Preterm babies are those born alive before 37 weeks of pregnancy are completed. The global figure for babies born early was 13.4 million in 2020. But statistics on preterm babies in African countries are poor. Obasanjo Bolarinwa and Kobi Ajayi, who research and teach public health and global healthcare management issues, unpack their research from Kenya.

What did you establish about preterm births in Kenya?

For millions of families in sub-Saharan African countries like Kenya, having a preterm birth is all too common. But one of the challenges the health profession has is that current prevalence and associated factors remain under-explored in countries like Kenya despite their significant public health implications.

That’s why we set out to determine its prevalence and to identify individual- and community-level factors influencing preterm births among women of reproductive age in Kenya.

We analysed data from 7,291 women aged 15-49 to determine the national prevalence and determinants of preterm births in Kenya. Our analysis shows that 7.14% or 1 in 14 Kenyan women who gave birth during the study year experienced preterm birth. The evidence indicates that it remains a public health crisis. In Nigeria, an estimate shows it to be 153 per 1,000 live births.

On the causes, our findings echo evidence from decades of research which suggest a complex web of root causes. These include biological, environmental and adverse social determinants of health.

In our research we found that preterm birth was influenced by individual characteristics and factors at other levels.

At the individual level, maternal age, particularly being in the 15-24 age group, increased the risk compared to women aged 25-34 and 35 and older. In other words, younger women may be more susceptible to preterm birth than their older counterparts.

The frequency of antenatal visits played a role too. Kenya’s care guidelines are that mothers should make at least eight visits to a clinic during pregnancy. Women who attended four or more antenatal visits had lower chances of experiencing preterm births than those with fewer than four visits.

This shows the importance of consistent, quality antenatal care and prenatal monitoring for early detection and management of risk factors. These include hypertension, diabetes and anaemia.

The study also found that a high position on the wealth index, a measure of socioeconomic status, was associated with preterm births. This was contrary to previous literature showing that women with higher socioeconomic status were less likely to report preterm birth. Our findings indicate that women in the highest wealth quintile had higher odds of preterm birth. This may be due to the use of specific, advanced medical interventions which are more common among higher-income families. These include in vitro fertilisation and caesarean delivery.

Our study also found that women living in communities with moderate literacy levels were more likely to experience preterm births. This pattern shows how education and geography are linked. Communities with similar literacy levels often have the same barriers to information, healthcare and other vital resources. Where a woman lives can influence her pregnancy outcomes.

Our study highlights the importance of focusing on community-based awareness and health education efforts.

Read more: 80% of premature baby deaths happen in poorer countries. Five simple measures that can help save them

What are the dangers and costs?

Preterm births carry a huge cost. They can have devastating health outcomes for the infant and mothers. They also present an emotional burden for the families. And they are financially costly for the families and healthcare systems.

Limited resources in Kenya exacerbate the burden. For example neonatal intensive care units are inadequate, there’s a shortage of skilled birth attendants, and there’s insufficient medical equipment like incubators and ventilators. Poor referral systems and inadequate access to essential medicines add to the problem.

This makes it the leading cause of death of neonates, infants, and children under five.

As a result, there is an urgent need to understand the burden of preterm births in Kenya in order to inform strategic health interventions.

Read more: Every 2 seconds in the world a baby is born prematurely – report identifies biggest challenges for their survival

What do you recommend as interventions?

Our study highlights the importance of reducing the high burden of preterm births in Kenya through a comprehensive approach that tackles socio-demographic and community disparities.

Multifaceted strategies that acknowledge the complex nature of preterm births risk in Kenya, the clinical and the contextual, are needed.

  1. Prioritise quality antenatal care: efforts to intensify antenatal visits of at least eight or more must be a priority. However, quality antenatal care hinges on universal healthcare access: ensuring that all Kenyan women can access it without barriers. While the Kenyan government has adopted the Social Health Insurance Fund, a mandatory and comprehensive insurance system that prioritises preventive care at the community level, challenges persist. This suggests a need for continuous improvement. Regardless, antenatal care-based interventions should reduce barriers and improve service delivery and attendance, especially for high-risk groups.

  2. Age-specific interventions: younger mothers continue to be at risk of adverse maternal and infant health outcomes. Sexual and reproductive health targeting young people must, in addition to pregnancy prevention messages, increase awareness of preconception counselling. There should also be age-appropriate health messages, improving access to skilled care, and addressing social needs.

  3. Address individual and community-level inequalities: policy, public health, and clinical-level interventions must acknowledge the complex drivers of preterm births in Kenya across all geographical clusters. Interventions should be community-centred, focusing on improving local knowledge and health literacy. Strategies must also address the specific health behaviours related to wealthier women’s surprising vulnerability and nuances, and tackle the identified risk in medium-literacy areas.

Read more: Nigeria offers free caesareans to save mothers' lives – but it's not enough

This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Obasanjo Bolarinwa, York St John University and Kobi Ajayi, Texas A&M University

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Obasanjo Bolarinwa is affiliated with York St John University.

Kobi Ajayi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.