Epidemio-Clinical Approach and Prognosis of Teenage Delivery in the Commune VI Du District of Bamako in Mali

Objective: To describe the epidemiological aspects, clinical characteristics, aspects of childbirth and to determine the maternal and perinatal prognosis during the delivery of adolescent girls at the reference health centre of commune VI of the district of Bamako in Mali. Materials and Methods: This was a descriptive, cross-sectional, analytical case-control study from January 1 to December 31, 2018, or 12 months with prospective data collection. Results: During the study period from January 01 to December 31, 2018, we recorded 1768 teenage deliveries out of a total of 9012 deliveries, a frequency of 19.61%. The average age of the cases was 17.4 ± 1 years. Single adolescent girls accounted for 14.67% (OR = 3.05, P = 0.001) unintended pregnancies (11.67% vs. 2.3%; P = 0.000007; OR = 5.52), the non-completion of the antenatal consultation (14.67% vs. 5.33%; P = 0.0001; preterm births (14.33% vs. 7.67%); P = 0.01; OR = 2.5), anaemia (7.33% vs. 3%; P = 0.009; OR = 2.01), instrumental extractions (P = 0.00008, OR = 2.87), perineal tears (P = 0.0016; OR = 3.05), mechanical dystocies (P = 0.0039); low birth weights (P = 0.039; OR = 2.2) were found to be significantly higher in adolescent girls than adults. Conclusion: Teenage versus adult births are associated with many more maternal-fetal complications.


Introduction
The word adolescence comes from the Latin verb "adolescere" which means to grow up towards (ad: verse, olescere: grow) [1]. According to the World Health Organization (WHO), the term refers to people aged 10 to 19. It is a period of physical, psychic and social maturation that extends between childhood and adults [2]. There are one billion adolescents in the world, 85% of whom live in developing countries [3]. Adolescent girls make up 22% of the female population in Africa [4]. This population is estimated at 23.1% in Mali [5]. Adolescence is marked in the daughter by the development and functioning of the reproductive organs. While the occurrence of pregnancy is possible, the adolescent is in a state of psychological imbalance and immaturity of the organs; this poses various problems obstetrical (prematurity, unsafe abortion, dystocia at the time of child-birth…), psychological, and social [2].
It is now estimated that one in two girls aged 13 and a half is able in her body to conceive a child.
The age of first sexual intercourse has become more and more early. In France, the average age of first sexual intercourse seems to have stabilized in recent years around 17 and a half years [11]. In Mali, for women aged 25 -49, the median age at first sexual intercourse is estimated at 17 years [12]. This incredible advance in biological maturation associated with early sexual activity makes it possible to be a parent at an extremely young age.
This age group contributes 14% to the total fertility of women in Mali [12].
More than 14 million teenage girls give birth each year. Although these births occur in all societies, 12.8 million, or more than 90%, occur in developing countries [13]. 40% -50% of girls have a baby before the age of 18 in Côte d'Ivoire, Liberia, Mali, Cameroon, Bangladesh [13].
For some young mothers, it is a happy event; they are well supported and give birth to a healthy daughter or son. But for millions of others, the pregnancy was not planned; the birth takes place too early and the experience is marked by fear and suffering. Adolescent girls face health risks during pregnancy and birth accounting for 15% of the global burden of maternal disease, and 13% of all maternal deaths [13].
The adverse outcomes of these complicated pregnancies and deliveries are essential: preterm birth, neonatal suffering, the birth of a low-weight child and the death of the newborn, without forgetting obstetric fistulas and its consequences on the girl's life [14].
A World Health Organization study on teen pregnancies alone states that age alone may not be the cause, education, social status and use of health facilities are factors involved.
In developing countries, only 53% of births are cared for by a qualified person.

S. O. Traoré et al. Open Journal of Obstetrics and Gynecology
Pregnancy among young people not only jeopardizes the health and survival of the child or woman, but also the schooling and professional future of the girl [15]. In Kenya, up to 10,000 girls a year leave school because of their pregnancies [16]. When pregnancy is not desired, it can lead to an abortion, a very limited opportunity in some countries because of its illegality, with its disastrous complications. Of the 19 million illegal abortions that take place each year, 2.2 to 4 million are among teenage girls [17].
In Mali, several studies have been done on teen childbirth. But given the magnitude of the phenomenon and its maternal-fetal complications, this study finds its place.

The Objective
Was to describe the epidemiological aspects, clinical characteristics, aspects of childbirth and to determine the maternal and perinatal prognosis during the delivery of adolescent girls at the reference health centre of commune VI of the district of Bamako in Mali.

Materials and Methods
This was a descriptive, cross-sectional, analytical study of type witness cases from January 1 to T December 31, 2018, is 12 months with prospective data collection. The study population: was all parturients admitted to the maternity ward of the reference health center of the as VI during the study period. The scaling was exhaustive. Inclusion criteria: We included in the study all participants meeting the definition of primipara regardless of gestity with a single-fetal pregnancy of at least 28 weeks of gestational age amenorrhea. Cases: These are teenagers between the ages of 10 and 19. Witnesses: These are participants aged 20 and over. We collected a case for a witness. The non-inclusion criteria: for, l cases, adolescents who were not primiparous or have multiple pregnancies or a pregnancy of more than 28SAwere not included in the study. For Witnesses: Multiparous or multiple-pregnancy or less than 2 -8-week amenorrhea patients are not included in the study. The women admitted after childbirth. The variables studied were socio-demographic aspects, clinical characteristics, labour delivery, mode of delivery, caesarean section indications and maternal-fetal prognosis. The participants were subjected to a questionnaire for this purpose.
The birthing register; emergency obstetric and neonatal care; Prenatal consultation book (NPC); the partogram and the post partum registry were consulted regularly during our investigation. Data analysis and processing: the counting of questionnaires has been manual. The collected data was captured and analyzed using the Epi Info software, version 3

Frequency and Socio-Demographic Aspects
During the study period from January 01 to December

Clinical Features
Of these, 0.67% had a history of abortion compared to 8% of the controls. In our study 13.67% of adolescent girls used a modern contraceptive method compared to 25.3%. Non-antenatal consultation was more common among adolescents than in controls with the respective frequencies 14.67% versus 5.33%. The average number of antenatal consultations was 2.7 for adolescent girls compared to 3.7 for controls. Only 36.67% of adolescent girls had completed at least 4 antenatal consultations compared to 55% of the witnesses. We also found that failure to perform antenatal counseling was strongly associated with unintended pregnancies, at 72.73% among adolescents compared to 43

The Process of Childbirth Work
The reference/evacuation was 38.55% for cases versus 26% for witnesses. Direct   among controls. Fetal heart noises less than 120 beat/mn were detected more in teenage girls 6.33% than controls 1%. The presentation of the summit was the most represented with frequencies of 92.67% for cases compared to 91.33% for witnesses. The admission procedures, the parameters of the mother and the fetus are summarized in Table 3.  Table 4.

Maternal and Fetal Prognosis
The majority of the parturients had given birth without complications, 89.5% among adolescents compared to 95.26% among controls. A significant number of perineal tears were observed in adolescent girls, at 6.8% compared to 2.37% for controls. We recorded 2 cases of maternal death among adolescent girls or 0.67% compared to 1 case among controls or 0.34%. Low birth weight (p-lt; 2500 g) was twice as common among adolescents 13.33% as among controls 6.33%.
Apgar's score at the first minute was poor in 10% of newborns of teenage moth-

Pathologies of Diaper Suites
In our study postpartum anaemia, postpartum eclampsia, endometritis were found to be more common in adolescent girls than in controls: 3.3% vs. 2%,

The Frequency of Teen Delivery
In the literature, studies on adolescence pose problems, comparisons are difficult because the chronological limits of this segment of the population are not precisely defined. Some authors take an upper age of 18, others 17 years, and 16 years for some [6] [7] [8] [9]. We took the 10 -19 age group recommended by WHO. In our series, this frequency was 19.61% superimposed on previous studies in Mali. Dembélé F. [18] in 2015, Dembélé S. [19] in 2012, Sanogo M. [20] in 2009, Yattasaye A. [4] in 1998 had found a teenage delivery frequency of 19.2%; 21.72%; 12.11%; 18.14% respectively. According to LEKE J.F.R. [21] in 1995, the incidence of teen pregnancy in black Africa ranged from 5 to 20%. The teen birth rate is much lower in developed countries such as France with 0.6%, the USA with 5.6%, Great Britain with 2.6% [22] in 2010. The high frequency of early marriages in our countries; the low level of education; the low use of contraception among adolescent girls; cultural and religious factors are factors that may explain this difference between the frequencies observed in Africa and elsewhere in the world.  [28]. The place of marital status in pregnancies and childbirth has been the subject of much study [29] [30]. In our series 85.33% of teenage girls were married compared to 94.67% of the witnesses (P-0.001).

The Clinical Aspects
As for Drabo A. [26], contraceptive use was 9.1% among adolescents versus 25% among controls.
Prenatal counseling: The purpose of prenatal consultation is to safeguard a woman's health during pregnancy, to allow her to give birth to a healthy child and to teach her the care of the newborn [21]. The failure to perform this antenatal consultation was more common in adolescent girls than in controls with the respective frequencies 14.67% versus 5.33%. The difference was statistically significant with a 3.05-fold increase in the risk of a pregnant adolescent not performing this antenatal consultation (P = 0.0001, OR = 3.05 given for this apathy towards antenatal care services include: ignorance of the importance of antenatal care (especially among non-registered), lack of family or social support, poverty, unpleasant remarks from health workers to unmarried adolescents who are pregnant [38]. Fear of HIV testing [39].
In the literature, numerous studies have shown the high frequency of anaemia in adolescent girls especially in developing countries where half of adolescent girls are anemic. The latter is favoured by intestinal parasitic infections, malaria, nutritional deficiency of iron and folic acid. Teenage mothers with iron deficiency anemia are more likely to give birth before term [2] [13] [19]. In our study, the prematurity rate was 7.33% among adolescents compared to 3% among controls with a 2.5-fold increased risk of preterm birth (P = 0.01; OR = 2.5). According to Boisselier [32], the rate of preterm birth among adolescent girls is 11.5% while it reaches 30% according to Suraiya [40]. Anaemia was twice as common among adolescent girls: 14.33% vs. 7.67% with a 2.01-fold increase in risk for adolescent girls (P = 0.009; OR = 2.01). This rate is comparable to the literature on which the rate of adolescent anaemia ranges from 12.5 to 25% [41] [42] [43]. We found no statistically significant difference in high blood pressure, 14% in adolescent girls versus 11% in controls with (P = 0.26); the rate of high blood pressure in adolescent girls varies between 10% and 17.5% [41]- [46]. The rate of malaria among adolescent girls in our study was 11.67% comparable to that of the literature which is estimated at 15% [47]. and Ongoiba A. [14] reported 24.1% and 20.04% of caesarean sections in adolescents, respectively. Hamada et al. [28] in Rabat, Morocco, reported 57% of mechanical dystocies as causes of caesarean section in adolescents compared to 20% in controls.

Maternal and Fetal Prognosis
According to some authors, the association between adolescence birth and adverse maternal and perinatal prognosis could be explained in part by the deleterious social environment [39]. Newborn weight: In our series, low birth weight (p-lt; 2500 g) was twice as common in adolescents 13.33% as in controls 6.33% (p-0.0039; OR-2.2).
Traoré F. [31] and Diallo D. [55] reported 13.5% and 11.8% of low birth weight respectively among newborns from adolescent mothers. As for Dembélé F. [18], the low birth weight rate was 10.26% among adolescent girls versus 5.41% for controls.
Low birth weight may be either preterm infants who are at gestational age or hypotrophy whose weight is less than gestational age. This low birth weight is detrimental to these newborns whose survival depends on rigorous follow-up by the family and health workers. In addition, the results of the multi-variety study conducted by Forum et al. [56] do not show a significant association between maternal age and delivery of a small-weight newborn.

The Reference Patterns of Newborns in Neonatology
In our series, 22.33% of newborns from teenage mothers were referred to neonatology compared to 12.67% of infants from controls with a statistically significant difference (P = 0.002; OR = 1.98). The reasons for evacuation were mainly:  [18] found that newborns were referred to paediatrics in 18.97% of adolescent cases and 11.18% in controls and Maiga R. [58] reported that the baseline rate for newborns was 15.9% for adolescent girls and 9.0% for controls.

Pathologies of Diaper Suites
In the literature, no particular complications of diapers are reported in young mothers [33] [59]. In our study, postpartum anemias, postpartum eclampsia, endometritis were found to be more common in adolescent girls than in con-

Conclusion
Teenage versus adult births are associated with many more maternal-fetal complications.

Authors' Contributions
All the authors participated in the writing of the manuscript. They all approve the final version of the manuscript.

Ethics Authorisation
The ethics committee's authorization was found prior to the start of the study.