Incidence, risk factors and consequences of preterm birth \u2013 findings from a multi-centric observational study for 14\u2009months in Nepal

Abhishek Gurung,Rejina Gurung,Prajwal Paudel,Amrit Pokhrel,Ashish Kc,Yuba Nidhi Basaula,Avinash K Sunny,Netra Rana,Johan Wrammert

doi:10.1186/s13690-020-00446-7

Abstract

BackgroundPreterm birth is a worldwide epidemic and a leading cause of neonatal mortality. In this study, we aimed to evaluate the incidence, risk factors and consequences of preterm birth in Nepal.MethodsThis was an observational study conducted in 12 public hospitals of Nepal. All the babies born during the study period were included in the study. Babies born < 37 weeks of gestation were classified as preterm births. For the association and outcomes for preterm birth, univariate followed by multiple regression analysis was conducted.ResultsThe incidence of preterm was found to be 93 per 1000 live births. Mothers aged less than 20 years (aOR 1.26;1.15–1.39) had a high risk for preterm birth. Similarly, education of the mother was a significant predictor for preterm birth: illiterate mothers (aOR 1.41; 1.22–1.64), literate mothers (aOR 1.21; 1.08–1.35) and mothers having basic level of education (aOR 1.17; 1.07–1.27). Socio-demographic factors such as smoking (aOR 1.13; 1.01–1.26), use of polluted fuel (aOR 1.26; 1.17–1.35) and sex of baby (aOR 1.18; 1.11–1.26); obstetric factors such as nulliparity (aOR 1.33; 1.20–1.48), multiple delivery (aOR 6.63; 5.16–8.52), severe anemia during pregnancy (aOR 3.27; 2.21–4.84), antenatal visit during second trimester (aOR 1.13; 1.05–1.22) and third trimester (aOR 1.24; 1.12–1.38), < 4 antenatal visits during pregnancy (aOR 1.49; 1.38–1.61) were found to be significant risk factors of preterm birth. Preterm has a risk for pre-discharge mortality (10.60; 9.28–12.10).ConclusionIn this study, we found high incidence of preterm birth. Various socio-demographic, obstetric and neonatal risk factors were associated with preterm birth. Risk factor modifications and timely interventions will help in the reduction of preterm births and associated mortalities.Trial registrationISRCTN30829654.

Highlights

Preterm birth is a worldwide epidemic and a leading cause of neonatal mortality
Socio-demographic characteristic such as age of mother, education level, smoking history and type of fuel all showed significant association (p < 0.001) with preterm births. Obstetric characteristics such as multiple delivery, primiparity, time of first Antenatal care (ANC) visit, frequency of ANC visits, major malformation and severe anemia during pregnancy were found to be significantly associated with preterm births
In a systematic review conducted with data available from 107 countries, the global preterm birth rate was reported at 10.6% [22] and a systematic analysis based on data available from 184 countries reported an estimated preterm births of 11.1% [1]

Summary

Introduction

Preterm birth is a worldwide epidemic and a leading cause of neonatal mortality. We aimed to evaluate the incidence, risk factors and consequences of preterm birth in Nepal. In Nepal, it is reported that around 81,000 newborns are born preterm every year [3]. A study conducted by Lee and colleagues in 2010 reported 14% preterm births [4]. Despite the increase in burden of preterm births worldwide, the data available from developing countries like Nepal is very scarce [5]. In order to achieve the Sustainable Development Goal 3 target of reaching the neonatal mortality rate to 12 per 1000 live birth by 2030, it is critical to address the burden of preterm births [6]

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