The health consequences of intrauterine growth retardation in southwestern Ethiopia

Prevalence and Determinants of Low Birth Weight in Ethiopia: A Systematic Review and Meta-Analysis

Introduction. Low birth weight (LBW) is the most significant risk factor for neonatal and infant mortality. It is one of the major public health problems in developing countries. Although there are various studies on low birth weight, findings were inconsistent and inconclusive. Therefore, this study was conducted to estimate the national-pooled prevalence of low birth weight and its associated factors in Ethiopia. Method. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. This meta-analysis employed a review of both published and unpublished studies conducted in Ethiopia. The databases used were PubMed, Google Scholar, CINAHL, and African Journals Online. Relevant search terms for prevalence and determinants of LBW were used to retrieve articles. The meta-analysis was conducted using STATA 14 software. Forest plots were used to present the findings. The Cochran Q test and I2 test statistics were used to test heterogeneity across studies. Egger’s test was used to assess the publication bias of included studies. The pooled prevalence and the odds ratios (OR) with 95% confidence intervals (CI) were computed and were presented using forest plots. Results. A total of 28 studies, 50,110 newborn babies, were included in this meta-analysis. The pooled prevalence of LBW in Ethiopia was 14.1% (95% CI = 11.2, 17.1). Higher variation in the prevalence of LBW in different regions across the country was observed. Significant association of LBW with sex of the newborn baby, higher odds among female babies (OR = 1.5 (95% CI = 1.2, 1.7)), prematurity (OR = 4.7 (95% CI = 1.5, 14.5)), not attending prenatal care (OR = 1.7 (95% CI = 1.4, 2.2)), pregnancy-induced hypertension (OR = 6.7 (95% CI = 3.5, 12.9)), and newborn babies whose mothers were from rural areas (OR = 1.8 (95% CI = 1.2, 2.6) were the factors associated with low birth weight. Conclusions. The prevalence of LBW in Ethiopia was high. LBW was associated with several maternal and newborn characteristics. The large disparity of LBW among the different regions in the country needs targeted intervention in areas with higher prevalence. Particular emphasis should be given to mothers residing in rural areas. Community-based programs are important to increase the use of prenatal care.

Developmental Outcomes of Preterm and Low Birth Weight Toddlers and Term Peers in Rwanda

Background:

As neonatal care improves in low-resource settings, more preterm or low birth weight (LBW) babies are surviving, but little is known about their long-term outcomes. Globally, preterm and/or LBW babies are at increased risk of mortality, malnutrition, and developmental delay.

Objectives:

We aim to describe the differences in development in rural Rwandan children at 24–36 months of age born preterm and/or LBW compared to their peers born term or normal birth weight (term/NBW), and to assess factors associated with poor development.

Methods:

We conducted a cross-sectional study using secondary data analysis from two combined datasets from 2014, using Ages and Stages Questionnaire (ASQ-3) for developmental assessment and anthropometrics for nutritional status (stunting and wasting). Demographic and clinical factors associated with poor developmental outcomes in univariate regression at α = 0.20 were included in a full model; we used backward stepwise penalized multivariable logistic regression to identify a final model at α = 0.05.

Findings:

In total, 445 children were included; 405 term/NBW, and 40 preterm and/or LBW. Half of them (n = 234; 52.6%) had developmental delay, including 207 (51.1%) among term/NBW and 27 (67.5%) among preterm and/or LBW (p = 0.048). In the final model, term/NBW children with stunting alone had a significant increase in the odds of developmental delay (OR 2.05, 95% CI 1.37–3.07), and children with wasting had a borderline statistically significant increased odds of developmental delay (OR 5.79, 95% CI 0.98-34.39). Being preterm and/or LBW and not stunted completely predicted delay.

Conclusion:

Half of the children had developmental delay in our sample from rural Rwanda. Preterm and/or LBW infants were more likely to have developmental delay, and the main predictor of developmental delay was stunting, with high rates of stunting observed also in term/NBW infants. Interventions to reduce undernutrition and prevent prematurity and LBW, alongside investments to promote early stimulation for optimal development, are needed if gains in addressing developmental delay are to be made.

Mechanistic Pathways From Early Gestation Through Infancy and Neurodevelopment

OBJECTIVE

To identify pathways through which pre- and postnatal factors directly or indirectly affect infant neurodevelopment at 12 months of age among Filipino infants.

METHODS

The Bayley Scales of Infant Development, third edition was used to assess the development of 314 infants of mothers enrolled in a trial examining the safety and efficacy of praziquantel during pregnancy. Maternal covariates included socioeconomic status, iron and nutritional status, cognitive performance, and alcohol intake. Infant covariates included birth weight and feeding practices, longitudinal growth and nutritional status, hemoglobin and iron status captured at birth, and 6 and 12 months of age. Multivariable regression and structural equation modeling were used to identify significant factors associated with infant development.

RESULTS

In regression models, maternal education, cognition, and iron status as well as infant weight-for-age z-score (WAZ), weight-for-length z-score, and WAZ gains were significantly associated with infant development at 12 months of age. Structural equation modeling demonstrated a direct effect of maternal cognition on most subscales of infant development and indirect effects on expressive language through effects on infant WAZ. Maternal iron status was a stronger predictor of infant cognition subscale scores than was infant iron status. Exclusive breastfeeding had a direct influence on expressive language rather than acting through improved infant iron or nutritional status.

CONCLUSIONS

We identified key modifiable risk factors for impaired neurodevelopment, including prenatal risk factors such as maternal iron status. Integrated nutritional interventions that impact both maternal and infant nutritional status are likely to positively affect infant neurodevelopment through identified pathways.

LBW and SGA Impact Longitudinal Growth and Nutritional Status of Filipino Infants

We performed this study to longitudinally compare rates of stunting, wasting and underweight among low birthweight (LBW), non-LBW, and/or small-for-gestational age (SGA) and non-SGA infants in Leyte, The Philippines and factors that predicted catch up. Birthweights of 357 infants born in Leyte, The Philippines were obtained within 48 hours of delivery and infants were evaluated at one, six and 12 months. Newborns were classified as LBW, SGA, or both. We derived length-for-age, weight-for-length and weight-for-age Z-scores using WHOAnthro. Generalized estimating equations models were used to compare the differences in prevalence and mean Z-scores for these growth and nutritional outcomes, with separate models made with LBW and SGA as distinct primary predictors. We compared the longitudinal risk of stunting, wasting and underweight during infancy among LBW versus non-LBW and SGA versus non-SGA infants, while also evaluating key potential confounding, explanatory and modifying covariates. Overall, 9.0% of infants were born prematurely, 14.0% of infants were LBW and 22.9% were SGA. LBW infants had significantly increased odds of stunting, wasting and underweight persisting to 12 months of age, and SGA infants had significantly increased odds of stunting and underweight. LBW and SGA infants had higher rates of weight-for-length gain in the first month of life. Maternal educational attainment and exclusive breastfeeding decreased the risk of stunting and undernutrition. In this setting, LBW and SGA infants have higher rates of growth stunting and undernutrition during the first year of life and do not exhibit catch-up growth by 12 months of age.

Prevalence and predictors of undernutrition among infants aged six and twelve months in Butajira, Ethiopia: the P-MaMiE Birth Cohort

Background

Child undernutrition is a major public health problem in low income countries. Prospective studies of predictors of infant growth in rural low-income country settings are relatively scarce but vital to guide intervention efforts.

Methods

A population-based sample of 1065 women in the third trimester of pregnancy was recruited from the demographic surveillance site (DSS) in Butajira, south-central Ethiopia, and followed up until the infants were one year of age. After standardising infant weight and length using the 2006 WHO child growth standard, a cut-off of two standard deviations below the mean defined the prevalence of stunting (length-for-age <-2), underweight (weight-for-age <-2) and wasting (weight-for-length <-2).

Results

The prevalence of infant undernutrition was high at 6 months (21.7% underweight, 26.7% stunted and 16.7% wasted) and at 12 months of age (21.2% underweight, 48.1% stunted, and 8.4% wasted). Significant and consistent predictors of infant undernutrition in both logistic and linear multiple regression models were male gender, low birth weight, poor maternal nutritional status, poor household sanitary facilities and living in a rural residence. Compared to girls, boys had twice the odds of being underweight (OR = 2.00; 95%CI: 1.39, 2.86) at 6 months, and being stunted at 6 months (OR = 2.38, 95%CI: 1.69, 3.33) and at 12 months of age (OR = 2.08, 95%CI: 1.59, 2.89). Infant undernutrition at 6 and 12 months of age was not associated with infant feeding practices in the first two months of life.

Conclusion

There was a high prevalence of undernutrition in the first year of infancy in this rural Ethiopia population, with significant gender imbalance. Our prospective study highlighted the importance of prenatal maternal nutritional status and household sanitary facilities as potential targets for intervention.

Intergenerational effect of weight gain in childhood on offspring birthweight

Background Some studies suggest that weight gain in childhood may increase the risk of chronic diseases in adulthood, and recent studies have noticed that the timing of weight gain may be related to its long-term consequence. However, weight gain in childhood has clear short-term benefits, and the literature on the pro and cons of weight gain in childhood is limited.

Methods In 1982, all 5914 hospital births (over 99% of all deliveries) occurring in Pelotas, Southern Brazil, were identified and studied prospectively on several occasions. In 2004–05, we attempted to trace the whole cohort and information on offspring birthweight was collected. Conditional growth modelling was used to assess the association between offspring birthweight and weight gain from birth to 20 months, and from 20 to 42 months.

Results In 2004–05, we interviewed 4297 subjects, with a follow-up rate of 77.4%. This manuscript includes data from 848 women who had already delivered a child and 525 men who were fathers at the mean age of 23 years. Maternal birthweight, weight and length for age Z-score at 20 months of age were positively associated with next-generation birthweight, whereas paternal variables were not related to the outcome. Conditional growth modelling analyses showed that women whose weight gain in the first 20 months of life was faster than predicted had heavier babies, whereas paternal weight gain was not associated. The association was strongest for mothers whose birthweight for gestational age was in the lowest tertile.

Conclusion Maternal, but not paternal birthweight and weight gain in early childhood are positively associated with next-generation birthweight.

Adverse birth outcomes in a malarious area

To determine factors associated with fetal growth, preterm delivery and stillbirth in an area of high malaria transmission in Southern Malawi, a cross-sectional study of pregnant women attending and delivering at two study hospitals was undertaken. A total of 243 (17.3%) babies were preterm and 54 (3.7%) stillborn. Intra-uterine growth retardation (IUGR) occurred in 285 (20.3%), of whom 109 (38.2%) were low birthweight and 26 (9.1%) preterm. Factors associated with IUGR were maternal short stature [adjusted odds ratio (AOR) 1.6, 95% confidence interval (CI) 1.0-2.5]; primigravidae (AOR 1.9, 95% CI 1.4-2.7); placental or peripheral malaria at delivery (AOR 1.4, 95% CI 1.0-1.9) and maternal anaemia at recruitment (Hb<8 g/dl) (AOR 1.9, 95% CI 1.3-2.7). Increasing parasite density in the placenta was associated with both IUGR (P=0.008) and prematurity (P=0.02). Factors associated with disproportionate fetal growth were maternal malnutrition [mid-upper arm circumference (MUAC)<23 cm, AOR 1.9, 95% CI 1.0-3.7] and primigravidae (AOR 1.8, 95% CI 1.0-3.1). Preterm delivery and stillbirth were associated with <5 antenatal care visits (AOR 2.2, 95% CI 1.3-3.7 and AOR 3.1, 95% CI 1.4-7.0 respectively) and stillbirth with a positive Venereal Disease Research Laboratory (VDRL) test (AOR 4.7, 95% CI 1.5-14.8). Interventions to reduce poor pregnancy outcomes must reduce the burden of malaria in pregnancy, improve antenatal care and maternal malnutrition.

Early and late growth and blood pressure in adolescence

OBJECTIVE

To assess the effect of growth during infancy and childhood on blood pressure in adolescence.

DESIGN

Birth cohort study.

SETTING

Pelotas, southern Brazil.

PARTICIPANTS

749 adolescents with complete information on birth weight and gestational age, as well as on anthropometric data at all three follow up visits (mean age 20 months, 42 months, and 15 years).

MAIN OUTCOME MEASUREMENTS

Systolic and diastolic blood pressure at adolescence.

RESULTS

After controlling for possible confounding variables, birth weight was negatively associated with systolic blood pressure, one unit increase in standard deviation score of birth weight for gestational age was associated with a decrease of 1.23 mm Hg (95% confidence intervals -2.03 to -0.43) in systolic blood pressure. Weight for age z score at the age of 15 years showed a strong positive association with systolic blood pressure, one unit increase in standard deviation score of birth weight for gestational age was associated with an increase of 4.4 mm Hg (95% confidence intervals 3.50 to 5.3). Diastolic blood pressure was not associated with birth weight. For adequate for gestational age infants, the positive association between weight in adolescence and blood pressure became stronger when previous weights were added to the model.

CONCLUSION

This study showed that early--as well as--late catch up growth is associated with increased systolic blood pressure in adolescence, whereas only late catch up is related with diastolic blood pressure. These findings suggest that catch up growth, irrespective of age, is associated with increased blood pressure in adolescence.

An Ethiopian birth cohort study

A one-year birth cohort was studied in Jimma town, South West Ethiopia, in 1992-93. We report here on the design and on the methods used in the study and describe the principal health outcomes. Infants were visited bimonthly until their first birthday. Background data on the physical, cultural and economic environment of the home were collected at the first visit, and data on nursing and weaning on traditional surgical and other practices, and on vaccination at the first visit and at each subsequent visit. Length, weight and mid upper arm circumference were measured, and details of the mother's handling of illness episodes recorded. Of 1563 children born, 86% were successfully followed to the end of their first year or to an earlier death. There were 141 deaths, indicating an infant mortality of 115/1000 (estimated probability of surviving to 1 year 0.8851, with s.e. 0.0101). The mean length and weight of the singleton infants at the end of their first year was -1.41 and -1.52 SD from the median of the NCHS/WHO reference population. Weights throughout the first year were analysed in more detail using a Reed model, fitted as a random coefficient regression model in ML3-E. There were clear differences in growth across the different ethnic groups, with the best growing group weighing on average about 1 kg more at the end of the first year than the groups growing least well.

Low birth weight and morbidity from diarrhea and respiratory infection in northeast Brazil

OBJECTIVE

To compare morbidity and mortality rates of low birth weight (LBW) and appropriate birth weight infants born at term, focusing on diarrheal and respiratory infections.

STUDY DESIGN

A cohort of 133 LBW infants (1500 to 2499 gm) and 260 appropriate birth weight infants (3000 to 3499 gm), individually matched by sex and season of birth, were followed for the first 6 months of life. None had congenital anomalies and all were from poor families living in the interior of Pernambuco, northeast Brazil. Data on infant deaths, hospitalizations, and morbidity were collected prospectively through daily home visits (except Sundays) from birth through week 8, then twice weekly for weeks 9 to 26. The effects of birth weight were assessed with a variety of multivariable techniques, controlling for confounders.

RESULTS

Of the LBW infants, 56% were wasted (thin), 23% were stunted, and 17% were both wasted and stunted. The LBW infants (median 2380 gm) experienced a sevenfold higher mortality rate and fourfold higher rate of hospitalization than appropriate birth weight infants. Almost all deaths and hospitalizations were in the postneonatal period. The LBW infants also experienced 33% more days with diarrhea and 32% more days with vomiting (p = 0.003 in each case). The prevalences of cough and fever were not significantly different.

CONCLUSIONS

Infant deaths, hospitalizations, and diarrheal morbidity are increased in term LBW infants who have only a modest weight deficit.