Prevalence and determinants of preterm delivery in an inner city referral hospital, Greater Accra Region, Ghana-2016

Abstract

Introduction : globally, preterm delivery contributes about 30% to 40% of neonatal mortality and 20% to 30% of infant and under-five mortality. The world’s preterm birth rate has been on the rise since the last two decades; with an increase of 20% since 1990 in high-income countries. Accurate data on prevalence and determinants of preterm delivery from low-income countries are not readily available. We assessed prevalence and determinants of preterm delivery in an inner city referral hospital in Ghana. Methods : a descriptive study followed by 12 unmatched case-control study was conducted from October 2015 to May 2016. A case of preterm was a baby in the hospital delivered during the study period at a gestational age between 28 and 36 weeks and a control was a baby delivered after 37 completed weeks of gestation. We interviewed mothers of cases and controls and reviewed maternal and fetal health records. Univariable analysis of categorical variables was expressed as frequencies and relative frequencies. At 95% confidence level, bivariable analysis and multiple logistic regression were done to determine associations between selected independent variables and preterm delivery. Results : of 5,215 deliveries, 796(15.3%) were preterm with 361(45.4%) of preterm babies being males. Mean gestational age was 32(+/-2.4) weeks. Determinants of preterm delivery were hypertensive complications in pregnancy [Odds ratio (OR)= 2.1, 95%CI 1.1-4.5], antepartum hemorrhage in index pregnancy (OR = 2.1, 95%CI 1.1-4.5), premature rupture of membranes (OR = 1.7, 95%CI 1.1-2.6) and Caesarean section delivery (OR = 1.4, 95%CI 1.2-4.6). Compared to controls, preterm babies were less likely to be delivered by mothers who had more than four antenatal clinics (ANC) attendance (OR = 0.2, 95%CI 0.0-0.1) and those with partner support (OR = 0.4, 95%CI 0.2-0.9) Conclusion : the proportion of preterm delivery was high, more likely in complicated pregnancies and less likely in ANC attendees and women with partner support. We educated mothers on need for ANC attendance and partner support.