The World Health Organization (WHO) defines teenage pregnancy as pregnancy in a girl aged 10 to 19 years old [1] . The teenage period is a period of transition from childhood to adulthood, with important biological and social development [2] . Teenagers constitute a high risk group requiring high priority services. Teenage pregnancies are considered to be high risk pregnancies [3] . This is due to the potential increased risk of adverse outcomes to both the mother and the baby [3] . Teenage delivery is a global issue with its burden being experienced all over the world [4] . Most of this burden is in low and middle income countries [5] . Teenage pregnancy constitutes a public health problem worldwide with an estimation of about 16 million births in a 2008 report occurred to teenage mother with 95% of these deliveries being in low and resource limited countries [6] . For this sustainable development goals to be attained by 2030 issues pertaining to adolescent and adolescent pregnancy must be kept under check.

Teenage pregnancy is a global phenomenon. Worldwide, teenage pregnancy rates range from 143 per 1000 in some sub-Saharan African countries to 2.9 per 1000 in South Korea [7] . Save the Children found that annually, 13 million children are born to women aged under 20 worldwide, with more than 90% in developing countries [7] .

In the industrialized Asian nations such as South Korea and Singapore, teenage birth rates are among the lowest in the world [7] . The pregnancy rate among teenagers in the USA was 67.8 pregnancies per 1000 women aged 15 - 19 in 2008 [7] . The teenage birth rate in the United States is highest in the developed world and the teenage abortion rate is also high [7] . In 2010 the birth rate in the USA was 34.3 births per 1000 women aged 15 - 19 [7] . This is twice as high as the rates found in England, France and Canada, three times as high as that in Sweden; and seven times as high as the Dutch rate, despite similar or higher rates of sexual activity in the other countries [2] .

In sub-Saharan Africa, teenage pregnancy and deliveries also constitute a high public health burden. In Cameroon, a study carried out by Tebeu et al. from 2003 to 2005, found out that adolescent’s contribution to deliveries ranges from 6.87% to 26.51%, with a national mean of 14.23% (1). Adolescents aged 16 or less contribute to 2.82% of deliveries while those aged from 17 to 19 contributed to 11.41% [1] . Another study done in the University teaching hospital Yaoundé (CHU) and Central Hospital Yaoundé shows that 12% and 9.3% of the deliveries respectively were by adolescents < 19 years old [8] [9] [10] . Its prevalence varies across regions in Cameroon with the Far North region having the highest rate of teenage deliveries (26.51%) [10] .

Factors that predisposed adolescents to high rate of pregnancy included cultures, early marriages, poor access to modern contraception, low level of education, and low socio-economic status [11] . Studies carried out by Clifford et al. show that these factors varied across different regions in sub-Saharan Africa; Community levels of female unemployment (P < 0.05) and community poverty (P < 0.05) in Southern and East Africa. While only community poverty (P < 0.05) independently predicted the outcome in West Africa. In sub-Saharan African region in general, adolescent pregnancy was associated with all that is family disruption (P < 0.05), Community levels of female unemployment (P < 0.05) and community poverty (P < 0.05).

These differences in neonatal and maternal outcome between teenage deliveries and adult deliveries were most of the time attributed to the maternal age alone [12] . But it is now known that they are other underlying factors. Some of these factors are [13] ; low number of prenatal visits, late initiation of prenatal care, and inappropriate prenatal care. Other factors are race, marital status, and low level of schooling, smoking, and poverty, low maternal weight, [13] [14] . Though other way around low socioeconomic level lead to women giving birth at teenage age.

What is the prevalence, outcome and factors associated with teenage pregnancy in two hospitals in the Bamenda health district?

The negative outcome of teenage pregnancy and their associated factors amongst women giving birth at the two hospitals in the Bamenda health district is statistically significance

This study was a hospital-based cross-sectional comparative analytic study.

This study was conducted over a period of 4months (February 2019 to May 2019).

The study was conducted at the maternity and post natal units of the Bamenda Regional Hospital and the Medicalised Health Center (CMA) Nkwen Bamenda, North-west region of Cameroon.

The northwest region is one of the 10 region of Cameroon, It has a population of about 1,804,695 inhabitants (25). It share boundary with Southwest region, West Region and the Federal Republic of Nigeria. It has Bamenda as the Regional headquarter, which also serves as headquarter of Mezam division. There are 17 health districts with 183 health areas. There is o one Regional drug supply structure known as the Northwest Regional special Fund for health, 4 private hospitals and 19 sub divisional medical Centers.

The Bamenda health district has a surface area of 560 km² and a population of about 236.336 inhabitants. It is bounded: To the North by the Bafut Health District, To the North east by the Tubah Health, District, to the Northwest by the Mbengwi Health District, to the South west by the Bali Health District, South by the Santa Health District, and to the Southeast by the Ndop Health District.

The Regional Hospital Bamenda (RHB) is a secondary health care center. It has a total bed capacity of about 600 beds and serves as main referral hospital in the region, as well as teaching hospital for the Faculty of Health Sciences, University of Bamenda. The maternity of this hospital conducts more deliveries than other health facilities in the region.

The BRH offers antenatal care (ANC), delivery care, and neonatal care family planning servces. The staffing situation in the maternity includes 2 obstetricians/gynaecologists, 2 general practitioners, 7 midwives, and 30 nurses.

The CMA Nkwen has 2 general practitioner, 2 midwives and 15 nurses. The labour and delivery room have 4 and 5 beds respectively. The postnatal unit of MHC Nkwen has two general wards each having 9 beds and 3 private wards (each containing 4 beds) giving a total of 30 beds.

All these amongst others turn to pull most pregnant women in the BHD to seek for care in these hospitals, hence a good representation of the population of the health district in particular and the Northwest Region in general.

All the women aged 10 - 19 at the maternity unit of BRH and MHC Nkwen during their hospital stay at the postnatal ward were recruited into the study population throughout the study period.

The protocol was submitted to the Institutional Ethical Review Board (IRB) of the faculty of health sciences (FHS) of University of Bamenda for ethical evaluation and for ethical clearance to be obtained from the Institutional review Board (IRB) of the Faculty of Health Sciences of the

University of Bamenda. Then an Administrative authorization from the Regional Delegate of Public Health for the North West Region (NWR) was also obtained for the study to be carryout in their area of administration. Lastly, an administrative authorization was obtained from the administration of the various health care institutions

During the study period, eligible participant for the study in conformity with the inclusion criteria were selected. A consecutive non-probabilistic sampling technique was used. A structured and pretested questionnaire was used to retrieve the necessary information from the participants to maintain consistency in the process. More data about maternal and fetal factors was collected from medical files of the patients concerned. Paper, pens, pencils, eraser, and a phone was used in the process. This information was stored in a computer, and a USB flash drive.

The information collected from the participant were:

➢ Socio demographic data age, occupation, resident, level of education, religion, marital status among others, level of income;

➢ Obstetric/clinical factors: Gravidity, parity, contraceptive knowledge and used, number of ANC, GA at first ANC;

➢ Fetal outcome: Prematurity, birth weight, Apgar score, admission to neonatology unit, neonatal death, still birth.

Maternal outcome: postpartum hemorrhage, mode of deliveries, maternal death, preeclampsia/eclampsia, placenta previa/placenta abruption, perineal tear, episiotomy.

All data were retrieved by the investigator. The data were secured in a confidential and private location. Participants were referred to by identification numbers and the consent forms were kept separate from the questionnaires. Both could only be linked by a coding sheet available only to the investigators. Data was entered using Microsoft excel. Analysis was done using the Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics was depicted using absolute numbers and simple percentages as appropriate Means (standard deviations) were used to summarize continuous variables and proportions for categorical variables. The OR and their confidence intervals are at 95% (for qualitative variables such as gravidity, level of education, occupation, etc.), and mean or median (for quantitative variables such as age of participant, gestational age etc.). The level of association was determined by using Bivariate logistic regression. The level of significance was set at a p-value less than 0.05. (P < 0.05) Data is presented as numbers, percentage, means, and one standard deviation. Tables were used to present data.

From the Figure 2 below, the prevalence of teenage delivery was 13.5%.

From the Table 8 below, the following socio-demographics determinants was found statistically significant with teenage pregnancy, teenagers in Rural area; (OR = 5.076; 95% CI = 2.95 - 8.72, P = 0.001), low level of monthly income among teenagers < 27,000; (OR = 4.2; 95% CI = 2.34 - 7.88; P = 0.001), Educational level among teenagers (secondary school); (OR = 4.64; 95% CI = 2.34 - 9.67; PV = 0.000).

OR = odd ratio, P = p-value, CI = confident interval at 95%.

The result from this study shows that out of the 325 participants, the age rang was from 15 - 35 years with a mean age of participants 25.02 ± 2.57 years. There was 44 of the participant that were teenagers (<20), with mean teenage age of 17.49 ± 0.63 years and the mean adult age was 28.43 ± 5.64 year [14] . This was similar to the result obtained by Fouelifack et al. at the Yaoundé Central Hospital, in the Centre Region of Cameroon 2010 were the adolescents participants had a mean age of 17.78 ± 1.31 years while the mean for the adult group was 28.32 ± 5 years [8] . This may be due to the fact that the two populations are similar in term of sexuality rate.

In literature, reports concerning developing countries indicate an inverse relationship between education level and frequency of adolescent pregnancy and/or childbearing Sulaiman et al. [12] . This was true for our study which confirm the fact that teenage mother mostly have low level of education, especially at tertiary level of education, we have 0.0% teenagers compare to 33.9% adult at that level of education.

Regarding marital status, teenage pregnancy in developed countries usually occurs outside marriage and in many communities and cultures carries a social stigma. In other countries and cultures, particularly in the developing world, teenage pregnancy is often within marriage and does not involve social stigma) [8] , but our study proved the contrary. We discovered that more teenage pregnancies occurred outside marriage than in it and most were leaving with their parents. This finding is similar to that obtained by Egbe et al. at the Buea Health District [5] . Whatever contradiction there is between our study and those carried out in other low-income countries could be explained by the socio-cultural differences from one situation to the other and the present low rate of schooling in ours setting. Our study also shows that majority (88.6%) of adolescent pregnancies were in their first gestation while in the control group the percentage was 1.7% and majority of the teenagers were from rural areas. This finding is confirmed by other study [12] .

In literature, the rates of use of contraception by adolescents are often low. Use of any contraceptive method in women aged 15 - 49 years who are married or in union has risen from 55% in 1990 to 63% in 2007. Among adolescents it is lower, but with large regional and country difference. A study of contraceptive use in married and unmarried adolescents in Latin America, European and Asian countries showed rates ranging between 42% and 68% [11] . African countries have the lowest rates ranging from 3% to 49% (11). In our study a similar result was obtained with low rate of contraceptive used in adolescent than in adult (21.1% Vs 12.8%) for male condom.

While only 2.6% of teenagers used modern contraception while (5.3%, 10.4% 3.2%) of adults uses COC, implants, and IUCD respectively. These may be due to the low socio-economic and low employment status of the teenagers. Similar result was obtained with another study by Sulaiman et al. [12] .

For employment status, our study shows that adult women were more employed as compared to teenagers this was similar to the one found by ahmed et al. in Egypt were most of the adult women were employed compare to the teenagers. This could be explained by the low level of schooling in the teenage population.

The prevalence of teenage births in this study was 13.54% (44/325).

The 13.54% prevalence of teenage pregnancies found among the study population fell within the National prevalence range of 6.87% to 26.51% according to a study carried out by Tebeu et al. done at different regional hospitals of the ten regions of Cameroon with an overall national prevalence of 14.23% [1] . This was also similar to the study carried out by Egbe et al. to assess the prevalence of adolescent hospital births at the Buea health district, South West Region, Cameroon who also come out with a prevalence of 13.3%.

But this prevalence is higher than a similar study carried out by Kemfang et al. at Yaoundé General Hospital where adolescent deliveries represented 2.84% (331 deliveries) of all deliveries registered during that study period [9] . The prevalence of teenage pregnancy found in our setting have increased, this high prevalence can be due to differences in socioeconomic status, level of education and level of employment that was found mostly within our adolescent population. All these can be attributed to the ongoing crisis in our setting. Low levels of education, unemployment and pre-marital adventures were earlier discovered to be important contributory factors to teenage pregnancy. These findings corroborated those reported by other studies [10] .

Factors associated with teen pregnancy cut across many aspects such as socio-economic, sociocultural and psychological factors that could be an important determinant of teenage pregnancy. Studies show that more women in rural area are more likely to become teenage mother [3] , our study shows similar results with teenage mother been more from rural area. According to a study done in Indonesia by Andriyana et al., Teenage pregnancy in Indonesia is concentrated among women with less education, who are unemployed, unmarried and with inadequate antenatal care and obstetric risks for poor pregnancy outcome. Our study shows that girls in the rural area are more statistically significant at risk (PV < 0.001, OR = 5.07; 95% CI = 2.34 - 7.88) of becoming teenage mothers compared to those in urban area. This is in line with result obtained by Egbe et al. at the Buea Health District [5] . This study also tell us that having low level of education, low level income are associated with being a teen mother (PV = 0.001, or =4.29; 95% CI = 2.343 - 7.880) whereas nonuse of contraception is not associated with teenage pregnancy.

Due to socio-political crisis in our setting, many participants fear to participate in the study due to the fear of the unknown.

This study was a hospital-based study and generalization of the prevalence to the overall prevalence will face some short coming.

This study is one among the few if any to have evaluated the prevalence, outcome and associated factors of teenage pregnancy in the Bamenda Health District.

The Regional hospital and the MHC Nkwen offer care to close to half of the population of the Bamenda Health district, with different socio-demographic socio-economic background including rural, and urban areas.

The information generated from this study provide important previously unstudied information, provide inside into system improvement opportunities in our setting.

From this study also we come to know the current trend of teenage pregnancy and hospital deliveries in the BRH and Nkwen medicalised health center this information will be used to compare with future trend.