Predictors Of Preterm Birth Among Women Of Pastoralist Communities In Marsabit County, Kenya.

ABSTRACT

Preterm birth (PTB) is a major cause of neonatal mortality worldwide. The prevalence of PTB in Africa (about 12%) is more than twice that in developed countries (about 5%). In Kenya, the prevalence is about 17% which is way more than the average in Africa, pointing to the need for targeted interventions to reduce its burden. Sub County Medical Officer of Health (SCMOH) of Moyale Sub-County, reported an increasing trend in Preterm Birth (PTB) in the region from 40% in 2012 to 60% in 2014. This study sought to establish the factors associated with PTB among mothers delivering in public hospitals in Moyale Sub-County. This was a cross-sectional study that involved 370 mothers with infants less than one year of age recruited at the post-natal clinics (PNC) from eight facilities in Moyale Sub-County. Systematic sampling method with stratum-proportional size allocation was used to select the study participants. Information on their socio-demographic characteristics, obstetric and antenatal history was collected from the participants using a structured interviewer-administered questionnaire. Data was analyzed using STATA version 15. Chi-square test of association was used to determine the associations between the mothers’ characteristics and preterm birth status. The mothers in this study were aged between 18 and 46 years with median of 29 years (IQR=25-35years). Majority (63.0%) of the participants were from rural parts of the study area. The prevalence of PTB in this population was 38.7% (95% CI: 30.8%-40.8%). Antenatal Clinic (ANC) attendance (1-3 visits vs none, PR=53.0% [0.40-0.71]& ≥4 visits vs none, PR=55.0%[0.39-0.76]), having UTI during pregnancy (PR= 64.0% [0.45-0.91]), history of miscarriage (PR= 46.5% [0.37-0.56]), history of underlying medical conditions during pregnancy (PR=42.5% [0.27-0.58), parity (PR=37.0% [0.12-0.62]), and employment status of the mother (PR=45.0% [0.16-0.74]) were significantly associated with the risk of PTB. The study shows that the prevalence of PTB in Moyale sub-county is high, almost 3 times higher than the National estimate. Among the factors found to have a significant effect on PTB prevalence, some like ANC attendance can be addressed through community sensitization on the importance of making such visits to improve attendance and detect potential complications that would lead to PTB in advance. Special attention should be accorded to mothers with history of underlying medical conditions and miscarriages to enhance survival of the neonates. Mothers who are self-employed were found to have a higher risk of PTB compared to the unemployed; a possible explanation for this would be exposure to extraneous physical activities during pregnancy. There is need to educate the women on the importance having sufficient rest and avoiding heavy manual work for the safety of the mother and baby.