Maternal determinants of adverse neonatal outcomes in a rural district hospital in East Africa

Abstract

Abstract: Background Maternal predisposing factors to adverse birth outcomes are often times assumed to be similar in rural and urban settings. This assumption has led to many failed or failing interventions. This study investigated the maternal risk factors of adverse birth outcomes in a remote community and compared with existing literature of similar studies done in urban areas or developed settings. Subject and methods: This was the baseline data of a prospective cohort study, carried out in Gitwe village, Rwanda, 2019. Healthy, 529 mother-singleton infant pairs were recruited consecutively from Gitwe District hospital.
Results: The burden of adverse neonatal outcomes of significance in this rural study (caesarean section delivery, low birth weight, small for gestational age and prematurity) were 38.8%, 10.6%, 21.4% and 4.9%, respectively. Significant (p<0.05) maternal characteristics associated with cesarean section delivery were obesity, high number of antenatal visits (>6), non-Christian religion, university education, entrepreneurs, positive HIV status and short stature. Unmarried mothers were likely to produce LBW and preterm babies, while primips were prone to deliver SGA babies. The magnitude of adverse birth outcomes in this rural study was unexpectedly higher than what exists in literature and their drivers were not exactly the same as in urban settings and at the national level.
Conclusion and Recommendations: The burden of adverse birth outcomes in this study was higher than that of several countries in the world. Therefore, mothers (not neglecting their marital, HIV, parity and religion status), residing in these rural areas should be prioritized for health care interventions, in order to lower the short- and long-term effects of these adverse
birth outcomes.