Adverse maternal and neonatal outcomes in Northern Sudan: the role of antenatal care and socioeconomic inequities in war.

BACKGROUND

The World Health Organization (WHO) has recommended increasing the minimum number of antenatal care (ANC) contacts from four to eight. High rates of maternal and neonatal complications and low ANC coverage are significant concerns in Sudan, especially after the war erupted. This study investigated the patterns of adverse maternal and neonatal outcomes and their correlation with ANC use and socioeconomic profile.

METHODS

This cross-sectional study was conducted on 267 postpartum women using convenience sampling in three public hospitals and one private clinic in Merowe locality, Northern Sudan. Structured interviews were conducted to collect data on socioeconomic and maternal characteristics, ANC use, and adverse maternal and neonatal outcomes. Descriptive, bivariate, and multivariate analyses were performed using Statistical Package for Social Science (SPSS).

RESULTS

The perinatal death rate was 3.4%. Preterm delivery and neonatal ICU admission rates were 10.1% and 7.1%, respectively. Adverse maternal outcomes occurred in 26.2% of the cases, with gestational hypertension (7.5%) and dystocia (4.1%) being the most prevalent. Displaced women showed higher rates of eclampsia and preeclampsia (p value = 0.002). Predictors of adverse maternal outcomes were gravidity of more than five (Adjusted Odds Ratio 2.55; 95% CI 1.04-6.23), rural residence (AOR = 2.52; 95% CI 1.25-5.12), and history of adverse events (AOR = 3.15; 95% CI 1.67-5.92). Fewer than four ANC contacts were associated with more perinatal deaths (p value = 0.032), while ≥ 8 visits did not improve the outcomes.

CONCLUSIONS

The rate of adverse maternal outcomes was high and was influenced by obstetric and socioeconomic profiles. Attending at least four ANC visits was significantly associated with better birth outcomes. Addressing the social determinants of health and implementing screening programs for high-risk women are recommended.