cause of neonatal mortality globally, with a disproportionately high burden in Sub-Saharan Africa (SSA).
- Understanding the epidemiology of PTB in SSA is critical for developing effective interventions.
- Accurate estimation of gestational age is essential for defining and measuring PTB, yet current methods are often unreliable.
Purpose of the Study:
- To conduct a scoping review of the existing literature on the burden, predictors, and outcomes of PTB in SSA.
- To identify key risk factors associated with PTB in the SSA region.
- To highlight the impact of PTB on neonatal morbidity and mortality in SSA.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Embase, and three other databases.
- Studies published from database inception to July 10, 2021, reporting PTB prevalence, risk factors, or outcomes were included.
- A total of 181 studies met the inclusion criteria from an initial pool of 4441 publications.
Main Results:
- The prevalence of PTB in SSA varied widely, ranging from 3.4% to 49.4%, with Last Menstrual Period (LMP) being the most common, albeit unreliable, method for gestational age estimation.
- Frequently reported risk factors for PTB included prior PTB, inadequate antenatal care, premature rupture of membranes, maternal age extremes, short interpregnancy intervals, malaria, HIV, and hypertension.
- Infants born preterm experienced high rates of hospital admission, impaired growth and development, and increased risk of morbidity and mortality.
Conclusions:
- There is a substantial burden of PTB in SSA, likely underestimated due to inaccurate gestational age assessment.
- Many identified risk factors for PTB are modifiable, presenting opportunities for targeted interventions.
- Comprehensive strategies are needed to reduce the incidence and improve the outcomes of PTB in SSA.
Abstract:
Preterm births (PTB) are the leading cause of neonatal deaths, the majority of which occur in low- and middle-income countries, particularly those in Sub-Saharan Africa (SSA). Understanding the epidemiology of prematurity is an essential step towards tackling the challenge of PTB in the sub-continent. We performed a scoping review of the burden, predictors and outcomes of PTB in SSA. We searched PubMed, Embase, and three other databases for articles published from the database inception to 10 July 2021. Studies reporting the prevalence of PTB, the associated risk factors, and/or its outcomes were eligible for inclusion in this review. Our literature search identified 4441 publications, but only 181 met the inclusion criteria. Last menstrual period (LMP) was the most commonly used method of estimating gestational age. The prevalence of PTB in SSA ranged from 3.4% to 49.4%. Several risk factors of PTB were identified in this review. The most frequently reported risk factors (i.e., reported in ≥10 studies) were previous history of PTB, underutilization of antenatal care (<4 visits), premature rupture of membrane, maternal age (≤20 or ≥35 years), inter-pregnancy interval, malaria, HIV and hypertension in pregnancy. Premature babies had high rates of hospital admissions, were at risk of poor growth and development, and were also at a high risk of morbidity and mortality. There is a high burden of PTB in SSA. The true burden of PTB is underestimated due to the widespread use of LMP, an unreliable and often inaccurate method for estimating gestational age. The associated risk factors for PTB are mostly modifiable and require an all-inclusive intervention to reduce the burden and improve outcomes in SSA.
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