Adverse obstetric outcomes in adolescent pregnancy in rural Zambia-the case of Kawambwa and Mansa Districts of Luapula Province

Abstract

Objectives: Adolescent pregnancy is a major public health problem throughout the world. It has been associated with adverse obstetric outcomes. In Zambia, Luapula province has the highest rate of adolescent pregnancy. The aim of this study was to investigate the maternal and perinatal outcomes among adolescents aged between 10 and 19years compared to older mothers aged between 20-24years delivering at selected health facilities in Kawambwa and Mansa. Methods: A retrospective cross-sectional analysis was carried out of all deliveries to mothers aged between 10 and 24 years for the period January 2012 to January 2013. A total of 2,797 ANC and delivery records were reviewed; 1,291 adolescents aged between 10-19years and 1,504 older mothers aged 20-24 years. Among the outcomes evaluated were eclampsia, anaemia, haemorrhage, fistulae, CPD, low birth weight, asphyxia and pre-term delivery. The crude and adjusted odds ratios for the association between maternal age and adverse obstetric outcomes were obtained through logistic regression models Results: The mean age of the adolescent mothers was 17.5years. Compared to those aged 20 to 24 years, mothers younger than 16years were found to face a higher risk factor for eclampsia (OR 40.56, 95%CI 13.09-125.65), haemorrhage (OR 3.59, 95% CI 1.01-12.74), CPD (OR 5.40, 95% CI 2.46-11.85), prolonged labour (OR 1.49, 95% CI 0.43-5.13) and caesarean section (OR 3.33, 95%CI 1.93-5.76) but not for anaemia, sepsis, fistulae, PROM and maternal death. After adjustment for four potential confounders, the association between maternal age and adverse obstetric outcome diminished; young maternal age remained a risk factor only for eclampsia. Children born to mothers younger than 16 were also at significant risk for LBW (OR 1.65, 95% CI 0.87-3.15), PTD (OR 2.26, 95% CI 0.51-10.14), low Apgar score (OR 1.82, 95% CI 0.87-3.83) and neonatal death (OR 1.83, 95% CI 0.63-5.31); the risk for asphyxia, however, tended to increase with age. The maternal death rate among adolescents was found to be 5 deaths per 1,000 live births, whereas the neonatal death rate was 36 deaths per 1,000 live births. Conclusion: The high rates of adolescent pregnancies in Luapula province are likely as a result of the predominantly rural and poor population. The findings of this study demonstrate that young maternal age is a risk factor for adverse obstetric outcomes. Understanding the factors that contribute to the high levels of adolescent pregnancy in the region will be vital in addressing the situation and subsequently reducing the high maternal and perinatal morbidity and mortality rates.