Adolescent deliveries in semi-urban Cameroon: prevalence and adverse neonatal outcomes

Adverse obstetric and neonatal outcomes of adolescent pregnancies in Africa: a scoping review

BACKGROUND

Adolescent pregnancy is a public health issue with well-defined causes and health risks with social and economic implications. Aim of this review was to examine adverse pregnancy outcomes and risk factors associated with adolescent pregnancy in Africa.

METHOD

PubMed Central, Science Direct and JSTOR were the main databases for the literature review. Other online sources and experts were consulted for relevant studies. In all, 11,574 records were identified and 122 were considered as full-text studies for evaluation after thorough screening and removal of duplicates. Finally, 53 studies were included in this review for thematic synthesis.

RESULTS

The 53 studies sampled 263,580 pregnant women, including 46,202 adolescents (< 20 years) and 217,378 adults (> 20 years). Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Factors of poor pregnancy outcomes included low socioeconomic and educational status, poor utilization of antenatal care, risky lifestyles such as alcohol consumption, and unattractive health care factors. Maternal health care utilization was identified as an important factor to improve pregnancy outcomes among adolescents in Africa.

CONCLUSION

To prevent adolescent pregnancy, stakeholders need to help lower socioeconomic inequalities, poor utilization of antenatal care, alcohol consumption, and improve adolescents' health care and their educational status. Issues such as child marriage, abortion, poor health care infrastructure and non-adolescent friendly health facilities need to be addressed.

Adolescent pregnancy outcomes at Queen Elizabeth Central Hospital, Malawi: a cross-sectional study

Malawi has a growing population with a high Maternal Mortality Ratio (MMR) of 439 per 100,000 live births to which adolescents contribute 25%. Current data suggests adolescent pregnancies in low resource settings are at an increased risk of both maternal and neonatal morbidity.

Objectives

This study assessed the pregnancy outcomes amongst adolescents while using women from the early adulthood (20 - 24-year-old) and advanced maternal age (35 years old and above) groups as reference.

Methods

This was a cross-sectional study, carried out at the Chatinkha maternity (labour) and post-natal wards at QECH, and included all adolescents (10 - 19 years old) and women between 20 - 24 years old (early adulthood) and 35 years old or older (advanced maternal age), presenting in labor, at any gestational age ≥ 28 weeks or with a birth weight of 1000 grams or above.

Results

The study found the prevalence of adolescent pregnancy to be 20.4% (N=5035) out of all the deliveries during the recruitment period. Sexually transmitted infections were proportionally higher in the adolescent group, with 12% testing HIV seroreactive and 10% syphilis seroreactive. Neonatal outcomes of birth asphyxia (3.5%), low birth weight (5%), prematurity (4.3%) and early neonatal death (4.3%) were not statistically different from the outcomes of the older age groups. The major causes of maternal morbidity were determined to be a high caesarean section rate of 31.9% and intrapartum diagnosis of urinary tract infection (7.4%), malaria (7.4%) and hypertensive disorders (14.5%).

Conclusions

Adolescents are a significant proportion of the pregnant population in Malawi. These adolescents are at increased risk of some pregnancy and peripartum complications when compared to women of older age groups. However, our study determined that these outcomes appear to be more likely related to the peripartum care received and not solely specific to maternal age.

An Increased Adverse Fetal Outcome Has Been Observed among Teen Pregnant Women in Rural Eastern Ethiopia: A Comparative Cross-Sectional Study

Background: According to the World Health Organization, teenage pregnancies are high-risk due to increased risks of fetal and infant morbidity and mortality. This study compares adverse fetal outcomes between teen and adult pregnant women from rural Eastern Ethiopia. Methods: Institutional-based cross-sectional study was conducted among women visiting maternity units from surrounding rural areas. A total of 481 teenagers (13-19 years old) and 481 adults (20-34 years old) women with a singleton pregnancy were included in the study. Two hospitals and 3 health centers were selected in Eastern Hararghe Zone, Eastern Ethiopia. Comparative analysis was carried out using the log-binomial regression model to identify factors associated with adverse fetal outcomes in both categories. The results are reported in adjusted prevalence ratios with 95% confidence intervals. Results: High proportion of adverse fetal outcome was observed among teenage women than adult (34.9% vs 21%). Statistically significant difference (P < .05) in the proportion of low birth weight (21.1% vs 9.3%), preterm birth (18.7% vs 10.6%), APGAR score at 5th minute (9.3% vs 4%) were found in teenagers compared to adult women. Antenatal care attendance (APR = 0.44; 95% CI: 0.23, 0.86); eclampsia (APR = 1.96; 95% CI: 1.26, 3.06); pre-eclampsia (APR = 1.73; 95% CI: 1.12, 2.67); and wealth index (rich) (APR = 0.55; 95% CI: 0.32, 0.94) were significantly associated with adverse fetal outcomes among the teenage women. Whereas intimate partner violence (APR = 2.22; 95% CI: 1.26, 3.90); preeclampsia (APR = 3.05; 95% CI: 1.61, 5.69); antepartum hemorrhage (APR = 2.77; 95% CI: 1.73, 4.46); and hyperemesis gravderm (APR = 1.75; 95% CI: 1.09, 2.79) were significantly associated with adverse fatal outcomes among the adult women. Conclusion: teenage pregnancy is associated with a high rate of adverse fetal outcomes. Early identification and treatment of problems during antenatal follow-up should be the mainstay to avert the massive adverse fetal effects.

Prevalence, indications and neonatal complications of caesarean deliveries in Cameroon: a systematic review and meta-analysis

BACKGROUND

The trend of increasing caesarean deliveries in developed countries over the past three decades is now being observed in sub-Saharan African. This rise might be associated with an increase in the complications that could arise from this surgical intervention. We therefore sought to assess the prevalence, indications and complications of caesarean deliveries in Cameroon.

METHODS

We systematically searched online databases: Medline; Global Health and the CINAHL from 01st January 1966 to 25th July 2019. We reviewed published cohort studies, retrospective register analysis and cross-sectional studies that described cohorts of pregnant women presenting at delivery facilities in Cameroon; and included those that had an estimate of the proportion of women who delivered by caesarean sections.

RESULTS

There were 126 articles initially identified by the search and 88 articles were retained after removal of duplicates. After screening of the titles and abstracts, and full text review, we identified 16 articles describing 22 cohorts of women presenting for delivery in health facilities in Cameroon. The overall estimate for the prevalence of caesarean deliveries was 9.9% (95% CI: 7.4, 12.8%, I2 = 99.68%, χ2 = 315.9, p < 0.001). The prevalence of caesarean deliveries increased progressively from 3.4% (95% CI: 2.2, 4.8%) before the year 2000, to 9.8% (95% CI: 7.4, 12.8%) between 2000 and 2009 and 14.7% (95% CI: 8.8, 21.7%) from 2010 to 2019. The three commonest indications for caesarean deliveries were: cephalopelvic disproportion (27.5%; 95% CI: 17.5, 38.7%); previous caesarean deliveries (13.2%; 95% CI: 7.4, 20.3%) and foetal distress (11.2%; 95% CI: 4.8, 19.5%). Neonates who were born by caesarean delivery were more likely to have neonatal asphyxia when compared with neonates born from vaginal deliveries (OR: 6.5; 95% CI: 2.5, 16.5).

CONCLUSION

The rates of caesarean deliveries in Cameroon falls just within the recommended 10-15% range proposed by the World Health Organisation but have however been increasing progressively in the past decades. There is a strong need to assess the various indications of caesarean deliveries in Cameroon in order to curb its associated complications.

Adolescent motherhood in Mozambique. Consequences for pregnant women and newborns

Introduction

In sub-Saharan Mozambique, high adolescent fertility rates are a significant public health problem. Understanding the consequences of teenage pregnancies facilitates effective strategies for improving the quality of care of both mother and the newborn.

Aims

To identify the factors associated with adolescent motherhood in Tete (Mozambique).

Methods

This was a cross-sectional study including 821 pregnant women (255 teenagers) admitted to the general maternity ward of the Provincial Hospital between March and October 2016. The survey included clinical data of the mother and newborn.

Results

The overall prevalence of adolescent deliveries was 31.8% (95% CI 27.9% - 34.2%). Multivariate analysis showed that independent factors associated with teenage motherhood were: number of pregnancies (OR 0.066; 95% CI 0.040–0.110), pregnancy follow-up (OR 0.29; CI 0.173–0.488) and previous abortions (OR 4.419; 95% CI 1.931–10.112). When the age of the mother was analysed as a continuous variable, positively associated factors were body mass index, arterial hypertension, HIV infection, previous abortions, pregnancy follow-up, and the weight of the newborn. Negatively associated factors were episiotomy and respiratory distress in the newborn.

Conclusion

Teenage motherhood is a serious public health problem in Mozambique. Intensive sexual and reproductive health planning for adolescents is needed.

Prevalence of adolescent deliveries and its complications in Cameroon: a systematic review and meta-analysis

BACKGROUND

Adolescent deliveries (10-19 years) carry a high risk of adverse outcomes due to the biological and physiological immaturity of these mothers. They pose a significant health burden in Cameroon, as it is reported that a high proportion of women attending delivery services are teenagers. We therefore sought to systematically assess the prevalence of adolescent deliveries in the country and its maternal and neonatal outcomes.

METHODS

This was a systematic review of literature and a meta-analysis. We searched MEDLINE, CINAHL and Global Health online databases for all studies that reported the proportion of adolescent women who presented for delivery in health facilities in Cameroon. All observational studies published up to 10th July 2019, were included.

RESULTS

A total of 47 articles were identified by the search. After removal of duplicates and screening of the titles and abstracts, 11 eligible studies were retained with ten articles meeting the inclusion criteria. These ten studies finally retained reported on nine different cohorts with a total of 99,653 women. The pooled prevalence of adolescent deliveries from the nine cohorts in Cameroon was 14.4% (95% CI: 10.7-18.6%), the prevalence for early adolescent deliveries was 2.8% (95% CI: 0.4-7.2%), meanwhile that for late adolescent deliveries was 12.5% (95% CI: 6.7-19.8%). The prevalence of adolescent deliveries in urban areas - 13.1% (95% CI: 7.8-19.6%) was similar to that in semi-urban areas- 14.1% (95% CI: 6.7-23.5%). Adolescents were more likely than adults (> 19 years) to have low birth weight babies (OR: 1.8; 95% CI: 1.6, 2.1); babies born with asphyxia (OR: 1.7; 95% CI: 1.3, 2.1); babies born before term (OR: 1.5; 95% CI: 1.1, 1.9) and babies who die in the neonatal period (OR: 2.1; 95% CI: 1.2, 3.8).

CONCLUSION

The prevalence of adolescent deliveries in Cameroon is high. Implementation of adolescent-friendly policies is necessary to reduce the proportion of adolescents who become pregnant in Cameroon.

Maternal risk factors for birth asphyxia in low-resource communities. A systematic review of the literature

Birth asphyxia (BA) affects millions of newborns annually, especially in low-resource communities. Given that much of the attention to this point has focussed upon secondary prevention, we sought to inform the development of primary prevention strategies for BA in resource-limited settings by identifying maternal risk factors. To this end, we systematically reviewed the MEDLINE, PsychInfo, and EMBASE databases, and identified 38 relevant studies. Upon analysis, we found 12 maternal variables associated with BA, and thematically arranged them into 3 categories: sociodemographic factors (age, literacy, gravidity, parity), health care factors (antenatal care, delivery location), and health status (hypertension, pre-eclampsia, eclampsia, anaemia, antepartum haemorrhage, pyrexia). The factors with the greatest, and/or most consistent influence upon likelihood for BA were: young maternal age (<20 years), limited maternal literacy, insufficient antenatal care, non-hospital delivery, maternal hypertension, and anaemia. We hope our review will assist stakeholders guiding the development of BA-related policies and programmes.

Pregnancy outcomes of adolescent primigravida and risk of pregnancy-induced hypertension: a hospital-based study in Southern Thailand

The objectives were to examine pregnancy outcomes in adolescent primigravida and to determine the effects of adolescent pregnancy on pregnancy-induced hypertension (PIH). A retrospective analysis of pregnancy outcomes was carried out in 2440 adolescent primigravida, compared with 14,259 primigravida aged 20-29 years. The adolescents had significantly higher rates of maternal death, maternal heart disease, PIH, puerperal infection, chorioamnionitis, urinary tract infection, foetal anomaly, preterm delivery, low birth weight, low Apgar scores and stillbirth. Multivariate logistic regression analysis showed that both older (16-19 years old) and younger (≤15 years old) adolescents were significantly at an increased risk of PIH (adjusted OR of 1.29; 95% CI, 1.03-1.62 and 1.90; 95% CI, 1.02-3.54, respectively). Adolescent primigravida had significantly lower rates of caesarean delivery, diabetes mellitus, chronic hypertension, placenta praevia and cephalopelvic disproportion (CPD). Inadequate antenatal care in adolescents increased rates of PIH and adverse foetal outcomes. Impact statement What is already known on this subject? Adolescent pregnancy is associated with adverse pregnancy outcomes in both mothers and foetuses. Conflicting evidence on some adverse maternal outcomes still exists. What the results of this study add? Our data suggest a significant increase risk of pregnancy-induced hypertension (PIH) in both younger and older adolescent primigravida. Inadequate antenatal care (<4 times) in adolescents increased rates of PIH and adverse foetal outcomes. Rate of maternal death was higher than previous study, with different causes of death. In our study, the major cause of death was heart disease, but previous study found hypertensive disorder to be the leading cause of death in adolescents. Rates of infection also increased during pregnancy and postpartum period. The adolescents had lower rates of caesarean delivery, diabetes mellitus, chronic hypertension, placenta praevia and cephalopelvic disproportion (CPD). What the implications are of these findings for clinical practice and/or further research? Early detection and prompt treatment for adverse maternal complications, especially PIH, infection and preterm labour are essential. Ultrasound screening at 18-20 weeks' gestation should be performed due to an increased risk of foetal anomaly. Further research in prevention of PIH in adolescent pregnancy is suggested.

Adolescent deliveries in urban Cameroon: a retrospective analysis of the prevalence, 6-year trend and adverse outcomes

Objective

Adolescent deliveries remain a public health problem in most developing countries. The aim of our study was to determine the prevalence, trends and outcome of adolescent deliveries in an urban setting in Cameroon. We carried out a retrospective register analysis over a 6-year period (January 2010–December 2015) at the Saint Albert Le Grand hospital Douala.

Results

The overall prevalence of adolescent deliveries was 8.2% (662 out of 8056). There was a significant decrease over the 6-year period (p-trend: < 0.05). Adolescents were at higher risk of preterm deliveries (gestational age < 37 weeks; odds ratio [OR], 1.7; 95% confidence interval [CI]; 1.3–2.2; p < 0.01): low birth weight (defined as birth weight < 2650 g, OR; 1.7, CI 1.4–2.2, p < 0.01) and asphyxia at 1st minute (OR, 1.5; 95% CI 1.1–2.2; p = 0.02). There was no difference in delivery outcomes between early and late adolescents. Our results suggest that the prevalence of adolescent deliveries is lower in urban settings. Adolescent deliveries are more likely to result in adverse fetal outcomes than adult deliveries. Measures directed towards the prevention of adolescent pregnancies should be implemented to reduce neonatal morbidity and mortality.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3578-0) contains supplementary material, which is available to authorized users.

Adolescent deliveries in rural Cameroon: comparison of delivery outcomes between primipara and multipara adolescents

Objective

Adolescent pregnancies are high risk and deliveries in this age group are usually associated with adverse outcomes. The perception that multiparous adolescents have better delivery outcomes than primiparous counterparts is not uncommon. We sought to determine if multiparous adolescents were precluded from having adverse delivery outcomes when compared to primiparous adolescents. The data used for the analysis is a side product from a published project aimed at mapping the epidemiology of adolescent deliveries in the Oku health district.

Results

From an 8-year (2009–2016) retrospective register analysis of data from two primary healthcare facilities in the Oku health district—a rural area in Cameroon, the prevalence of multiparous adolescent deliveries was 21.5% (78/363). After multivariable analyses, and adjusting for age, sex of baby, gestational age, marital status and HIV status, primiparous adolescents were more likely to have low birth weight infants (LBW) (OR: 3.2; 95% CI 1.1, 9.7; p = 0.04) when compared with multiparous adolescents. Though primiparous adolescents were more likely to have LBW infants than multiparous adolescents, this group of mothers are generally ill-equipped to handle pregnancies and adolescent-friendly programs are necessary to decrease the associated burden.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3550-z) contains supplementary material, which is available to authorized users.