Assessment of neonatal outcomes among teenage mothers at Kitale County Referral Hospital, Kenya

Abstract

Introduction: Approximately 14 million mothers aged 15 – 19 years give birth annually globally. The number of teenage births in Sub Saharan Africa (SSA) is particularly high with an estimated 50% of mothers under the age of 20. In Kenya one in every five school going teenage girls gets pregnant before they reach 20 years. The national teenage pregnancy prevalence rate in Kenya is 18% with Trans-Nzoia County having a rate of 23% ranking position 10 out of the 47 counties. Teenage mothers have a significantly higher risk of neonatal mortality, low birth weight and premature deliveries in comparison to adults. SSA and south Asia make up over 60 percent of preterm births worldwide. Of the 15 million babies born as extreme premature each year, more than one million die due to complications related to preterm birth. Objective: This study aimed at determining prevalence and factors associated with adverse neonatal outcomes (low birth weight, preterm and neonatal mortality) among teenage mothers in Kitale County Referral Hospital (KCRH). Methods: This was a retrospective study using records of pregnant mothers aged 11-19 years who delivered at KCRH. A total of 454 records of teenage mothers that gave birth at KCRH were systematically sampled from the records department, whereby every 10th file was systematically selected to participate in the study. Data was collected using a records checklist comprising four sections (individual characteristics, maternal health care and health system factors, biological factors and the outcome of birth). Data analysis was done using STATA version 16. The odds ratios (OR) and the corresponding 95% confidence intervals (95% CI) were reported. Descriptive statistics were used to summarize the variables; mean and median were used to summarize continuous variables while frequencies were used to summarize categorical variables. Bivariate and multivariate analysis was used to analyze the factors associated with the adverse outcomes. Results were presented using tables and figures. A p value < .05 at 95% confidence interval was considered statistically significant. Results: The mean age of the participants was 17 years (std = 1.3), 170 (37.4%) had attended antenatal clinic up to the fourth visit, 262 (57.7%) had spent less than twelve hours in labor and 410 (90.3%) gave birth via SVD. Of all the sampled teenage mothers, 62 (13.7%) had less than two years inter-pregnancy intervals. Out of 454, 244(54%) had newborns with adverse outcomes while 210 (46%) had normal newborns. The prevalence of preterm, low birth weight and neonatal mortality was (126)27.8 %, (114)25.1% and (4)0.9% respectively. Adjusting for age, occupation, residence, parity, number of ante-natal visits, mode of delivery and pregnancy interval; maternal HIV (human immunodeficiency virus) status was statistically significantly associated with low birth weight (LBW) neonates. For teenage mothers who were HIV positive, their odds of having a low birth weight neonate was 5 times (AOR = 5.12, 95% C.I. = 1.38-21.2, p-value = 0.016) more than that of HIV negative teenage mothers. The odds of giving birth to a low birth weight neonate among students was twice (AOR = 2.49, 95% C.I. = 0.95-7.91, p-value = 0.086) that of the employed teenage mothers though not statistically significant. Although not statistically significant, multiple pregnancies had 50% outcome in preterm deliveries. Conclusions: Prematurity was the commonest adverse neonatal outcome among the participants. HIV infection among the teenage mothers was a factor associated with LBW newborns. This study did not find any association between the variables and preterm delivery as well as neonatal deaths. Recommendations: Delayed teenage pregnancy programs and other programs to discourage early marriages as well as health education to the teens especially on contraceptive use is highly recommended. There is need for healthcare providers in KCRH to put more emphasis on focused antenatal care to ensure risk of LBW and preterm delivery is detected early and treated appropriately, especially among mothers with a positive HIV status.