Prevalence and determinants of preterm birth among women of reproductive age in Kenya: a multilevel analysis of the 2022 Demographic Health Survey

Abstract

Background:

Globally, over 15 million preterm births (PTB) occur annually, with sub-Saharan Africa bearing a disproportionate burden. In Kenya, studies conducted between 2017 and 2021 at the hospital level show a PTB prevalence ranging from 15.9% to 20.2%. However, current PTB prevalence and associated factors remain underexplored despite their significant public health implications. Understanding the prevalence and factors associated with PTB is critical for effective interventions.

Objectives:

This study aimed to determine the prevalence of PTB and also to identify individual- and community-level factors influencing PTB among women of reproductive age in Kenya.

Design:

The study utilised a cross-sectional design, analysing data from the 2022 Kenya Demographic and Health Survey.

Methods:

A sample of 7291 women aged 15–49 was analysed using weighted multilevel logistic regression in Stata 17.0. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) and a significance threshold of p < 0.05 were used to identify predictors of PTB.

Results:

The prevalence of PTB was 7.14%. Women aged 25–34 (aOR = 0.67; 95% CI: 0.49–0.94) and 35+ (aOR = 0.86; 95% CI: 0.59–1.24) were less likely to experience PTB compared to younger women (15–24 years). Attending four or more antenatal care visits reduced PTB likelihood (aOR = 0.68; 95% CI: 0.53–0.88). Women in the richest wealth index had higher odds of PTB (aOR = 2.28; 95% CI: 1.39–3.74), while medium community literacy levels increased PTB risk (aOR = 1.56; 95% CI: 1.21–2.03).

Conclusion:

This study highlights that individual- and community-level factors significantly influence PTB in Kenya. Addressing disparities in socio-demographic and obstetric factors through targeted, multipronged strategies is essential for reducing PTB rates and improving maternal and neonatal outcomes.

Plain Language Summary

Preterm births in Kenya: how common are they and what factors contribute

Preterm birth (PTB) is when a baby is born before 37 weeks of pregnancy. It’s a major public health issue, with over 15 million cases globally each year. Sub-Saharan Africa, including Kenya, has a high share of PTB, but there’s limited research about it in Kenya. This study looked at how common PTB is in Kenya and what factors increase the risk. Using data from the 2022 Kenya Demographic and Health Survey, the authors analysed 7,291 women aged 15–49. They used statistical methods to find patterns and identify factors linked to PTB. The study found that 7.14% of women in the sample had a preterm birth. Younger women aged 15–24 were more likely to experience PTB compared to women aged 25–34 or 35 and older. Women who attended at least four antenatal care visits were less likely to have a preterm birth. Surprisingly, women from the richest households had a higher risk of PTB, and living in communities with medium levels of literacy also increased the risk. The findings show that both personal and community factors affect the chances of preterm birth. To reduce PTB rates, efforts should focus on improving access to antenatal care, addressing social and economic inequalities, and promoting education at the community level. These steps can help improve the health of mothers and babies in Kenya.