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Identifying women giving birth preterm and care at the time of birth: a prospective audit of births at six hospitals in India, Kenya, Pakistan and Uganda

Mitchell, Eleanor J.; Benjamin, Santosh; Ononge, Sam; Ditai, James; Qureshi, Zahida; Masood, Shabeen Naz; Whitham, Diane; Godolphin, Peter; Duley, Lelia


Santosh Benjamin

Sam Ononge

James Ditai

Zahida Qureshi

Shabeen Naz Masood

Diane Whitham

Peter Godolphin

Lelia Duley


Background: Globally, 15 million infants are born preterm each year, and one million die due to complications of prematurity. Over 60% of preterm births occur in Sub-Saharan Africa and south Asia. Care at birth for premature infants may be critical for survival and long term outcome. We conducted a prospective audit to assess whether women giving birth preterm could be identified, and to describe cord clamping and neonatal care at hospitals in Africa and south Asia.
Methods: This prospective audit of livebirths was conducted at six hospitals in Uganda, Kenya, India and Pakistan. Births were considered preterm if between 28+0 and 33+6 weeks gestation and/or the birthweight was 1.00 to 1.99 kg. A pre-specified audit plan was agreed with each hospital. Livebirths before 28 weeks gestation with birthweight less than 1.0 kg were excluded. Data were collected on estimated and actual gestation and birthweight, cord clamping, and neonatal care.
Results: Of 4149 women who gave birth during the audit, data were available for 3687 (90%). As 107 were multiple births, 3781 livebirths were included, of which 257 (7%) were preterm. Antenatal assessment correctly identified 148 infants as ‘preterm’ and 3429 as ‘term’, giving a positive predictive value of 72% and negative predictive value of 97%. For term births, cord clamping was usually later at the two Ugandan hospitals, median time to clamping 50 and 76 seconds, compared with 23 at Kenyatta (Kenya), 7 at CMC (India) and 12 at FBH/LNH (Pakistan). At the latter two, timing was similar between term and preterm births, and between vaginal and Caesarean births. For all the hospitals, the cord was clamped quickly at Caesarean births, with Mbale (Uganda) having the highest median time to clamping (15 seconds ‘term’, 19 ‘preterm’). For preterm infants temperature on admission to the neonatal unit was below 35.5°C for 50%, and 59 (23%) died before hospital discharge.
Conclusions: Antenatal identification of preterm birth was good. Timing of cord clamping varied between hospitals, although at each there was no difference between ‘term’ and ‘preterm’ births. For premature infants hypothermia was common, and mortality before hospital discharge was high.


Mitchell, E. J., Benjamin, S., Ononge, S., Ditai, J., Qureshi, Z., Masood, S. N., …Duley, L. (2020). Identifying women giving birth preterm and care at the time of birth: a prospective audit of births at six hospitals in India, Kenya, Pakistan and Uganda. BMC Pregnancy and Childbirth, 20(1), Article 439.

Journal Article Type Article
Acceptance Date Jul 21, 2020
Online Publication Date Jul 31, 2020
Publication Date Jul 31, 2020
Deposit Date Jul 27, 2020
Publicly Available Date Aug 25, 2020
Journal BMC Pregnancy and Childbirth
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 20
Issue 1
Article Number 439
Keywords low and middle income countries, cord clamping, prospective audit, neonatal care, preterm birth
Public URL
Publisher URL https://bmcpregnancychi...1186/s12884-020-03126-0


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