Abstract

Background: Preterm birth is a major determinant of neonatal morbidity and mortality with long term adverse health consequences. It is the leading cause of neonatal and under-5 mortality world wide. Most preterm births result from maternal or fetal medical conditions. In Cameroon, especially in the South West Region, there is paucity of data as concerns preterm birth, its related morbidities and outcome.

Objectives: Our objective was to determine the prevalence and hospital outcome of preterm babies at the Regional Hospital Limbe.

Methods: We carried out a four year hospital-based retrospective study from the month of January to April 2021. Files of preterm babies admitted in the neonatology unit from the period of January 2017 to December 2020 were reviewed. A structured pretested questionnaire was used.  Data was analysed using Statistical Package for Social Sciences (SPSS) version 26.0.

Result: The prevalence of preterm babies admitted at the LRH was 16.5%. The common morbidities were respiratory distress syndrome (49.1%), hypothermia (26.8%), anaemia (26.0%), infection (24.2%) and jaundice (23.4%) The mortality rate was 31.8%. significant association was observed between gestational age (p=0.000), gender (p=0.012), birth weight (p=0.000) and mortality. Preterm babies who had congenital malformation, apnoea, respiratory distress and anemia were 25 times (AOR: 25.39;95%CI:1.80-356.38), 6 times (AOR:6.36;95%CI:1.49-27.09), 6 times (AOR:6.15;2.75-13.77), 2 times (AOR:2.19;95%CI:1.07-4.50) respectively, more likely to die compared tothose who did not have these comorbidities.

Conclusion: We found a high prevalence high mortality rate in the preterm babies admitted at the neonatology unit, and that mortality rate decreased with increasing gestational age. A number of factors were significantly associated with mortality of preterm babies.

CHAPTER ONE

INTRODUCTION

1.1 Background

Preterm birth (PTB) is defined by the World Health Organisation (WHO) as any viable birth before 37 completed weeks of gestation or less than 259 days since the first day of a woman’s last menstrual period. It is classified as being extremely preterm (less than 28 weeks), very preterm (28 to less than 32 weeks), and moderate to late preterm (32 to less than 37 weeks) [1].

According to the WHO, of the 15 million babies are born each year world wide of whom over 1 million die due to the complications [2,3]. Complications of preterm birth are the leading direct causes of neonatal deaths, responsible for 35% of the world’s 3.1  million deaths yearly [4]. Globally, the rate of prematurity is at 5 to 18% [5,6].

In Europe the prevalence of preterm birth is 5% to 10%. India, China, Nigeria, Pakistan, Indonesia, and the United States account for 50% of the total preterm births in the world [3]. Africa and South Asia account for 60% of preterm births [7–9]. Prematurity is one of the leading causes of neonatal deaths in Africa with prevalence of about 11.9% [1].

In Africa the frequency of prematurity is estimated to be above 15%. A study conducted in Cameroon reported a prevalence of preterm birth at 13% in 2010 [10]. In high-income countries, about 50% of preterm infants born at 24 weeks survive the neonatal period (the first 28 days of life), rising to 90% at 28 weeks gestation. In contrast, often less than 10% of those born at 28 weeks survive in low-income countries and only those born at 34 weeks or later that have survival rates of greater than 50% [11].

The survival of these preterm infants greatly depends on their biological maturity and technological advancement [12]. Factors such as level of prenatal care, gestational age at birth, sex, availability of resources, adequate and well-trained personnel also influence management success of prematurity [13].

Preterm birth remains an important public health priority worldwide. There is a need for evidence-based strategies to prevent prematurity from occurring, as well as mitigating its effects on preterm newborns particularly in low-resource settings [14]. 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 [15].

Addressing the global burden of preterm birth is crucial to achieving Sustainable Development Goal 3 (ensure healthy lives and promote wellbeing for all at all ages) and for reducing preterm-related neonatal and child mortality[16]. Thus an urgent need for the establishment of a neonatal intensive care unit with adequate man power as well as appropriate diagnostic and management facilities so as to improve the survival rates of this vulnerable group of patients[13].

1.2 Problem Statement

Preterm birth is a critical global health problem because of its implications on morbidity and mortality as well as its socio-economic liability. The highest Preterm birth rates occurred in 2010 in Southeastern Asia, South Asia and Sub-Saharan Africa [17].

The risk of neonatal death due to complications of preterm birth is at least 12 times higher for an African baby than for a European baby [9]. More than 90% of extremely preterm babies survive in the high income countries compared to less than 10% in the resource-limited settings[18]. The evolution of neonatal intensive care is one of the recent advances that ensures survival of the preterm neonate but sadly this is not readily available in most developing countries.

The cost of sophisticated equipment, need for constant power supply, constant use of laboratory facilities and low staff to patient ratio makes neonatal intensive care expensive [13]. Research on preterm birth and its outcome is limited in sub-Saharan Africa with gross under estimation of the problem although the bulk of the burden is deeply rooted in this setting [18].

1.3 Justification

Information obtained from multiple indicator cluster survey and demographic health survey in Cameroon on neonatal mortality has remained high over the past 20 years, despite the improvement in the health care system. Preterm birth which is a major contributing factor cannot be neglected. Studies have been carried out in Yaounde, Bamenda and Douala, but not much has been done in the South West Region.

Hence this study will add to already existing data on preterm birth and associated morbidities. In addition, it will create a base for advocacy so that new neonatology units will be created and already existing neonatology units will be well equipped and so as to reduce the burden of morbidity and mortality associated with preterm birth. It will also add to existing knowledge on preterm birth in our setting.

1.4 Research Questions

1. What is the prevalence of preterm babies admitted at the Regional Hospital Limbe (RHL)?
2. What are the main complications during hospitalization of preterm babies at the RHL?
3. What is the mortality rate of preterm babies admitted at the RHL?
4. What are the causes of death in preterm babies admitted at the RHL?

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