The data revealed themes related to the quality of care for preterm infants, the prevalence of preterm births among women, available services for improving outcomes of preterm births, risk factors for preterm birth, and interventions to reduce the likelihood of preterm birth at Bundung Maternal and Child Hospital. Direct quotes from transcripts highlight specific issues and help provide context for the response. Participants' identities are withheld to maintain confidentiality.
QUALITY OF CARE
Participants were surveyed on the quality of care provided to premature babies, and a significant portion of them expressed mainly negative opinions. It is considered non-standard because of the accessible materials. A participant elaborates on her statement regarding the substandard quality of service.
“I wouldn’t say it is up standard because we do not have all the required materials to take care of the preterm babies. We do try our best, we improvise sometimes to care because caring of preterm babies needs a lot of resources which are not available in this part of the world. Resources like antenatal corticosteroids”. (Participant A)
The hospital lacks essential tools and resources to properly care for premature babies, leading to challenges in providing appropriate care for preterm infants in our health institutions.
Other participants noted that the hospital's quality of care is good due to the presence of incubators for baby care. Here are a few comments:
“I wouldn’t say it is excellent but its good because we do our best to take care of the preterm babies”. (Participant C)
Other participants were not sure if the quality of care is good or not good, but they believe that they are trying their best to care.
PROPORTION OF WOMEN
The study shows that the majority of mothers who give birth to preterm kids are married. Most of these married women are aged 30 and above, while some are less than 30 years old when pregnant. The results are as follows:
“Most of these women are at their 30’s going up and, in most case, they are married women. Although we do have the lower ages like 20’s and so but its more dominant in the older ages base on my observation”. (Participant B)
“But base on my observation its diverse because sometimes you see middle-aged women giving birth to preterm and at times even young ladies”. (Participant C)
“Well, the issue of giving birth to preterm babies is mostly predominant in married women than single women base on my observation in this hospital”. (Participant C)
Preterm birth is more common in married women than in single women. This could be due to the fact that married women have greater duties compared to unmarried women. Intimate partner violence could be a contributing factor to the higher prevalence of preterm birth in married women compared to unmarried women. Women's age has been shown as a significant predictor of premature birth. Maternal age beyond 30 is a significant risk factor leading to premature births.
SERVICES AVAILABLE TO REHABILITATE THE OUTCOMES
Most, if not all, interviewees discussed the usage of incubators as the sole service for rehabilitating preterm outcomes. Some drugs, such as caffeine, are not always accessible for preventing apnea of prematurity. Most respondents mentioned using incubators as the sole service available for rehabilitating preterm outcomes.
“The only service design is the provision of incubators. Certain medications are not also available like the caffeine which is given to prevent apnea of prematurity” (participant A)
“The only services available as of now is the incubators. It is the only one that is use in this hospital to care for the preterm”. (Participant B)
“The only services available in this hospital is the use of incubators. Medications like caffeine is good but are not available”. (Participant D)
Preterm babies need a lot of service to care for their survival chances. Caring of preterm babies is never easy like that and needs a lot of services like Kangaroo Mother care, thermal care, incubators, etc. But however, the only service available in BMCHH to care for the preterm born is the use of incubators only.
PREDICTORS OF PRETERM BIRTH
Participants extensively discuss the determinants of preterm birth in nearly all hospitals in the Gambia. The predictors of preterm delivery were categorised based on the replies from the key informants. The categories include chronic conditions, pregnancy history, maternal malformations, and social and behavioural issues. Most participants identified pre-eclampsia as the primary risk factor for premature birth in the hospital. “Predictors are different and varies with different mothers but if you look at it, pre-eclampsia is a major risk factor if not to all, but I can say the majority of those women who gave birth to preterm in this hospital”.
Respondents also mentioned preterm premature rupture of membranes, history of preterm birth, twin pregnancy, delayed prenatal care initiation, urinary tract infection, antepartum haemorrhage, and birth spacing of less than two years as risk factors. The majority indicated that pre-eclampsia is a significant factor leading to preterm birth. Here are some of the responses:
“Most of the risk factors that these mothers encounter leading them to have preterm babies includes pre-eclampsia, having a previous history of preterm birth gives an individual a high chance of giving birth again to a baby that is not matured, giving birth to twins and in this case both of the babies use to be immature during birth”. (Participant A)
“The factors that these women mostly encounter leading them to have preterm babies includes pre-eclampsia, birth to twins and in most of the cases they all become premature, premature rupture of the membrane which is the tiring of the sac that is carrying the foetus, history of preterm birth, late antenatal booking and also irregular antenatal visits of the mothers during pregnancy, and also bleeding during pregnancy. All these are the risk factors that mothers are facing leading them to have babies that are not matured in this hospital”. (Participant B)
“The risk factors are many and varies with different people. They include: premature rupture of the membrane that is the tiring of the sack that is surrounding the baby before 37 weeks of gestation, pre-eclampsia, giving birth to twins, haven given birth to a premature baby before may also prompt you to give birth to a baby that is not matured again (previous history of preterm birth), and also late antenatal booking during pregnancy might also imposed a woman to give birth to a premature baby”. (Participant C)
“There are of cause risk factors leading some women to give birth to babies that are not matured and to list them they includepre-eclampsia, a history of preterm delivery, gestational diabetes, premature rupture of the membrane, birth interval of less than two years, bleeding during pregnancy, urinary tract infection”. (Participant E)
Some of the participants stated that most of these women that gave birth to preterm babies undergoes caesarian section mode of delivery. One can say that they undergo CS route of delivery because it helps in protecting the health of the mother and help in better survival rate of the infant.
“And if you look at it, most of these women undergoes caesarian section mode of delivery”. (Participant E)
SUGGESTIONS AND INTERVENTIONS
Participants in the study extensively discussed strategies that could lower the elevated risk of premature birth in women. Most people revealed that early antenatal checkups are quite important for both the mother and the developing foetus. Both regular and early antenatal care visits enable nurses to identify early indications and risk factors, facilitating early prevention for the benefit of both the mother and the growing baby. An interviewee remarked:
” Routine antenatal care is very crucial with regards to the mother and the developing foetus. Early antenatal booking and regular antenatal care visits will help the nurses to know some of the early signs of this risk factors and will be able to provide some medications that will help in getting rid of the risk factor. So, I will advise all expecting mothers to go and do early booking like in their first trimester that will sure help a lot”. (Participant A)
Study participants acknowledged that certain interventions are also very important in helping the preterm baby to survive, such interventions include “early and regular antenatal visits”. Also, there are other interventions that could help reduce the rate in which a mother could give birth to a premature baby intervention like: “family planning because when you go into family planning it will help you to practice birth spacing which is very good for one’s health”. (Participant D)
“Early antenatal booking and regular antenatal visit will help improve these women to get rid of this risk factors. And going into family planning, this will help you in practicing birth spacing because birth interval of less than two years is one of the major risk factors causing women to give birth to preterm babies”. (Participant B)
“But there are also interventions which could help both the mother and the baby and that is the use of family planning, breastfeeding of the baby immediately after birth”. (Participant D)
“Early antenatal booking and regular antenatal visits will help in preventing preterm delivery. Also, interventions like family planning, breastfeeding of the baby after birth, cord care”. (Participant C)
Among all, the most recommended interventions to prevent preterm birth is the early and regular ANC visits of mothers. Mothers are expected to register in their first trimester, doing so will help the nurses to see the early signs of infections or conditions which might prompt preterm birth and will be able to put on measures or interventions to reduce the chances of preterm birth or to reduce the complications that might arise. This is supported by a comment made by a participant during the interview and it state: “I will advise all expecting mothers to go and do early booking like in their first trimester that will sure help a lot”. (Participant A)
It was evident from the interviews that there is a significant amount of work required to address preterm birth at Bundung Maternal and Child Health Hospital. The participants clearly indicated that the quality of care provided to preterm newborns is below standard, which could contribute to the low survival rate of preterm neonates at that institution. Incubators are available, however other therapies such as KMC, prenatal corticosteroids, and antibiotics are also important for rehabilitating premature neonates. Various factors can predict preterm birth, such as the age of mothers, particularly advanced maternal age. Timely and regular antenatal care (ANC) will greatly decrease the prevalence of preterm birth in conjunction with other suggested therapies. It is advisable to seek antenatal care early, preferably in the first trimester.