Determinants Of Preterm Delivery In Ridge Regional Hospital, Greater Accra

ABSTRACT

Introduction: Globally, prematurity is a major determinant of neonatal morbidity and mortality contributing about 30%-40% of neonatal mortality and 20% to 30% of infant and under-five mortality. The world‟s preterm birth rate keeps rising since the last two decades with an increase of 20% since 1990 in high-income countries. Major risk factors remain unknown. The consequences are enormous with developmental and childhood complications as well as high economic and psycho-social burden on the parents (family) and society. The objectives of the study assessed determinants (maternal and foetal factors) of preterm delivery. 

Methods: The study was conducted in Ridge Regional Hospital, a secondary referral facility in Accra, Ghana (October, 2015 -May, 2016). Firstly, the proportion of preterm delivery was determined by reviewing the summary data of preterm delivery and total delivery from the health information unit of the hospital. Secondly, 1:2 unmatched case control study design was adopted. The sample size of 360 mother and baby pairs were selected with 120 cases and 240 controls. A case was a mother who delivered between 28 weeks and 36 weeks of gestation (preterm) and a control was a mother who delivered after 37 completed weeks (term). Data collection was done by interview technique using structured questionnaire and review of maternal and foetal records using a checklist. Univariable analysis of categorical variables was expressed as frequencies, proportions and Chi-square analysis to establish associations between selected individual independent variables and preterm delivery. Multiple logistic regression was done between independent variables and preterm delivery to determine the strength of association with Odds Ratio 95% CI and their respective significance. 

Results: In all, 130 preterm deliveries and 260 term deliveries were studied. Proportion of preterm delivery was 15.3% .Odds Ratios for Partner support was 0.4 (95%CI 0.2-0.9), ANC visit ≥ 4 times was 0.2(0.02-0.05), Male baby was 0.5(0.3-0.9), Cephalic presentation was 0.5(0.3-0.9), and Apgar score of >7 was 0.3(0.2-0.5). These variables protected against preterm delivery.ry. However, Odds Ratios for hypertensive complications was, antepartum haemorrhage was 2.1(1.1-4.5), premature rupture of membrane was 1.7(1.1-2.6) and Caesarean section delivery was 1.4(1.2-4.6). These variables were determinants of preterm delivery.

Conclusion: Proportion of preterm delivery is high. Partner support is protective.

However, preterm premature rupture of membrane, hypertensive complications and antepartum haemorrhage are likely contributing determinants of preterm delivery. Birth weight ≥2.5 and Apgar score >7 are protective.  Partner support policy implementation may reduce preterm delivery.