ASSESSING PREGNANT WOMEN’S KNOWLEDGE AND PRACTICE ON THE RISK FACTORS AND PREVENTION OF PRETERM BIRTH IN TIKO HEALTH DISTRICT

SUMMARY

Introduction: Prematurity is an important cause of neonatal mortality, and it is defined as delivery of a live neonate before 37 completed weeks of pregnancy. It is a global health problem with an estimated 15 million premature births each year and the second cause of infant morbidity and mortality in children under 5 years of age. It affects both low and high income countries with Cameroon inclusive.
Aim: To Determine pregnant women’s knowledge and practice on the risk factors and prevention of preterm birth in Tiko Health District.

Methods: This will be a hospital based cross-sectional study to be carried out from February 2023 to May 2023 where primary data will be collected from pregnant women attending antennal care in Tiko Health District. Four Health Facilities (mostly Integrated Health Centres) in Tiko Health District will be selected conveniently and data will be collected using questionnaire. Data collected will be analysed in SPSS version 25 using a binary logistic regression model to determine risk factors and practices associated with preterm birth.
Expected outcomes: To determine the risk factors involved with preterm birth among pregnant women.

Keywords: Preterm birth, risk factors, practice, and prevention.

CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND

Preterm birth [PTB] is defined by the World Health Organisation [WHO] as any birth before 37 completed weeks of gestation, or fewer than 259 days since the first day of the woman’s last menstrual period [LMP]. This is further subdivided on the basis of gestational age [GA]: extremely preterm (less than 28 weeks); very preterm (28 to less than 32 weeks); moderate or late preterm (32 to less than 37 completed weeks of gestation) [1,2]. Approximately 45-50% of PTBs are idiopathic or spontaneous, 30% are related to preterm rupture of membranes, and 15-20% are attributed to medically indicated due to pre-eclampsia or eclampsia, and intrauterine growth
restriction [3].
Each year, 15 million babies are born preterm and the rate is increasing in almost all the countries[4]. It is the leading cause of death in children under the age of 5years [5]. Globally, it is estimated that 1.1 million neonatal deaths occur annually due to preterm birth complications with 80% of these occurring in Asia and sub-Saharan Africa [6]. In 2021, preterm birth affected about 1 of every 10 infants born in the United States.

The preterm birth rate rose to 4% in 2021, from 10.1% in 2020 to 10.5% in 2021 [7] despite advancing knowledge of risk factors and mechanisms related to preterm labour, and the introduction of many public health and medical interventions designed to reduce preterm birth [8]. More than 380,000 babies are born preterm each year in the United States and according to a release by March of Dimes [9] accounting for more than one in ten of the world’s preterm births and of these, more than one million died as a direct result of their prematurity [10].

Prematurity has been the leading cause of neonatal mortality worldwide for about a decade. However, during 2012, new global estimates placed preterm birth as the second leading cause of child mortality (leading cause of death in children under-5 years), behind pneumonia, with more than a million deaths each year and the single most important direct cause of death in the critical first month of life [11]. For the babies who survive, many face a lifetime of significant disability (such as learning impairments, cerebral palsy, and visual disorders) which accounts for 3.1% of all Disability Adjusted Life Years (DALYs) in the Global Burden of Disease. Hence, preterm birth is one largest
single condition in the Global Burden of Disease analysis given the high mortality and the considerable risk of lifelong impairment [9].

Of the 11 countries with preterm birth rates over 15%, all but two are in sub-Saharan Africa [2]. While 60% of preterm births occur in South Asia and sub-Saharan Africa [2], the United States and Brazil both rank among the top 10 countries with the highest number of preterm births. Yet, the burden remains highest in the regions with the fewest human resources [2]. Thus, preterm birth is a global problem that requires collective and coordinated global action and prematurity is an explicit public health priority as the problem and rates are shared and increasing in almost all countries (high, middle, and low income countries) with reliable time trend data [1].

Also, approximately 90% of PTB is concentrated in developing countries with South Asia and sub-Saharan Africa alone contributing to 81.1% of these preterm births, with countries like India, China, Nigeria, Bangladesh, Indonesia and Pakistan having 7.0 million (47.7%) of preterm births globally in 2014 [12]. In Cameroon, preterm birth still presents a major public health problem with a prevalence of 26.5% [13]. It is reported that, nearly 90,000 new-borns are born each year with a weight of less than 2,500 g in Cameroon [14]. According to a study carried out on prevalence, risk factors, and hospital outcome of preterm births in a regional hospital in Cameroon, the study reveals that the prevalence of prematurity was 18.5% [15].

Although the exact cause of PTB is unknown, several factors have been identified as risks for preterm birth. Socio-demographic factors such as ethnicity, older age of mothers and smoking have been reported as risk factors for preterm birth [11, 12]. Low education levels of mothers, smoking, tobacco consumption, multiple gestations, premature rupture of membranes [PROP], high blood pressure [HBp], diabetes and stress have also been documented as risk factors for preterm birth by many studies [13–15]. Further, poor access to antenatal care services during pregnancy leads to poor pregnancy outcomes like preterm births. Studies have also been conducted showing provider initiated interventions like induction of labour and caesarean section are attributable to preterm births [5, 18, 19].

Preventing deaths and complications from preterm birth starts with a healthy pregnancy. However, with the understanding that innovative solutions are needed to decrease mortality from preterm birth, the World Health Organization (WHO) published recommendations in 2015 on interventions to improve quality of care and outcomes surrounding preterm birth and to help women benefit good health and wellbeing before and throughout pregnancy such as, counselling on healthy diet and optimal nutrition, preventing tobacco and substance use, fetal measurements including use of early ultrasound to help determine gestational age and detect multiple pregnancies; antenatal care (ANC) which includes a minimum of 8 contacts with health professionals to identify and manage other risks such as infections [16].
In addition, women who attend ANC, screened for sexually transmitted infections (STIs), high blood pressure (HBp), diabetes, pre-eclampsia and eclampsia, pre-conception care including family planning like birth spacing, education, counselling on healthy diet and optimal nutrition, fetal measurement including the use of ultrasound to determine gestational age (GA), and detect multiple pregnancies will help prevent PTB.

Significant progress has been made in the care of PTB infants but not in reducing its prevalence. This study is therefore aimed to determine pregnant women’s knowledge and practice on the risk factors and prevention of preterm birth so that interventions should be directed to all women for the primary prevention and reduction of the risk of PTB like smoking cessation programmes and programmes aimed at minimising the risk of women with known risk factors.
1.2 Rationale
Despites efforts put in place by the WHO and other organizations to reduce PTBs and PTB outcomes, the incidence keeps on rising in both the developed and the developing countries. In low-incomes countries, averages of 12% babies are born preterm compared with 9% in higher-incomes countries.
This might be due risk factors such as advanced aged, birth spacing, twins or multiple pregnancies, short cervix, depression, underweight, infections and smoking. In addition, preterm birth due to preterm complications is responsible for most of the neonatal deaths worldwide with majority of the cases occurring in Sub-Sahara African countries. Moreover, inadequate infrastructures, low standard of living, inaccessibility to healthcare are responsible for preterm in the developing countries.
However, effective management and implementation of preventive measures can help to prevent preterm births and reduce its morbidity and mortality. Therefore, this study is aimed to determine pregnant women’s knowledge and practice on the risk factors and prevention of preterm birth in Tiko Health District.

1.3 Research goal