Factors associated with low birthweight among newborns delivered at public health facilities of Nekemte town, West Ethiopia: a case control study

Is Oral Iron and Folate Supplementation during Pregnancy Protective against Low Birth Weight and Preterm Birth in Africa? A Systematic Review and Meta-Analysis

BACKGROUND

Despite recent evidence demonstrating iron and folate supplementation reduces the risk of low birth weight and preterm births, synthesis of the evidence is not sufficient to understand their impacts in Africa.

METHOD

MEDLINE, PsycINFO, Embase, Scopus, CHINAL, Web of Science, Cochrane databases, and Google Scholar were searched for the published and grey literature. Either iron-only, folate-only, or iron-folic acid (IFA) oral supplementation during pregnancy was the primary exposure/intervention. The focus of this review was low birth weight and preterm births in the African region. Qualitative synthesis, meta-analysis, and subgroup analysis were employed.

RESULTS

In the qualitative synthesis (n = 4), IFA supplementation showed a positive impact on reducing preterm birth. Additionally, the meta-analysis showed that IFA and iron-only supplementation reduced the odds of low birth weight by 63% (OR 0.37; 95% CI: 0.29, 0.48) and 68% (OR 0.32; 95% CI: 0.21 to 0.50), respectively.

CONCLUSION

Both iron-only and IFA supplementation are effective in reducing the risk of low birth weight in Africa. There is also promising evidence suggesting a potential reduction in preterm births. Consequently, further research is needed, particularly targeting high-risk groups such as women residing in rural areas with limited support and low levels of literacy.

Determinants of Low Birth Weight Among Newborns Delivered at Public Health Facilities of Bishoftu Town, East Shewa Zone, Ethiopia: Unmatched Case-Control Study

Background: Low birth weight (LBW) is a major global public health issue that can have a number of serious, potentially fatal health consequences. It is the most common cause of neonatal and child death in low- and middle-income countries, which also has a number of negative health effects. However, the determinants of LBWs were not yet completely recognized in Ethiopia. Thus, it is aimed at identifying the determinants of LBW among newborns delivered at public health facilities in Bishoftu town, Ethiopia. Methods: A facility-based unmatched case-control study was conducted at Bishoftu town. Data were collected from mothers having newborns with birth weight < 2500 gm (cases) and 2500 to 4000 gm (controls) using a pretested questionnaire and medical record review. Lastly, Epi Info 7 to enter the obtained data, and SPSS version 21 was used for analysis. Factors in the bivariate analysis with a p value less than 0.25 were added to the multivariable logistic regression, where a p value less than 0.05 was deemed statistically significant. Results:A total of 285 neonates (95 cases and 190 controls) were included in the study. Being not preeclampsia (AOR = 0.34; 95% CI: 0.13-0.88), lack of iron supplementation (AOR = 12.16; 95% CI: 5.40-27.42), preterm delivery (AOR = 7.49, 95% CI: 3.23-17.36), lack of information (AOR = 4.65, 95% CI: 1.37-15.750), and not experienced premature rupture of membranes (PROM) (AOR = 0.27; 95% CI: 0.08-0.91) were identified as statistically significant variables in LBW. Conclusion: LBW was significantly influenced by preeclampsia, PROM, missing iron-folate supplementation during pregnancy, and ignorance of the warning symptoms of premature delivery during pregnancy. Therefore, reducing LBW requires a lot of work, including developing effective interventions and monitoring policies.

Risk Factors Associated With Low-Birth-Weight Babies in Tertiary Health Care Facilities in Lahore, Pakistan: A Case-Control Study

Introduction Low birth weight (LBW) is a well-known contributing factor to neonatal health, emphasizing the importance of maternal health and socio-economic conditions. The birth weight of a newborn is a major public health problem, which is more common in low-middle-income countries (LMICs). Objective The objective of this study is to assess the association of different socio-economic and maternal factors with LBW babies in Lahore. Methods This case-control study was carried out at the Obstetrics and Gynecological Department in Mayo Hospital, Lahore, Pakistan from September 25, 2023 to December 31, 2023. A total of 186 mothers who delivered in the maternity ward, categorized into two groups (93 cases and 93 controls), were included and data was collected with the help of a self-administered structured tool. A chi-square test was used to identify maternal risk factors significant for LBW babies. The strength of association between maternal risk factors and LBW babies was presented using the odds ratio (OR) with the respective 95% confidence interval (CI). Results The study revealed that maternal anemia [OR: 3.378, 95% CI: 1.568, 7.275] and inadequate nutritional status [OR: 1.031, 95% CI: 0.014, 0.071] were more likely to cause delivery of LBW babies. Regarding socio-demographic factors, household income < 25000 [OR: 5.185, 95% CI: 2.770, 9.707] and illiterate mothers [OR: 3.325, 95% CI: 1.820, 6.074] were associated with increased likelihood of LBW babies. Maternal age < 20 had a strong association [OR: 10.920, 95% CI: 2.455,48.575] with delivery of LBW children.  Conclusion The study concludes that multiple risk factors including anemia, inadequate nutritional status, household income < 25000, illiterate mother, and maternal age < 20 are strongly associated with LBW babies. It is apparent that a multimodal strategy is necessary to reduce the risk of LBW babies.

Bayesian rank likelihood-based estimation: An application to low birth weight in Ethiopia

BACKGROUND

Low birth weight is a significant risk factor associated with high rates of neonatal and infant mortality, particularly in developing countries. However, most studies conducted on this topic in Ethiopia have small sample sizes, often focusing on specific areas and using standard models employing maximum likelihood estimation, leading to potential bias and inaccurate coverage probability.

METHODS

This study used a novel approach, the Bayesian rank likelihood method, within a latent traits model, to estimate parameters and provide a nationwide estimate of low birth weight and its risk factors in Ethiopia. Data from the Ethiopian Demographic and Health Survey (EDHS) of 2016 were used as a data source for the study. Data stratified all regions into urban and rural areas. Among 15, 680 representative selected households, the analysis included complete cases from 10, 641 children (0-59 months). The evaluation of model performance considered metrics such as the root mean square error, the mean absolute error, and the probability coverage of the corresponding 95% confidence intervals of the estimates.

RESULTS

Based on the values of root mean square error, mean absolute error, and probability coverage, the estimates obtained from the proposed model outperform the classical estimates. According to the result, 40.92% of the children were born with low birth weight. The study also found that low birth weight is unevenly distributed across different regions of the country with the highest amounts of variation observed in the Afar, Somali and Southern Nations, Nationalities, and Peoples regions as represented by the latent trait parameter of the model. In contrast, the lowest low birth weight variation was recorded in the Addis Ababa, Dire Dawa, and Amhara regions. Furthermore, there were significant associations between birth weight and several factors, including the age of the mother, number of antenatal care visits, order of birth and the body mass index as indicated by the average posterior beta values of (β1= -0.269, CI=-0.320, -0.220), (β2= -0.235, CI=-0.268, -0.202), (β3= -0.120, CI=-0.162, -0.074) and (β5= -0.257, CI=-0.291, -0.225).

CONCLUSIONS

The study showed that the low birth weight estimates obtained from the latent trait model outperform the classical estimates. The study also revealed that the prevalence of low birth weight varies between different regions of the country, indicating the need for targeted interventions in areas with a higher prevalence. To effectively reduce the prevalence of low birth weight and improve maternal and child health outcomes, it is important to concentrate efforts on regions with a higher burden of low birth weight. This will help implement interventions that are tailored to the unique challenges and needs of each area. Health institutions should take measures to reduce low birth weight, with a special focus on the factors identified in this study.

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.

Determinants of low birth weight among newborns delivered in public hospitals of North Shewa Zone, Amhara region, Ethiopia: A case-control study (2023)

BACKGROUND

Low birth weight (LBW), defined as a birth weight less than 2500 g, irrespective of gestational age, poses a significant health concern for newborns. Despite efforts, the incidence of LBW in sub-Saharan Africa has remained stagnant over the past decade, warranting attention from healthcare providers, policymakers, and researchers.

OBJECTIVE

This study aimed to identify factors associated with LBW among newborns delivered in public hospitals of North Shewa Zone, Amhara Region, Ethiopia, from May 2 to June 10, 2023.

METHODS AND MATERIALS

An unmatched case-control study was conducted from May 2 to June 10, 2023, involving 318 participants (106 cases and 212 controls). Data were collected using pretested interviewer-administered structured questionnaires, medical record reviews, and direct anthropometric measurements. Bivariate analyses were conducted, and variables with a p-value ≤ 0.25 were included in a multivariable logistic regression model to determine significant determinants of LBW. A significance level of p < 0.05 was used.

RESULTS

A total of 309 newborns (103 cases and 206 controls) were included, yielding a response rate of 97.2%. Among the findings, females exhibited a higher risk of LBW (adjusted odds ratio [AOR]: 3.13, 95% CI: 1.34, 7.32, p = 0.008), as did mothers aged 20 or younger (AOR: 3.42, 95% CI: 1.35, 8.66, p = 0.009). Lack of formal education was associated with increased risk (AOR: 6.82, 95% CI: 2.94, 15.3, p < 0.001), as were unplanned pregnancies (AOR: 3.08, 95% CI: 1.38, 6.84, p = 0.006) and missed antenatal care visits (AOR: 2.74, 95% CI: 1.16, 6.49, p = 0.021). No significant associations were found with residency type or maternal age above 35.

CONCLUSION

Mothers aged ≤ 20 years, with inadequate minimum dietary diversity, lack of antenatal care attendance, and unplanned pregnancies, faced heightened risks of LBW. Addressing these factors is vital for reducing LBW occurrences and improving newborn health outcomes in Ethiopia.

Dietary diversity and other predictors of low birth weight in Gurage Zone, Ethiopia: Prospective study

BACKGROUND

Low birth weight (LBW) is a major public health problem in Ethiopia. Dietary diversity is a key indicator of maternal dietary adequacy that may affect birth weight but little is known about their relationship. Hence, this study aimed to assess the association of suboptimal maternal dietary diversity during pregnancy and low birth weight in Gurage Zone, Ethiopia.

METHODS

The prospective study was conducted among 1062 pregnant women enrolled consecutively in between 16 to 20 gestational weeks and followed until delivery. The baseline data were collected at recruitment and dietary diversity was assessed using the minimum dietary diversity score for women (MDD-W) tool in three different rounds. The average of three scores was considered to categorize women into optimal (consumed ≥ 5 food groups) and suboptimal (consumed < 5 food groups) dietary diversity groups. The risk of low birth weight among suboptimal dietary diversity was assessed using modified Poisson regression with robust standard error.

RESULTS

Of the 1062 pregnant women recruited, 959 (90.4%) women completed follow-up. Among them, 302 (31.5%) women are having optimal and the rest, 657 (68.5%) women are having suboptimal dietary diversity. The risk of low birth weight was significantly higher among women with sub-optimal dietary diversity than among those with optimal diversity (ARR = 1.89, 95% CI: 1.25, 2.84). Other factors such as rural residence (ARR = 1.61, 95% CI: 1.43, 1.87), age > = 35 years (AAR = 3.94, 95% CI: 2.41, 6.46), being underweight (ARR = 1.81, 95% CI: 1.14, 2.86), height < 150cm (ARR = 4.65, 95% CI: 2.52, 8.59), unwanted pregnancy (ARR = 3.35, 95% CI: 2.23, 5.02), preterm delivery (3.65, 95% CI: 2.27, 5.84) and lack of nutritional counseling (ARR = 1.69, 95% CI: 1.08, 2.67) significantly increased the risk of low birth weight.

CONCLUSION

Suboptimal dietary diversity associated low birth weight. Promoting dietary diversity by strengthening nutritional education and avoiding unwanted pregnancy particularly among rural residents may help to reduce the incidence of low birth weight.

Adverse birth outcome among women who gave birth at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia

BACKGROUND

In Ethiopia, various maternal and child health interventions, including comprehensive and basic obstetric cares were conducted to curb high neonatal and infant morbidity and mortality. As such, adverse birth outcome has been a public health concern in the country. Thus, this study aimed to assess the burden and associated factors with adverse birth outcomes among women who gave birth at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

METHODS

A health facility-based cross-sectional study was employed from 30 March to 01 May 2021 at the University of Gondar Comprehensive Specialized Hospital. A total of 455 women were interviewed using a structured questionnaire. A binary logistic regression model was fitted Adjusted Odds Ratio (AOR) with 95%CI and p-value < 0.05 were used to declare factors significantly associated with adverse birth outcomes.

RESULTS

In this study, 28% of women had adverse birth outcomes (8.4% stillbirths, 22.9% preterm births, and 10.11% low birth weights). Women aged 20-34) (AOR: 0.32, 95%CI: 0.14, 0.76), rural dwellers (AOR: 2.7, 95%CI: 1.06, 6.32), lack of ANC visits (AOR: 4.10, 95%CI: 1.55, 10.85), APH (AOR: 3.0, 95%CI: 1.27, 7.10) and fever (AOR: 7.80, 95%CI: 3.57, 17.02) were associated to stillbirths. Multiple pregnancy (AOR:7.30, 95%CI:1.75, 20.47), rural dwellers (AOR:4.60, 95%CI:1.36, 15.52), preterm births (AOR: 8.60, 95% CI: 3.88, 19.23), previous perinatal death (AOR:2.90, 95%CI:1.35, 6.24), fever (AOR:2.7,95%CI:1.17 ,6.23) and premature rupture of membrane (AOR:2.60, 95% CI:1.02, 6.57) were affecting low birth weights. In addition, previous antepartum hemorrhage (AOR: 2.40, 95%CI: 1.37, 4.10) and fever (AOR: 3.8, 95%CI: 2.13, 6.89) were also factors contributing to preterm births.

CONCLUSION

Adverse birth outcomes continue to pose a significant public health concern. Such high rates of adverse birth outcomes, such as preterm birth, low birth weight, and birth defects, can have serious and long-lasting effects on the health and well-being of both infants and their families, and the community at large. As such, public health efforts are crucial in addressing and mitigating the risk factors associated with adverse birth outcomes. This may involve implementing interventions and policies to improve maternal health, access to prenatal care and nutritional support, and reducing exposure to environmental risks.

A systematic review of dietary data collection methodologies for diet diversity indicators

The purpose of the current study was to critically assess the gaps in the existing methodologies of dietary data collection for diet diversity indicators. The study proposed the importance of smartphone application to overcome the drawbacks. The review paper identified and assessed the conventional methodologies used in diet diversity indicators including Minimum Dietary Diversity for Women (MDD-W), Minimum Dietary Diversity of Infant and Young Child Feeding Practices (IYCF-MDD), and Household Dietary Diversity Score (HDDS). The 80 research studies from 38 countries were critically assessed on the basis of their research aim, study design, target audience, dietary data collection methodology, sample size, dietary data type, dietary data collection frequency, and location point of dietary data collection. Results indicated that most studies employed interviewer-administered 24-h recall assessing the dietary diversity. The review paper concluded that smartphone application had potential to overcome the identified limitations of conventional methodologies including recall bias, social-desirability bias, interviewer training, and cost-time constraints.

Level of exposure to aflatoxins during pregnancy and its association with adverse birth outcomes in Africa: a meta-analysis

BACKGROUND

Aflatoxins are various poisonous carcinogens and mutagens produced by Aspergillus species. Exposure to aflatoxins during pregnancy results in adverse birth outcomes. This meta-analysis was carried out to determine the estimates of how much aflatoxin is harmful to the pregnancy and its outcome, including birthweight, birth length, low birthweight (LBW), small for gestational age (SGA), stunting, poverty, food insecurity, income, pesticides and stillbirth, in an African context.

METHODS

Both published and unpublished studies in Africa were searched on MEDLINE, PubMed, Embase, SCOPUS, Web of Science and Google Scholar. Stata version 18.2 software was used for cleaning and analysis. The prevalence with a 95% confidence interval (CI) was estimated using the random effects model and a forest plot was used to present the findings. In addition, the heterogeneity of the study was assessed using Cochrane I2 statistics and publication bias was assessed using Egger's intercept and funnel plot.

RESULTS

This review included 28 studies with a total of 6283 pregnant women and newborns. The analysis showed the overall level of exposure to aflatoxins was 64% (95% CI 48 to 78, τ2=0.66, I2=99.34%, p=0.001). In the subgroup analysis by publication year, the highest level of exposure to aflatoxins (82% [95% CI 69 to 92]) was observed among studies published from 2020 to 2023. This study also found that exposure to aflatoxins during pregnancy had an association with prematurity, LBW, SGA and stillbirth.

CONCLUSIONS

The data analysed in this study indicated that three of every five pregnant women had exposure to aflatoxins in Africa. Moreover, pregnant women exposed to aflatoxins had a higher likelihood of having a LBW and SGA newborn. Thus governments and all stakeholders should initiate policies that mitigate the toxicity of aflatoxins in pregnant women, foetuses and newborns.

Use of antianemics in prenatal care: A population cohort from a capital city in the North region of Brazil

Anemia during pregnancy is a significant risk factor for adverse maternal and fetal outcomes, including preterm birth, low birth weight, and maternal mortality. In Brazil, anemia prevention and treatment programs are available, but regional variations in prevalence and factors associated with antianemic drug use remain understudied. The objective was to identify the prevalence of gestational anemia and the factors associated with the use of antianemic drugs during pregnancy in a cross-sectional population-based study carried out in Rio Branco, AC. To do so, we planned a cross-sectional, population-based study with a total of 1190 postpartum women who gave birth between April 6 and July 10, 2015, were interviewed about demographic, socioeconomic, reproductive, and prenatal care factors. The prevalence of anemia during pregnancy was found to be 13.8 %, with 93.2 % of women using antianemic drugs, such as ferrous sulfate and folic acid. Factors positively associated with antianemic drug use were higher education (elementary school II RCajust = 2.46; 95 %, CI: 1.01-6.13; high school RCajust = 2.61; 95 %, CI: 1.11-6.12), primiparity (ACadjust = 1.69; 95 %, CI: 0.98-3.74), 6 to 8 prenatal consultations (ACjust = 2.16; 95, CI%: 1.15-4.05), and planned pregnancy (ARjust = 1.94; 95 %, CI: 1.05-3.74). Food security during pregnancy was inversely associated. These findings suggest that while anemia prevention and treatment programs exist, more targeted strategies are needed, particularly for women with lower socioeconomic status, to improve maternal and fetal health outcomes.

Nutrition, stress, and healthcare use during pregnancy are associated with low birth weight: evidence from a case-control study in West Ethiopia

Background

Low Birth Weight (LBW) remains a major public health concern globally, especially in lower and middle-income countries. In Ethiopia in general and in the study area in particular there is limited evidence regarding maternal factors associated with low birth weight. This study aimed to identify the maternal factors associated with low birth weight among neonates born in public health facilities in the west Wollega zone, West Ethiopia.

Methods

We used a case-control study design and selected participant mothers with a newborn using the delivery database from three public hospitals and five health centers, between March 2022 and April 2022. Cases were identified using a newborn birth weight of <2,500 grams. Controls were identified using a newborn birth weight of ≥2,500 grams. An interviewer-administered structured questionnaire and chart review were used for data collection. Model fitness was assessed by Hosmer and Lemenshow goodness-of-fit test, including multi-collinearity checks. Candidate predictor variables were selected (using a value of p <0.25 in bivariable logistic regression models) for multivariable logistic regression to quantify the association between independent variables and LBW, expressed using Odds Ratios (OR) with a 95% Confidence Interval (CI). Mean and Standard Deviation (SD), all such values.

Results

A total of 324 mothers with their newborns (81 cases and 243 controls) were eligible for inclusion. The mean age of participants was 27.9 years (SD 6.4) in cases and 25 years (SD 3.9) in controls. Mean birth weight was 2,128 grams (SD 1,697) in cases and 2,988 grams (SD 378) in controls. In multivariable logistic regression analysis, lack of nutritional counseling (OR = 2.4; 95%CI: 1.24-4.72), maternal middle upper arm circumference of <23 cm (OR = 3.1; 95%CI: 1.64-5.91), maternal stress during pregnancy (OR = 2.8; 95% CI:1.23-6.36), and antenatal follow up less than four visits (OR = 2.8; 95% CI: 1.12-6.82) were independently associated with LBW.

Conclusion

In this study, lack of nutritional counseling, maternal undernutrition, maternal stress during pregnancy, and antenatal follow-up visits less than recommended were associated with LBW. Special attention should be given to promoting antenatal care and counseling mothers on nutrition and relaxation to prevent stress during pregnancy.

Inadequate dietary diversity during pregnancy increases the risk of maternal anemia and low birth weight in Africa: A systematic review and meta-analysis

Inadequately diversified food consumption during pregnancy can lead to micronutrient deficiencies, which can affect maternal and newborn health outcomes. Previous studies on maternal dietary diversity have either been limited to a specific geographical region or consist entirely of systematic reviews, without meta-analyses. Thus, this study aimed to determine the pooled estimate of the association between inadequate dietary diversity during pregnancy, maternal anemia, and low birth weight in Africa. A systematic review of observational studies published between January 2000 and April 2022 was undertaken using the Google Scholar, PubMed, and CINAHL databases. The PRISMA checklist was followed to present the results. Microsoft Excel was used to abstract the data. STATA version 17 was used to analyze the data, and a random-effects meta-analysis model was applied to compute the pooled estimates. The study was registered in PROSPERO with protocol number CRD42022320873. A total of 22 publications with 9,696 participants were included in the final meta-analysis. The pooled adjusted odds ratio (AOR) for inadequate dietary diversity and maternal anemia was 2.15 (95% CI, 1.66-2.65), while that for low birth weight was 2.04 (95% CI, 1.46-2.63). The highest pooled estimate of maternal anemia was reported in Cameroon (AOR = 9.8, 95% CI: 1.68-17.92), followed by Ethiopia (AOR = 2.6, 95% CI: 1.95-3.25). Similarly, the pooled estimates of low birth weight were highest in Cameroon (AOR = 3.04, 95% CI: 1.19-4.88) and Ethiopia (AOR = 1.8, 95% CI: 1.29-2.39). In Africa, pregnant mothers with inadequate dietary diversity are two times more likely to develop anemia and low birth weight. Social protection policies that prioritize pregnant women, maternal nutrition promotion in the community, and dietary counseling during antenatal care visits, using national food-based dietary guidelines, should be strengthened.

Maternal low and high hemoglobin concentrations and associations with adverse maternal and infant health outcomes: an updated global systematic review and meta-analysis

BACKGROUND

Growing evidence suggests low and high maternal hemoglobin (Hb) concentrations may have adverse consequences for maternal and child health. There remain questions on specific Hb thresholds to define anemia and high Hb as well as how cutoffs may vary by anemia etiology and timing of assessment.

METHODS

We conducted an updated systematic review (using PubMed and Cochrane Review) on low (< 110 g/L) and high (≥ 130 g/L) maternal Hb concentrations and associations with a range of maternal and infant health outcomes. We examined associations by timing of Hb assessment (preconception; first, second, and third trimesters, as well as at any time point in pregnancy), varying cutoffs used for defining low and high hemoglobin concentrations and performed stratified analyses by iron-deficiency anemia. We conducted meta-analyses to obtain odds ratios (OR) and 95% confidence intervals.

RESULTS

The updated systematic review included 148 studies. Low maternal Hb at any time point in pregnancy was associated with: low birthweight, LBW (OR (95% CI) 1.28 (1.22-1.35)), very low birthweight, VLBW (2.15 (1.47-3.13)), preterm birth, PTB (1.35 (1.29-1.42)), small-for-gestational age, SGA (1.11 (1.02-1.19)), stillbirth 1.43 (1.24-1.65)), perinatal mortality (1.75 (1.28-2.39)), neonatal mortality (1.25 (1.16-1.34), postpartum hemorrhage (1.69 (1.45-1.97)), transfusion (3.68 (2.58-5.26)), pre-eclampsia (1.57 (1.23-2.01)), and prenatal depression (1.44 (1.24-1.68)). For maternal mortality, the OR was higher for Hb < 90 (4.83 (2.17-10.74)) than for Hb < 100 (2.87 (1.08-7.67)). High maternal Hb was associated with: VLBW (1.35 (1.16-1.57)), PTB (1.12 (1.00-1.25)), SGA (1.17 (1.09-1.25)), stillbirth (1.32 (1.09-1.60)), maternal mortality (2.01 (1.12-3.61)), gestational diabetes (1.71 (1.19-2.46)), and pre-eclampsia (1.34 (1.16-1.56)). Stronger associations were noted earlier in pregnancy for low Hb and adverse birth outcomes while the role of timing of high Hb was inconsistent. Lower Hb cutoffs were associated with greater odds of poor outcomes; for high Hb, data were too limited to identify patterns. Information on anemia etiology was limited; relationships did not vary by iron-deficiency anemia.

CONCLUSION

Both low and high maternal Hb concentrations during pregnancy are strong predictors of adverse maternal and infant health outcomes. Additional research is needed to establish healthy reference ranges and design effective interventions to optimize maternal Hb during pregnancy.

Determinants of Low Birth Weight Among Newborns at Debre Tabor Referral Hospital, Northwest Ethiopia: A Cross-Sectional Study

Introduction

Low birth weight is one of the important predictors of perinatal survival, infant morbidity, and mortality, as well as the risk of developmental disabilities and diseases in the future.

Objective(s)

The study aimed to identify the associated factors of low birth weight among newborns at Debre Tabor referral hospital, Northwest Ethiopia.

Methods

A hospital-based cross-sectional study was conducted from January 1, 2021 to October 30, 2021 at Debre Tabor Referral Hospital. A total sample of 420 newborn birth records was considered. The binary logistic regression model was used to assess the associated factors of low birth weight. The results are presented as crude odds ratios and adjusted odds ratios (AOR) together with their corresponding 95% confidence intervals.

Results

In this study, 422 participants were included. Rural residence (AOR = 2.01; 95%CI 1.10–3.69), married marital status (AOR = 0.82; 95%CI 0.78–0.86), formal education (AOR = 0.79; 95%CI 0.67–0.92), smoking during pregnancy (AOR = 1.19; 95%CI 1.07–1.33), attended antenatal care (ANC) visits (AOR = 0.57; 95%CI 0.35–0.91), diabetes during pregnancy (AOR = 4.34; 95%CI 3.50–5.39), iron supplementation (AOR = 0.23; 95%CI 0.20–0.25), and maternal history of anemia (AOR = 5.87; 95%CI 2.67–12.89) were significantly associated with low birth weight of newborns.

Conclusion

This finding showed that residence, marital status, educational status, smoking during pregnancy, ANC visit, diabetes during pregnancy, iron supplementation, and mother's history of anemia were significantly associated with low birth weight. Therefore, policy makers and public health experts/practitioners should plan smoking preventive public health promotion campaigns. Furthermore, it is important that all health professionals properly manage the possible cause of LBW during pregnancy.

The Impact of Antenatal Balanced Plate Nutrition Education for Pregnant Women on Birth Weight: A Cluster Randomised Controlled Trial in Rural Bangladesh

Low birth weight (LBW) is a global public health problem with the highest prevalence in South Asia. It is strongly associated with maternal undernutrition. In South Asia, intra-household food distribution is inequitable, with lower dietary adequacy in women. Evidence that nutrition education improves diet during pregnancy and reduces LBW is weak. We assessed the impact of nutrition education for pregnant women on birth weight in rural Bangladesh. We conducted a parallel, two-arm, cluster-randomised controlled trial, with 36 clusters allocated equally to intervention (n = 445) or standard care (n = 448). From their first trimester until delivery, intervention participants received education about eating balanced meals to meet daily dietary requirements with diverse food groups. The primary outcome of mean birth weight was 127.5 g higher in the intervention compared to control women, and the intervention reduced the risk of LBW by 57%. Post hoc analyses showed a significantly higher birth weight and a greater reduction in LBW amongst adolescent mothers. The mean number of food groups consumed was significantly higher in the intervention from the third month of pregnancy than in the control. A community-based balanced plate nutrition education intervention effectively increased mean birth weight and reduced LBW, and improved dietary diversity in rural Bangladeshi women.

Association between Maternal Factors, Preterm Birth, and Low Birth Weight of Chilean Singletons

There has been an increase in preterm (PT) births in Western countries in recent years, which is associated with low-birthweight (LBW) children. The aim of this study was to determine the association between maternal factors and PT and LBW Chilean newborns. Methods: This was an analytical cross-sectional study of a national sample of 903,847 newborns and their mothers. The newborn gestational age, birth weight, maternal age, marital status, education, employment situation, and residence were analyzed. A multivariate logistic regression model was applied (α = 0.05) (STATA v.15). The prevalence was 6.8% and 5.0% for PT and LBW, respectively. The probability of the newborns being PT and LBW was 1.18 and 1.22 times if their mothers had <12 years of education and 1.38 and 1.29 times if the mothers were ≥35 years old, respectively. Mothers with <12 years education and ≥35 years were risk factors for PT and LBW newborns. Maternal educational attainment was a protective factor for the Chilean newborns, and a maternal age ≥35 years was a risk factor for PT and LBW.

Influence of gestational weight gain on baby's birth weight in Addis Ababa, Central Ethiopia: a follow-up study

BACKGROUND

Gestational weight gain (GWG) is an important indicator of fetal well-being during pregnancy. Inadequate or excessive GWG could have undesirable effects on birth weight. However, information regarding the influence of GWG on birth weight is lacking from the Ethiopian setting.

OBJECTIVE

This study aimed to determine the influence of GWG and other maternal-related factors on birth weight in Addis Ababa, Ethiopia.

DESIGN AND METHODS

A cohort of pregnant women who received the first antenatal care before or at 16 weeks of gestation in health centres in Addis Ababa were followed from 10 January 2019 to 25 September 2019. Data were collected using a structured questionnaire and medical record reviews. We conducted a multivariable linear regression analysis to determine the independent effect of gestational weight on birth weight.

RESULTS

Of the 395 women enrolled in the study, the participants' pregnancy outcome was available for 329 (83.3%). The mean birth weight was 3130 (SD, 509) g. The proportion of low birth weight (<2500 g) was 7.5% (95% CI 4.8% to 11.0%). Babies born to underweight women were 150.9 g (95% CI 5.8 to 308.6 g, p=0.049) lighter than babies born to normal-weight women. Similarly, babies whose mothers gained inadequate weight were 248 g (95% CI 112.8 to 383.6 g, p<0.001) lighter than those who gained adequate weight. Moreover, babies whose mothers had a previous history of abortion or miscarriages or developed gestational hypertension in the current pregnancy were 147.2 g (95% CI 3.2 to 291.3 g, p=0.045) and 310.7 g (95% CI 62.7 to 552.8 g, p=0.012) lighter, respectively, compared with those whose mothers had not.

CONCLUSIONS

Prepregnancy weight, GWG, having had a previous history of abortion or miscarriages, and developing gestational hypertension during a current pregnancy were independently associated with birth weight. Pregnancy-related weight management should be actively promoted through intensive counseling during routine antenatal care contacts.

Effects of inter-pregnancy intervals on preterm birth, low birth weight and perinatal deaths in urban South Ethiopia: a prospective cohort study

Background

Preterm birth, low birth weight and perinatal deaths are common adverse perinatal outcomes that are linked with each other, and a public health problems contributing to neonatal mortality, especially in developing countries. Although more than half of women in Ethiopia become pregnant within a short interval after the preceding childbirth, whether the short intervals increase the risk of adverse perinatal outcomes or not is understudied. We, therefore, aimed to assess the effects of inter-pregnancy intervals (IPIs) on the adverse perinatal outcomes.

Methods

A community-based prospective cohort study was conducted among 2578 pregnant women in urban South Ethiopia. Pregnant women with IPIs < 24 months (IPIs < 18 and 18–23 months) were exposed groups, and those with IPI 24–60 months were the unexposed group. A multilevel analysis (mixed-effects) was done to estimate the effect of IPIs on preterm birth and low birth weight, and a generalized linear model for a binary outcome (fixed-effect) was done for perinatal deaths, using a 95% confidence level.

Results

In this study, IPI < 18 months found to increase the risk of preterm birth (Adjusted Relative Risk (ARR) = 1.35, 95% CI: 1.02, 1.78), term low birth weight (ARR = 2.20, 95% CI: 1.35, 3.58) and perinatal deaths (ARR = 3.83, 95% CI: 1.90, 7.71) than 24–60 months. The results suggest that, about 9% of preterm birth, 21% of term low birth weight and 41% of perinatal deaths in the study population were attributed to IPI < 18 months. These could be prevented with the removal of the IPI < 18 months in the study population. IPI 18–23 months has shown no effect on the three adverse perinatal outcomes.

Conclusion

This study has shown that, IPI under 18 months has a higher risk of adverse perinatal outcomes than IPI 24–60 months. Due attention should still be given for spacing pregnancies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40748-022-00138-w.

Maternal and neonatal factors associated with low birth weight among neonates delivered at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia

INTRODUCTION

Low birth weight is a major contributory factor to infant mortality. Although low birth weight remains an important public health problem in Ethiopia, little emphasis is paid to its intervention as a means of reducing neonatal mortality. The aim of this study was to assess the magnitude of low birth weight and its associated maternal and neonatal factors in newborns delivered at the University of Gondar Comprehensive Specialized Hospital.

METHODS

Hospital-based cross-sectional study was conducted, and 481 study participants were selected using systematic random sampling methods. Pre-tested interviewer-administered questionnaires were used to collect the data. Bivariable and multivariable binary logistic regression was implemented. Finally, the odds ratio with a 95% CI and a p-value of <0.05 were used to identify factors associated with low birth weight.

RESULT

The prevalence of low birth weight was 12.5% (95% CI; 9.8, 15.7%). Preterm birth (AOR = 38; 95% CI: 15.3, 93.0), pregnancy-induced hypertension (PIH) (AOR = 2.6; 95%CI: 1.1, 6.4), maternal body mass index (BMI) of < 18.5 kg/m² (AOR = 6.8; 95% CI: 1.5, 31.1), and grand multiparity (AOR = 4.2; 95% CI: 1.2, 16) were factors positively associated with low birth weight. However, babies delivered from mothers with age > 35 years (AOR = 0.14:95% CI 0.03, 0.7) had lower odds of low birth weight.

CONCLUSION

In this study, the prevalence of low birth weight was higher than in the previous studies. The study revealed preterm birth, PIH, BMI of < 18.5 kg/m², and grand multiparity were independent factors that increase the low birth weight while maternal age > 35 years reduces the low birth weight. Therefore, healthcare professionals should emphasize the early identification and management of women with PIH, tackling prematurity, and preventing maternal malnutrition through nutritional counseling as much as possible.

Lived experiences of women with low birth weight infants in the Solomon Islands: A descriptive qualitative study

Every year, around 20 million women worldwide give birth to low birth weight (LBW) infants, with majority of these births occurring in low-and middle-income countries, including the Solomon Islands. Few studies have explored the pregnancy lived experience of women who deliver LBW infants. The aim of the study is to understand the lived experience of women in the Solomon Islands who gave birth to LBW infants by exploring their personal (socio-demographic and health), behavioural, social and environmental contexts. We used a qualitative descriptive approach and purposely selected 18 postnatal women with LBW infants in the Solomon Islands for an in-depth interview. All data were analysed using thematic analysis in NVivo. We identified six themes reported as being related to LBW: health issues, diet and nutrition, substance use, domestic violence, environmental conditions and antenatal care. Our findings suggest that women in the Solomon Islands are exposed to various personal, behavioural, social and environmental risk factors during pregnancy that can impact birth outcomes, particularly LBW. We recommend further research should be redirected to look at the factors/themes identified in the interviews.

Maternal Undernutrition and Low Birth Weight in a Tertiary Hospital in Sudan: A Cross-Sectional Study

BACKGROUND

The World Health Organization set a Global Nutrition Target of a 30% reduction in LBW by 2025. Maternal malnutrition/undernutrition is among the most important modifiable risk factors for impaired fetal growth. This study investigates the effect of maternal undernutrition on LBW in Sudan.

METHODS

A cross-sectional study was conducted at Saad Abuelela Hospital in Khartoum, Sudan, from May to October 2020. The sociodemographic and obstetric data of the women were gathered via questionnaire, and their mid-upper arm circumference (MUAC) was measured. Maternal undernutrition was defined as a MUAC of <23 cm.

RESULTS

In total, 1,505 pairs of pregnant women and their newborns were enrolled in the study. The medians [interquartile (IQR)] of the age, parity, and gestational age were 27.0 (9.0) years, 1.0 (3.0), and 38.0 (2.0) weeks, respectively. The median (IQR) of the birth weight was 3,028.0 (690.0) g. Of the 1,505 participants, 182 (12.1%) delivered LBW infants. Multivariate logistic regression showed that MUAC [adjusted odds ratio (AOR) = 0.91, 95% confidence interval (CI) = 0.87-0.96] and gestational age (AOR = 0.79, 95% CI = 0.73-0.85) were negatively associated with LBW. The level of antenatal care <2 visits (AOR = 2.10, 95% CI = 1.30-3.57) was associated with LBW. Women with undernutrition were at a higher risk of delivering LBW infants (AOR = 1.66, 95% CI = 1.09-2.53).

CONCLUSION

LBW is a health problem in Sudan, and women with undernutrition were at a higher risk of delivering LBW infants.

Length of stay in health facilities after childbirth and associated maternal and neonatal factors in Ethiopia: a cross-sectional study from a national survey

OBJECTIVE

This study aimed to assess the length of stay in health facilities after childbirth and associated maternal and neonatal factors in Ethiopia.

DESIGN

A cross-sectional study.

SETTING

Ethiopia.

PARTICIPANTS

2260 mothers who participated in the 2016 Ethiopian Demographic and Health Survey were included in the study.

OUTCOME

Length of stay in health facilities after childbirth was the outcome variable of the study.

RESULT

In Ethiopia, the mean duration of postpartum stay for mothers in health facilities was 21.96 (19.97-23.94) hours. Nine hundred and sixty-eight (34.80%) women remained in health institutions for ≥24 hours after delivery. Gestational age, birth weight and mode of delivery were significantly associated with length of stay. Gestational age was found to be inversely associated with length of stay. Mothers who had a vaginal delivery were 8.89% (adjusted HR (AHR) 8.89, 95% CI (4.28 to 18.46), p<0.001) more likely to discharge earlier from health facilities after delivery, compared with those who had a caesarian section. Women with larger size neonates during birth were 19% (AHR=0.81, 95% CI (0.67 to 0.96), p=0.019) more likely to stay longer in health facilities than women with average size neonates. Women with a smaller size neonate during birth were 16% (AHR=0.84, 95% CI (0.70 to 0.99), p=0.040) more likely to stay longer at a health facility, compared with those with an average size neonate.

CONCLUSION

A small percentage of Ethiopian mothers stayed in health facilities for 24 hours or more after delivery. Encouraging mothers to stay in health facilities for the recommended period after childbirth can play a significant role in reducing maternal and neonatal deaths.

Effect of under-nutrition during pregnancy on low birth weight in Tigray regional state, Ethiopia; a prospective cohort study

Background

Under-nutrition during pregnancy affects birth outcomes and neonatal outcomes. Worldwide, 20.5 million children were low birth weight, mainly in poor countries. However, there is no longitudinal-based evidence on the effect of under-nutrition during pregnancy on birth weight in Tigray regional state. Therefore, this study aimed at investigating the effect of under-nutrition during pregnancy on low birth weight in Tigray regional state.

Methods

We conducted a prospective cohort study among consecutively selected 540 pregnant women attending antenatal care in hospitals from October 2019 to June 2020. Pregnant women with mid upper arm circumference (MUAC) < 23 cm were exposed and those with MUAC≥23 cm were unexposed. Data on socio-demographic, diet, hygiene and anthropometry measurements were collected using pretested and structured questionnaires. SPSS version 25 was used for analysis. A log-binomial model was used to estimate the adjusted risk ratio and its 95%CI of the risk factors for low birth weight. Multi-collinearity was checked using the variance inflation factor (VIF) at a cut-off point of 8 and there was no multi-collinearity.

Result

The overall incidence of low birth weight was 14% (95%CI: 11.1, 17.4%). The incidence of low birth weight was 18.4 and 9.8% among the exposed and unexposed women, respectively. The difference in low birth weight incidence between the exposed and unexposed groups was statistically significant (p-value = 0.006). The risk factors of low birth weight were maternal illiteracy (ARR: 1.8, 95%CI: 1.01, 3.3), low monthly family income < 50 US Dollar (ARR: 1.6, 95%CI: 1.07, 2.2), lack of latrine utilization (ARR: 0.47, 95%CI: 0.28, 0.78), and diet diversity score < 5 (ARR: 1.9, 95%CI: 1.05, 2.61).

Conclusion

Low birth weight was significantly higher among the exposed pregnant women. Maternal illiteracy, low monthly income, lack of latrine utilization, and low DDS were risk factors of low birth weight. It is then important to strengthen nutritional assessment and interventions during pregnancy, with a special attention for illiterate, and low monthly income pregnant women. Again, there has to be a promotion of latrine utilization and consumption of diversified diets.

Level and predictors of dietary diversity among pregnant women in rural South-West Ethiopia: a community-based cross-sectional study

OBJECTIVE

To assess the magnitude of dietary diversity and associated factors among pregnant women in the rural communities of Jimma Zone, south-west Ethiopia.

DESIGN

A community-based cross-sectional study was conducted from 1 June to 30 June 2020.

SETTINGS

The study was conducted in Seka Chekorsa and Mana districts. From a total of 63 listed kebeles, 21 were randomly selected.

PARTICIPANTS

Three hundred sixty first-trimester pregnant women have participated in this study. We used a systematic random sampling method to select the participants after a home-to-home census.

PRIMARY AND SECONDARY OUTCOMES

Dietary diversity was assessed using a 24 hours dietary recall method. Descriptive statistics were computed to describe the study subjects. Bivariate and multivariable logistic regression was run to control for all possible confounding effects and measure the strength of association between the outcome of interest and predictor.

RESULTS

The overall magnitude of adequate dietary diversity was found to be 186 (51.7%); 95% CI 46.1% to 56.4%). Having attended elementary education (adjusted OR (AOR)=2.45; 95% CI 1.33 to 4.51), completed grade 8 (AOR=6.05; 95% CI 2.65 to 13.80), attended high school (AOR=11.69; 95% CI 3.76 to 36.27), completed high school and above (AOR=2.92; 95% CI 1.16 to 7.32), husbands attended high school (AOR=2.92; 95% CI 1.15 to 7.47), family size of less than five (AOR=3.44; 95% CI to 1.77-6.66) were positively significantly associated with adequate dietary diversity. On the other hand, not had additional meal during pregnancy (AOR=0.42; 95% CI 0.21 to 0.83) was negatively associated with adequate dietary diversity.

CONCLUSIONS

We observed that the adequate dietary diversity score of pregnant women was low compared with the pooled proportion of dietary diversity conducted in Ethiopia. Therefore, strengthening and promoting female education through intersectoral collaborations and additional meal counselling during pregnancy is indispensable.

Evaluating Association of Maternal Nutritional Status With Neonatal Birth Weight in Term Pregnancies: A Cross-Sectional Study With Unexpected Outcomes

Introduction

Birth weight is described as the primary determinant of the chances of survival among newborns. Low birth weight (LBW) is considered to be a major public health issue, especially among developing countries where poor maternal nutritional status is identified as a cause of both long and short-term adverse consequences. In developing countries, the majority of the LBW infants are born at term but are affected by intrauterine growth restriction, which might have begun early in the pregnancy period. We conducted this study in order to determine the possible effects of the poor nutritional status of mothers on the birth weight of their newborns. However, in disparity to the previous literature, our study evaluated unpredictable results.

Methods

This is a cross-sectional study that was conducted at two tertiary care teaching hospitals from November 2020 to April 2021 in order to determine the possible effects of the poor nutritional status of mothers on the birth weight of their newborns. 156 women both primigravida and multigravida of ages between 15 and 50 years and those who delivered low birth weight (LBW) babies of either gender at term (37-40 weeks of gestation) were included. For all mothers who delivered LBW (<2500 g) at term, their mid-upper arm circumference (MUAC) was measured by inelastic tape. Mothers with MUAC less than 21 cm were considered malnourished.

Results

A total of 156 study participants were included in the study, with majority (n=112, %=71.8%) of them between the ages of 20 and 30 years. The mean age of all included participants was calculated to be 25.96±4.54 years (ranging from 18 to 38 years). Prevalence of maternal malnutrition was observed in 41 (26.3%) of the included women who delivered LBW babies, in contrast to high prevalence rates in previous literature.

Conclusions

In contrast to the previous literature, our study has shown that the nutritional status of mothers has no significant impact on the weight of neonates and the majority of neonates in our study were not severely low weight

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.

Effects of guided counseling during pregnancy on birth weight of newborns in West Gojjam Zone, Ethiopia: a cluster-randomized controlled trial

Background

The high proportion of birth weight in Ethiopia is hypothesized to be due to inadequate maternal diet which is associated with poor nutrition education during pregnancy. There was no study that evaluated the effect of nutrition education on birth weight in the study area. This study aimed to assess the effects (overall, direct and indirect effects) of guided counseling on the birth weight of neonates.

Methods

A two-arm parallel cluster randomized controlled community trial was conducted from May 1, 2018, to April 30, 2019, in West Gojjam Zone, Northwest Ethiopia. At the baseline, 346 pregnant women in the 11 intervention clusters and 348 pregnant women in the 11 control clusters were recruited. However, birth weight was measured from 258 and 272 newborns in the intervention and control groups, respectively.

In the intervention group, counseling was given monthly for four consecutive months in the participant’s homes. Besides, leaflets with key counseling messages were distributed to each woman in the intervention arm. Pregnant women who attended routine nutrition education given by the health system were recruited as control. Dietary practice, nutritional status, and birth weight were the primary, secondary and tertiary outcomes of this intervention. Data were collected using a structured data collection tool. Birth weight was measured within 48 h after birth. Independent sample t-test, linear mixed-effects model, and path analysis were fitted to assess effects of the intervention.

Results

The intra-cluster correlation coefficient was 0.095. The average birth weight of newborns in the intervention group was 0.257 kg higher compared with their counterparts in the control arm (β = 0.257, P < 0.001). The direct effect of this intervention on birth weight was 0.17 (β = 0.17, P<0.001 ) whereas the indirect effect of this intervention was 0.08 (β = 0.08, P<0.001 ).

Conclusion

Counseling using the health belief model and the theory of planned behavior has a positive effect on improving birth weight. The findings suggest the need for enhancing nutrition education of pregnant women through the application of theories to improve birth weight.

Trial registration

Clinical Trials.gov NCT03627156, “Retrospectively registered Jun, 13, 2018”.

Burden and Determinant of Inadequate Dietary Diversity among Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis

Background

Inadequate dietary diversity intake during pregnancy results in increased risks of negative maternal and perinatal outcomes. About one million neonates die on the first day of life due to inadequate dietary intake during pregnancy as a result of maternal complication and adverse birth outcomes. This review summarizes the burden of inadequate dietary diversity and its determinants among pregnant women at the national level of Ethiopia.

Methods

Studies were retrieved from selected electronic databases, including PubMed, Cochrane Library, and Google Scholar. Random-effects model meta-analysis was used to estimate the pooled burden of inadequate dietary diversity and its determinants at a 95% confidence interval with its respective odds ratio (OR) using statistical R-software version 3.6.1. Moreover, quality appraisal of the included studies, publication bias, and level of heterogeneity were checked with subgroup analysis and sensitivity influential test. The searches were restricted to articles published in the English language only, and Medical Subject Headings (MeSH terms) was used to help expand the search in advanced PubMed search.

Result

A total of 850 articles were identified through the initial search of which 21 studies were included in the final review yielding a total sample size of 9,230 pregnant women. The pooled prevalence of inadequate dietary diversity was 53% (95% CI: 44%, 62%). Food insecurity [AOR = 2.18, (95% CI: 1.02, 4.63)], family size of greater than four [AOR = 1.46, (95% CI: 1.10, 1.95)], rural residence [AOR = 4.52, (95% CI: 1.02, 20.09)], no formal educational status [AOR = 4.50, (95% CI: 1.02, 20.09)], and a lack of counseling about dietary diversity [AOR = 2.75, (95% CI: 2.17, 3.48)] were among the significantly associated factors for inadequate dietary diversity.

Conclusion

In this review, there was a high prevalence of inadequate dietary diversity among pregnant women at the national level in Ethiopia. Therefore, strengthening early counseling and diagnosis of dietary intake and undernutrition during the antenatal care period is important.

Determinants of low birth weight among live birth newborns delivered at public hospitals in Gamo Gofa Zone, South Ethiopia: Unmatched case control study

Background:

Birth weight is one of the major determinants of perinatal survival, infant morbidity, and mortality. There are only few published reports on assessment of low birth weight in Ethiopia and the determinants of low birth weight have not been well characterized.

Objective:

The aim of this study was to assess determinants of low birth weight among live birth newborns delivered at public hospitals in Gamo Gofa Zone, South Ethiopia.

Methods:

Institution-based case control study was conducted from February 25 to April 25, 2018 and consecutively selected 60 cases and 240 controls were enrolled in this study. The data were collected using face-to-face interview and review of medical records. Moreover, we have measured the newborns’ birth weight using a standard weight scale and mother’s mid-upper arm circumference using a standard World Health Organization mid-upper arm circumference measuring tape. Statistical analysis of the data was done using SPSS version 21.

Results:

A total of 300 newborns were included in the study. Late antenatal care booking (adjusted odds ratio = 1.87, confidence interval = [1.32–2.6]), birth interval <2 years (adjusted odds ratio = 0.385, confidence interval = [0.176–0.83]), anemia (adjusted odds ratio = 4.4, confidence interval = [1.84–10.5]), mid-upper arm circumference <23 cm (adjusted odds ratio = 7.99, confidence interval = [3.5–20.3]), nutritional counseling (adjusted odds ratio = 5.85, confidence interval = [2.14–14.8]), and husband smoking (adjusted odds ratio = 4.73; confidence interval = [1.42–15.7]) were found to be determinant factors of low birth weight.

Conclusion:

Most of the determining factors of low birth weight were preventable. Therefore, clinical and public health interventions should target on those determinant factors to prevent its adverse effects.

Interactions between the Physical and Social Environments with Adverse Pregnancy Events Related to Placental Disorders-A Scoping Review

BACKGROUND

Due to different social and physical environments across Africa, understanding how these environments differ in interacting with placental disorders will play an important role in developing effective interventions.

METHODS

A scoping review was conducted, to identify current knowledge on interactions between the physical and social environment and the incidence of placental disease in Africa.

RESULTS

Heavy metals were said to be harmful when environmental concentrations are beyond critical limits. Education level, maternal age, attendance of antenatal care and parity were the most investigated social determinants.

CONCLUSIONS

More evidence is needed to determine the relationships between the environment and placental function in Africa. The results show that understanding the nature of the relationship between social determinants of health (SDH) and placental health outcomes plays a pivotal role in understanding the risk in the heterogenous communities in Africa.

Maternal genitourinary infections and poor nutritional status increase risk of preterm birth in Gasabo District, Rwanda: a prospective, longitudinal, cohort study

BACKGROUND

Preterm birth (PTB) is a leading cause of early childhood mortality and morbidity, including long-term physical and mental impairment. The risk factors for PTB are complex and include maternal nutritional status and infections. This study aimed to identify potentially modifiable risk factors for targeted interventions to reduce the occurrence of PTB in Rwanda.

METHODS

We conducted a prospective, longitudinal cohort study of healthy pregnant women aged 18 to 49 years. Women at 9-15 gestational weeks were recruited from 10 health centers in Gasabo District, Kigali Province between September and October 2017. Pregnancy age was estimated using ultrasonography and date of last menstruation. Anthropometric and laboratory measurements were performed using standard procedures for both mothers and newborns. Surveys were administered to assess demographic and health histories. Categorical and continuous variables were depicted as proportions and means, respectively. Variables with p <  0.25 in bivariate analyses were included in multivariable logistic regression models to determine independent predictors of PTB. The results were reported as odds ratios (ORs) and 95% confidence intervals (CI), with statistical significance set at p <  0.05.

RESULTS

Among 367 participants who delivered at a mean of 38.0 ± 2.2 gestational weeks, the overall PTB rate was 10.1%. After adjusting for potential confounders, we identified the following independent risk factors for PTB: anemia (hemoglobin < 11 g/dl) (OR: 4.27; 95%CI: 1.85-9.85), urinary tract infection (UTI) (OR:9.82; 95%CI: 3.88-24.83), chlamydia infection (OR: 2.79; 95%CI: 1.17-6.63), inadequate minimum dietary diversity for women (MDD-W) score (OR:3.94; CI: 1.57-9.91) and low mid-upper arm circumference (MUAC) < 23 cm (OR: 3.12, 95%CI; 1.31-7.43). indicators of nutritional inadequacy (low MDD-W and MUAC) predicted risk for low birth weight (LBW) but only UTI was associated with LBW in contrast with PTB.

CONCLUSION

Targeted interventions are needed to improve the nutritional status of pregnant women, such as maternal education on dietary diversity and prevention of anemia pre-pregnancy. Additionally, prevention and treatment of maternal infections, especially sexually transmitted infections and UTIs should be reinforced during standard antenatal care screening which currently only includes HIV and syphilis testing.