Risk Factors Associated with Premature Birth at a District Hospital in Bisho, Eastern Cape

Introduction and background: It is estimated that as many as 12.4 of every 1 000 live births in South Africa, are premature births. Prematurity is the leading cause of death in children under five years old. Furthermore, preterm infants have an increased risk of life-long morbidities. Globally at least 2.5 million premature infants die annually due to complications or lack of proper healthcare. Prematurity and the outcomes of its complications have raised concerns globally, as greater disparity is being seen between rich and poor countries. Lack of resources, poorly skilled health care professionals and poor management of small and pre-term babies, are areas of great concern in especially in poorer countries. Identifying the causes of prematurity will consequently not only help reduce the prevalence but more so the morbidity and mortality rates caused by preterm labour. It is therefore important to highlight and understand the consequences of such a high incidence in preterm births, when identifying these risk factors. Aims and objectives: The aim of the study was to identify which risk factors are associated with the cause of prematurity at Bisho Hospital, a district hospital in central Eastern Cape, South Africa. The objectives of the study were to identify which risk factors between the full-term and pre-term group were more prevalent and therefore associated with prematurity as well as identifying which risk factors could be prevented or even treated at Bisho Hospital. Methodology: A descriptive quantitative correlation study design was used, where premature as well as full-term infants were included in the study. Data was collected by means of a questionnaire. All accessible medical notes of both the mother and infant were used as well. The questionnaire was used to establish which risk factors were most prevalent during the pregnancies of women in each group and whether these risk factors were significant contributors to prematurity. Results: A sample of fifty mothers, with prematurely born babies were included in the study, along with eighty mothers who delivered full-term babies. The four main risk factors associated with pre-term birth within this study population was: a positive 6 HIV status (p=0.022), a poor maternal nutritional status (p=0.031), mothers living far distances from their local clinic (0.041-0.024) and mothers having previously delivered a pre-term baby (p=0.009). Discussion: The four major risk factors identified in this study have shown to have significant effects on pregnancy outcomes in other studies too. Modifiable risk factors such as a poor nutritional status can be identified and addressed as a preventative measurement for prematurity. While the other three risk factors are non-modifiable, mothers who are HIV positive, have previously had a premature baby and those who live farther than 5km (or a walk of 15-30 minutes long) away from their closest clinic, should be identified as a high risk for pre-term births in current pregnancies. While addressing these risk factors is important in attempting to reduce the prevalence of prematurity, improved care of small and premature babies could help combat the growing problem of early infant deaths within this same group. Recommendation: Financial investment and analysis of current policies in the prevention and management of premature delivery should be a priority. Ensuring health care workers are regularly trained as well as equipping nurseries with the basic resources to manage a pre-term baby, can help reduce mortality and morbidity associated with prematurity.Thesis (MA) -- Faculty of Health Sciences, 202