DOI: 10.14288/1.0445053
title: The epidemiology and risk factors for postnatal complications among postpartum women and neonates in Southwestern Uganda: a prospective cohort study

description: &lt;br/&gt;&lt;strong&gt;Background:&lt;/strong&gt; Sub-Saharan Africa accounts for two-thirds of the global burden of maternal and newborn deaths. Adverse outcomes among postpartum women and newborns occurring in the first six weeks of life are often related, though data co-examining patients are limited. This study is an exploratory analysis describing the epidemiology of postnatal complications among postpartum women and newborns following facility birth and discharge in Mbarara, Uganda.&lt;br/&gt; &lt;br /&gt;&lt;strong&gt;Methods: &lt;/strong&gt; This single-site prospective cohort observational study enrolled postpartum women following facility-based delivery. To capture health information about both the postpartum women and newborns, data was collected and categorized according to domains within the continuum of care including (1) social and demographic, (2) pregnancy history and antenatal care, (3) delivery, (4) maternal discharge, and (5) newborn discharge. The primary outcomes were readmission and mortality within the six-week postnatal period as defined by the WHO. Multivariable logistic regression was used to identify risk factors. &lt;br /&gt; &lt;br /&gt;&lt;strong&gt;Findings: &lt;/strong&gt; Among 2930 discharged dyads, 2.8% and 9.0% of women and newborns received three or more postnatal visits respectively. Readmission and deaths occurred among 108(3.6%) and 25(0.8%) newborns and in 80(2.7%) and 0(0%) women, respectively. Readmissions were related to sepsis/infection in 70(88%) women and 68(63%) newborns. Adjusted analysis found that caesarean delivery (OR:2.91; 95%CI:1.5–6.04), longer travel time to the facility (OR:1.54; 95%CI:1.24–1.91) and higher maternal heart rate at discharge (OR:1.02; 95%CI:1.00–1.01) were significantly associated with maternal readmission. Discharge taken on all patients including maternal haemoglobin (per g/dL) (OR:0.90; 95%CI:0.82–0.99), maternal symptoms (OR:1.76; 95%CI:1.02–2.91), newborn temperature (OR:1.66; 95%CI:1.28–2.13) and newborn heart rate at (OR:1.94; 95%CI:1.19–3.09) were risk factors among newborns. Readmission and death following delivery and discharge from healthcare facilities is still a problem in settings with low rates of postnatal care visits for both women and newborns. Strategies to identify vulnerable dyads and provide better access to follow-up care, are urgently required. &lt;br /&gt; &lt;br /&gt;&lt;strong&gt;Data Collection Methods:&lt;/strong&gt; This prospective cohort study aimed to enroll women presenting in labor at &gt;28 weeks’ gestation who delivered liveborn infants and were routinely discharged together home with their infants. Following delivery, we obtained written consent to complete a structured questionnaire in-person and a follow-up questionnaire over the phone six weeks later. Specifically, following enrolment, research nurses prospectively collected study variables previously identified through two systematic reviews on risk factors for re-admission and mortality among postpartum women and infants, as well as through discussion with colleagues and other experts. Given the interactive health relationship between postpartum women and infants, variables were collected and categorized according to relevant time points across the continuum of care. A total of 86 variables were collected and broadly categorized into five domains: (1) social and demographic, (2) pregnancy history and antenatal care, (3) delivery, (4) maternal discharge, and (5) neonatal discharge (Table 4A-E). Apart from discharge measurements, we prioritized gathering data from the hospital medical record, followed by interviews with the postpartum women and finally confirmation with the medical team if there were discrepancies, missing information, or questions the postpartum woman was unable to answer. With respect to discharge measurements, we obtained and recorded clinical data for both mother and their newborns on every dyad discharged together from the hospital. Blood pressure was measured using a Welch Allyn Vital Signs Monitor 300 Series (Welch Allyn, New York, USA). Oxygen saturation (SpO2) and heart rate was measured using the Masimo iSpO2® (Masimo Corporation, California, USA) and respiratory rates were measured using the RRate Application. Maternal hematocrit was quantified using a microhematocrit centrifuge. Random blood glucose was measured on mother and newborn using the FreeStyle Optimum Xceed (Abbott Healthcare, Massachusetts, USA). Anthropometric data of infants (length, weight, mid-upper arm circumference (MUAC), head circumference) were also measured and recorded. All dyads received routine care during admission and were discharged at the discretion of their medical teams. Six weeks following discharge, women who were discharged with their newborns were contacted by phone to determine the status of the mother and newborn and timing and frequency of postnatal care visits. For children who died, the cause of death was collected, as reported by the caregiver (mother or other family member). In addition to vital status, details surrounding the timing, frequency and length of stay pertaining to readmissions and health seeking were also recorded. Data were collected and managed using Research Electronic Data Capture (REDCap) tools hosted at the BC Children’s Hospital Research Institute in Vancouver, Canada.&lt;br /&gt; &lt;br /&gt;&lt;strong&gt;Data Processing Methods:&lt;/strong&gt;The initial cleaned data file was created using R version 4.2.1 (R Foundation for Statistical Computing, Vienna, Austria). Further processing to obtain the final dataset used for analysis including creating new columns, removing redundant columns, and removing duplicate data were also performed in R in the R scripts titled “MBEPI2024_DataManipulations_Code_SD.R” and “MBEPI2024_CombinedDatasetforOR_Code_SD.R” . All analyses were conducted using R version 4.2.1 (R Foundation for Statistical Computing, Vienna, Austria)&lt;br/&gt; &lt;br /&gt;&lt;strong&gt;Ethics Declaration:&lt;/strong&gt; Institutional review boards at the University of British Columbia (H18-02523), the Mbarara University of Science and Technology (14/09-18), and the Uganda National Council for Science and Technology (SS 4853) approved the study.&lt;br /&gt;