Preterm Birth and Cofactors of Survival Time and Time to First Hospitalization in Western Kenya

Abstract: Preterm Birth and Cofactors of Survival Time and Time to First Hospitalization in Western Kenya Olivia Dietz Chair of the Supervisory Committee: Grace John-Stewart, MD, PhD Department of Epidemiology, Medicine, Global Health, and Pediatrics BackgroundAn estimated 10.6% of all births globally are preterm, rising to an estimated12% in sub-Saharan Africa. We evaluated the influence of preterm birth on infant mortality and time to first hospitalization in a birth cohort in Western Kenya. MethodsThis secondary analysis used data collected in a cluster randomized clinical trial on PrEP implementation strategies among HIV-negative women (PriMA, NCT#03070600). Women (N=4447) were enrolled during pregnancy at 20 antenatal care clinics in Western Kenya and mother-infant pairs were followed for 9 months postpartum. We used Kaplan-Meier and Cox regression to compare preterm and term infants for outcomes of death, first hospitalization, and first hospitalization or death, and to identify correlates of these outcomes both in the general population and among preterm infants. ResultsAmong 4107 deliveries, 7350 (17.8%) were preterm (PTB). PTB was associated with 4.43-fold increased risk of hospitalization (95% confidence interval [CI]: 2.19, 8.95) and a higher likelihood of neonatal mortality than term births (2.5% versus 1.4% p=0.045). Overall, the majority of first hospitalizations and deaths occurred within the first week of life among both preterm and term infants, and risk of first hospitalization was associated PTB, lower gestational age, and household crowding. Among preterm infants, male sex, lower gestational age and longer travel time to clinic (HR 3.56 [1.12, 11.34]) were associated with higher risk of first hospitalization. Lower maternal social support, and partner positive or unknown HIV status, were associated with decreased risk of mortality and first hospitalization. ConclusionPreterm birth, lower gestational age, low birth weight, and male sex were associated with increased risk of hospitalization and mortality. Among preterm infants, social context influenced likelihood of mortality. Targeted interventions to facilitate timely medical attention and address maternal support may improve outcomes for preterm infants.