Adverse birth outcomes and associated factors among newborns delivered in a western African country: a case-control study

BackgroundNewborns with one or more adverse birth outcomes (ABOs) are at greater risk of mortality or long-term morbidity with health impacts into adulthood. Hence, identifying ABO-associated factors is crucial for devising comprehensive and relevant interventions. The aim of this study was to identify factors that are associated with the occurrence of ABO - prematurity (PTB), low birth weight (LBW), macrosomia, congenital anomalies, asphyxia, and sepsis - among babies delivered at the only hospital of Sao Tome & Principe (STP), a resource-constrained sub-Saharan Western African country. MethodsHospital-based unmatched case-control study conducted in STP among newborns from randomly selected mothers from July 2016 to November 2018. Newborns with one or more ABO (gestational age <37 weeks, LBW < 2.5 kg, BW >4 kg, 5-minute Apgar score <7, major congenital anomalies, and probable sepsis based on clinical criteria) were the cases (ABO group), while healthy newborns without ABO were the controls (no-ABO group). Data were collected by a face-to-face interview and abstracted from antenatal pregnancy cards and medical records. Multivariable logistic regression analysis was performed to identify ABO risk factors considering a level of significance =0.05. ResultsA total of 519 newborns (176 with ABO and 343 with no-ABO) were enrolled. The mean gestational age and birth weight of cases and controls were 36 (SD=3.7) weeks with 2659 (SD=881.44) g and 39.6 (SD=1.0) weeks with 3256 (SD=345.83) g, respectively. In a multivariable analysis, twin pregnancy [aOR 4.92, 95% CI 2.25-10.74], prolonged rupture of membranes [aOR 3.43, 95% CI 1.69-6.95], meconium-stained amniotic fluid [aOR 1.59, 95% CI 0.97-2.62], and fewer than eight antenatal care (ANC) visits [aOR 0.33, 95% CI 0.18-0.60] were significantly associated with adverse birth outcomes. ConclusionModifiable factors were associated with ABOs in this study and should be considered in cost-effectiveness interventions. The provision of high-quality ANC with eight or more visits should be a priority at ANC service delivery in STP. Twin pregnancies as well as intrapartum factors such as prolonged rupture of membranes and meconium-stained amniotic fluid are red flags for adverse birth outcomes that should receive prompt intervention and follow-up.