School of Statistics and Planning, Makerere University, Kampala, Uganda.
Faculty of Public Health, Lira University, Lira, Uganda.
BMC Pregnancy Childbirth. 2023 Nov 23;23(1):814. doi: 10.1186/s12884-023-06120-4.
The World Health Organization (WHO) defines Preterm Birth (PTB) as "a live birth taking place before the expected 37 weeks of gestation". Annually, approximately 15 million infants are born prematurely, constituting significantly to infant mortality during the initial four weeks of life, responsible for 40% of deaths among children under the age of five. Evidently, preterm deliveries have contributed to 46% of admissions to the neonatal intensive care unit (NICU) at Lira Regional Referral Hospital (LRRH) over the past three years. Paradoxically, while the prevalence of preterm births remains high, there is a lack of documented information regarding the underlying risk factors. Consequently, the primary objective of this study was to assess the potential risk factors associated with preterm birth at LRRH.
An analytical cross-sectional research was undertaken at LRRH, employing a quantitative methodology. The study utilized secondary data obtained from a total of 590 comprehensive maternal medical records, of deliveries that occurred at the facility between April 2020 and July 2021. The collected data underwent analysis using STATA version 17 software. To identify predictors of preterm birth, a Logistic regression model was applied, yielding adjusted odds ratios (AOR) alongside 95% confidence intervals (CI). The significance level was set at p < 0.05 to establish statistical significance. Furthermore, assessments for multicollinearity and model fitness were conducted using the Variance Inflation Factor (VIF) and linktest, respectively.
The prevalence of preterm delivery among mothers who gave birth at LRRH stood at 35.8%. The outcomes of logistic regression analysis revealed that maternal employment status had a statistically significant association with preterm birth (AOR = 0.657, p = 0.037, 95%CI: 0.443-0.975); having a baby with low birth weight (AOR = 0.228, p < 0.001, 95% CI: 0.099-0.527) and experiencing preeclampsia (AOR = 0.142, p < 0.001, 95% CI: 0.088-0.229) were also identified as significant predictors of preterm birth in the study.
The occurrence of preterm delivery is significantly higher (35.8%) among mothers who gave birth at LRRH when compared to the national average (13.6%). The prevalence of preterm birth among mothers was linked to factors such as employment status, delivery of low birth weight infants, and the presence of preeclampsia. Consequently, the research proposes a set of recommendations. Firstly, the Ministry of Health (MoH) should evaluate the present state of readiness within the healthcare system to effectively handle cases of preterm birth both within medical facilities and the community. Secondly, the Ministry of Gender, Labour, and Social Development should leverage Labor Officers to implement and uphold the regulations stipulated in the Employment Act and Labor Laws.
世界卫生组织（WHO）将早产（PTB）定义为“在预期的 37 周妊娠之前发生的活产”。每年，约有 1500 万婴儿早产，这对生命最初四周的婴儿死亡率有重大影响，占五岁以下儿童死亡人数的 40%。显然，早产导致过去三年里利拉地区转诊医院（LRRH）新生儿重症监护病房（NICU）的入院率增加了 46%。矛盾的是，尽管早产的发生率仍然很高，但缺乏有关潜在风险因素的记录信息。因此，本研究的主要目的是评估 LRRH 与早产相关的潜在风险因素。
在 LRRH 进行了一项分析性横断面研究，采用定量方法。该研究使用了 2020 年 4 月至 2021 年 7 月期间在该设施分娩的 590 份综合产妇医疗记录的二手数据。使用 STATA 版本 17 软件对收集的数据进行分析。为了确定早产的预测因素，应用了逻辑回归模型，得出调整后的优势比（AOR）和 95%置信区间（CI）。置信水平设置为 p<0.05，以确定统计学意义。此外，使用方差膨胀因子（VIF）和 linktest 分别对多重共线性和模型拟合进行评估。
在 LRRH 分娩的母亲中，早产的发生率为 35.8%。逻辑回归分析的结果表明，母亲的就业状况与早产有统计学显著关联（AOR=0.657，p=0.037，95%CI：0.443-0.975）；婴儿出生体重低（AOR=0.228，p<0.001，95%CI：0.099-0.527）和子痫前期（AOR=0.142，p<0.001，95%CI：0.088-0.229）也被确定为该研究中早产的显著预测因素。
与全国平均水平（13.6%）相比，在 LRRH 分娩的母亲中，早产的发生率（35.8%）显著更高。母亲早产的发生率与就业状况、低出生体重婴儿的分娩以及子痫前期的存在等因素有关。因此，研究提出了一系列建议。首先，卫生部（MoH）应评估卫生系统目前对有效处理医疗设施内和社区内早产病例的准备情况。其次，性别、劳动和社会发展部应利用劳动官员实施和维护《就业法》和《劳动法》规定的法规。
