Adverse birth outcome and associated factors among mothers with … – Nature.com

Study design and period

An institutional-based cross-sectional study was conducted among mothers delivered from September 2016 to September 2019 in northwest Amhara region referral hospitals and the data was extracted from March 3 to May 18/2020.

Amhara national region is one of the ten national states in Ethiopia which is found in the Northern part of Ethiopia. The region has 80 hospitals, 847 health centers, and 3342 health posts. there are 6 referral hospitalsnamely Gondar University Comprehensive Specialized Hospital (GUCSH), Felegehiwot Comprehensive Specialized Hospital (FCSH), Dessie Referral Hospital (DRH), Debre-Markos Referral Hospital (DMRH), Debre-Birhan Referral Hospital (DBRH) and Debre tabor referral hospitals. Three out of six referral hospitals were found in the Northwest part of the Amhara region. These include: the University of Gondar comprehensive and specialized Hospital (UoGCSH), Felege Hiwot comprehensive, and specialized hospital (FHCS), and Debre Markos referral hospital. Each referral hospitals catchment population is estimated to be 57 million people. The annual average number of births in each hospital is 6000 per year. according to the hospital report. All three hospitals are providing full ANC/PMTCT, ART, delivery services, and ultrasound-guided obstetric care.

All mothers with HIV delivered from September 2016September 2019 in northwest Amhara region referral hospitals with a gestational age of 28weeks and above were included in the study. However, mothers who had unknown or unreliable last normal menstrual period (LNMP) with the absence of ultrasound evidence and a mother with unrecorded birth outcome were excluded from the study.

The dependent variable in this study was the adverse birth outcome. Whereas Socio-demographic, obstetric, medical, nutritional, and HIV-related variables were the independent variables. This includes age, residence, educational status, marital status history of substance use, including alcohol drinking and smoking, nutritional counseling during ANC, iron and folic acid supplementation during pregnancy, pre-pregnancy BMI, MUAC, CD4 count, viral load, WHO clinical stage of the disease, initiation of ART, time of initiation of ART, time of diagnosis with HIV, types of ARV, anemia, chronic medical disease, Urinary tract infection (UTI), pregnancy-induced hypertension (PIH), Antepartum hemorrhage (APH), the premature rapture of the membrane (PROM), previous history of abortion, previous history of stillbirth, parity, and gravidity.

Adverse birth outcomes: A woman who had at least one of the following stillbirth, low birth weight, preterm birth22.

Preterm birth: Preterm is defined as babies born alive before 37weeks of gestation but after viability (28weeks of gestation) and gestational age was calculated based on LNMP or first-trimester ultrasound result23.

Low birth weight: a birth weight<2500g irrespective of gestational age24.

Stillbirth: dead birth after the 28th week of gestation and before the expulsion from the uterus25.

APH: defined as any vaginal bleeding in the mother after 28weeks of gestation as documented in the records by the attending clinician26.

PIH: defined clinically as a blood pressure of>140/90mmHg after 20weeks of gestation with or without proteinuria and/or edema as diagnosed and documented by the attending clinician26.

Anemia: documented Hgb level below 11gm/dl laboratory diagnosis26.

UTI: Defined as a documented clinical/laboratory diagnosis of UTI at any time during the pregnancy26.

The required sample size was determined by using the single population proportion formula n=za2/2p(1p)/d2 by considering the prevalence PTB among mothers with HIV was 16.6%16, 95% confidence interval (CI), 3% margin of error to yield a total of 590 study participants. The total sample size was proportionally allocated for the three Hospitals depending on their load of delivery. A simple random sampling technique was employed to select the study participants medical records. The delivery registration logbooks were used as a sampling frame and selected each record for our study used a computer-generated random number. Whenever the selected chart did not fulfill the inclusion criteria, the next medical record was considered (Fig.1.).

Schematic presentation of the sampling procedure for the prevalence of an adverse birth outcome and associated factors among mothers with HIV-positive delivered in northwest Amhara region referral hospitals.

The patient's medical records were used as a source of data. The data, consisting of socio-demographic variables, clinical and obstetric history as well as birth outcome, were collected using a data extraction tool. Maternal BMI was determined by using the mothers pre-pregnancy, initial weight, and height from their ART and PMTCT follow-up. Newborn weight was measured using standard beam balance within the first hour of birth Six Bachelor of science (BSc) Midwives collected the data, while 3 midwives who have a second degree in clinical midwifery supervised the data collection process. Data quality was maintained by the following data quality control mechanisms; A 5% preliminary chart review was conducted in the Gondar university comprehensive and specialized hospital before the actual data collection and amendments were considered based on the result of a preliminary chart review. One day of training was given to data collectors and supervisors. Strict supervision of the data collection was carried out throughout the data collection period. The collected data was checked for its consistency and completeness before any attempt to enter, code, and analyze it.

Data were coded and then entered using EPI data version 4.6 and exported to SPSS. The final statistical analysis was done by SPSS version 25. Before analysis, data were cleaned using frequency; listing, and sorting to identify any missed values, and then corrections were made by revising the original questionnaire. There are different techniques of missing data management. Deletion, replacement using the mean or mode of the data (mean substitution/replacement) or predicted values from a regression to substitute the missing values. So for this study, we had used replacement by mean for continuous and Mode for categorical variable if less than 20% of values are missed in one variable, but if more than 20% of values are missed in one variable, we discard the variables. Descriptive statistics were made for categorical variables using frequencies. The result was presented using texts and tables. a multivariable binary logistic regression model was used to assess the association between dependent and independent variables. P-value<0.05 and Adjusted Odds Ratio (AOR) with 95% CI was used to declare statistically significant predictors in multivariable analysis.

Ethical approval was obtained and the need for informed consent was waived by the ethical review committee of the Institute of public health on behalf of the Institutional Review Board (IRB) of the University of Gondar. Permission was obtained from the clinical director of each hospital. Since this study uses secondary data to ensure confidentiality Personal Identifiers Were not used on the data collection form, and all data were kept strictly confidential and used only for the study purposes. The research was conducted according to the Helsinki declarations.

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