We sampled 427 records, 81 records were discarded due to more than 20% missing data. Of the discarded records, 3.2% had an adverse pregnancy outcome, 8.6% had complications and 6.2% had delivered by non-vertex delivery methods.
The remaining 346 records were used in the final analyses. Adverse pregnancy outcomes (stillbirth or neonatal death) were recorded in 54 (15.61%; 95% CI: 0.12–0.20) cases. Live births were recorded in 292 (84.39%; 95% CI: 0.80–0.88) cases.
Women sampled were between 17 and 43 years of age with a mean age of 26 (SD: 6.42). Most women (72.43%; 95% CI: 0.67–0.77) were between 20 and 34 years of age and 13.78% (95% CI: 0.10–0.18) were 35 years and older. Most of the women resided in urban areas (62.10%; 95% CI: 0.57–0.67) while 37.90% (95% CI: 0.33–0.43) were from rural areas and referred for maternal services (Table 1). Most of the women were married (97.92%; 95% CI: 0.95–0.99) while 2.08% (95% CI: 0.01–0.05) were separated, divorced or single. Close to 98% (95% CI: 0.964–0.999) of the women were Christians (either Pentecostal or orthodox, apostolic sect), and 2% (95% CI: 0.0004–0.0364) were non-Christians (either Moslem or African Tradition religion). Twenty two percent of the women (n = 73) had some form of primary education and more than 60 % had secondary education. Of the 346 women sampled, 12.7% (95% CI: 0.09–0.18) were formally employed as teachers, cashiers or nurse aides while 87.3% (95% CI: 0.82–0.91) were involved in informal trading or were housewives. Paternal variables were not analysed due to lack of data.
Maternal reproductive health characteristics
Sixty seven percent of women had no history of previous obstetric complications while 33% (95% CI: 0.27–0.38) had experienced a complication like stillbirth, neonatal death, abortion or eclampsia in a previous pregnancy (Table 2). Delivery by caesarean section in the previous pregnancy was also recorded as a previous complication. Diagnosis of a complication in previous birth resulted in precautionary measures like referral to next level for delivery.
Fifteen percent of the women were HIV positive, while 2% (95% CI: 0.01–0.05) of the women had non-HIV chronic conditions like hypertension, diabetes, asthma, and psychosis prior to pregnancy.
Approximately 8% (95% CI: 0.03–0.18) of the women had an episode of malaria (n = 64) and 3% (95% CI: 0.004–0.1978) had tested positive for syphilis (n = 34) while pregnant. The median parity and gravidity were 1 and 2 respectively. The median inter-pregnancy interval (between the delivery under review and the previous birth) was 4 years (IQR 2–7).
Of the 80 women who had information on ANC visits, 12.5% (95% CI 0.07–0.22) had not accessed antenatal care, while 36.25% (95% CI; 0.26–0.47) had 1 to 3 visits and 51.25% (95% CI; 0.40–0.62) had 4 or more visits. ANC visits were not assessed if conducted according to WHO Focused ANC recommendations as the information was missing.
Fifty one percent of neonates were female and 49% (95% CI 0.44–0.55) male (Table 2). The interquartile weight range for neonates was 2700 to 3400 g with a mean weight of 3000 ± 599.26 g. The mean gestation age was 37 weeks while the minimum and maximum were 24 and 43 respectively. Approximately 15% (95% CL; 0.11–0.19) of the neonates were of low birth weight (< 2500 g) while 1.86% (95% CI; 0.01–0.04) had weight of above 4000 g. Birthweight was associated with adverse outcome (p = 0.001), where 31.91% of adverse outcomes where among the LBW neonates.
Most deliveries 94% (95% CI: 0.92–0.97) were attended to by a skilled health professional, midwife or doctor and the rest 6% (95% CI: 0.03–0.08) by non-skilled professionals. Skilled professionals were either midwifes or doctors as indicated in the register. All the non-skilled deliveries occurred at Sakubva, a secondary level facility. Reasons for delivery by non-skilled workers (e.g. nurse aides) at health centres could not be established in this study. Further studies to establish reasons for non-skilled delivery at facility need to be researched.
Seventy-six percent (95% CI: 0.72–0.81) of the women had a normal vertex delivery, 4.71% (95% CI: 0.03–0.08) successfully delivered a breech presentation baby through assisted NVD, and 18.21% (95% CI:0.15–0.23) delivered by caesarean section (Table 2). Firstly, 38 % of the women who had caesarean section and parity data available (n = 60), 38.3% were nulliparous and 61.67% were multiparity. Secondly, all caesarean section (n = 58) where among those with gestation age 32 and above. Thirdly, of the women who had a caesarean section performed, 22.97% where among those with complications. Finally, the overall reasons for conducting a caesarean section included hypertension in pregnancy, fetal distress, previous caesarean section and complications of a breech presentation.
Sixty-three, 63% (95% CI: 0.58–0.69) of women who delivered, experienced pregnancy associated complications. Complications recorded included, cord prolapse, mal-presentation, antepartum haemorrhage (APH), eclampsia, prolonged labor and fetal distress.