Prevalence and associated risk factors of adverse maternal and newborn outcomes in inner-city Johannesburg: a cross- sectional analysis of birth registers

Abstract

Background Improved maternal and newborn health are important WHO sustainable development goal targets. In the inner-city of Johannesburg, a population with specific vulnerabilities, information on the extent of adverse maternal and neonatal outcomes is scarce. To address this gap, we aimed to estimate the prevalence and risk factors for adverse maternal and newborn outcomes among women and their infants in two inner-city health facilities in Johannesburg, South Africa.

Methods Birth register data from the Hillbrow Community Healthcare Centre (HCHC) and Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) were extracted for deliveries from July 2017 to June 2018. Demographic and clinical data included age, comorbid conditions, obstetric history, intrapartum factors, maternal and newborn outcomes, and neonatal anthropometry. Prevalences of eight outcomes of interest were estimated: any hypertensive disorder, prolonged labour, haemorrhage, maternal death, preterm birth, low birth weight (LBW), stillbirth, and congenital anomalies. A separate logistic regression model was used for each outcome to determine risk factors associated with each outcome.

Results Of the deliveries, a portion were from HCHC and the remainder from CMJAH. Most women were between 20–34 years old, with some pregnancies among adolescents and others among women older than 35 years. Among patients with nationality recorded, over half were South African, while others were Zimbabwean or from other predominantly African countries. Almost five percent of women had no record of antenatal care during pregnancy. Women living with HIV comprised more than a quarter; HIV status was unknown in a small percentage. The Caesarean Section rate was higher at CMJAH compared to the overall rate.

Among pregnant women, a notable proportion had a hypertensive disorder, prolonged labour, or maternal haemorrhage. Risk factors for hypertensive disorders included older maternal age, nulliparity, and pre-existing diabetes, while HIV had a protective effect. Nulliparity was the only risk factor for prolonged labour. Risk factors for maternal haemorrhage included Caesarean section delivery, pre-viable deliveries, preterm deliveries, post-term deliveries, retained placenta, and genital lacerations, while hypertension had a protective effect. Five maternal deaths occurred; all were preterm deliveries, and the majority had hypertensive disorders.

Multiple gestation occurred in a small percentage of deliveries; thousands of neonates were born, almost half of them female. Among neonates, nearly a quarter were preterm, a significant proportion had LBW, some were stillborn, and a smaller percentage had congenital anomalies (most commonly polydactyly, unspecified dysmorphic features, club foot, and umbilical hernia). Maternal factors associated with preterm birth included younger maternal age, HIV, unknown HIV status, hypertensive disorders, nulliparity, multiple gestation, placental abruption, and obstetric haemorrhage. Risk factors for LBW included older maternal age, HIV, nulliparity, very early or moderately preterm gestational age, and multiple gestation. Stillbirth was significantly associated with unknown HIV status, hypertensive disorders, haemorrhage, birth before arrival, preterm delivery, LBW, and congenital anomalies. No significant associations were found with congenital anomalies in the multivariable model.

Conclusion We report high prevalences of haemorrhage and preterm birth from birth registers in inner-city health facilities in Johannesburg, South Africa. Women younger than 20 years or older than 35 years, and women living with HIV are at increased risk of certain adverse maternal outcomes and are more likely to deliver infants with adverse outcomes. Maternal and newborn health, important SDG targets, are difficult to achieve in vulnerable populations such as the inner-city of Johannesburg. The birth register maintained at delivery facilities is a useful source of routine information on maternal and early neonatal outcomes. Improving completeness of birth register data, and electronic data capture will allow for additional analyses that can help further examine inner-city maternal and neonatal health outcomes.