scholarly journals Predictors of perinatal death in the presence of missing data: A birth registry-based study in northern Tanzania

PLoS ONE ◽  
2020 ◽  
Vol 15 (4) ◽  
pp. e0231636
Author(s):  
Innocent B. Mboya ◽  
Michael J. Mahande ◽  
Joseph Obure ◽  
Henry G. Mwambi
Keyword(s):  
Missing Data ◽  
Perinatal Death ◽  
Birth Registry ◽  
Northern Tanzania

scholarly journals Joint Modeling of Singleton Preterm Birth and Perinatal Death Using Birth Registry Cohort Data in Northern Tanzania

2021 ◽  
Vol 9 ◽  
Author(s):  
Innocent B. Mboya ◽  
Michael J. Mahande ◽  
Joseph Obure ◽  
Henry G. Mwambi
Keyword(s):  
Preterm Birth ◽  
Pregnancy Outcomes ◽  
Perinatal Death ◽  
Substantial Reduction ◽  
Adverse Pregnancy Outcomes ◽  
Birth Registry ◽  
Cohort Data ◽  
Northern Tanzania ◽  
Management Of Complications ◽  
Adverse Pregnancy

Understanding independent and joint predictors of adverse pregnancy outcomes is essential to inform interventions toward achieving sustainable development goals. We aimed to determine the joint predictors of preterm birth and perinatal death among singleton births in northern Tanzania based on cohort data from the Kilimanjaro Christian Medical Center (KCMC) zonal referral hospital birth registry between 2000 and 2017. We determined the joint predictors of preterm birth and perinatal death using the random-effects models to account for the correlation between these outcomes. The joint predictors of higher preterm birth and perinatal death risk were inadequate (<4) antenatal care (ANC) visits, referred for delivery, experiencing pre-eclampsia/eclampsia, postpartum hemorrhage, low birth weight, abruption placenta, and breech presentation. Younger maternal age (15–24 years), premature rupture of membranes, placenta previa, and male children had higher odds of preterm birth but a lessened likelihood of perinatal death. These findings suggest 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 a substantial reduction of adverse perinatal outcomes and improving maternal and child health.

scholarly journals Predictors of singleton preterm birth using multinomial regression models accounting for missing data: A birth registry-based cohort study in northern Tanzania

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249411
Author(s):  
Innocent B. Mboya ◽  
Michael J. Mahande ◽  
Joseph Obure ◽  
Henry G. Mwambi
Keyword(s):  
Preterm Birth ◽  
Regression Models ◽  
Perinatal Death ◽  
Placenta Previa ◽  
Preterm Births ◽  
Late Preterm ◽  
Multinomial Regression ◽  
Birth Registry ◽  
Northern Tanzania ◽  
Extremely Preterm

Background Preterm birth is a significant contributor of under-five and newborn deaths globally. Recent estimates indicated that, Tanzania ranks the tenth country with the highest preterm birth rates in the world, and shares 2.2% of the global proportion of all preterm births. Previous studies applied binary regression models to determine predictors of preterm birth by collapsing gestational age at birth to <37 weeks. For targeted interventions, this study aimed to determine predictors of preterm birth using multinomial regression models accounting for missing data. Methods We carried out a secondary analysis of cohort data from the KCMC zonal referral hospital Medical Birth Registry for 44,117 women who gave birth to singletons between 2000-2015. KCMC is located in the Moshi Municipality, Kilimanjaro region, northern Tanzania. Data analysis was performed using Stata version 15.1. Assuming a nonmonotone pattern of missingness, data were imputed using a fully conditional specification (FCS) technique under the missing at random (MAR) assumption. Multinomial regression models with robust standard errors were used to determine predictors of moderately to late ([32,37) weeks of gestation) and very/extreme (<32 weeks of gestation) preterm birth. Results The overall proportion of preterm births among singleton births was 11.7%. The trends of preterm birth were significantly rising between the years 2000-2015 by 22.2% (95%CI 12.2%, 32.1%, p<0.001) for moderately to late preterm and 4.6% (95%CI 2.2%, 7.0%, p = 0.001) for very/extremely preterm birth category. After imputation of missing values, higher odds of moderately to late preterm delivery were among adolescent mothers (OR = 1.23, 95%CI 1.09, 1.39), with primary education level (OR = 1.28, 95%CI 1.18, 1.39), referred for delivery (OR = 1.19, 95%CI 1.09, 1.29), with pre-eclampsia/eclampsia (OR = 1.77, 95%CI 1.54, 2.02), inadequate (<4) antenatal care (ANC) visits (OR = 2.55, 95%CI 2.37, 2.74), PROM (OR = 1.80, 95%CI 1.50, 2.17), abruption placenta (OR = 2.05, 95%CI 1.32, 3.18), placenta previa (OR = 4.35, 95%CI 2.58, 7.33), delivery through CS (OR = 1.16, 95%CI 1.08, 1.25), delivered LBW baby (OR = 8.08, 95%CI 7.46, 8.76), experienced perinatal death (OR = 2.09, 95%CI 1.83, 2.40), and delivered male children (OR = 1.11, 95%CI 1.04, 1.20). Maternal age, education level, abruption placenta, and CS delivery showed no statistically significant association with very/extremely preterm birth. The effect of (<4) ANC visits, placenta previa, LBW, and perinatal death were more pronounced on the very/extremely preterm compared to the moderately to late preterm birth. Notably, extremely higher odds of very/extreme preterm birth were among the LBW babies (OR = 38.34, 95%CI 31.87, 46.11). Conclusions The trends of preterm birth have increased over time in northern Tanzania. Policy decisions should intensify efforts to improve maternal and child care throughout the course of pregnancy and childbirth towards preterm birth prevention. For a positive pregnancy outcome, interventions to increase uptake and quality of ANC services should also be strengthened in Tanzania at all levels of care, where several interventions can easily be delivered to pregnant women, especially those at high-risk of experiencing adverse pregnancy outcomes.

scholarly journals Obstetric outcomes of women referred for delivery to a tertiary hospital in northern Tanzania– a descriptive retrospective study based on a hospital birth registry

2020 ◽  
Author(s):  
Carolyn Lissu ◽  
Helena Volgsten ◽  
Festu Mazuguni ◽  
Eusebious Maro
Keyword(s):  
Retrospective Study ◽  
Pregnant Women ◽  
Tertiary Hospital ◽  
Health Facilities ◽  
Obstetric Outcomes ◽  
Birth Registry ◽  
Maternal Deaths ◽  
Hospital Birth ◽  
Northern Tanzania ◽  
Lower Health

Abstract Background: Maternal mortality remains a great challenge in a low-income country like Tanzania, despite global and national efforts to improve women’s reproductive health. Timeliness and appropriateness of referral from a lower- to higher-level health facility comprise an important factor for the obstetrics outcome for pregnant women. This study aimed to determine the obstetric outcomes, such as maternal deaths, of women referred to KCMC, a tertiary hospital in northern Tanzania. Methods: A descriptive retrospective study based on a hospital birth registry was conducted, using consecutive stored data on pregnant women referred while in labor and managed at the KCMC tertiary hospital in northern Tanzania between the years 2000 and 2015. All referred pregnant women whose labor status information was missing during admission were excluded from the study. Results: During the study period, a total of 53662 deliveries were managed at KCMC. Among these, 6066 women were referred from lower health facilities, with 4193 (69.2%) of them being referred while in labor. The main reason for referral was poor progress of labor (31.0%), followed by prolonged labor (27.1%) and obstructed labor (19.5%). For 1859 (44.6%) women, delivery was by caesarean section. A total of 292 maternal deaths occurred between 2000 and 2015. Of these, almost a quarter (22.6%) occurred in women referred from other health facilities while in labor. Conclusions: Most of the maternal complications during labor and delivery were prevalent among women referred from lower health facilities. This underscores the need to strengthen lower health facilities’ ability to detect complications in timely manner and provide effective emergency obstetric care, as well as to refer women to higher-level facility.

scholarly journals Prediction of perinatal death using machine learning models: a birth registry-based cohort study in northern Tanzania

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e040132
Author(s):  
Innocent B Mboya ◽  
Michael J Mahande ◽  
Mohanad Mohammed ◽  
Joseph Obure ◽  
Henry G Mwambi
Keyword(s):  
Machine Learning ◽  
Logistic Regression ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Perinatal Death ◽  
Learning Models ◽  
Net Benefit ◽  
Birth Registry ◽  
Perinatal Deaths ◽  
Machine Learning Models

ObjectiveWe aimed to determine the key predictors of perinatal deaths using machine learning models compared with the logistic regression model.DesignA secondary data analysis using the Kilimanjaro Christian Medical Centre (KCMC) Medical Birth Registry cohort from 2000 to 2015. We assessed the discriminative ability of models using the area under the receiver operating characteristics curve (AUC) and the net benefit using decision curve analysis.SettingThe KCMC is a zonal referral hospital located in Moshi Municipality, Kilimanjaro region, Northern Tanzania. The Medical Birth Registry is within the hospital grounds at the Reproductive and Child Health Centre.ParticipantsSingleton deliveries (n=42 319) with complete records from 2000 to 2015.Primary outcome measuresPerinatal death (composite of stillbirths and early neonatal deaths). These outcomes were only captured before mothers were discharged from the hospital.ResultsThe proportion of perinatal deaths was 3.7%. There were no statistically significant differences in the predictive performance of four machine learning models except for bagging, which had a significantly lower performance (AUC 0.76, 95% CI 0.74 to 0.79, p=0.006) compared with the logistic regression model (AUC 0.78, 95% CI 0.76 to 0.81). However, in the decision curve analysis, the machine learning models had a higher net benefit (ie, the correct classification of perinatal deaths considering a trade-off between false-negatives and false-positives)—over the logistic regression model across a range of threshold probability values.ConclusionsIn this cohort, there was no significant difference in the prediction of perinatal deaths between machine learning and logistic regression models, except for bagging. The machine learning models had a higher net benefit, as its predictive ability of perinatal death was considerably superior over the logistic regression model. The machine learning models, as demonstrated by our study, can be used to improve the prediction of perinatal deaths and triage for women at risk.

scholarly journals Trend in female genital mutilation and its associated adverse birth outcomes: A 10-year retrospective birth registry study in Northern Tanzania

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244888
Author(s):  
Issa Rashid Suleiman ◽  
Eusebious Maro ◽  
Benjamin C. Shayo ◽  
Julius Pius Alloyce ◽  
Gileard Masenga ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Hospital Stay ◽  
Birth Outcomes ◽  
Apgar Score ◽  
Female Genital Mutilation ◽  
Adverse Birth Outcomes ◽  
Birth Registry ◽  
Genital Mutilation ◽  
Northern Tanzania ◽  
Female Genital

Background Approximately 200 million women and girls were reported to have undergone female genital mutilation worldwide in 2015.UNICEF’s data based on household survey estimates 15% of women from 15–49 years have undergone FGM from year 2004–2015. Despite this, reliable data on trend of prevalence of female genital mutilation and its associated birth outcomes have not been documented in Tanzania. This study aimed at determining the trends of female genital mutilation and associated maternal and neonatal adverse outcomes in northern Tanzania. Methods A cross-sectional study was conducted using maternally-linked data from Kilimanjaro Christian Medical birth registry involving 30,286 women who gave birth to singletons from 2004–2014. The prevalence of female genital mutilation was computed as proportion of women with female genital mutilation yearly over 10 years. Odds ratios with 95% confidence intervals for adverse birth outcomes associated with female genital mutilation were estimated using multivariable logistic regression model. Results Over the 10-year period, the prevalence of female genital mutilation averaged 15.4%. Female genital mutilation decreased from 23.6% in 2005 to 10.6% in 2014. Female genital mutilation was associated with increased odds for caesarean section (aOR1.26; 95% CI: 1.18–1.34), post-partum haemorrhage (aOR 1.31; 95% CI: 1.10–1.57) and long hospital stay (aOR 1.21; 95% CI: 1.14–1.29). Female genital mutilation also increased women’s likelihood of delivering an infant with low Apgar score at 5th minute (aOR 1.60; 95% CI: 1.37–1.89).FGM type III and IV had increased odds of caesarean section, episiotomy and prolonged duration of hospital stay as compared to FGM type I and II, although the association was statistically insignificant. Conclusion Female genital mutilation prevalence has declined over the study period. Our study has demonstrated that postpartum haemorrhage, delivery by caesarean section, long maternal hospital stays and low APGAR score are associated with FGM. Initiatives to mitigate FGM practice should be strengthened further to reduce/eliminate this practice. Moreover, surgical interventions to improve severe form FGM are welcomed to improve the aforementioned aspects of obstetric outcome in this locality.

scholarly journals Selective fertility – the examples of perinatal death and preeclampsia

2009 ◽  
Vol 17 (2) ◽  
Author(s):  
Rolv Skjærven ◽  
Kari Klungsøyr Melve
Keyword(s):  
Perinatal Death ◽  
Birth Registry ◽  
Cross Sectional ◽  
Unit Of Analysis ◽  
Perinatal Epidemiology ◽  
Number Of Children ◽  
Independent Events ◽  
Medical Birth Registry ◽  
Cross Sectional Design ◽  
Using Data

Introduction. Studies of foetal or perinatal losses are hampered by the fact that a woman’s pregnancies are not independent events, making traditional “cross sectional” design and analyses difficult. A complicating issue is the mechanism of “selective fertility”. Selective fertility is the tendency for a woman to replace a<br />perinatal loss with a new pregnancy until the desired number of children is attained. We wanted to evaluate the effects of selective fertility related to perinatal deaths and to preeclamptic pregnancies, using data covering four decades. Material and Methods. We use data from the Medical Birth Registry of Norway, covering the years 1967-2006, altogether 2.3 million births, organized into 1.1 million sibships with the mother as the unit of analysis. Results. Following a perinatal death, the continuation to a next pregnancy is higher then after a live birth, and this elevation of ‘fertility’ has increased over time. After two perinatal losses, the continuation is more then doubled. On the other hand, continuing to a next pregnancy is reduced after a preeclamptic pregnancy, and after two preeclamptic pregnancies the reduction corresponds to 25%. Conclusions. These two examples show that samples of births are strongly hampered by self-selection to pregnancy. Therefore, data organized into sibships should be obligatory for studies in perinatal epidemiology. Perinatal epidemiology is in need for analytical designs that account for dependencies in data

scholarly journals Frequency, Risk Factors, and Adverse Fetomaternal Outcomes of Placenta Previa in Northern Tanzania

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Elizabeth Eliet Senkoro ◽  
Amasha H. Mwanamsangu ◽  
Fransisca Seraphin Chuwa ◽  
Sia Emmanuel Msuya ◽  
Oresta Peter Mnali ◽  
...  
Keyword(s):  
Risk Factors ◽  
Placenta Previa ◽  
Significant Risk ◽  
Past Research ◽  
Birth Registry ◽  
Logistic Regression Models ◽  
Northern Tanzania ◽  
Gynecological Diseases ◽  
Kilimanjaro Christian Medical Centre ◽  
Independent Risk Factors

Background and Objective. Placenta previa (PP) is a potential risk factor for obstetric hemorrhage, which is a major cause of fetomaternal morbidity and mortality in developing countries. This study aimed to determine frequency, risk factors, and adverse fetomaternal outcomes of placenta previa in Northern Tanzania.Methodology. A retrospective cohort study was conducted using maternally-linked data from Kilimanjaro Christian Medical Centre birth registry spanning 2000 to 2015. All women who gave birth to singleton infants were studied. Adjusted odds ratios (ORs) with 95% confidence intervals for risk factors and adverse fetomaternal outcomes associated with PP were estimated in multivariable logistic regression models.Result. A total of 47,686 singleton deliveries were analyzed. Of these, the frequency of PP was 0.6%. Notable significant risk factors for PP included gynecological diseases, alcohol consumption during pregnancy, malpresentation, and gravidity ≥5. Adverse maternal outcomes were postpartum haemorrhage, antepartum haemorrhage, and Caesarean delivery. PP increased odds of fetal Malpresentation and early neonatal death.Conclusion.The prevalence of PP was comparable to that found in past research. Multiple independent risk factors were identified. PP was found to have associations with several adverse fetomaternal outcomes. Early identification of women at risk of PP may help clinicians prevent such complications.

scholarly journals Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway

BMJ Open ◽  
2017 ◽  
Vol 7 (4) ◽  
pp. e014979 ◽  
Author(s):  
Solveig Bjellmo ◽  
Guro L Andersen ◽  
Marit Petra Martinussen ◽  
Pål Richard Romundstad ◽  
Sissel Hjelle ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Cohort Study ◽  
Perinatal Death ◽  
Birth Registry ◽  
Breech Delivery ◽  
Vaginal Breech Delivery

scholarly journals Incidence, recurrence and predictors associated with recurrence of low birth weight in Northern Tanzania

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Michael Johnson Mahande ◽  
Joseph Obure ◽  
Miriam Hamisi Mvunta
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Recurrence Risk ◽  
Subsequent Pregnancy ◽  
Birth Registry ◽  
Important Indicator ◽  
Normal Birth ◽  
Northern Tanzania ◽  
Increased Risk ◽  
Associated Risk Factors

ABSTRACTBackgroundLow birth weight (LBW) is an important indicator of newborn survival and is associated with higher risk of infant mortality, morbidity and long term health consequences later in life. Little has been explored on the recurrence of LBW and associated risk factors in developing countries including Tanzania. This study aimed to determine incidence, recurrence and associated risk factors for in Northern Tanzania.MethodsThis was a retrospective cohort study using maternally-linked data from Kilimanjaro Christian Medical Centre (KCMC) medical birth registry. A total of 48,008 births from 8,417 women who delivered live born between 2000 and 2014 were followed for subsequent deliveries. Recurrence risk with 95% CI for LBW and associated risk factors were estimated in a multivariate log binomial model while accounting for correlation between births of the same mother.ResultsIncidence of LBW was 7.9%. The recurrence rate of LBW was 24.9% compared with 5.9% for those who had normal birth weight babies in first pregnancy. This corresponded to a relative risk of 3.7 (95% CI: 3.10 – 4.52). Some maternal conditions in the first pregnancy were associated with increased risk of LBW in the subsequent pregnancy. These include; HIV positive status (RR 2.0; 95% CI 1.26 – 3.21), preterm birth (RR 1.2; 95% CI 1.03 – 1.63) and preeclampsia (RR 1.8; 95% CI 1.26 – 2.45). Only preeclampsia in the first pregnancy was associated with increased risk of recurrent of LBW (RR: 1.6 95% CI 1.01-2.54).ConclusionAlthough the incidence of LBW is low in the study population, but the recurrence risk is high. Preeclampsia in the first pregnancy was associated with recurrent LBW. Early prenatal identification of women at risk of preeclampsia to address modifiable risk factors and counsel mothers on persisting risk factors for recurrence will mitigate the risk of recurrence of LBW.

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