Obstetric outcomes and antenatal access among adolescent pregnancies in KwaZulu-Natal, South Africa

Correlates of adverse outcomes of adolescent pregnancy in Sidama region, Ethiopia. An unmatched case-control study

INTRODUCTION

Adolescent pregnancy has received little attention, despite being it is the leading cause of maternal mortality and morbidity in low-income countries, including Ethiopia. Sidama regional state is one of the regions in Ethiopia that has high rates of adolescent pregnancy. This study aimed to identify factors related to adverse outcomes of adolescent pregnancy, in the Sidama region, Ethiopia.

METHODS

A hospital-based unmatched case-control study was conducted among 120 cases and 240 controls of pregnant adolescents. Structured interviews and patient record reviews were used to examine the potential correlates and adverse outcomes of adolescent pregnancy. Using binary logistic analysis, adjusted odds ratio (AOR) with 95% confidence intervals, were computed to identify factors related to adverse outcomes of adolescent pregnancies.

RESULTS

A monthly income below the poverty level (AOR: 3.40; 95% CI, 1.21-9.58), lack of antenatal care follow-up (AOR: 4.22; 95% CI, 1.97-9.04), experiencing gender-based violence (AOR: 2.03; 95% CI, 1.16-3.57), and referral to a specialized health facility (AOR: 2.79; 95% CI,1.39, 5.62) were associated with higher odds of adverse pregnancy outcomes.

CONCLUSION

Several socio-economic and health care system-related determinants are associated with adverse outcomes of adolescent pregnancy. Therefore, it is crucial to improve free and accessible maternal health care services for adolescents, focusing on education, challenging social norms that condone gender-based violence as well as enhancing the referral system to lessen the burden of adverse outcomes of adolescent pregnancy.

The burden and predictors of late antenatal booking in a rural setting in Ghana

AIM

The aim of the study was to determine the prevalence and key predictors of late booking among pregnant women accessing antenatal care services in a rural district of Ghana.

DESIGN

Cross-sectional study.

METHODS

Data on demographic characteristics, knowledge of accessing antenatal care services and booking gestation were collected from 163 randomly selected pregnant women accessing accessing antenatal care in rural Ghana from 1 March 2022 to 30 April 2022 using a structured questionnaire. The chi-square and logistic regression were used to explore associations between exposure and dependent variables.

RESULTS

The prevalence of late accessing antenatal care booking among study participants was 44.8% (73/163). About 79.1% (129/163) of them had adequate knowledge of accessing antenatal care services. Maternal age of 35-49 years (AOR: 8.53, 95% CI: 2.41-30.12), participants whose partners had no formal education (AOR: 3.43, 95% CI: 1.03-11.39) and participants with adequate knowledge about accessing antenatal care services (AOR: 0.21, 95% CI: 0.07-0.62) were associated with late booking for accessing antenatal care services among study participants.

A Scoping Review of Preterm Births in Sub-Saharan Africa: Burden, Risk Factors and Outcomes

Preterm births (PTB) are the leading cause of neonatal deaths, the majority of which occur in low- and middle-income countries, particularly those in Sub-Saharan Africa (SSA). Understanding the epidemiology of prematurity is an essential step towards tackling the challenge of PTB in the sub-continent. We performed a scoping review of the burden, predictors and outcomes of PTB in SSA. We searched PubMed, Embase, and three other databases for articles published from the database inception to 10 July 2021. Studies reporting the prevalence of PTB, the associated risk factors, and/or its outcomes were eligible for inclusion in this review. Our literature search identified 4441 publications, but only 181 met the inclusion criteria. Last menstrual period (LMP) was the most commonly used method of estimating gestational age. The prevalence of PTB in SSA ranged from 3.4% to 49.4%. Several risk factors of PTB were identified in this review. The most frequently reported risk factors (i.e., reported in ≥10 studies) were previous history of PTB, underutilization of antenatal care (<4 visits), premature rupture of membrane, maternal age (≤20 or ≥35 years), inter-pregnancy interval, malaria, HIV and hypertension in pregnancy. Premature babies had high rates of hospital admissions, were at risk of poor growth and development, and were also at a high risk of morbidity and mortality. There is a high burden of PTB in SSA. The true burden of PTB is underestimated due to the widespread use of LMP, an unreliable and often inaccurate method for estimating gestational age. The associated risk factors for PTB are mostly modifiable and require an all-inclusive intervention to reduce the burden and improve outcomes in SSA.

Adverse obstetric and neonatal outcomes of adolescent pregnancies in Africa: a scoping review

BACKGROUND

Adolescent pregnancy is a public health issue with well-defined causes and health risks with social and economic implications. Aim of this review was to examine adverse pregnancy outcomes and risk factors associated with adolescent pregnancy in Africa.

METHOD

PubMed Central, Science Direct and JSTOR were the main databases for the literature review. Other online sources and experts were consulted for relevant studies. In all, 11,574 records were identified and 122 were considered as full-text studies for evaluation after thorough screening and removal of duplicates. Finally, 53 studies were included in this review for thematic synthesis.

RESULTS

The 53 studies sampled 263,580 pregnant women, including 46,202 adolescents (< 20 years) and 217,378 adults (> 20 years). Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Factors of poor pregnancy outcomes included low socioeconomic and educational status, poor utilization of antenatal care, risky lifestyles such as alcohol consumption, and unattractive health care factors. Maternal health care utilization was identified as an important factor to improve pregnancy outcomes among adolescents in Africa.

CONCLUSION

To prevent adolescent pregnancy, stakeholders need to help lower socioeconomic inequalities, poor utilization of antenatal care, alcohol consumption, and improve adolescents' health care and their educational status. Issues such as child marriage, abortion, poor health care infrastructure and non-adolescent friendly health facilities need to be addressed.

The prevalence, risk factors and outcomes of anaemia in South African pregnant women: a systematic review and meta-analysis

BackgroundAnaemia is associated with maternal and perinatal morbidity and mortality. The pooled prevalence of anaemia in the South African (SA) pregnant population was ascertained by systematically reviewing available literature. Severity, risk factors (HIV, tuberculosis, race, province, year of study), maternal morbidity and mortality (hypertensive disorders of pregnancy), birth outcomes (including low birth weight) and supplementation during pregnancy were also described.MethodsEligible studies reported on haemoglobin concentration or prevalence of anaemia in a SA pregnant population and were available in full text. Case-control and estimation studies were excluded with no restriction on the date of publication. PubMed, CINAHL, EMBASE, EBSCO, Ovid maternity and infant care databases, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS were searched, using the keywords 'anaemia', 'haemoglobin', 'pregnancy', 'South Africa'. Risk of bias was conducted using the Hoy tool and the Doi plot and LFK ratio. Overall study quality was assessed using the GRADE tool. Due to heterogeneity amongst studies subgroup analyses were performed (random effects and quality effects model) using MetaXL addon tool for Microsoft Excel.ResultsThe initial search yielded 7010 articles and 26 were selected for inclusion. Twenty studies were cross-sectional, three were longitudinal and one a randomised control trial. Studies ranged in publication year from 1969 to 2020. The pooled prevalence of anaemia in pregnant women in SA was determined to be 31% (95% CI, 23-40%). Hypertensive disorders of pregnancy and low birth weight were associated with anaemia. While iron deficiency was reported as the main cause, other risk factors included HIV and other infections.DiscussionLimitationsThere was limited data reporting on prevalence of anaemia and direct maternal and foetal outcomes. Heterogeneity amongst studies was not explained by subgroup analysis. Majority of cross-sectional study designs reduced the ability to infer causality.InterpretationWhile the prevalence of anaemia remains high and of concern, risk factors are varied. Iron deficiency is still common but the presence of comorbidities also contributes to anaemia and should not be ignored. More longitudinal research into associations between anaemia and birth outcomes is needed due to a lack of available evidence.Systematic review registrationPROSPERO 2020: CRD42020157191.

Factors associated with changes in adequate antenatal care visits among pregnant women aged 15-49 years in Tanzania from 2004 to 2016

BACKGROUND

Antenatal care (ANC) is crucial for the health of the mother and unborn child as it delivers highly effective health interventions that can prevent maternal and newborn morbidity and mortality. In 2002, the World Health Organization (WHO) recommended a minimum of four ANC visits for a pregnant woman with a positive pregnancy during the entire gestational period. Tanzania has sub-optimal adequate (four or more) ANC visits, and the trend has been fluctuating over time. An understanding of the factors that have been contributing to the fluctuating trend over years is pivotal in increasing the proportions of pregnant women attaining adequate ANC visits in Tanzania.

METHODS

The study used secondary data from Tanzania Demographic Health Survey (TDHS) from 2004 to 2016. The study included 17976 women aged 15-49 years. Data were analyzed using Stata version 14. Categorical and continuous variables were summarized using descriptive statistics and weighted proportions. A Poisson regression analysis was done to determine factors associated with adequate ANC visits. To determine factors associated with changes in adequate ANC visits among pregnant women in Tanzania from 2004 to 2016, multivariable Poisson decomposition analysis was done.

RESULTS

The overall proportion of women who had adequate ANC visits in 2004/05, 2010 and 2015/16 was 62, 43 and 51% respectively. The increase in the proportion of women attaining adequate ANC from 2010 to 2015/16 was mainly, 66.2% due to changes in population structure, thus an improvement in health behavior. While 33.8% was due to changes in the mother's characteristics. Early initiation of first ANC visit had contributed 51% of the overall changes in adequate ANC attendance in TDHS 2015/16 survey.

CONCLUSION

Early ANC initiation has greatly contributed to the increased proportion of pregnant women who attain four or more ANC visits overtime. Interventions on initiating the first ANC visit within the first twelve weeks of pregnancy should be a priority to increase proportion of women with adequate ANC visit.

An analysis of obstetric practices and outcomes in a deep rural district hospital in South Africa

Background

Internationally, there has been a focus on ensuring that Caesarean deliveries are performed only when indicated, to ensure the best outcome for mother and baby. In South Africa, despite a variety of health system interventions, maternal and perinatal mortality remain unacceptably high.

Objectives

To describe and compare the clinical outcomes related to the mode of delivery, for patients managed at rural primary healthcare level.

Methods

This retrospective cross-sectional observational analytical study was conducted at a deep rural district hospital in northern KwaZulu-Natal, South Africa. Maternity Case Records and Caesarean delivery audit tools from 2018 were reviewed.

Results

In total, 634 files were retrieved. The Caesarean delivery rate in the sample was 30.8% (193 of 634 deliveries), and according to the Robson classification, groups 5 and 1 were the biggest contributors to Caesarean delivery. All Caesarean deliveries were deemed to have been medically indicated. As compared to those whose delivery was normal vaginal, the odds of having post-partum haemorrhage were 25 times higher, and the odds of having any complication were three times higher, if a mother delivered by Caesarean (p<0.001). In neonates who were delivered by Caesarean, the odds of being admitted to nursery were four times higher than those delivered vaginally (p<0.001).

Conclusion

Showing a significantly higher risk of maternal and neonatal complications, this study validated Caesarean delivery at rural primary care as a potentially dangerous undertaking, for which adequate precautions should be taken. There is a need for interventions targeting rural healthcare in South Africa, to ensure that obstetric services are offered to patients in as safe a manner as possible in this environment.

Antenatal Care and Weight Gain in Adolescent Compared to Adult Pregnancy

Background:

The aim of this study is to compare the antenatal care, body weight, and weight gain in pregnancy between the adolescent and adult pregnancies and, thus, examine the impact of adolescence on the studied parameters.

Methods:

This prospective study includes 300 pregnant women who were the patients of University Clinical Center Tuzla, Clinic for Gynecology and Obstetrics from January 2011 to December 2014. The women were divided into two groups: an experimental group consisted of 150 adolescent pregnant women aged 13–19 years and a control group consisted of 150 adult pregnant women aged 20–35 years. The following parameters were analyzed: age of pregnant women, number of antenatal controls in pregnancy, prepregnancy body weight, weight gain in pregnancy, parity, and obstetric history data.

Results:

A significantly higher number of adolescent pregnant women belongs to a subgroup from one to two examinations during pregnancy (P < 0.000013) and to subgroups from three to five examinations (P < 0.000001). A significantly smaller number of adolescent pregnant women performed their first antenatal control in the first 2 lunar months (P < 0.01). A subgroup with optimal body weight (from 51 to 69 kg) are the most prevalent among adolescent pregnant women (P < 0.000001). A significantly larger number of adolescent pregnant women had an optimal weight gain of 7.8 to 12.99 kg (P < 0.001).

Conclusions:

The adolescent pregnant women have suboptimal antenatal care, which could lead to adverse maternal and birth outcomes, but have optimal body weight and weight gain during pregnancy.

Girls' Empowerment and Adolescent Pregnancy: A Systematic Review

Background: 21 million girls get pregnant every year. Many initiatives are empowering girls. Various studies have looked at girl empowerment, however, there is contradicting evidence, and even less literature from developing countries. Methods: We searched articles published between January 2000 to January 2019. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered our protocol on the International Prospective Register of Systematic Reviews PROSPERO (CRD42019117414). Nine articles were selected for review. Quality appraisal was done using separate tools for qualitative studies, cohort and cross-sectional studies and randomized control trials. Results: Eight studies included educational empowerment, four studies included community empowerment, three studies included economic empowerment, while two studies discussed policy empowerment. Three studies were of fair quality; two qualitative and one cross-sectional study were of high quality, while three studies had low quality. Discussion. Studies showed a favorable impact of girl empowerment on adolescent pregnancies and risky sexual behaviors. Education empowerment came through formal education or health systems such as in family planning clinics. Community empowerment was seen as crucial in girls' development, from interactions with parents to cultural practices. Economic empowerment was direct like cash transfer programs or indirect through benefits of economic growth. Policies such as contraceptive availability or compulsory school helped reduce pregnancies.

Factors associated with skilled attendants at birth among married adolescent girls in Nigeria: evidence from the Multiple Indicator Cluster Survey, 2016/2017

BACKGROUND

This study examines the factors associated with skilled birth attendants at delivery among married adolescent girls in Nigeria.

METHODS

The study was a secondary data analysis of the fifth round of the Multiple Indicator Cluster Survey conducted between September 2016 and January 2017. Married adolescent girls aged 15-19 y who had live births in the last 2 y preceding the survey were included in the analysis. We performed univariate and multivariate logistic regression analyses with a skilled birth attendant (doctor, nurse or midwife) at delivery as the outcome variable and sociodemographic, male partner- and maternal health-related factors as explanatory variables.

RESULTS

Of the 789 married adolescent girls, 387 (27% [95% CI=22.8-30.7]) had a skilled birth attendant at delivery. In the adjusted model, adolescent girls who were aged ≥18 y (ref: <18 y), primiparous (ref: multiparous), had antenatal care (ANC) provided by skilled healthcare providers (ref: no ANC), belonged to at least the poor and middle wealth index quintiles (ref: poorest), and resided in the south west zone (ref: north central), independently had a significantly higher likelihood of having a skilled birth attendant at delivery.

CONCLUSIONS

Interventions that will reduce pregnancy in younger adolescent girls, poverty, and increase ANC provided by skilled attendants, are likely to improve deliveries assisted by skilled birth attendants among married adolescent girls in Nigeria.

Maternal obstetric and socio-demographic determinants of low birth weight: a retrospective cross-sectional study in Ghana

Background

Birth weight is an important predictor of early neonatal mortality, morbidity, and long-term health outcomes. Annually, approximately 20 million babies are born globally with weights less than 2.5kg. In sub-Saharan Africa, the prevalence of LBW is around 13 to 15 percent. In Ghana, 10% of babies born in 2014 were with LBW. The aim of this study was to identify maternal socio-demographic and obstetric risk factors associated with the birth weight of newborns in the Sunyani Municipality of Ghana.

Methods

This retrospective cross-sectional study analysed data from 931 birth records of all deliveries between January 1 and December 31, 2017, at the Sunyani Municipal Hospital in the Brong-Ahafo Region of Ghana. Univariate and multivariable logistic regression models were fitted to estimate the effect of maternal factors on low birth weight.

Results

We found that the mean age of the participants and the mean gestational age at birth were 27.21(SD = 5.50) years and 37.95(SD = 1.85) weeks respectively. Nearly 10% of the infants born within the study period had birth weights below 2.5kg. The findings revealed that the odds of delivering LBW baby were significantly high (OR 1.77, 95%CI 1.14-2.76) among urban dwellers. However, mothers who attended or completed secondary or higher education were 63% (95% CI 0.20–0.78) less likely to give birth to a LBW baby when compared with uneducated mothers. We found that the odds of LBW significantly decreased with every one-week increase in gestational age (OR 0.67 95%CI 0.59-0.76) and significantly increased with increasing parity (OR 1.43 95%CI 1.21-1.70). Further, the likelihood of delivering LBW baby decreased with every additional ANC visit (OR 0.78 95%CI 0.67-0.90) and with every additional gram of haemoglobin (OR 0.78 95%CI 0.63-0.95).

Conclusion

The evidence from this study suggests that maternal educational level, residence, haemoglobin level, parity, number of ANC visits, and gestational age are independent predictors of low birth weight. The current findings add substantially to the growing literature on the influence of maternal socio-demographic and obstetric factors on LBW in resource-constrained settings and provide empirical data for clinical and public health interventions aimed at reducing low birth weight and its associated complications.

Nurses' perception of the multidisciplinary team approach of care for adolescent mothers and their children in Ugu, KwaZulu-Natal

BACKGROUND

Adolescent childbearing has numerous consequences on maternal health, child health and the well-being of society. Because of the high-risk nature of adolescent pregnancy, a multidisciplinary team (MDT) approach is recommended to achieve satisfactory pregnancy outcomes.

AIM

The aim of this study was to explore nurses' perceptions of the MDT approach in the continuum of care for adolescent mothers and their children.

SETTING

The study was conducted in a local district hospital in Ugu, KwaZulu-Natal.

METHODS

An explorative and descriptive qualitative study design was used. The first author and hospital staff (clinical midwives and the clinical manager of obstetrics and gynaecology) collaborated on the development of the focus group discussion (FGD) guide to explore nurses' perception of the MDT approach of care for adolescent mothers and their children. A total of three FGDs were conducted. Data were analysed using thematic analysis.

RESULTS

Six overarching themes emerged from the data analysis which included professional benefits of adopting the MDT approach of care for adolescent mothers and their children, barriers to the multidisciplinary collaboration, clinical benefits of adopting the MDT approach of care for parenting adolescent mothers, problems and needs of adolescent mothers, and nurses' reasons regarding their willingness to participate in a multidisciplinary collaboration in the care of parenting adolescent mothers.

CONCLUSION

In the opinion of nurses, the MDT approach of care for adolescent mothers and their children is an important strategy to improve maternal and child health outcomes. This study has important implications for the design of an intervention.