Determinants of Preterm Birth among Women Referred from Community Health Facilities for Delivery: A Comparative Cross-Sectional Study

Abstract

Preterm birth (PTB) is a major global health concern and a leading cause of neonatal morbidity, mortality, and long-term developmental challenges, particularly in resource-limited settings. This study aimed to compare factors associated with preterm birth among pregnant women referred from the community to a referral centre and a district hospital for delivery. A comparative cross-sectional study was conducted from 1st January to 30th June 2023 at a tertiary referral hospital and a district hospital in southern India. A total of 334 pregnant women referred from community health facilities (health posts, primary health care centre, and community health centre) to a referral centre and a district hospital for delivery were enrolled in the study, with 167 participants recruited from each facility using purposive sampling. Data on socio-demographic, obstetric, and newborn factors, including preterm birth, were collected using a pretested structured interview schedule. Statistical analysis included descriptive statistics, Chi-square tests, and binary logistic regression, with significance set at p <0.05. Preterm birth was more frequent in the district hospital (40.1%) than in the referral centre (33.5%), particularly among primiparous women. Women aged 26–30 years had a higher risk of PTB, while rural residence, private employment, and higher socioeconomic status were protective. Overall, PTB was influenced by maternal age, parity, occupation, residence, socioeconomic status, and facility-related factors. Determinants of PTB vary across health facilities, reflecting the influence of maternal, socioeconomic, and contextual factors on neonatal outcomes. Strengthening antenatal care, improving referral pathways, and addressing social and economic disparities are essential to reduce preterm births and improve newborn health in resource-limited settings.