Determinants of adverse maternal and neonatal pregnancy Outcomes among pastoralist women of reproductive age in Marsabit county, Kenya

Abstract

Adverse maternal and neonatal pregnancy outcomes refer to abnormal birth outcomes that can manifest through the neonate, pregnant woman, or both. These outcomes mainly contribute to neonatal and maternal morbidity and mortality in low- and middle-income countries. In Sub- Saharan Africa, the prevalence of adverse pregnancy outcomes is 29.7%. In Kenya, an estimated 5,000 annual maternal deaths are attributable to adverse pregnancy outcomes. Marsabit County reports a Maternal Mortality Rate of 1127 deaths per 100,000 live births, which is 2.3 times more than the national rate. Adverse maternal and neonatal pregnancy outcomes and its determinants have been identified as; maternal individual-related, socio-cultural and health systems determinants. However, there is limited documentation of these determinants amongst pastoralist women of Marsabit County. The study's specific objectives were; to assess maternal-individual determinants, to investigate socio-cultural determinants and to assess health systems determinants of adverse maternal and neonatal pregnancy outcomes amongst pastoralist women of reproductive age; 15 to 49 years, in Marsabit County. The study applied a cross-sectional study design at four facilities purposively selected. The study used the Fisher et al. (1998) formula to calculate the sample size of 422 inclusive of 10% non-response. A structured questionnaire was used to collect quantitative data from 400 participants where systematic random sampling was applied. A response rate of 94.7% was attained, while, 22 sampled participants were unresponsive. Additionally, qualitative data was purposively obtained from eight healthcare providers using a Key Informant Interview schedule to triangulate with the quantitative data. Qualitative data were analyzed manually while quantitative data was analyzed with descriptive and inferential statistics. Pearson chi-square test determined the proportionality of associations between independent and dependent categorical variables. Variables showing associations underwent binary logistic regression to derive the Odds Ratio, which was used to determine the degree of associations between independent variables and dependent variables. The result demonstrated that the mean age of the participants was 25.87 (± 5.31 SD) whereby a high proportion of them; 35.3% were aged 25 to 29 years. Planning pregnancy reduced the chances of occurrence of adverse pregnancy and neonatal outcome by 69% (OR=0.309, 95% CI: 0.099- 0.967; p=0.044). Having a birth plan reduced the chances of adverse outcomes by 55% (OR=0.445, 95% CI: 0.245-0.806; p=0.008). Starting ANC attendance between 0 to 3rd month reduced the odds of occurrence of adverse pregnancy and neonatal outcome by 76% (OR=0.238, 95% CI: 0.072-0.786; p=0.018). Having a prim parous pregnancy increased the odds of determining an adverse outcome by 3.5 times (OR=3.529, 95% CI: 1.782-6.986; p<0.0001). Maternal age demonstrated a 48% reduction in odds of adverse maternal and neonatal pregnancy outcomes (OR=0.575, 95% CI: 0.449-0.735; p<0.0001). In line with socio-cultural factors, the type of marriage allowed demonstrated a 53% reduction in odds of adverse outcome (OR=0.471, 95% CI: 0.274-0.811; p=0.007). The use of native herbs during pregnancy was 2.4 times likely to increase the likelihood of adverse outcomes (OR=2.402, 95% CI: 1.038-5.557; p=0.041). Discussing contraceptive use with a male partner increased the likelihood of determining adverse maternal and neonatal pregnancy outcomes by 2.6 times (OR=2.595, 95% CI: 1.354-4.975; p=0.004). Distance to health facilities demonstrated a 72% reduction in the likelihood of adverse outcomes (OR=0.277, 95% CI: 0.075-1.022; p=0.054). Waiting time increased the chances of determining the outcome by 3.7 times (OR=3.661, 95% CI: 1.494-.8.974; p=0.005). Availability of comprehensive MCH services reduces the chances of occurrence of the outcome by 77% (OR=0.226, 95% CI: 0.060-0.859; p=0.029). Marsabit County Department of Health should adopt a multidimensional approach in addressing reported determinants of adverse pregnancy outcomes. Specifically, the county should intensify awareness of cultural sensitivity, improve health system infrastructure, education, training for health care workers, community services, and engagement as well as integration of maternal and neonatal services.