Prevalence and factors associated with spontaneous preterm birth at the university teaching hospital, Lusaka.

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Mwansa, Kaindu
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The University of Zambia
Preterm birth is defined by World Health Organization as all births occurring before 37 completed weeks of gestation. (Hannah et al 2013). The etiology is often multifactorial and in about 50%, the cause is unknown. The factors associated with preterm birth are classified into maternal, fetal and placental. In 2010, 11.1% of 135 million births were preterm and the prevalence is increasing. Preterm birth is the leading cause neonatal morbidity and mortality and the leading cause of death among children under 5 years. In Zambia, 12.9% of babies are born prematurely (Hannah et al 2013). This study aimed to investigate the prevalence and factors associated with spontaneous preterm birth in women delivering at the University Teaching Hospital (UTH) Lusaka. This was a cross-sectional study on postnatal women delivering at UTH Lusaka. Between 01 February 2018 and 31 august 2018, a structured questionnaire was used to collect data on socio-demographic, past and present medical and obstetric history. Babies were physically examined to assess for gestation age using the Finnstrom scoring. A sample size of 210 women was collected out of which 105 had preterm and 105 term deliveries. The risk of spontaneous preterm birth was estimated with OR and 95%CI for several predictors. A logistic regression analysis was then performed to identify independently associated factors. The mean gestational age was 33.1 weeks and 39.4 weeks respectively for term and preterm births. Of the preterm births, 48 (45.7%) were ranged between 34+0 and 36+6 weeks. Four babies were born with less than 1000 grams and 58 (52.3%) with weight between 1500-2499 grams. The prevalence of spontaneous Preterm birth was 7.7%. On multivariate analysis, age was not associated with preterm birth (p=0.066). Single status [OR: 2.659, (1.480-4.777), p=0.001], low education level [OR: 3.857, (1.143-13.020), p=0.030], low family income [OR: 7.75, (1.296-46.327), p=0.025] and alcohol intake [OR: 2.549, (1.301-4.998), p=0.006] were associated with preterm birth. For the feto-maternal factors, parity was not associated with preterm birth (p=0.878). However, gestational age at booking of less than 20 weeks was protective [OR: 0.485, (0.274-0.860), p=0.013]. A few antenatal visits [OR: 8.060, (3.693-17.493), p<0.0001] and history of draining for less than 18 months [OR: 2.80, (1.364-5.747), p=0.005] were significantly associated with preterm birth. Spontaneous preterm birth remains a major problem at UTH Lusaka. 8 out of 100 deliveries are spontaneous preterm deliveries. Occasional alcohol drinking, a few antenatal visits and preterm premature rupture of membranes were significantly associated with preterm birth.
Thesis of Master of Medicine in Obstetrics and Gynecology.