Joint predictors of preterm birth and perinatal death among singleton births at a zonal referral hospital in northern Tanzania: a birth registry based study from 2000 to 2017.

Doctoral Degree. University of KwaZulu-Natal, Pietermaritzburg.Background: Globally, preterm birth (births before 37 completed weeks of gestational) contributes to under-five and newborn deaths. Tanzania ranks the tenth country with the highest preterm birth rates globally and shares 2.2% of the global proportion of all preterm births and contributes to perinatal deaths. Perinatal deaths (stillbirths and early neonatal deaths) continue to increase relative to under-five deaths, especially in low- and middle-income countries. Previous exposure to perinatal death increases preterm birth risk. Understanding the independent and joint predictors of these outcomes may inform interventions to accelerate progress towards achieving sustainable development goals. The study aimed to determine the joint predictors of preterm birth and perinatal death among singleton births in northern Tanzania. Methods: The study utilized birth registry data from Kilimanjaro Christian Medical Center (KCMC) zonal referral hospital from 2000 to 2017, located in Moshi Municipality, Kilimanjaro region, Northern Tanzania. Generalized estimating equations (GEE) estimated the marginal effects of covariates on perinatal death. The predictive capacity of machine learning algorithms was compared with the classical logistic regression model to predict perinatal death. Multinomial logistic regression with cluster adjusted robust standard errors determined predictors of preterm birth. Joint predictors of preterm birth and perinatal death and the co-occurrence were estimated using the random-effects models to account for the correlation between these outcomes. Results: Perinatal mortality in this cohort slightly declined while preterm birth rates were increasing. Maternal demographic characteristics and pregnancy-related conditions and complications increase the risk of these outcomes. The joint predictors of higher risk of preterm birth and perinatal death were inadequate (<4) ANC visits, referred for delivery, and complications during pregnancy and childbirth, specifically pre-eclampsia/eclampsia, PPH, LBW, abruption placenta, and breech presentation. Younger maternal age (15-24 years), PROM, placenta previa, and male children have higher odds of preterm birth but a lessened likelihood of perinatal death. Conclusion: ANC is a critical entry point for delivering the recommended interventions to pregnant women, especially those at high risk of experiencing adverse pregnancy outcomes. Improved management of complications during pregnancy and childbirth and the postnatal period may eventually lead to substantially reducing adverse perinatal outcomes towards improving maternal and child health

Trends and factors associated with repeated adolescent pregnancies in Tanzania from 2004-2016: evidence from Tanzania demographic and health surveys

Introduction:&nbsp;a repeated pregnancy represents a failure of health and social systems to educate and provide the necessary services and skills to ensure adolescent girls do not experience any further unwanted pregnancies during this young age. We aimed to determine trends and factors associated with repeated adolescent pregnancies in Tanzania 2004-2016. Methods:&nbsp;an analytical cross-sectional study was conducted using secondary data from Tanzania demographic and health surveys of the years 2004-2005, 2010 and 2015-2016 among adolescent mothers aged 15 to 19 years. Data analysis was performed using STATA version 15 and considered the complex survey design. The Poisson regression model was used to estimate prevalence ratios (PR) and 95% confidence intervals for factors associated with repeated adolescent pregnancy. Results:&nbsp;the proportion of repeated adolescent pregnancies increased from 15.8% in 2004/2005 to 18.6% in 2010, then to 18.8% in 2015/2016. Adolescents who delivered their first pregnancy at home (APR: 1.36, 95% CI: 1.03, 1.78) and who started sexual activity before 15 years of age (APR: 1.80, 95% CI: 1.40, 2.31) were likely repeated adolescent pregnancy. In contrast, adolescents who used contraception (APR: 0.52, 95% CI: 0.34, 0.81) had a lower prevalence of repeated adolescent pregnancies. Conclusion:&nbsp;the prevalence of repeated adolescent pregnancies has increased and remains unacceptably high. Adolescents who had low education delivered their first pregnancy at home and were non-contraceptive users need to be targeted in policies and programs for the prevention of repeated adolescent pregnancies

Paternal characteristics associated with low birth weight among singleton births: a hospital-based birth cohort study in northern Tanzania

Introduction:&nbsp;low birth weight (LBW) remains a devastating adverse pregnancy outcome in low and middle income countries (LMICs). There is evidence showing that maternal demographic and pregnancy-related characteristics are associated with LBW. Little attention is given to paternal characteristics, which may be associated with a higher risk of LBW. This study aimed to assess the effect of paternal characteristics on LBW among singleton deliveries at Kilimanjaro Christian Medical Centre (KCMC) zonal referral hospital in Kilimanjaro region, northern Tanzania. Methods:&nbsp;this was a secondary analysis of a hospital-based cohort study from maternally-linked medical birth registry data at KCMC between 2000 and 2018. A total of 47,035 singleton deliveries were included in this study. Data analysis was performed using statistical package for social sciences (SPSS), version 20 (IBM Corp., Armonk, NY). Relative risk and corresponding 95% confidence intervals (CI) were used to determine association between LBW and paternal characteristics using log-binomial regression models, with robust standard errors to account for clustering of deliveries within mothers. Results:&nbsp;the proportion of LBW during the study period was 9.6%. After adjusting for maternal characteristics, higher risk of LBW was among fathers with low education level (RR=1.72, 95% CI: 1.22, 2.41, p=0.002), aged ≤24 years old (RR=1.37, 95% CI: 1.21, 1.55), and those unemployed (RR= 1.11, 95% CI: 1.01, 1.21). Lower risk of LBW was among fathers aged ≥40 years (RR=0.97, 95% CI: 0.88, 1.08), but this association was not statistically significant. Conclusion:&nbsp;the study confirmed paternal young age (≤24 years old), paternal low education level and unemployment as predictors for LBW . Current evidence on the effect of paternal characteristics on LBW might suggest that programs and policies should target their engagement as a key strategy for improving birth outcomes during the perinatal period. Future studies should assess how paternal factors are associated with the risk of adverse birth outcomes