Date of Award

Summer 7-18-2018

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Shannon Self-Brown, PhD

Second Advisor

Curtis Blanton, MA

Abstract

Background: In Tanzania, about 60-70% of perinatal deaths occur during the intrapartum death period and these are most often linked to maternal complications. Maternal hypertensive disorders contribute to perinatal mortality and often cause preterm delivery, low birth weight and intrauterine fetal death. Women with hypertensive disorders in pregnancy, especially preeclampsia and eclampsia have a 3-5-fold increased risk of perinatal death.

Objective: This study examines the association between hypertensive disorders in pregnancy and perinatal mortality in Kigoma Region Tanzania and the confluence of other risk factors on this association from 2011-2015. It is hypothesized that maternal hypertensive disorders will affect perinatal outcomes of birthweight and mortality risks will be negatively impacted.

Methods: A retrospective descriptive analysis was conducted using secondary data from the Pregnancy Outcome Monitoring System (POMS) collected by the Global Reproductive Health Evidence Action Team at the Center for Disease Control and Prevention. POMS includes labor and delivery registry data from facilities in 8 districts (Buhigwe, Kakonko, Kasulu, Kasulu Township Authority, Kibondo, Kigoma Rural, Kigoma Municipal-Ujiji, and Uvinza) in the Kigoma Region of Tanzania from 2011-2015. The outcome variables of interest are “baby dead before discharge” to include live births but died before discharge and stillbirths (both fresh and macerated). The corresponding covariates of interest are weight of baby, mode of delivery, type of maternal hypertensive disorder (pregnancy-induced hypertension, pre-eclampsia, eclampsia, and generalized/unspecified hypertension), and any baby complications. Descriptive statistics were obtained for each variable of interest and were tested by maternal hypertensive disorder category. Mothers with maternal hypertensive disorder were compared to mothers with no documented complications regarding perinatal outcomes. The neonatal case fatality rates, stillbirth case fatality, rates and perinatal case fatality rates were calculated.

Results: Among mothers with any maternal hypertensive disorder, 33.87% of mothers had documented pregnancy-induced hypertension, 14.39% of mothers had documented preeclampsia, 49.09% of mothers had documented eclampsia, and 2.71% had documented generalized/unspecified hypertension. Specifically, 18.36% of mothers with pregnancy-induced hypertension, 17.55% of mothers with preeclampsia, 25.66% of mothers with eclampsia, and 9.09% of mothers with generalized hypertension had babies born in a weight classification of 2 kg or less, while 2.95% of mothers with no documented complication delivered a baby born in a weight classification of 2 kg or less. Fetal distress, birth asphyxia, and prematurity were the most prevalent baby complications of babies born to mothers with documented maternal hypertensive disorders deliver by Cesarean section. For mothers with any documented hypertensive disorder in pregnancy, the still-birth specific case fatality rate is 7.4 per 1000, neonatal specific case fatality rate is 2.44 per 1000 and the perinatal specific case fatality rate is 9.84 per 1000. For mothers with no maternal complication, the stillbirth specific case fatality rate is 2.4 per 1000, neonatal case fatality rate is 0.005 per 1000, and the perinatal case fatality rate is 2.4 per 1000.

Conclusion: The results do not support the hypothesis that there is a direct association between maternal hypertensive disorders in pregnancy and perinatal mortality in Kigoma Region, Tanzania because the baby outcome by maternal hypertensive disorder status is not statistically significant. However, mothers with a documented maternal hypertensive disorder had increased rates of stillbirth, more low birth weight babies, and higher perinatal case fatality rates compared to mothers with no complication. More literature needs to be developed regarding sub-Saharan African to capture contextual information about social determinants and barriers specific to this population.

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