Short interbirth interval and associated factors among women with antecedent cesarean deliveries at a tertiary hospital, Southwestern Uganda

Abstract

Background: Women with previous cesarean deliveries, have a heightened risk of poor maternal and perinatal outcomes, associated with short inter-birth intervals. We determined the prevalence of short inter-birth interval, and associated factors, among women with antecedent cesarean deliveries who delivered at Mbarara Regional Referral Hospital (MRRH), in southwestern Uganda. Methods: We conducted a cross-sectional study on the postnatal ward of MRRH from November 2020 to February 2021. We enrolled women who had antecedent cesarean deliveries through consecutive sampling. We obtained participants’ socio-demographic and obstetric characteristics through interviewer-administered structured questionnaires. We defined short inter-birth interval as an interval between two successive births of < 33 months. Modified Poisson regression was used to identify factors associated with short inter-birth intervals. Results: Of 440 participants enrolled, most had used postpartum family planning (PPFP) prior to the current pregnancy (67.5%), and most of the pregnancies (57.2%) were planned. The mean age of the participants was 27.6 } 5.0 years. Of the 440 women, 147 had a short inter-birth interval, for a prevalence of 33% (95%CI: 29–38%). In multivariable analysis, non-use of PPFP (adjusted prevalence ratio [a PR] = 2.24; 95%CI: 1.57–3.20, P < 0.001), delivery of a still birth at an antecedent delivery (a PR = 3.95; 95%CI: 1.43–10.9, P = 0.008), unplanned pregnancy (a PR = 3.59; 95%CI: 2.35–5.49, P < 0.001), and young maternal age (a PR = 0.25 for < 20 years’ vs 20–34 years; 95%CI: 0.10–0.64, P = 0.004), were the factors significantly associated with short inter-birth interval. Conclusion: One out of every three women with antecedent caesarean delivery had a short inter-birth interval. Short inter-birth intervals were more common among women with history of still births, those who did not use postpartum family planning methods, and those whose pregnancies were unplanned, compared to their counterparts. Young mothers (< 20 years) were less likely to have short inter-birth intervals compared to those who were 20 years or older. Efforts should be made to strengthen and scale up child-spacing programs targeting women with previous cesarean deliveries, given the high frequency of short inter-birth intervals in this study population