Abstract
Understanding independent and joint predictors of adverse pregnancy outcomes is essential to inform interventions toward achieving sustainable development goals. We aimed to determine the joint predictors of preterm birth and perinatal death among singleton births in northern Tanzania based on cohort data from the Kilimanjaro Christian Medical Center (KCMC) zonal referral hospital birth registry between 2000 and 2017. We determined the joint predictors of preterm birth and perinatal death using the random-effects models to account for the correlation between these outcomes. The joint predictors of higher preterm birth and perinatal death risk were inadequate (<4) antenatal care (ANC) visits, referred for delivery, experiencing pre-eclampsia/eclampsia, postpartum hemorrhage, low birth weight, abruption placenta, and breech presentation. Younger maternal age (15–24 years), premature rupture of membranes, placenta previa, and male children had higher odds of preterm birth but a lessened likelihood of perinatal death. These findings suggest 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 a substantial reduction of adverse perinatal outcomes and improving maternal and child health.
Highlights
There is a notable decline of under five mortality rates since the year 1990 [1]
The highest proportions of preterm birth were among younger fathers, that is, 15–24 years (16.2%), with no education (20.5%), and farmers (17.9%)
For every 1-year increase, we expect to see the odds of preterm birth increasing significantly by 4% (OR = 1.04, 95% CI 1.03, 1.05) and 3% decrease in perinatal death (OR = 0.97, 95% CI 0.95, 0.99)
Summary
There is a notable decline of under five mortality rates since the year 1990 [1] Despite this decline, the share of mortality burden increased in the group of children in younger ages, especially in the first 28 days of life (neonatal period) [1,2,3]. The United Nations (UN) Inter-agency Group for Child Mortality Estimation report indicated that at a global rate of 17 deaths per 1,000 live births, and approximately 6,700 neonatal deaths everyday in 2019, neonatal period is the most vulnerable time for children under 5 years of age [1]. The share of neonatal mortality to under five deaths has increased from 40% in 1990 to 47% in 2019 [1].
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