Adapting the Preterm Birth Phenotyping Framework to a Low-Resource, Rural Setting and Applying It to Births from Migori County in Western Kenya
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Date
2023
Authors
Miller, Lara
Schmidt, Christina N.
Wanduru, Phillip
Wanyoro, Anthony
Santos, Nicole
Butrick, Elizabeth
Lester, Felicia
Otieno, Phelgona
Walker, Dilys
Journal Title
Journal ISSN
Volume Title
Publisher
BMC
Abstract
Background Preterm birth is the leading cause of neonatal and under-fve mortality worldwide. It is a complex
syndrome characterized by numerous etiologic pathways shaped by both maternal and fetal factors. To better
understand preterm birth trends, the Global Alliance to Prevent Prematurity and Stillbirth published the preterm birth
phenotyping framework in 2012 followed by an application of the model to a global dataset in 2015 by Barros, et al.
Our objective was to adapt the preterm birth phenotyping framework to retrospective data from a low-resource, rural
setting and then apply the adapted framework to a cohort of women from Migori, Kenya.
Methods This was a single centre, observational, retrospective chart review of eligible births from November 2015 –
March 2017 at Migori County Referral Hospital. Adaptations were made to accommodate limited diagnostic capabilities and data accuracy concerns. Prevalence of the phenotyping conditions were calculated as well as odds of adverse
outcomes.
Results Three hundred eighty-seven eligible births were included in our study. The largest phenotype group
was none (no phenotype could be identifed; 41.1%), followed by extrauterine infection (25.1%), and antepartum
stillbirth (16.7%). Extrauterine infections included HIV (75.3%), urinary tract infections (24.7%), malaria (4.1%), syphilis (3.1%), and general infection (3.1%). Severe maternal condition was ranked fourth (15.6%) and included anaemia (69.5%), chronic respiratory distress (22.0%), chronic hypertension prior to pregnancy (5.1%), diabetes (3.4%),
epilepsy (3.4%), and sickle cell disease (1.7%). Fetal anaemia cases were the most likely to transfer to the newborn
unit (OR 5.1, 95% CI 0.8, 30.9) and fetal anomaly cases were the most likely to result in a pre-discharge mortality (OR
3.9, 95% CI 0.8, 19.2).
Conclusions Using routine data sources allowed for a retrospective analysis of an existing dataset, requiring less time
and fewer resources than a prospective study and demonstrating a feasible approach to preterm phenotyping for use
in low-resource settings to inform local prevention strategies.
Description
Article
Keywords
Premature birth, Phenotype, Maternal infection, Perinatal mortality
Citation
Miller, L., Schmidt, C. N., Wanduru, P., Wanyoro, A., Santos, N., Butrick, E., ... & Walker, D. (2023). Adapting the preterm birth phenotyping framework to a low-resource, rural setting and applying it to births from Migori County in western Kenya. BMC Pregnancy and Childbirth, 23(1), 729.