Obstetric outcomes and factors associated with adolescent pregnancies at the university teaching hospital Lusaka,Zambia

Abstract

Adolescent pregnancies are a major health concern in Zambia. Obstetric outcomes of and factors associated with adolescent pregnancies seen at the UTH were not clearly understood, defined and documented. This study explored this aspect. This was a comparative prospective cross sectional study. A purposeful sample of 200 consenting pregnant adolescents and women aged between 20 and 30 years who were admitted in labour and in a ratio of 1:1 was studied. A total of 3,456 women aged between 14 and 30 years delivered at the UTH between September and October, 2015 out of which 480 (13.9%) were adolescents. Of the 100 adolescents studied, 62(62 %) had dropped out of school due to pregnancy (p <0.001, AOR 14.6; 95% CI: 5.15 - 41.53) with 81(81 %) of their pregnancies being unplanned. Factors associated with adolescent pregnancies noted from the study included mean age at coitarche (p <0.001), early marriages (p <0.001; AOR 14.6, 95% CI: 4.642 - 45.99), primary education (p 0.002; AOR 4.522, 95% CI: 1.758 – 11.634), having a boyfriend (p <0.001; AOR 12.70, 95% CI: 4.04 – 39.91) and contraceptive use. There were 95(95%) adolescents who had never used a contraceptive before compared to 40(40%) older women (p <0.001). Adolescents were also significantly associated with first degree perineal tears (p <0.001; AOR 3.46, 95% CI: 1.83 - 6.56) and preterm deliveries (p 0.026, AOR 2.60, 95% CI: 1.16 - 5.78). Furthermore, although not statistically significant, more adolescents 22(22%) had low birth weight babies compared to 14(14%) older women (p 0.132) and 11(11%) had pregnancy induced hypertension versus 7(7%) older mothers (p 0.323). In addition, out of the 10 documented caesarean sections among the study participants, 8(80%) were among adolescents (p 0.052). Several factors and adverse obstetric outcomes are associated with adolescent pregnancies seen at the UTH. Although adolescent pregnancy is reducing, it remains high and contributing significantly to discontinuation of school. Key stakeholders including the ministry of health and its cooperating partners need to continue targeting adolescents with appropriate health messages including an emphasis on increased access to and utilization of effective contraceptives.