CHAPTER 1: INTRODUCTION

1.1.  BACKGROUND

Birth interval also known as interdelivery interval [1] is defined as the length of time between two successive live births [2]. Adequately spaced births allow women to recover from previous pregnancies, on the other hand, non-optimal birth interval which refers to short birth interval is known to contribute to adverse maternal, perinatal, neonatal, and child health outcomes [3]. The World Health Organization (WHO) recommends at least 33months (33 months = 24 months for not conceiving + 9 months period of pregnancy)  interval between a live birth to the next live birth, interval shorter than 33months is considered as short birth intervals (short birth interval) [3–6].

Globally, it was estimated that 25% of births still occur at intervals less than 24 months [7]. Most of the cases of short birth intervals were observed with relatively high proportions in Central Asia (33%) [4, 7]  and Sub-Saharan Africa (57%) [4]. Furthermore, studies on Demographic Health Survey (DHS) done by Setognal et al in 2020 revealed a high level of short birth intervals (short birth intervals) in many African countries: 20% Rwanda, 25.3% Uganda, 20.4% Ethiopia and 21.3% Cameroon [7–9]. Similarly, a study done in Cameroon reported that the percentage of short birth interval has fluctuated over time between 21 and 25% [10].

Various studies done all over the world  have  identified several risk factors associated with short birth interval which are:  younger maternal age and low level of  education, husband or partner’s education level, death of the index child, sex preference of the parents, no use of contraceptives, the ideal number of children, socio-cultural factors, religion, short breastfeeding duration (less than 24 months), and poor wealth index [2, 6, 8, 11].

There is a growing body of evidence associating short birth spacing with adverse maternal and child health outcomes [12]. Studies done in USA, DHS from 66 low and middle income countries and in Bangladesh showed that when the optimal birth interval was not respected, neonatal, infant, child mortality and stillbirth were high [13]. Congruent with this, a study done in Ethiopia reported that short birth interval affects fertility as well as neonatal, infant and childhood mortality [13].  Some of the perinatal, neonatal, and child health outcomes associated with short birth interval  are as follows: preterm birth, low birth weight, perinatal death, still birth, small for gestational age, low Apgar score, intellectual disability, and developmental delay [6, 7, 11, 12] and  under-nutrition [14]. Neonatal and infant mortality are found to be higher among children born in short birth interval [15].

Furthermore short birth interval has also been associated with adverse maternal health outcomes these include: postpartum haemorrhage, maternal anaemia, nutritional depletion, cervical incompetence, pre-eclampsia/eclampsia, premature rupture of membranes, abruption placenta, placenta praevia and uterine rupture especially in women who went through trial of labour [5, 16], suboptimal lactation for the newborn, infections, sibling competition, incomplete healing of the uterus, and abnormal remodelling of endometrial blood vessels. Short birth intervals may also limit the opportunities for economic development of women and their families.

On the other hand, optimal birth spacing yields the greatest health, social, and economic benefits for the family [3]. Optimal birth interval which is known to reduce the risk of these adverse perinatal and maternal outcomes associated with short birth interval can be achieved by the means of postpartum contraceptive use. This study therefore set out to highlight the adverse outcomes linked to short birth interval in the BRH.

1.2.  PROBLEM STATEMENT

The health hazards of short inter-birth intervals are severe in Cameroon, one-quarter of inter-birth intervals are less than 24 months and the probability of death before age 5 for children born after a short interval is double that associated with intervals of 36–47 months [10]. Thus the need to pay attention to birth interval is evidence based and the adverse outcomes of closely spaced births are enormous [17]. Short birth interval has been proven worldwide to be associated with increased risk for neonatal mortality, infant mortality, under-five mortality, and maternal morbidity and mortality with the most common cause of the latter being Postpartum Haemorrhage(PPH) which is the single most common bleeding related cause of maternal mortality accounting for 25-33% of worldwide maternal mortality [18]. The adverse outcomes associated with sort birth interval are still unknown in the BRH and literature in the North West region is scanty.   

1.3.  RATIONALE

Shorth birth interval has been proven to be associated with adverse maternal, perinatal, neonatal, and child health outcomes. On the other hand optimal birth spacing (defined as inter-birth interval length of 36–59 months) [19] has greater health advantages for both mother and child, which can give an opportunity for the mother to recover from pregnancy, labour and lactation[7]. Improved birth spacing as a result of contraceptive use is also likely to contribute to maternal survival because it enables a longer recovery period between pregnancies, allowing more time for mothers to improve their nutritional status [20],  it also allows the next pregnancy and birth to occur more likely to be at full gestation and growth. Studies also revealed optimum birth interval can improve the health status of children thus survival of children could increase each year if all women had optimal birth interval and decrease child mortality [2]. Several studies in the world have been conducted for this purpose, but however in health facilities in Cameroun, especially in Bamenda, no study has been published on the subject, hence the interest of the present study in the Bamenda Regional Hospital. Therefore, this study will help provide information needed by health care workers to provide health services that will prevent short birth intervals thus preventing the adverse outcomes. Data generated will enhance evidence-based health decisions on the subject matter.

1.4.  RESEARCH QUESTIONS

What are the adverse outcomes associated with short birth interval in the Bamenda Regional Hospital?

1.5.  RESEARCH HYPOTHESIS

Short birth interval is not associated with adverse materno-foetal outcomes.

1.6.  OBJECTIVES

1.6.1 GENERAL OBJECTIVE

To study the adverse maternal and foetal outcomes associated with short birth interval at the Bamenda Regional Hospital.

1.6.2 SPECIFIC OBJECTIVES

• To determine the prevalence of short birth interval
• To determine the adverse maternal outcomes associated with short birth interval.
• To determine the adverse fetal outcomes associated with short birth interval.