Associated factors of pregnancy loss in two urban slums of Nairobi: A generalized estimation equations approach

Abstract

Complications often arise during pregnancy leading to unfavorable pregnancy outcomes such as stillbirths, abortions/miscarriages, and neonatal losses placing a substantial burden on families, communities, and the health care system. In this study, we estimate pregnancy loss and identify associated factors that drive pregnancy loss among women in two urban slums in Nairobi. In order to estimate the population-level effects of risk factors on pregnancy loss, we use the generalized estimation equation (GEE), which also allows us to account for the clustering of deliveries within pregnant women. From 2003 to 2016, the rate of pregnancy loss was 16 per 1000 deliveries (7 per 1000 and 9 per 1000 for stillbirth and miscarriages, respectively). Pregnancy loss was 6% less likely among pregnant women in Viwandani as compared to Korogocho, for a unit increase in years while holding other factors constant [i.e adjusted odds ratio (AOR) of 0.9429, 95% confidence interval (CI) of (0.9006, 0.9872)]. In addition, the study found that for a unit change in gravidity, the odds of experiencing pregnancy loss was 16% less among women in the lowest wealth tertile compared to women in the highest wealth tertile. Also, the odds of pregnancy loss was 6% more for a unit increase in women's age [AOR: 0.8425; 95% CI: (0.7134, 0.9949)]. Currently married and previously married pregnant women were, respectively, thrice and twice more likely to lose pregnancy compared to never-married women [AOR: 3.0180; 95% CI: (1.6930, 5.3798)]. In conclusion, advanced maternal age and being married were found to be strongly associated with the risk of pregnancy loss. The association between pregnancy loss and wealth tertile depends on the level of gravidity of the women. Identification of risk factors associated with pregnancy loss in slum settings can aid in public health programming and designing interventions to ensure safer pregnancy for women. Further research is required to investigate possible hidden factors affecting pregnancy loss for women with higher gravidity in the highest household wealth tertiles.