Factors associated with birth before arrival (BBA) at DR Yusuf Dadoo hospital, Krugersdorp, west rand, Gauteng
INTRODUCTION: According to the WHO, the global maternal mortality rate in 2015 was 216 maternal deaths per 100 000 live births. The maternal mortality rate in South Africa is 138 per 100 000 live births. Although neonatal mortality has shown a decline from 37 deaths per 1,000 live births in 1990 to 18 in 2017, about 40% of this neonatal deaths occurred on the first day of life. Lack of skilled health personnel at delivery is believed to contribute to this high maternal and neonatal mortality rates. Birth before arrival (BBA) at a healthcare facility is associated with adverse maternal and neonatal outcomes. This study explored the factors associated with babies being born before arrival at Dr Yusuf Dadoo Hospital in Gauteng Province, South Africa. METHODOLOGY: A prospective descriptive cross-sectional study on 133 mothers of babies born before arrival, undertaken over a six-month period (August 2017 to January 2018) in a district hospital in South Africa. A researcher administered questionnaire was used to collect the data. Participants were asked about their pregnancy history, details of the index pregnancy and delivery. Main outcome measures included delivery intention and reasons for BBA. Ethical approval was granted by the University of the Witwatersrand. RESULTS: Majority of the participants were of South African origin, married, and unemployed with high school education. The mean age of participants was 28.2 years and majority of the women in the study were aged between 26 and 35 years. More than a third of the participants (51/133, 38.4%) resided outside West Rand district. During the study period a total of 3116 in-facility births and 157 babies were born before arrival (BBA). The study BBA incidence was 4.80%. The main reasons cited by participants for planning out of facility delivery were unpleasant experience with health facility, no benefit in hospital delivery and religious/cultural belief. Mothers with a history of BBA (OR 13.2 [95%CI 2.18 – 80.39]) and mothers who did not attend ANC (OR 13.2 [95%CI 2.18 – 80.39]) were more likely to have a BBBA in the index pregnancy. CONCLUSION: The incidence of BBA is low in the study setting and is mostly an unintentional pregnancy endpoint. Efforts at reducing BBA and the consequent neonatal complications need to promote antenatal clinic uptake and break the reinforcing influence of previous BBA on the index pregnancy.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Family Medicine