Impact of change in maternal age composition on the incidence of Caesarean section and low birth weight: analysis of delivery records at a tertiary hospital in Tanzania, 1999-2005

Abstract

Background: Previous studies on change in maternal age composition in Tanzania do not indicate its impact on adverse pregnancy outcomes. We sought to establish temporal changes in maternal age composition and their impact on annual Caesarean section (CS) and low birth weight deliveries (LBWT) at Muhimbili National Hospital in Tanzania.

Methods: We conducted data analysis of 91,699 singleton deliveries that took place in the hospital between 1999 and 2005. The data were extracted from the obstetric data base. Annual proportions of individual age groups were calculated and their trends over the years studied. Multiple logistic analyses were conducted to ascertain trends in the risks of CS and LBWT. The impact of age composition changes on CS and LBWT was estimated by calculating annual numbers of these outcomes with and without the major changes in age composition, all others remaining equal. In all statistics, a p value < 0.05 was considered significant.

Results: The proportion of teenage mothers (12-19 years) progressively decreased over time while that of 30-34 years age group increased. From 1999, the risk of Caesarean delivery increased steadily to a maximum in 2005 [adjusted OR = 1.7; 95%CI (1.6-1.8)] whereas that of LBWT declined to a minimum in 2005 (adjusted OR = 0.76; 95% CI (0.71-0.82). The current major changes in age trend were responsible for shifts in the number of CS of up to206 cases per year. Likewise, the shift in LBWT was up to 158 cases per year, but the 30-34 years age group had no impact on this.

Conclusion: The population of mothers giving birth at MNH is progressively becoming older with substantial impact on the incidence of CS and LBWT. Further research is needed to estimate the health cost implications of this change.

Figure 1

Annual trends of age composition for mothers who delivered singleton pregnancies at MNH, 1999–2005.

Figure 2

Annual trends of Parity composition for mothers who delivered singleton pregnancies at MNH, 1999–2005. P1 = Para1; P2 = Para 2; P3–5 = Para 3 to 5; P6+ = Para6 or above (Grand multipara).

Figure 3

Impact of the major changes in maternal age composition on annual CS deliveries at MNH, 1999–2005.

Figure 4

Impact of the major changes in maternal age composition on annual LBWT deliveries at MNH, 1999–2005.