RISK FACTORS ASSOCIATED WITH ADVERSE PREGNANCY OUTCOMES AMONG WOMEN OF REPRODUCTIVE AGE IN SOBA L.G.A, KADUNA STATE

RISK FACTORS ASSOCIATED WITH ADVERSE PREGNANCY OUTCOMES AMONG WOMEN OF REPRODUCTIVE AGE IN SOBA L.G.A, KADUNA STATE

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SUMMARY

Adverse outcomes of pregnancy include: miscarriages, preterm delivery, low birth weight babies,

stillbirth, maternal morbidity and maternal mortality. The most severe adverse outcome of

pregnancy is the death of the mother or the offspring. Poor pregnancy outcomes are influenced

by a myriad of biological, social and environmental factors. Maternal mortality In Nigeria is

currently 545-630/100,000 live births. According to the World Health Organization 75% percent

of the maternal deaths in Africa are attributable to direct obstetric complications, such as

hemorrhage, obstructed labor, infection, toxemia, and unsafe induced abortion. However it is

now clear that these complications are not necessarily fatal; they cause deaths only because they

occur within the context of the severe socioeconomic deprivations that are present in these

countries.

This study was conducted to identify the risk factors associated with adverse pregnancy

outcomes and measure their effect on maternal health. One research assistant and six data

collectors were recruited and trained. We conducted a case control study using a structured pre-

tested questionnaire involving 138 respondents (69 cases and 69 controls). Information was

obtained on demographic, pregnancy outcomes, risk factors and current health status.

Anthropometric measurements were obtained using weighing scales and standiometers. Body

mass indices were subsequently calculated. Blood pressure measurements were taken using

aneroid sphygmomanometers. Qualitative data was also obtained using six focus group

discussions (FGDs) comprising grandmothers, mothers and teenagers. Univariate, bivariate and

multivariate analysis was done using Epi-info version 3.5.3. Qualitative data were analyzed by

thematic fields using a coding sheet in Microsoft excel software.

vii


The median age of cases: 25 years (Range: 16-43), controls: 27 years (Range: 16-44). Compared

with controls, the cases did not differ significantly in terms of residence and income. Bivariate

analysis showed Cases were more likely to: number of pregnancies ≥4 (OR: 5.6; 95% CI: 2.6-

12.6), commence early antenatal (ANC) attendance <4months (OR: 0.4; 95% CI: 0.2-0.99) and

height <1.52 meters (OR: 0.2; 95% CI 0.1-0.7) compared with controls. Unconditional logistic

regression revealed: ANC attendance <4 months: (aOR: 0.32; 95%CI: 0.12-0.81) and Number of

pregnancies ≥4: (aOR: 5.02; 95% CI: 1.97-12.82) to be protective and increase risk of adverse

outcomes respectively. No respondent 0(0.0%) had ever received pre-conception care or

counseling. Cases were more likely to have ongoing health problems (OR: 2.1; 95% CI: 0.8-5.4)

though insignificant. Qualitative findings identified hypertension, bleeding and eclampsia as the

commonest adverse pregnancy outcomes. Majority of respondents believed early antenatal care;

delayed marriage and improved girl child education would improve outcomes.

Risk factors significantly associated with adverse outcomes are multiple pregnancies and delayed

antenatal care. We recommended introduction of pre-conception care and counseling, frequent

community health talks, early antenatal care, and improvement of maternal care facilities at the

rural hospital, girl child education and utilization of family planning services.

KEY WORDS: Adverse, Hypertension, Miscarriage, Outcome, Pregnancy

CHAPTER ONE

INTRODUCTION

Adverse outcomes of pregnancy include: miscarriages, preterm delivery, low birth weight babies,

stillbirth, maternal morbidity and maternal mortality. These outcomes are far more frequent in

the developing world. The most severe adverse outcome of pregnancy is the death of the mother

or the offspring. Maternal death has become an extremely rare event in the developed world,

with many countries reporting maternal mortality ratios of 5-10 per 100,000 live births. In the

least developed countries, the ratios are 100 times higher. Wide disparities probably exist in the

rate of late fetal deaths (stillbirths), although fetal deaths in underdeveloped countries are grossly

underreported. Even if both mother and infant survive, pregnancy complications or problems at

delivery or during the neonatal period can lead to severe maternal or infant morbidity.1 Maternal

mortality In Nigeria is currently 545-630/100,000 live births and is ranked 10th in the world by

the United Nations. Maternal deaths are those occurring during pregnancy, childbirth and within

42 days of termination pregnancy irrespective of duration and site of pregnancy in a specified

year. According to the world health organization (WHO) Nigeria had the highest estimated

number of maternal deaths (37,000) in Africa, second only to India (136,000) globally. 75%

percent (27,750) of these maternal deaths are attributable to direct obstetric complications, such

as hemorrhage, obstructed labor, infection, toxemia, and unsafe induced abortion.


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