Medication related risk factors for preterm birth – Kitui County

1. Medication related risk factors for preterm birth – Kitui County Dr. Albert N Kaburi Supervisors: Dr. Margaret Oluka Prof. Charles K Maitai Dr. Rose Kosgei

2. Introduction • Preterm birth occurs less than 37 weeks gestation • Premature infants contribute substantially to infant morbidity and mortality especially in low resource areas. • Understanding the factors that contribute to pre-mature birth is important in strategy to reduce them • Medication-related risk factors important, justifying this study

3. Introduction • Medication exposure classified into: • Herbal remedies • Self-medication • Prescription medication • Timing of exposure depended on the trimester the first dose was taken • Intensity of exposure determined using the number of days the use lasted

4. Purpose of the study • To investigate the medication-related risk factors for preterm birth in Kitui County Broad objective • To investigate medication related risk factors between immediate postpartum mothers who had preterm term birth and compared to those who had term birth in Kitui County, 2014

5. Specific objectives • Among immediate postpartum mothers who had preterm birth and to those who had term birth in Kitui County, to determine and compare the difference in: • Prescription medication use in pregnancy • Self-medication use in pregnancy • Herbal remedy use in pregnancy

6. Methodology • Study carried out in Kitui and Mwingi DHs • Study was carried out among immediate postpartum mothers who consented • Sample size: • Calculated: cases = 115, controls=460: a 1:4 case to controls hospital based unmatched case control study • Actual sample: cases =107, controls=453 • Study period: 3 months (May 16th to Aug 15th 2014)

7. Methodology: Participant recruitment • Participants were recruited on a daily basis • To recruit the cases, the researchers visited the postnatal wards that housed mothers who delivered infants admitted in the Newborn Unit • All mothers with preterm birth within 24 hours were approached to give consent • The control mothers were administered from postnatal wards • From Mwingi District Hospital, 36 cases and 149 controls were sampled, while Kitui District Hospital contributed 71 cases and 304 controls.

8. Methodology: Ethical considerations • Ethical approval given by the Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (KNH/UoN-ERC)ref: P77/02/2014 • Written informed consent was obtained from each potential participant before admission • All the filled questionnaires were kept under lock and key by the investigator

9. Data collection • Structured interviews with participants using a questionnaires to identify: • Herbal remedy use in pregnancy • Self-medication in pregnancy • Data abstraction forms to extract prescription medication information from primarily from Mother and Child Booklet • Research assistants had undergone a 1-day training

10. Data analysis • Descriptive data analysis was done on socio-demographic variables. • Mean and standard deviation were determined for normally distributed continuous variables • Counts and percentages were used for categorical variables • Logistic regression was done to determine significant medication-related risk factors for herbal remedy use, self-medication and prescription medication use • Odds ratios and 95% confidence intervals were reported. p≤0.05 was considered statistically significant

11. Results

12. Age and significant baseline characteristics

13. Baseline characteristics

14. Herbal remedy use

15. Herbal remedy use

16. Self-medication

17. Self-medication

18. Prescription medication use: significant variables

19. Prescription medication use

20. The FDA categorization

21. The FDA categorization

22. Key findings • Use of herbal remedies in the first trimester was associated with increased risk for preterm birth. The longer the use of herbal remedies the higher the risk of preterm birth • Self medication is a common practice and contributes to preterm birth • Prescription of FDA categories C and D is associated with higher risk for preterm birth • Folic acid, ferrous sulphate and management of maternal infections lowers risk of preterm birth

23. Recommendations • Maternal education programmes should be instituted and strengthened to educate mothers on the dangers of using herbal remedies • Pregnant mothers should be encouraged and enabled to consult registered medical practitioner to avoid use of medicines without a valid prescription • Folic acid and ferrous supplementation should be encouraged • Prescribers should also be trained on safe use of medicines in pregnancy