Prevalence and determinants of preterm birth among women of reproductive age in Kenya: a multilevel analysis of the 2022 Demographic Health Survey.

Background: Globally, over 15 million preterm births (PTB) occur annually, with sub-Saharan Africa bearing a disproportionate burden. In Kenya, studies conducted between 2017 and 2021 at the hospital level show a PTB prevalence ranging from 15.9% to 20.2%. However, current PTB prevalence and associated factors remain underexplored despite their significant public health implications. Understanding the prevalence and factors associated with PTB is critical for effective interventions.

Objectives: This study aimed to determine the prevalence of PTB and also to identify individual- and community-level factors influencing PTB among women of reproductive age in Kenya.

Design: The study utilised a cross-sectional design, analysing data from the 2022 Kenya Demographic and Health Survey.

Methods: A sample of 7291 women aged 15-49 was analysed using weighted multilevel logistic regression in Stata 17.0. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) and a significance threshold of p < 0.05 were used to identify predictors of PTB.

Results: The prevalence of PTB was 7.14%. Women aged 25-34 (aOR = 0.67; 95% CI: 0.49-0.94) and 35+ (aOR = 0.86; 95% CI: 0.59-1.24) were less likely to experience PTB compared to younger women (15-24 years). Attending four or more antenatal care visits reduced PTB likelihood (aOR = 0.68; 95% CI: 0.53-0.88). Women in the richest wealth index had higher odds of PTB (aOR = 2.28; 95% CI: 1.39-3.74), while medium community literacy levels increased PTB risk (aOR = 1.56; 95% CI: 1.21-2.03).

Conclusion: This study highlights that individual- and community-level factors significantly influence PTB in Kenya. Addressing disparities in socio-demographic and obstetric factors through targeted, multipronged strategies is essential for reducing PTB rates and improving maternal and neonatal outcomes.