Risk Factors Associated With Born Before Arrival And Birth Outcome Among Postnatal Women In Tharaka Nithi County, Kenya

ABSTRACT

Born before arrival (BBA) is a childbirth that occurs outside health facility. BBA constitute a high-risk newborn population and have increased perinatal mortality and morbidity. BBA neonatal adverse birth outcome prolong hospital stay. Tharaka Nithi was among Counties with the highest number of BBA (2 %) compared with national (0.9%). The objective of the study was to assess risk factors associated with BBA and birth outcome among postnatal women in Tharaka Nithi County. The study used 1:2 age matched case-control study design to analyze the comparison between the case and the control. The study was conducted in Tharaka Nithi County and the study population were post-natal women in Tharaka Nithi. Purposive and simple random sampling techniques were used to select cases and Controls, and questionnaire was used to collect the data. Data was analyzed using SPSS version 23.0. Descriptive statistics (frequencies and percentages) were used to describe sample characteristics and inferential statistics (chi square, Fishers exact test and Odds Ratio) were used to infer the sample characteristics to the population level. Ethical clearance was sought from Kenyatta University Ethical and Review Committee, permit was sought from NACOSTI and consent sought from respondents. The Socio-demographic risk factors associated with BBA were; marital status (p=0.005), education level (p=0.004), monthly income (p=0.001) and parity (p=0.003), however there was no association between occupation and BBA The physical risk factors associated with BBA were; distance to the health facility (p=0.005), availability of means of transport (p=0.004), status of the road (p=0.003) and time of delivery (p=0.001). The Obstetric risk factors associated with BBA were; duration of labor (p=0.011), mode of previous delivery(p=0.016), and recognition of onset of labor (p=0.001). The non-ANC compliance and birth preparedness factors associated with BBA were; ANC attendance (p=0.004), timing of ANC attendance (p=0.001), number of ANC visits (p=0.014),identification for health facility for delivery (p=0.001), identification for means of transport (p=0.020), knowledge of signs and symptoms of labor (p=0.003), knowledge of EDD (p=0.001), financially prepared for hospital delivery (p=0.010), and basic supplies for birth (p=0.001). There was significant difference between BBA and hospital birth outcome. The adverse birth outcome were asphyxia, neonatal sepsis, prematurity, and hypothermia. The study recommends Tharaka Nithi County Government responsible departments to use the study new knowledge to reduce/eliminate risk factors associated with BBA and consequently reduce BBA and advanced birth outcome.