Environmental risk factors associated with low birth weight: The case study of the Haifa Bay Area in Israel

Determinants of low birth weight and its effect on childhood health and nutritional outcomes in Bangladesh

BACKGROUND

The high incidence of low birth weight (LBW) is associated with an increased risk of infant mortality, adverse pregnancy outcomes for mothers, and a decline in overall health and well-being. The current study aimed to identify the various determinants of LBW and its effect on adverse health and nutritional outcomes of children aged 0-23 months in Bangladesh.

METHODS

Bangladesh Demography and Health Survey (BDHS) 2017-18 data was used. A chi-square test and multivariable logistic regression analysis were used to find out the associations between independent variables and outcomes (e.g., LBW, child illness and undernutrition).

RESULTS

The overall prevalence of LBW among was 16.3%. Mother with no formal education (AOR = 2.64, 95% CI = 0.55-3.30, p = 0.01), female child (AOR = 1.31, 95% CI = 1.04-1.65, p = 0.023); and poorest economic status (AOR = 1.69, 95% CI = 1.13-2.51, p = 0.010), were identified significant determinants of LBW. Of home environment and hygiene factors, unimproved toilet facilities (AOR = 1.38, 95% CI = 1.03-1.84, p = 0.030) had a significant effect on LBW. In addition, children born with LBW were more likely to suffer fever (AOR = 1.26, 95% CI = 1.05-1.60, p = 0.050), stunting (AOR = 2.42, 95% CI = 1.86-3.15, p = < 0.001), wasting (AOR = 1.47, 95% CI = 1.02-2.25 p = 0.049), and underweight (AOR = 3.19, 95% CI = 2.40-4.23, p = < 0.001).

CONCLUSION

One out of five children was LBW in Bangladesh. Maternal education, sex of child, wealth index, and toilet facilities had significant effects on LBW. In addition, LWB contributed to children's poor health and nutritional outcomes. Enhancing maternal pregnancy, and child health outcomes necessitates policies addressing poverty, gender inequality, and social disparities. Key strategies include promoting regular prenatal care, early medical intervention, reproductive health education, and safe hygiene practices. To combat the negative impacts of LBW, a comprehensive strategy is vital, encompassing exclusive breastfeeding, nutritional support, growth monitoring, accessible healthcare, and caregiver education.

Industrial air pollution and low birth weight in New Mexico, USA

In recent decades, the low birth weight (LBW) rate in New Mexico has consistently exceeded the Unites States average. Maternal exposure to air pollution during pregnancy may be a significant contributor to LBW in offspring. This study investigated the links between maternal residential exposure to air pollution from industrial sources and the risk of LBW in offspring. The analysis included 22,375 LBW cases and 233,340 controls. It focused on 14 common chemicals listed in the Toxic Release Inventory (TRI) and monitoring datasets, which have abundant monitoring samples. The Emission Weighted Proximity Model (EWPM) was used to calculate maternal air pollution exposure intensity. Adjusted odds ratios (adjORs) were calculated using binary logistic regressions to examine the association between maternal residential air pollution exposure and LBW, while controlling for potential confounders, such as the maternal age, race/ethnicity, gestational age, prenatal care, education level, consumption of alcohol during pregnancy, public health regions, child's sex, and the year of birth. Multiple comparison correction was applied using the False Discovery Rate approach. The results showed that maternal residential exposure to 1,2,4-trimethylbenzene, benzene, chlorine, ethylbenzene, and styrene had significant positive associations with LBW in offspring, with adjusted odds ratios ranging from 1.10 to 1.13. These five chemicals remained as significant risk factors after dividing the estimated exposure intensities into four categories. In addition, significant linear trends were found between LBW and maternal exposure to each of the five identified chemicals. Furthermore, 1,2,4-trimethylbenzene was identified as a risk factor to LBW for the first time. The findings of this study should be confirmed through additional epidemiological, biological, and toxicological studies.

National blood bank services as a platform for national human biomonitoring - A proof-of-concept study

BACKGROUND

Human biomonitoring (HBM) is crucial for identifying potential risks to human health from exposure to environmental hazards. However, it is an expensive and labor-intensive endeavor. To save on samples' collection process we suggested using a national blood banking system as a platform for a national HBM program. For the case study, we used a comparison of blood donors from heavily industrialized Haifa Bay region, northern Israel, with donors from the rest of the country.

METHODS

The study population comprised a random sample of blood donors donating blood all over Israel. Samples of whole blood were tested for arsenic (As), cadmium (Cd), chromium (Cr) and lead (Pb). Donors' donations sites and residential locations were geocoded. Smoking status was verified based on Cd levels, after calibrating their concentrations vs Cotinine in a sub-sample of 45 subjects. Metal concentrations were compared between regions using a lognormal regression, while controlling for age, gender, and predicted probability of smoking.

RESULTS

During Mar 2020-Feb 2022, we collected 6230 and tested 911 samples. Concentrations of most of the metals were modified by age, gender, and smoking. Cr and Pb appeared to be 1.08-1.10 times higher among Haifa Bay residents than in the rest of the country (although with borderline significance of 0.069 for Cr). Cr and Pb were 1.13-1.15 times higher for those who donated blood in the Haifa Bay region, but not necessarily resided in the area. Donors from Haifa Bay had lower levels of As and Cd as compared to other donors in Israel.

CONCLUSIONS

Using a national blood banking system for HBM proved to be feasible and efficient. Blood donors from Haifa Bay area were characterized by elevated levels of Cr and Pb and lower levels of As and Cd. An extensive investigation of industries in the area is warranted.

Impact of industrial air pollution on the quality of atmospheric water production

The atmospheric water generator (AWG) is a commercially available device that produces water from the air in large volumes over short times. This method can be applied in most regions of the world to solve chronic and acute drinking water scarcity. However, knowledge of the effects of air chemical composition on AWG-produced water quality is still very limited. In this study, a comprehensive survey of AWG-produced water quality was conducted in a heavily polluted industrial environment; 83 AWG water samples were analyzed for 99 different quality parameters, including organic, inorganic, and microbial contamination. Two parameters-nickel (15 samples) and dichloromethane (2 samples)-exceeded sporadically their drinking water standards of EPA, EU and IL. Ammonia was the only parameter consistently above standard limits of 0.5 mg/L (61% of samples, relevant to 47 countries) and even higher than 1.5 mg/L. Comparison to real air concentrations of volatile pollutants in the same environment did not reveal any significant correlations; while some pollutants were found at high concentrations in the air, this was not reflected by their presence in the produced water. The findings show that even in areas that are considered excessively polluted relative to the natural environment, the water produced from the air by AWG could be considered suitable for drinking, with careful attention to very specific contaminants.

Using household survey data to explore the effects of the domiciliary environment on weight at birth: a multilevel mixed-effects analysis of the 2016 Ethiopian Demographic Health Survey

BACKGROUND

Low birth weight (LBW) is associated with infant mortality and postpartum health complications. In previous studies, overall LBW has been found to be significantly associated with several sociodemographic factors, including ethnicity, maternal age, and family income. Few studies have evaluated the association between environmental risk factors and LBW rates. This study investigated the effect of pre-birth water, sanitation, and hygiene (WASH) and housing conditions on self-reported low birth weight.

METHODS

The Ethiopian Demographic and Health Survey, which covered all administrative regions of Ethiopia from January to June 2016, provided data for this study. STATA version 16 was used to analyze 12,125 participants across weighted samples. Multivariable multilevel mixed-effect logistic regression analysis was conducted to determine the effects of each factor on the outcome while accounting for data clustering. The adjusted odds ratios and corresponding 95% confidence intervals were used to determine the statistical significance of the independent variables.

RESULTS

One thousand five hundred and seventeen newborns, or 12.59% [95% CI (10.2- 15.3)], had low birth weights. When other factors were taken into account, the following factors were significantly associated with low birth weight: not using small-scale water treatment technology before using water [AOR (95% CI) 1.36 (1.08-2.23)], burning solid fuels for energy [AOR (95% CI) 1.99 (1.60-2.21)], living in homes with natural wall coverings [AOR (95% CI) 1.81 (1.47-2.21)], using a shared latrine within a woman's housing complex or compound [AOR (95% CI) 1.63(1.06-2.25)], and living in peripheral, isolated regions [AOR (95% CI) 1.38 (1.06-2.21)].

CONCLUSION

A little more than one out of every ten deliveries in Ethiopia was under normal (recommended) weight. This study shows that poor housing conditions and lack of household WASH infrastructure are independent predictors of poor birth outcomes among Ethiopian women, adding to the limited evidence that environmental factors within the domicile contribute to low birth weight. Interventions to address these issues may help lower the prevalence of LBW.

Reproductive toxicity and underlying mechanisms of fine particulate matter (PM2.5) on Caenorhabditis elegans in different seasons

Although numerous studies have investigated that atmospheric fine particulate matter (PM_2.5) can be toxic to environmental organisms, the research on the reproductive toxicity of PM_2.5 is limited, and the key toxic components and underlying mechanisms remain unknown. In this work, PM_2.5 samples of four seasons in Nanjing from March 1, 2021, to February 28, 2022 were collected and the chemical components were analyzed. Caenorhabditis elegans (C. elegans) was employed to conduct the toxicological testing. The reproductive toxicity of PM_2.5 to C. elegans in different seasons was evaluated by multiple reproductive endpoints. Exposure to high concentrations of PM_2.5 significantly decreased the brood size and the number of fertilized eggs in utero. PM_2.5 exposure also increased the number of germ cell corpses and caused abnormal expression of apoptosis-related genes (ced-9, ced-4, and ced-3), which confirmed that PM_2.5 induced germline apoptosis. In addition, PM_2.5 exposure significantly increased the production of reactive oxygen species (ROS) in C. elegans and the fluorescence intensity of HUS-1 protein in of transgenic strain WS1433. Meanwhile, the expression of genes related to DNA damage (cep-1, clk-2, egl-1, and hus-1) and oxidative stress (mev-1, isp-1, and gas-1) also significantly altered in C. elegans, suggesting induction of DNA damage and oxidative stress. According to Pearson correlation analyses, DNA damage and oxidative stress were significantly correlated with multiple reproductive endpoints in C. elegans. Thus, it was speculated that PM_2.5 caused reproductive dysfunction and germ cell apoptosis in C. elegans may be by inducing ROS and DNA damage. In addition, heavy metals in PM_2.5 were significantly correlated with multiple endpoints at physiological and biochemical, suggesting that the heavy metals might be an important contributor to the reproductive toxicity induced by PM_2.5.

Perinatal Health Inequalities in the Industrial Region of Estonia: A Birth Registry-Based Study

Despite the increasing number of studies on industrially contaminated sites (ICS) and their health effects, there are very few studies on perinatal health outcomes in ICSs. In the present study, we examined the perinatal health inequalities by comparing adverse birth outcomes (ABOs) in the oil shale industry region of Ida-Viru County in Estonia with national-level figures and investigated the effects of maternal environmental and sociodemographic factors. Based on the 208,313 birth records from 2004-2018, Ida-Viru ICS has a birth weight 124.5 g lower than the average of 3544 g in Estonia. A higher prevalence of preterm birth (4.3%) and low birth weight (4.8%) in Ida-Viru ICS is found compared to 3.3% on both indicators at the national level. Multiple logistic regression analysis shows the statistically significant association of ABOs with fine particle (PM_2.5) air pollution, mother's ethnicity, and education throughout Estonia. However, in Ida-Viru ICS, the ABOs odds are remarkably higher in these characteristics except for the mother's ethnicity. Furthermore, the ABOs are associated with the residential proximity to ICS. Thus, the Ida-Viru ICS has unequally higher odds of adverse perinatal health across the environmental and sociodemographic factors. In addition to reducing the air pollutants, policy actions on social disparities are vital to address the country's unjustly higher perinatal health inequalities, especially in the Ida-Viru ICS.

Industrial Air Pollution Leads to Adverse Birth Outcomes: A Systematized Review of Different Exposure Metrics and Health Effects in Newborns

Objectives: To review the evidence of associations between adverse birth outcomes (ABO) and industrial air pollution.

Methods: Searches were conducted in PubMed, and Scopus databases, and additional articles were found from snowball search techniques. The included studies feature a study population of mothers with live-born babies exposed to industrial air pollutants, and they examine the effects of industrial pollutants on adverse birth outcomes—namely, low birth weight, term low birth weight, preterm birth, and small for gestational age.

Results: Altogether, 45 studies were included in this review. Exposure to PM2.5, PAHs, benzene, cadmium, and mixtures of industrial air pollutants and living near an industrial area affect birth outcomes.

Conclusion: This study concludes that industrial air pollution is an important risk factor for ABO, especially low birth weight and preterm birth. The strongest evidence is associations between ABO and air pollution from power plants and petrochemical industries. Understanding of specific chemicals that are critical to birth outcomes is still vague. However, the evidence is strongest for more specific air pollutants from the industry, such as PAH, benzene, BTEX, and cadmium.

Impact of children born with low birth weight on stunting and wasting in Sindh province of Pakistan: a propensity score matching approach

Low Birth Weight (LBW) is considered as a major public health issue and leading cause of neonatal death. Almost one in four newborns are reported as underweight in Pakistan. Children born with low birth weight are highly vulnerable to develop diseases and death and/or remain undernourished (i.e., stunted and wasted). This study determines the LBW newborns are more prone to develop stunting and wasting in province of Sindh, Pakistan. Moreover, regression-based estimation of the impact of LBW on the child health outcomes of under five years of age, may be prone to selection bias because of the nature of non-experimental data set, thus, propensity score matching methods are used in this study. Data for this study was used from Multiple Indicators Cluster Survey (MICS-2014). MICS is a two-stage, stratified cluster sampling household level data covering urban and rural areas and consists of 19,500 households from five administrative divisions and 28 districts of Sindh province of Pakistan. The total sample size of children less than five years of age after cleaning the data are 7781, of which 2095 are LBW having birth weight categorized as "smaller than average and very small" and 5686 are normal birth weight (NBW) having birth weight very large, larger than average, and average. This study employed propensity score matching (PSM) regression methods to understand whether the children born as low birth weight are more prone to stunting and wasting and/or both. In province of Sindh, moderate wasting children under five years were 21%, severe wasting 6% and both wasting and stunting 10%. The propensity score results are shown significant in all groups. Specifically, all four types of PSM methods confirm a significant difference in the potential outcome variables-meaning that a child born with LBW has a significant adverse effect on the potential child health outcome variables (stunting, wasting and both). Thus, the propensity score matching findings confirm a significant and adverse effect of LBW on potential health outcomes of under five children. Similarly, low birth weight children are significantly more likely to be moderately wasted (OR = 1.5, CI = 1.3-1.6) and severely wasted (OR = 1.6, CI = 1.3-2.0) and both (stunted and wasted, OR = 2.0, CI = 1.7-2.3) as compared to children with normal birth weight. Male children, if born with low birth weight, are significantly more likely to be moderately wasted (OR = 1.3, CI = 1.1-1.5) and both (wasted and stunted, OR = 1.3, CI = 1.1-1.5) than girls. This large data analysis finding proved that the LBW newborns are on higher risk to develop wasting and stunting in Pakistan.

Mapping the prevalence and socioeconomic predictors of low birth weight among Bangladeshi newborns: evidence from the 2019 Multiple Indicator Cluster Survey

BACKGROUND

Low birth weight (LBW) remains a global concern for childhood morbidity and mortality. This study examined the socioeconomic factors associated with LBW among Bangladeshi newborns and drew a district-level prevalence map.

METHODS

Data were extracted from the 2019 Multiple Indicator Cluster Survey for Bangladesh. Multivariate logistic regression was used to identify the predictors of LBW.

RESULTS

The prevalence of LBW among Bangladeshi newborns was found to be 14.5%. Overall, the Eastern and South-Eastern regions had a higher burden of LBW. Mothers' educational status, mode of delivery, wealth index quintile of the household and area were identified as independent predictors of newborns' LBW. Mothers who completed primary and secondary education grades had a 1.6- and 1.3-fold higher possibility of having an LBW baby compared with those who completed higher secondary or higher educational grades (adjusted OR=1.62 and 1.32, 95% CI 1.21 to 2.18 and 1.06 to 1.65, respectively). Children belonging to the poorest households and residing in urban areas had a 1.4-fold higher likelihood of being LBW (p<0.05).

CONCLUSIONS

This study indicates that LBW is still highly prevalent in Bangladesh. Immediate public health action is required in the highly prevalent regions identified in this study.

Maternal proximity to petrochemical industrial parks and risk of premature rupture of membranes

BACKGROUND

Living near petrochemical industries has been reported to increase the risks of adverse birth outcomes, such as low birth weight and preterm delivery. However, evidence regarding the role of petrochemical exposure in pregnancy complications remains limited. This study evaluated the association between maternal proximity to petrochemical industrial parks (PIPs) during pregnancy and the occurrence of premature rupture of membranes (PROM).

METHODS

We performed a population-based 1:3 case-control study by using the 2004-2014 Taiwanese Birth Certificate Database. Birth records reported as stillbirth or bearing congenital anomalies were excluded. Cases were newborns reported to have PROM, whereas controls were randomly sampled from those without any pregnancy complications by matching birth year and urbanization index of the residential township. The proximity to PIPs was evaluated by calculating the distance to the nearest PIP of the maternal residential township during pregnancy. Furthermore, petrochemical exposure opportunity, accounting for monthly prevailing wind direction, was quantified during the entire gestational period. We applied conditional logistic regression models to evaluate the associations.

RESULTS

In total, 29371 PROM cases were reported during the study period, with a corresponding 88113 healthy controls sampled. The results revealed that living within a 3-km radius of PIPs during pregnancy would increase the risk of PROM (odds ratio [OR] = 1.76, 95% CI: 1.66-1.87). Furthermore, compared with the lowest exposed group, those with high petrochemical exposure opportunity had a significantly increased risk of PROM occurrence (OR = 1.69-1.75). The adverse effects remained robust in the subgroup analysis for both term- and preterm-PROM.

CONCLUSIONS

The results of the present work provide evidence that living near PIPs during pregnancy would increase the risk of PROM, and additional studies are warranted to confirm our findings.

Space-time hot spots of critically ill small for gestational age newborns and industrial air pollutants in major metropolitan areas of Canada

We assessed the association of spatiotemporal hot spots of critically ill small for gestational age (ciSGA) newborns and industrial air emissions. Using neonatal admission data from the Canadian Neonatal Network between 2006 and 2010 (n = 32,836 infants), we aggregated maternal residential postal codes from nineteen census metropolitan areas (CMA) into space-time cubes and applied emerging hot spot analyses. Using National Pollutant Release Inventory data (n = 161 chemicals) and Environment Canada weather station data (n = 19 sites), we estimated monthly wind-dispersion of air emissions and calculated hot spots. We associated the patterns using logistic regression, with covariates for low socioeconomic status, NO₂ pollution, and number of infants. A total of 5465 infants were identified as ciSGA and the larger CMAs had more and larger hot spots (i.e. accumulation of events in space and time). Seventy-eight industrial chemical hot spots were associated with ciSGA hot spots. The highest number of positive associations were for 28 different pollutants, which differed by CMA. Twenty-one were known or suspected developmental toxicants, such as particulate matter, carbon monoxide, heavy metals, and volatile organic compounds. Associations with hot spots of industrial chemical emissions were geographically specific and may help explain the space-time trends of ciSGA.

Birth Cohorts in Highly Contaminated Sites: A Tool for Monitoring the Relationships Between Environmental Pollutants and Children's Health

Industrial areas are characterized by the dispersion of environmental stressors that could possibly have long-term detrimental effects on both human health and the environment. Environmental contamination has been indicated to be one of the major risks for reproductive health. In this context, the effects of environmental pollution on pregnant women living in heavily polluted areas is of special interest. In fact, fetal development is a crucial phase due to the dynamic interaction between the maternal/external environments and the developing organs and tissues. Moreover, following Barker's postulate of the intrauterine origin of health and disease, the events occurring in this time window could affect future health. Birth cohorts provide the most suitable design for assessing the association between early-life and possible long-term health outcomes in highly contaminated sites. By providing an assessment of the early life environment throughout the collection of biological samples, birth cohorts offer the opportunity to study in-depth several possible confounders and outcomes by means of questionnaires and follow-ups based on clinical evaluations and bio-specimen samplings. The exposome comprises the totality of exposures from conception onwards; the birth cohort approach allows the integration of the exposures as a whole, including those related to socioeconomic status, with "omics" data from biological samples collected at birth and throughout life. In the characterization of the "fetal exposome," the placenta represents a highly informative and scarcely considered organ. For this purpose, the "Neonatal Environment and Health Outcomes" (NEHO) birth cohort has been established by enrolling pregnant women residing in contaminated sites and in surrounding areas.

Human biologic monitoring based on blood donations to the National Blood Services

Background

The ambient exposure does not always reflect the internal levels of pollution absorbed in the body. While human biomonitoring (HBM) could provide a valid estimate of exposure extent, it is usually an expensive and a heavily manpowered enterprise. Using samples collected during blood donations for HMB may provide a more efficient platform for a routine biomonitoring.

Methods

The current study is aimed to explore the feasibility of using the national blood banking system for the purposes of HBM, to compare between residents of a suspected polluted area in northern Israel (Haifa Bay) to the rest of the country. Specifically, we will assemble a geographically representative sample of blood donors residing in the study area and of the general population, to test for four industry and traffic-related metals: lead (Pb), cadmium (Cd), arsenic (As) and chromium (Cr). Samples of whole blood from donors will be tested in the Laboratory of Public Health Services managed by the Ministry of Health. The information on donors’ biomarkers levels will be further linked with the air pollution and meteorological data assessed at the location of the blood collection sites (short-term exposure) and donors’ permanent address (long-term exposure), as recorded by the monitoring stations spread throughout Israel and the satellite-based exposure models. The association between biomarkers and ambient environmental exposures will be assessed.

The samples’ collection is planned for 2 years of 2020–2021.

Discussion

The information collected in this study could lead to environmental regulations within Haifa Bay area aimed to prevent exposure to high levels of hazardous chemicals.

Prevalence and risk factors of childhood blepharoptosis in Koreans: the Korea National Health and Nutrition Examination Survey

Purpose:

Childhood blepharoptosis may cause cosmetic and functional problems in children, but there is a paucity of studies about its epidemiology. This study aimed to investigate the prevalence of childhood blepharoptosis and associated risk factors in a representative Korean population.

Methods:

This cross-sectional nation-wide study analysed the data set acquired from the Korea National Health and Nutrition Examination Survey 2008–2012. A total of 8218 children aged 3–18 years were included. The prevalence of childhood blepharoptosis, defined as a margin reflex distance (MRD) of < 2 mm in either eye, was estimated, and the risk factors were identified using multivariate logistic regression analysis.

Results:

The mean age of participants was 11.3 ± 0.1 years, and 52.8 ± 0.6% were boys. The overall prevalence of childhood blepharoptosis in Korea was 8.0% (95% CI, 6.9–9.1%). Boys exhibited a higher prevalence of blepharoptosis than girls at most of ages. Levator function increased with age in the normal general population. The proportion of subjects exhibiting MRD1 ≥ 4.0 mm also increased significantly with age (p < 0.001). Male gender, higher body mass index, and urban residency were significantly associated with childhood blepharoptosis.

Conclusions:

The prevalence of childhood blepharoptosis is higher in urban obese boys. The increase of levator function with age should be considered in evaluations of childhood ptosis.

Factors associated with low birth weight in Afghanistan: a cross-sectional analysis of the demographic and health survey 2015

OBJECTIVES

This study aimed to investigate the factors associated with low birth weight (LBW) in Afghanistan.

DESIGN

Cross-sectional study.

SETTING

This study used data collected from the Afghanistan Demographic and Health Survey 2015.

PARTICIPANTS

Facility-based data from 2773 weighted live-born children enrolled by a two-stage sampling strategy were included in our analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was LBW, defined as birth weight <2.5kg.

RESULTS

Out of 2773 newborns, 15.5% (n=431) had LBW. Most of these newborns were females (58.3%, n=251), had a mother with no formal schooling (70.5%, n=304), lived in urban areas (63.4%, n=274) or lived in the Central region of Afghanistan (59.7%, n=257). In multivariable analysis, residence in Central (adjusted OR (AOR): 3.4; 95% CI 1.7 to 6.7), Central Western (AOR: 3.0; 95% CI 1.5 to 5.8) and Southern Western (AOR: 4.0; 95% CI 1.7 to 9.1) regions had positive association with LBW. On the other hand, male children (AOR: 0.5; 95% CI 0.4 to 0.8), newborns with primary maternal education (AOR: 0.5; 95% CI 0.3 to 0.8), birth interval ≥48 months (AOR: 0.4; 95% CI 0.1 to 0.8), belonging to the richest wealth quintile (AOR: 0.2; 95% CI 0.1 to 0.6) and rural residence (AOR: 0.3; 95% CI 0.2 to 0.6) had decreased odds of LBW.

CONCLUSIONS

Multiple factors had association with LBW in Afghanistan. Maternal, Neonatal and Child Health programmes should focus on enhancing maternal education and promoting birth spacing to prevent LBW. To reduce the overall burden of LBW, women of the poorest wealth quintiles, and residents of Central, Central Western and South Western regions should also be prioritised. Further exploration is needed to understand why urban areas are associated with higher likelihood of LBW. In addition, research using nationally representative samples are required.