Determinants of Preterm Birth among Mothers Who Gave Birth in Dilla University Referral Hospital, Southern Ethiopia: A Case‐Control Study

Abstract

Globally, every year, 1.1 million newborns die due to prematurity. In Ethiopia, 320,000 preterm births occur each year; out of these, 24,400 deaths were due to preterm complications. However, there is little evidence about preterm birth in the study area. Therefore, this study provides an important direction for health professionals, health programmers, and researchers. A facility-based unmatched case-control study design was employed among 244 women (61 cases and 183 controls) who gave birth in Dilla University Referral Hospital and were selected with purposive sampling. The bivariate and multivariable logistic regression model was used to select independent predictors of preterm birth. The multivariate analysis was used, and the results were interpreted using an adjusted odds ratio at 95% confidence interval and statistically significant level at a P value less than 0.05. A total of 240 mothers (60 cases and 180 controls) were included in the study with a 98.3% response rate. Factors like attending secondary educational and above [adjusted odd ratio aOR = 0.07 (0.08-0.65)] and attending antenatal care [ aOR = 0.41 (0.18-0.93)] were protective whereas having urinary tract infection [ aOR = 3.6 (1.1-11)], having human immune virus diseases [ aOR = 4.2 (0.9-18)], having a history of abortion [ aOR = 2.3 (1.1-5)], having a history of preterm delivery [ aOR = 5 (1.6-15)], and having hypertensive disorders of pregnancy [ aOR = 5 (1.9-13)] were significantly associated risk factors for preterm birth. The main determinant factors for preterm birth are having antenatal care follow-up, attending secondary education and above, hypertensive disorders of pregnancy, having HIV/AIDS, and history of abortion. This shows a need to strengthen female education; screen mothers for HIV/AIDS, urinary tract infection, and hypertension; and strengthen nutritional counseling, during ANC visits.

A Scoping Review of Preterm Births in Sub-Saharan Africa: Burden, Risk Factors and Outcomes

“…Other reported sociodemographic factors included low socio-economic class [ 86 , 108 ], limited maternal education (only primary or no education) [ 77 , 95 , 104 , 106 ], rural residence [ 27 , 30 , 48 , 50 , 81 , 106 ], employment [ 41 , 86 ], Muslim mothers [ 41 ], mothers who had fear of delivery [ 41 ], and mother’s exposure to unfavourable working conditions including stressful jobs [ 41 ], exposure to vibration [ 12 ], and carrying heavy loads [ 24 ] which were all reported to increase the risk of PTB. Additionally, in 6 of the included studies [ 30 , 31 , 34 , 39 , 58 , 86 ], unmarried mothers had increased odds of having PTB compared to their married counterparts.…”

“…Lack of or underutilization of antenatal care (ANC) was by far the most reported obstetric risk factor associated with PTB. Twenty-six of the included studies [ 9 , 18 , 19 , 22 , 23 , 25 , 29 , 30 , 36 , 37 , 39 , 41 , 48 , 50 , 52 , 58 , 60 , 62 , 71 , 74 , 76 , 86 , 90 , 97 , 104 , 106 ] reported that pregnant mothers with fewer (<4 ANC visits) or with no ANC visits were more likely to have a PTB. In one study that compared the prevalence of PTB among mothers who had one, two, three or four ANC visits, the prevalence decreased with an increase in number of ANC visits (21.6%, 22.3%, 17.5% and 5.6%, respectively) [ 25 ].…”

“…Previous history of PTB was found in 14 studies [ 9 , 19 , 26 , 27 , 54 , 58 , 61 , 68 , 90 , 91 , 94 , 101 , 104 , 110 ] to be significantly associated with increased risk of PTB in subsequent pregnancies. One study in Tanzania [ 68 ] evaluating the impact of previous PTB on successive deliveries found an increasing risk of PTB with an increase in the number of previous PTBs.…”

“…Premature rupture of membrane (PROM) was another frequently reported risk factor of PTB reported in 15 of the included studies [ 9 , 18 , 19 , 20 , 23 , 27 , 29 , 37 , 50 , 74 , 76 , 77 , 86 , 91 , 103 ]. In addition, other adverse birth outcomes in previous deliveries such as previous abortions [ 49 , 63 , 77 , 81 , 104 ], caesarean delivery [ 26 , 86 ], stillbirths [ 19 , 49 ], miscarriages [ 26 , 94 ], low birth weight [ 26 , 68 ], complicated pregnancy/delivery [ 36 , 57 , 58 , 71 , 74 , 76 , 90 ], and perinatal death [ 68 ] were reported to be associated with increased odds of PTB. Five of the included studies [ 36 , 57 , 58 , 71 , 74 , 76 , 90 ] also reported antepartum haemorrhage as a risk factor for PTB.…”

“…Anaemia in pregnancy was also reported to be associated with increased odds of PTB in eight of the included studies [ 18 , 19 , 49 , 56 , 63 , 76 , 77 , 108 ], with the risk of PTB increasing with its severity [ 56 ]. Other infections or conditions in pregnancy that were reported to increase the burden of PTB were bacterial vaginosis [ 105 ], tuberculosis [ 84 ], diabetes [ 108 ], depression [ 78 ], urinary and reproductive tract infections [ 39 , 71 , 90 , 104 ], opportunistic infections [ 47 ], and periodontal disease [ 26 , 51 , 100 ].…”