Preterm birth in Mogadishu, Somalia: Burden and determinants from a retrospective cross-sectional study

Introduction: Preterm birth, delivery before 37 weeks of gestation, affects 15 million births globally and causes 1.1 million under-five deaths annually. In Somalia, decades of civil war have severely weakened the healthcare infrastructure, posing significant challenges to maternal and neonatal healthcare. However, data on preterm birth and its determinants in Somalia remain limited. Objective: This study examines the prevalence and determinants of preterm birth among women delivered at the Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital. Design: Retrospective cross-sectional study. Methods: A retrospective review of 1900 medical records from January to December 2022 was conducted. Data were analyzed using Stata 17, with logistic regression employed to identify significant determinants of preterm birth. The Hosmer–Lemeshow test (p = 0.64) was used to assess model fit, and statistical significance was determined at p < 0.05. Results: The prevalence of preterm birth was 17.5% (95% confidence interval: 15.8%–19.3%), which aligns with similar studies in Ethiopia (16.1%–16.3%) and Malawi (16.3%), but is lower than in Uganda (24.6%) and Kenya (20.2%). Maternal age below 20 years (adjusted odds ratio = 2.4; 95% confidence interval: 1.34–4.17; p = 0.003), absence of antenatal care visits (adjusted odds ratio = 16.4; 95% confidence interval: 10.96–24.48; p < 0.001), and fewer than four antenatal care visits (adjusted odds ratio = 4.1; 95% confidence interval: 2.66–6.47; p < 0.001) were significant predictors of preterm birth. Obstetric complications such as antepartum haemorrhage (adjusted odds ratio = 12.3; 95% confidence interval: 5.75–26.36; p < 0.001), pregnancy-induced hypertension (adjusted odds ratio = 6.0; 95% confidence interval: 3.77–9.56; p < 0.001), and premature rupture of membranes (adjusted odds ratio = 23.2; 95% confidence interval: 12.60–42.71; p < 0.001) were also significant determinants. Additionally, severe anaemia (adjusted odds ratio = 1.8; 95% confidence interval: 1.06–2.97; p = 0.030) and multiple gestations (adjusted odds ratio = 9.7; 95% confidence interval: 4.27–21.97; p < 0.001) were associated with preterm birth. Conclusion: The study highlights the high prevalence of preterm birth and identifies significant factors, including inadequate antenatal care visits, pregnancy complications, and multiple gestations. Strengthening antenatal care services, early risk detection, and targeted interventions are critical for reducing preterm birth rates in Somalia.