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Maternal, obstetric and gynecological factors associated with preterm birth in Rwanda: findings from a national
Erigene Rutayisire1, Monica Mochama2, Corneille Killy Ntihabose3
1College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda. rerigene@yahoo.com.
Insights
Preterm birth affects 13.8% of newborns in Rwanda, with advanced maternal age, secondhand smoke, and hypertension being key risk factors. Early screening for high-risk pregnancies is recommended to mitigate adverse outcomes.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Neonatal Medicine
Background:
- Preterm birth is a leading cause of neonatal mortality in low-income countries.
- Rwanda faces a significant burden, with 35,000 annual preterm births and 2600 under-five deaths.
- Limited national data exists on preterm birth prevalence and associated factors.
Purpose of the Study:
- To determine the national prevalence of preterm birth in Rwanda.
- To identify maternal, obstetric, and gynecological factors associated with preterm birth.
Main Methods:
- Longitudinal cohort study of 817 first-trimester pregnant women from July 2020 to July 2021.
- Data collected via questionnaires, medical record reviews, and ultrasound for gestational age confirmation.
- Multivariable logistic regression analysis used to identify independent risk factors.
Main Results:
- Prevalence of preterm birth was 13.8%.
- Independent risk factors identified: advanced maternal age (35-49 years), secondhand smoke exposure, history of abortion, premature membrane rupture, and hypertension during pregnancy.
- Specific adjusted odds ratios (AOR) and 95% confidence intervals (CI) were reported for each factor.
Conclusions:
- Preterm birth is a significant public health concern in Rwanda.
- Advanced maternal age, secondhand smoke, hypertension, history of abortion, and preterm membrane rupture are key risk factors.
- Routine antenatal screening for high-risk groups is recommended to reduce preterm birth complications.
Background:
Preterm birth is one of the key causes of morbidity and mortality among neonates in low-income countries. In Rwanda, at least 35,000 babies are born prematurely each year, and 2600 children under the age of five die due to direct complications of prematurity each year. A limited number of studies have been conducted locally, many of which are not nationally representative. Thus, this study determined the prevalence as well as the maternal, obstetric, and gynecological factors associated with preterm birth in Rwanda at the national level.
Methods:
A longitudinal cohort study was conducted from July 2020 to July 2021 among first-trimester pregnant women. A total of 817 women from 30 health facilities in 10 districts were included in the analysis. A pre-tested questionnaire was used to collect data. In addition, medical records were reviewed to extract relevant data. Ultrasound examination was used to assess and confirm gestational age on recruitment. A multivariable logistic regression analysis was performed to determine the independent maternal, obstetric, and gynecological factors associated with preterm birth.
Results:
The prevalence of preterm births was 13.8%. Older maternal age- 35 to 49 years [Adjusted odds ratio (AOR) = 2.00; 95% Confidence Interval (CI) = 1.13-3.53)], secondhand smoke exposure during pregnancy (AOR = 1.91; 95% CI = 1.04-3.51), a history of abortion (AOR = 1.89; 95% CI = 1.13-3.15), premature membrane rupture (AOR = 9.30; 95% CI = 3.18-27.16), and hypertension during pregnancy (AOR = 4.40; 95% CI = 1.18-16.42) were identified as independent risk factors for preterm birth.
Conclusion:
Preterm birth remains a significant public health issue in Rwanda. The associated risk factors for preterm birth were advanced maternal age, secondhand smoke, hypertension, history of abortion, and preterm membrane rupture. This study therefore recommends routine antenatal screening to identify and closely follow-up of those high-risk groups, in order to avoid the short- and long-term effects of preterm birth.
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