Joint predictors of preterm birth and perinatal death among singleton births at a zonal referral hospital in northern Tanzania: a birth registry based study from 2000 to 2017.
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Date
2021
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Abstract
Background: Globally, preterm birth (births before 37 completed weeks of
gestational) contributes to under-five and newborn deaths. Tanzania ranks the
tenth country with the highest preterm birth rates globally and shares 2.2% of the
global proportion of all preterm births and contributes to perinatal deaths. Perinatal
deaths (stillbirths and early neonatal deaths) continue to increase relative to
under-five deaths, especially in low- and middle-income countries. Previous
exposure to perinatal death increases preterm birth risk. Understanding the
independent and joint predictors of these outcomes may inform interventions to
accelerate progress towards achieving sustainable development goals. The study
aimed to determine the joint predictors of preterm birth and perinatal death among
singleton births in northern Tanzania.
Methods: The study utilized birth registry data from Kilimanjaro Christian Medical
Center (KCMC) zonal referral hospital from 2000 to 2017, located in Moshi
Municipality, Kilimanjaro region, Northern Tanzania. Generalized estimating
equations (GEE) estimated the marginal effects of covariates on perinatal death.
The predictive capacity of machine learning algorithms was compared with the
classical logistic regression model to predict perinatal death. Multinomial logistic
regression with cluster adjusted robust standard errors determined predictors of
preterm birth. Joint predictors of preterm birth and perinatal death and the
co-occurrence were estimated using the random-effects models to account for the
correlation between these outcomes.
Results: Perinatal mortality in this cohort slightly declined while preterm birth
rates were increasing. Maternal demographic characteristics and pregnancy-related
conditions and complications increase the risk of these outcomes. The joint
predictors of higher risk of preterm birth and perinatal death were inadequate (<4)
ANC visits, referred for delivery, and complications during pregnancy and
childbirth, specifically pre-eclampsia/eclampsia, PPH, LBW, abruption placenta,
and breech presentation. Younger maternal age (15-24 years), PROM, placenta
previa, and male children have higher odds of preterm birth but a lessened
likelihood of perinatal death.
Conclusion: ANC is a critical entry point for delivering the recommended
interventions to pregnant women, especially those at high risk of experiencing
adverse pregnancy outcomes. Improved management of complications during
pregnancy and childbirth and the postnatal period may eventually lead to
substantially reducing adverse perinatal outcomes towards improving maternal
and child health.
Description
Doctoral Degree. University of KwaZulu-Natal, Pietermaritzburg.