Pregnancy outcomes among adolescents attending a rural health facility in Uganda :

Abstract

Background: Adolescent pregnancy is a public health problem and it is estimated that about 23 million adolescent girls aged 15 to 19 years become pregnant and around 16 million give birth every year globally. About 95% of these births are concentrated in middle and low-income countries. Adolescent pregnancy is associated with high maternal and perinatal morbidity and mortality. Despite interventions by the government, adolescent pregnancy has remained high. Objective: This study, therefore, aimed to determine pregnancy outcomes among adolescents who delivered at Apac Hospital from first July 2016 to 30th June 2018 Methodology: This was a cross-sectional study in which records of adolescent women aged 15-19 years who delivered in Apac hospital from July 2016 to June 2018 were reviewed. Data was collected using a data abstraction tool, coded and entered into Microsoft Excel, and exported to Stata 14.0 statistical software for analysis. At the Univariate level, descriptive statistics like mean, frequencies, and percentages were used to assess the maternal and fetal outcomes among adolescent mothers who delivered at Apac hospital. Bivariate analysis (chi-square test) was carried out between the dependent and independent variables to determine their association and help in selecting variables to enter into the multivariate models. Variables with a P-value ≤0.25 at bivariate levels were selected for entry into the multivariate models. Other variables selected for entry into the multivariable models were those with biological plausibility and those known to be confounders. Multivariable logistic regression analysis was carried out to assess the strength and direction of statistical association of fetal outcomes, maternal outcomes, and the independent factors affecting these outcomes. For fetal outcome which was sparsely distributed, penalized logistic regression was conducted to adjust for the sparse distribution. The strength of statistical association was measured by adjusted odds ratios at 95% confidence intervals. Statistical significance was declared at P<0.05. The results were presented in form of tables, figures, and charts. Results: Of the 501 records reviewed and analyzed, most adolescents, 79.4% (n=398) who delivered at Apac hospital were 18-19years, and most of them were from rural areas, 70.0% (n=353). The prevalence of stillbirth was at 4.4% (n=22), low birth weight at 20.9% (n=106), and birth asphyxia was at 9.6% (n=48). The commonest maternal outcomes were; post-partum hemorrhage (PPH) at 11.2 %(n=56), followed by obstructed labour at 10.2% (n=51) and cesarean delivery at 10.2% (n=51). At multivariate level, for fetal outcomes, low birth weight babies (<2.5kg) had higher odds of death, aOR 0.50(95%CI; 3.73-24.25, P<0.0001), as well as male babies, aOR 3.96(95%CI; 1.33-11.77, P=0.013). Infants born to adolescents with a parity of 2 or more had higher odds of death compared to infants born to adolescents giving birth for the first time, aOR 4.89 (95%CI; 1.65-14.55, P=0.004). For maternal outcomes, adolescent mothers not monitored using a partograph had higher odds of delivery by caesarian section compared to those monitored using a partograph, aOR 2.42 (95%CI; 1.22-4.80, P=0.011). Conclusion: Adolescent pregnancy is associated with poor fetal and maternal outcomes, including perinatal death (stillbirth), low birth weight, birth asphyxia, high rate of caesarian delivery, obstructed labor, and postpartum hemorrhage. Recommendation: All adolescent mothers in labor should be monitored on partograph as non-partograph use was associated with higher odds of caesarian section. Adolescent pregnant women with low birth weight babies (estimated) and those with a repeat pregnancy should be closely monitored right from antenatal, through the perinatal period to minimize stillbirth.