RESUMO
The environmental and socioeconomic risk factors for preterm delivery were assessed in a West African urban population (Bobo-Dioulasso, Burkina Faso). The study population were 102 cases of preterm delivery matched with 102 controls obtained from 4124 sequential deliveries which occurred between May and October 1989 in the three maternity centres in the city. The univariate analysis identified the risk factors as age (< 20 years), primiparity, marital status (single), low frequency of antenatal visits, death of a previous child and level of education of the mother. The following risk factors identified by multivariate analysis (logistic regression) are consistent with those identified in previous studies: youth of the mother, primiparity (P = 0.01) and death of a previous child (P < 0.05). On the other hand, in this study, the level of education of the parent was identified as an independent risk factor (P < 0.001). This finding could be used to determine a target population for prevention programmes.
PIP: Between May and October 1989 in Burkina Faso, a pediatrician daily visited the clinic at the maternity hospital, the Farakan maternity clinic, and the Guimbi maternity clinic (the only 3 maternity clinics) in Bobo-Dioulasso to confirm the diagnosis of preterm delivery (gestational age 28-37 weeks) and to collect data on 102 deliveries and on 102 full-term deliveries occurring at the same time. The physician and epidemiologists conducted perhaps the first case control study of preterm delivery risk factors in West Africa. The incidence of preterm deliveries was 2.6%. The univariate analysis identified the following to be risk factors of prematurity: being 20 years old (odds ratio [OR] = 6.9 for 15-19 year olds vs. older women; p .01), primiparity (OR = 2.88; p = .03), being single (OR = 3.44; p .01), having less than 3 prenatal care visits (OR = 7.9; p .001), death of a previous child (OR = 3.1; p .01), and malaria prophylaxis (OR = 1.7; p = .05). Absence of schooling of parents appeared to be a protective factor (OR = .47; p .001). The multivariate analysis uncovered 3 significant risk factors of prematurity: young mother and primiparity (OR = 4.4; p = .01), less than 3 prenatal visits (OR = 9.3; p .001), and death of a previous child (OR = 2.2; p .05). Lack of schooling continued to have a protective effect when researchers adjusted for other variables (OR = .37; p .001). As a possible explanation for education being a risk factor of prematurity in Burkina Faso, the researchers suggested that educated parents are more likely to use motorized transport on bumpy roads for 6-7 hours at a time which caused intrauterine vibrations, resulting in preterm delivery. In developed countries, education reduces the risk of preterm delivery.