Survival patterns of neonates born to adolescent mothers and the effect of pregnancy intentions and marital status on newborn survival in Kenya, Uganda, and Tanzania, 2014–2016

Abstract

Background Adolescent pregnancy and associated neonatal mortality are major global health challenges. In low-income settings where 90% of the 21 million global adolescent pregnancies occur, half are unintended and a fifth experience unsafe abortion. In Kenya, Uganda, and Tanzania, the survival patterns of neonates born to adolescents are unclear. Objectives To assess survival patterns among neonates born to adolescents and the effect of pregnancy intentions and marital status on survival in Kenya, Uganda, and Tanzania. Methods Cross-sectional data from demographic and health surveys in Kenya, Uganda, and Tanzania 2014–2016 were used. Kaplan-Meier estimates investigated patterns of neonatal survival among adolescent mothers, aged 15–19 years, compared to mothers aged 20–29 years. Cox proportional hazards regression determined the hazard ratios (HR) for the predictors of neonatal survival. Results About 50% of adolescent pregnancies were unintended and neonatal death rate was twice as high than older mothers (26.6 versus 12.0 deaths/1000 live births). The median survival time was two days for adolescent-born babies and four days among older mothers. The hazard of death for all adolescent-born neonates was about twofold that of 20–29 years-old-mothers, HR 1.80 (95% CI 1.22–2.63). Among married adolescents with unintended newborn pregnancies, the HR was 4-folds higher than corresponding older mothers, HR 4.08 (95% CI 1.62–10.31). Among married, primiparous adolescents with unintended pregnancies, the HR was six times higher than corresponding older mothers. Conclusion Our findings reveal how unintended pregnancies and deaths of neonates born to adolescents contribute substantially to preventable neonatal deaths in East Africa. Full implementation of existing adolescent health policies and utilization of contraceptives should be ensured. Partnership with youths and novel efforts that address sociocultural norms to reduce adolescent pregnancies or marriage should be supported. Regulations requiring adolescents’ obstetric care conducted by only skilled personnel should be introduced and implemented.

The influence of socioeconomic and demographic factors on rural-urban disparities in infant mortality in Kakamega Central Sub-County, Kakamega County, Kenya

“…In urban areas, there were higher likelihoods of neonatal mortality among mothers aged less than 20 years with reference to mothers aged 20 to 34 years. The findings in urban areas relate to findings of other studies (Akinyemi et al, 2015;Woodall & Driscoll, 2020;Arunda et al, 2022;Wardani et al, 2022). A nationwide study conducted in Nigeria by Akinyemi et al (2015) found hazard ratios of 1.75 and 1.50 comparing neonatal deaths among adolescent mothers to mothers aged 20 to 35 years.…”

“…The USA national report indicated that neonatal mortality rate was 121.67 percent higher among teenage mothers compared to mothers aged 20 to 29 years (26.6 versus 12.0 deaths per 1,000 live births) (Woodall & Driscoll, 2020). A study done in Kenya, Uganda and Tanzania by Arunda et al (2022) found the adjusted hazards ratio of death among neonates born to mothers aged less than 20 years to be 0.86 times higher compared to those born to mothers aged 20 to 29 years (aHR = 1.86; 95% CI = 1.06 -3.29). In support of these findings, a key informant said: "The younger mothers may not be well experienced: it could be a case of unintended pregnancy or a case of sexual violence.…”

Proximate and distant determinants of maternal and neonatal mortality in the postnatal period: A scoping review of data from low- and middle-income countries

“…Desire for pregnancy. Of the eight studies [25,27,42,51,63,67,68,81] that examined desire for pregnancy for pregnancy and risk of mortality, only one [81] found an association. Arunda et al found that there was the highest risk in neonatal mortality among adolescent mothers who had unintended pregnancies in marital union [81].…”

Cost-effectiveness of the dual prevention pill for contraception and HIV pre-exposure prophylaxis

“…Second, we did not include incremental risks of neonatal mortality or child morbidity for children born as a result of unintended pregnancy. In our literature search, we found mixed results on the impact of unintended pregnancies on health outcomes of the child ( 55 – 57 ). In some cases, women were less likely to indicate a pregnancy was unwanted if it ended in neonatal death ( 57 ).…”