An Increased Adverse Fetal Outcome Has Been Observed among Teen Pregnant Women in Rural Eastern Ethiopia: A Comparative Cross-Sectional Study

Estimated effect of teenage pregnancy on adverse birth outcome in Sub-Saharan African countries: propensity score matching analysis of recent demographic and health survey data

INTRODUCTION

Globally adverse birth outcome is being a series public health problem. As studies showed, even though the etiologies are multifactorial, extreme age pregnancies have more risk for adverse birth outcome. This study determines the estimated effect of teenage pregnancy on adverse birth outcome.

METHOD

The study analyzed data from the most recent Demographic and Health Surveys (DHS) data. Propensity score matching (PSM) analysis was employed by using age as treatment variable, teenager as treated and non-teenagers as control group and weighted sample of 45,790 (non-teenagers = 41,769 and teenagers = 4,021). The outcome variable; adverse birth outcome was categorized as "Yes" if a woman had either preterm birth, still birth, low birth weight or macrosomia in her recent birth and "No" otherwise. Covariates that had significant association with the treatment and outcome variables were considered for PSM analysis. After testing of each matching techniques (nearest neighbor, kernel and radius), the nearest neighbor (10) approach produced better covariate balance and selected as the best matching algorism for our analysis. Finally, the effect of teenage pregnancy on adverse birth outcome was measured and reported as average treatment effect on the treated (ATT) and the quality of matching and sensitivity to hidden bias was assed by t-statistics significance level and Mantel-Haenszel statistic respectively.

RESULTS

This study found that around one in ten (8.7%) of the women had pregnancy between the age of 15 and 19 years. The magnitude of adverse birth outcome among teenagers and non-teenagers was also 45.4% and 39.9% respectively. Teenage pregnancy contributed to a 4.7% increasing adverse birth outcome (ATT = 4.7%). Similarly, the Average Treatment Effect on Untreated (ATU) was 4.8%.

CONCLUSION

This study revealed that around one in teen women had pregnancy between the age of 15 and 19 years and teenage pregnancy had more risk of having adverse birth outcomes as compared to non-teenagers. Thus, we recommend to policy makers and implementers to design policies and strategies to improve teenagers' access to prenatal care, family planning, and sexual education, awareness of creation on teenage pregnancy risks.

Association between quality of antenatal care service utilisation and adverse birth outcomes among adolescent women in 22 Sub-Saharan African countries. A mixed-effects multilevel analysis

OBJECTIVES

This study aimed to assess the association between the quality of antenatal care (ANC) service utilisation and adverse birth outcomes among adolescent women in Sub-Saharan Africa (SSA).

METHODS

A two-level mixed-effects model was employed using the recent Demographic Health Survey (DHS) data from 22 SSA countries. Both bivariable and multivariable multilevel analyses were conducted to assess the association between individual and community level factors with adverse birth outcomes. The results of the fixed effects model were interpreted in the form of adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs).

RESULTS

In SSA, 23.5 % of adolescent mothers experienced adverse birth outcomes. This study found that receiving high quality ANC was associated with a 28 % reduction in the likelihood of adverse birth outcomes (AOR = 0.72, 95 % CI: 0.63, 0.83). Among the individual-level factors, middle-aged adolescence (AOR = 1.23, 95 % CI: 1.11, 1.36), being a female newborn (AOR = 1.15, 95 % CI: 1.05, 1.26), single marital status (AOR = 0.87, 95 % CI: 0.78, 0.96) and higher educational status (AOR = 0.83, 95 % CI: 0.74, 0.93) were significantly associated with adverse birth outcomes. From the community-level variables, women from Eastern Africa had positive significant association with adverse birth outcomes (AOR = 1.30, 95 % CI: 1.15, 1.46).

CONCLUSIONS

Nearly one-fourth of adolescent women in SSA experienced at least one type of adverse birth outcome. Low quality of ANC was significantly associated with adverse birth outcomes. Policymakers need to consider a comprehensive, essential, and minimal package of ANC to enhance the quality of ANC, which is crucial for better adolescent birth outcomes.

Teenage pregnancy and its predictors in Africa: A systematic review and meta-analysis

Objective

Although teenage pregnancy has declined in the last decade, it remains a major public health issue in Africa. Maternal mortality is common among teenagers due to their increased risk of obstetric and medical complications. In Africa, there is a lack of robust and comprehensive data on the prevalence and predictors of teenage pregnancy. As a result, this systematic review and meta-analysis were carried out to summarize evidence that will assist concerned entities in identifying existing gaps and proposing strategies to reduce teenage pregnancy in Africa.

Methods

The review is registered by the international prospective register of systematic reviews (CRD42021275013). This search included all published and unpublished observational studies written in English between August 23, 2016, and August 23, 2021. The articles were searched using databases (PubMed, CINHAL [EBSCO], EMBASE, POPLINE, Google Scholar, DOAJ, Web of Sciences, MEDLINE, Cochrane Library, and SCOPUS). Data synthesis and statistical analysis were conducted using STATA version 14 software. Forest plots were used to present the pooled prevalence and odds ratio (OR) with a 95% confidence interval (CI) of meta-analysis using the random effect model.

Results

A total of 43,758 teenagers (aged 13-19) were included in 23 studies. In Africa, the overall pooled prevalence of teenage pregnancy was 30% (95% CI: 17-43). Western Africa had the highest prevalence of teenage pregnancy 33% (95% CI: 10-55). Age (18-19) (OR = 2.99 [95% CI = 1.124-7.927]), wealth index (OR = 1.84 [95% CI = 1.384-2.433]), and marital status (OR = 6.02 [95% CI = 2.348-15.43]) were predictors of teenage pregnancy in Africa.

Conclusion

In Africa, nearly one-third of teenagers become pregnant. Teenage pregnancy was predicted by age (18-19), wealth index, and marital status. Strengthening interventions aimed at increasing teenagers' economic independence, reducing child marriage, and increasing contraceptive use among married teenagers can help to prevent teenage pregnancy.

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.