Distribution and Determinants of Low Birth Weight in Developing Countries

The association between serum uric acid and low birth weight in advance maternal age women with hypertension: An observational study

In China, the implementation of 2-child policy since 2015 entitles increasing number of advanced maternal age. Recently, Chinese hypertensive disorders of pregnancy (HDP) in advanced-age women have attracted significant clinical and epidemiological research interest. Previous studies have shown an association between serum uric acid (SUA) levels and low birth weight (LBW) in children. Several studies have reported that advanced maternal age is a risk factor for many complications in pregnancy, including LBW. However, it remains unclear whether SUA affects LBW risk in advanced maternal age mothers with hypertensive diseases. The study was observational in nature. A total of 692 advanced maternal age with hypertension were enrolled in our study. A variety of demographic and vital sign data, laboratory test results, and pregnancy outcomes were collected. Children born with LBW served as the clinical endpoint. On admission, blood samples were taken, and women with advanced maternal ages were divided into 2 groups based on their SUA levels. In order to investigate the association between SUA and LBW, a logistic regression model was used. E-value analysis was used to determine the residual unmeasured confounding. The mean SUA level was increased in advanced maternal age patients with HDP. Of 692 newborns, 244 (35.26%) have LBW. With possible confounders adjusted, high SUA levels were independent risk factors for LBW (odds ratio [OR]2.88, 95% confidence intervals [CI]1.22-6.81), multivariate logistic regression analysis using SUA as a continuous variable recapitulated the pattern (OR 1.01, 95% CI 1.00-1.01). In addition, SUA levels in women with advanced maternal age and hypertension were linearly related to LBW incidence. According to this study, SUA levels in patients with advanced maternal age and HDP are associated with LBW incidence.

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.

Birth weight mediates the association of maternal undernutrition with child undernutrition prevalence in West Africa

BACKGROUND

Maternal nutritional status before and during pregnancy is an important determinant of foetal health. In West Africa, maternal and child undernutrition remains a major public health problem and it is important to establish the mechanistic pathway linking the two disorders to help address the problem. We therefore assessed the mediating role of low birth weight (LBW) in the relationship of maternal undernutrition with child undernutrition in West Africa.

METHODS

We included recent (2010-2019) DHS data from thirteen West African countries. Poisson regression model with robust standard errors was used to assess the relationship between maternal undernutrition (body mass index and anaemia) and child undernutrition (stunting, wasting, underweight, and anaemia). Structural equation modelling was used to conduct the mediation analysis.

RESULTS

Prevalence of stunting, wasting, underweight, and anaemia among under-five children in West Africa was found to be 32.4%, 8.1%, 20.1%, and 71.5%, respectively. We found children of underweight mothers to be more likely to be undernourished (stunted, wasted, and underweight) and anaemic compared to children of normal-weight mothers. Also, children of anaemic mothers were more likely to be stunted and anaemic but not wasted compared with children of non-anaemic mothers. LBW mediated the observed relationships between maternal BMI and childhood stunting (22.6%), and maternal anaemia and childhood stunting (24.9%), wasting (11.7), and anaemia (6.6%).

CONCLUSION

We found maternal undernutrition to be associated with child undernutrition in West Africa with LBW noted to be a mediator of the observed relationship. We recommend that, to address the child undernutrition problem in West Africa, governments and policymakers must integrate measures to address the burden of LBW.

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.

Multilevel multinomial regression analysis of factors associated with birth weight in sub-Saharan Africa

Birth weight significantly determines newborns immediate and future health. Globally, the incidence of both low birth weight (LBW) and macrosomia have increased dramatically including sub-Saharan African (SSA) countries. However, there is limited study on the magnitude and associated factors of birth weight in SSA. Thus, thus study investigated factors associated factors of birth weight in SSA using multilevel multinomial logistic regression analysis. The latest demographic and health survey (DHS) data of 36 sub-Saharan African (SSA) countries was used for this study. A total of a weighted sample of 207,548 live births for whom birth weight data were available were used. Multilevel multinomial logistic regression model was fitted to identify factors associated with birth weight. Variables with p-value < 0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel multinomial logistic regression analysis, the adjusted Relative Risk Ratio (aRRR) with the 95% confidence interval (CI) was reported to declare the statistical significance and strength of association. The prevalence of LBW and macrosomia in SSA were 10.44% (95% CI 10.31%, 10.57%) and 8.33% (95% CI 8.21%, 8.45%), respectively. Maternal education level, household wealth status, age, and the number of pregnancies were among the individual-level variables associated with both LBW and macrosomia in the final multilevel multinomial logistic regression analysis. The community-level factors that had a significant association with both macrosomia and LBW were the place of residence and the sub-Saharan African region. The study found a significant association between LBW and distance to the health facility, while macrosomia had a significant association with parity, marital status, and desired pregnancy. In SSA, macrosomia and LBW were found to be major public health issues. Maternal education, household wealth status, age, place of residence, number of pregnancies, distance to the health facility, and parity were found to be significant factors of LBW and macrosomia in this study. Reducing the double burden (low birth weight and macrosomia) and its related short- and long-term effects, therefore, calls for improving mothers' socioeconomic status and expanding access to and availability of health care.

Effect of a chimney-fitted improved stove on pregnancy outcomes in Northwest Ethiopia: a randomized controlled trial

BACKGROUND

Exposure to household air pollution during pregnancy has been linked to adverse pregnancy outcomes. Improved stove was implemented in Ethiopia to reduce this exposure and related health problems. However, the effects of improved stove interventions on pregnancy outcomes remains uncertain.

METHOD

Individually randomized stove replacement trial was conducted among 422 households in six low-income rural kebeles of Northwestern Ethiopia. Pregnant women without known health conditions were recruited at ≤ 24 weeks gestation and randomized to an intervention or control group with a 1:1 ratio. A baseline survey was collected and a balance test was done. Two-sided independent samples t-test for continuous outcomes and chi-square for categorical variables were used to compare the effect of the intervention between the groups. Mean differences with 95% CIs were calculated and a p-value of < 0.05 was considered statistically significant.

RESULT

In this study, the mean birth weight was 3065 g (SD = 453) among the intervention group and not statistically different from 2995 g (SD = 541) of control group. After adjusting for covariates, infants born from intervention group weighed 55 g more [95% CI: - 43 to 170) than infants born from the control group, but the difference was not statistically significant (P = 0.274). The respective percentages for low birth weight were 8% and 10.3% for intervention and control groups respectively (P = 0.346). However, the average gestational age at delivery was higher among improved stove users (38 weeks (SD = 8.2) compared to control groups 36.5 weeks (SD = 9.6) with statistically significant difference at 0.91 weeks (95% CI: 0.52 to 1.30 weeks, p < 0.001). The corresponding difference in risk ratio for preterm birth is 0.94 (95% CI:0.92 to 0.97; p < 0.001). The percentages for maternal complications, stillbirth, and miscarriage in the intervention group were not statistically different from the control group.

CONCLUSIONS

While the increase in average birth weight among babies born to mothers using improved stoves was not statistically significant, babies had a longer gestational age on average, offering valuable health benefits. However, the study didn't find a significant impact on other pregnancy outcomes like stillbirth, miscarriage, or maternal complications.

TRIAL REGISTRATION

The study was registered at the Pan African Clinical Trial Registry website under the code PACTR202111534227089, ( https://pactr.samrc.ac.za/ (Identifier). The first trial registration date was (11/11/2021).

Evaluating causal influence of maternal educational attainment on offspring birthweight via observational study and Mendelian randomization analyses

Background

Although extensive discussions on the influence of maternal educational attainment on offspring birthweight, the conclusion remains controversial, and it is challenging to comprehensively assess the causal association between them.

Methods

To estimate effect of maternal educational attainment on the birthweight of first child, we first conducted an individual-level analysis with UK Biobank participants of white ancestry (n = 208,162). We then implemented Mendelian randomization (MR) methods including inverse variance weighted (IVW) MR and multivariable MR to assess the causal relation between maternal education and maternal-specific birthweight. Finally, using the UK Biobank parent-offspring trio data (n = 618), we performed a polygenic score based MR to simultaneously adjust for confounding effects of fetal-specific birthweight and paternal educational attainment. We also conducted simulations for power evaluation and sensitivity analyses for horizontal pleiotropy of instruments.

Results

We observed that birthweight of first child was positively influenced by maternal education, with 7 years of maternal education as the reference, adjusted effect = 44.8 (95%CIs 38.0-51.6, P = 6.15 × 10-38), 54.9 (95%CIs 47.6-62.2, P = 4.21 × 10-128), and 89.4 (95%CIs 82.1-96.7, P = 4.28 × 10-34) for 10, 15 and 20 years of maternal educational attainment, respectively. A causal relation between maternal education and offspring birthweight was revealed by IVW MR (estimated effect = 0.074 for one standard deviation increase in maternal education years, 95%CIs 0.054-0.093, P = 2.56 × 10-13) and by complementary MR methods. This connection was not substantially affected by paternal education or horizontal pleiotropy. Further, we found a positive but insignificant causal association (adjusted effect = 24.0, 95%CIs -150.1-198.1, P = 0.787) between maternal education and offspring birthweight after simultaneously controlling for fetal genome and paternal education; this null causality was largely due to limited power of small sample sizes of parent-offspring trios.

Conclusion

This study offers supportive evidence for a causal association between maternal education and offspring birthweight, highlighting the significance of enhancing maternal education to prevent low birthweight.

A cohort study of maternal near-miss events and its adverse perinatal outcomes: an obstetrical finding in Northwest Ethiopia

BACKGROUND

Globally, various studies have reported that most adverse perinatal outcomes were associated with maternal near-misses. In Ethiopia, studies on adverse perinatal outcomes from maternal near-miss are scarce.

OBJECTIVE

This study aimed to assess the incidence, determinants, and maternal near-miss effects on perinatal outcomes among women at public hospitals in the South Gondar zone in 2021.

STUDY DESIGN

A facility-based prospective cohort study was conducted from January 10, 2021, to May 10, 2021. The chi-square test, multivariable logistic regression methods, and SPSS software were used. The strength of associations and significance level were examined using P values and odds ratios with 95% confidence intervals, respectively. In addition, multicollinearity and model fitness were checked.

RESULTS

A total of 304 respondents (76 exposed and 228 unexposed) were included in the study with a response rate of 100.0%. The incidence rates of adverse perinatal outcomes among exposed and unexposed groups were 71.1% (95% confidence interval, 60.0-73.8) and 21.1% (95% confidence interval, 15.8-28.8), respectively. Multivariable logistic regression showed that short interbirth interval (adjusted odds ratio, 8.39; 95% confidence interval, 5.36-16.08), lower household income (adjusted odds ratio, 3.61; 95% confidence interval, 1.12-6.54), rural residence (adjusted odds ratio, 2.54; 95% confidence interval, 1.21-4.07), previous stillbirth (adjusted odds ratio, 4.24; 95% confidence interval, 1.04-17.31), absence of antenatal care (adjusted odds ratio, 9.84; 95% confidence interval, 4.89-17.51), and anemia (adjusted odds ratio, 4.19; 95% confidence interval, 1.01-17.46) were significantly associated with increased odds of adverse perinatal outcomes.

CONCLUSION

This study revealed that the incidence of adverse perinatal outcomes was significantly higher among exposed groups than unexposed groups. The result signified the need for improving the health of mothers by all stakeholders to improve perinatal outcomes.

Nutritional status of Vietnamese infants assessed by Fenton growth chart and related factors: A cross-sectional study

Importance

Nutritional status of infants, measured by birth weight and length, is an essential factor in neonatal development. Malnutrition in newborns may lead to a higher risk of mortality, neurological and cognitive impairment, and poor language development.

Objective

This study aims to assess the nutritional status of infants and related factors regarding maternal anthropometric characteristics and medical history.

Methods

A cross-sectional study was conducted at the National Hospital of Obstetrics and Gynecology, Vietnam from May 2021 to May 2022 on 340 infants and mothers. Low birth weight was defined following the Intergrowth-21 standards. Stunting was evaluated using the Fenton growth chart when the length was below the 10% percentile line of the gestational week. Multivariate regression models were applied to identify factors associated with the nutritional status of infants.

Results

We found that 12.4% and 14.1% of infants in our study fell into stunted and underweight categories, respectively. Infants of mothers over 35 years old, having a height lower than 150 cm or experiencing anemia during pregnancy were more likely to be stunted or have low birth weight. Serum albumin deficiency during pregnancy was strongly associated with the infant being underweight (odds ratio [OR]  =  2.8, 95% confidence interval [95%CI] 1.1-7.3). Newborns were more likely to be stunted if their mothers had a history of preterm birth (OR = 3.3, 95%CI 1.1-10.2).

Interpretation

Maternal nutritional status is closely related to infant malnutrition, particularly in preterm infants. Improving the understanding of mothers regarding prenatal care, reproductive healthcare, adequate nutritional diet, and multi-micronutrient supplements during pregnancy is therefore important.

A Comparative Cross-sectional Study on Prevalence of Low Birth Weight and its Anticipated Risk Factors

Objective. This study aims to highlight the low birth weight (LBW) in Taiz City (Yemen), as LBW is one of the public health challenges experiencing a profound effect on newborns. Methods. This was a cross-sectional study since the interview and medical records were the sources of data to be analyzed by SPSS. Results. The findings of this study include; a high prevalence of LBW (39.11%), the maternal age was not associated with LBW (P = .68), and education level, economic status, residence place, and health status were not associated with LBW (P < .05). Although the pre-pregnancy BMI, during-pregnancy BMI, MUAC, and gestational age were significantly associated with LBW (P < .05), the only risk factor was gestational age (OR = 9.606, CI = 3.988-23.135, P = .00). Conclusion. LBW is highly prevalent in Taiz (Yemen), so providing good healthcare services is essential to manage LBW incidence.

The association between timing in pregnancy of drought and excess rainfall, infant sex, and birthweight: Evidence from Nepal

Background

Past research on the impact of climatic events, such as drought, on birth outcomes has primarily been focused in Africa, with less research in South Asia, including Nepal. Existing evidence has generally found that drought impacts birthweight and infant sex, with differences by trimester. Additionally, less research has looked at the impact of excess rain on birth outcomes or focused on the impact of rainfall extremes in the preconception period. Using data from a large demographic surveillance system in Nepal, combined with a novel measure of drought/excess rainfall, we explore the impact of these on birthweight by time in pregnancy.

Methods

Using survey data from the 2016 to 2019 Chitwan Valley Study in rural Nepal combined with data from Climate Hazards InfraRed Precipitation with Station, we explored the association between excess rainfall and drought and birthweight, looking at exposure in the preconception period, and by trimester of pregnancy. We also explore the impact of excess rainfall and drought on infant sex and delivery with a skilled birth attendant. We used multilevel regressions and explored for effect modification by maternal age.

Results

Drought in the first trimester is associated with lower birthweight (β = -82.9 g; 95% confidence interval [CI] = 164.7, -1.2) and drought in the preconception period with a high likelihood of having a male (odds ratio [OR] = 1.41; 95% CI = 1.01, 2.01). Excess rainfall in the first trimester is associated with high birthweight (β = 111.6 g; 95% CI = 20.5, 202.7) and higher odds of having a male (OR = 1.48; 95% CI = 1.02, 2.16), and in the third trimester with higher odds of low birth weight (OR = 2.50; 95% CI = 1.40, 4.45).

Conclusions

Increasing rainfall extremes will likely impact birth outcomes and could have implications for sex ratios at birth.

Clinical findings and kidney morphology in chronic kidney disease of unknown cause in India

BACKGROUND

Chronic kidney disease of unknown cause (CKDu) is an emerging health problem in India and other countries worldwide. However, clinical descriptions, including kidney pathology, are scarce.

METHODS

This is a descriptive case series of patients with CKDu from an endemic region in India, with a focus on clinical and biochemical characteristics, kidney biopsy findings, and environmental exposure. Patients with suspected CKDu, aged 20-65, and eGFR 30-80 mL/min/1.73 m2 from rural areas with endemic prevalence of CKDu were included. The exclusion criteria were diabetes mellitus, uncontrolled hypertension, proteinuria >1 g/24 h, or other known kidney diseases. The participants underwent kidney biopsies, and blood and urine samples were collected.

RESULTS

Fourteen participants (3 females, 11 males) with a mean eGFR of 53 (range 29-78) mL/min/1.73 m2 were included. Kidney biopsies showed a combination of chronic tubulointerstitial damage, glomerulosclerosis, and glomerular hypertrophy, with varying degrees of interstitial inflammation. Eight participants had polyuria (diuresis ≥ 3 L/day). The urinary sediments were bland, with no haematuria. Serum potassium and sodium levels were, in most cases, normal but within the lower reference interval.

CONCLUSION

The kidney morphology and clinical characteristics in patients with CKDu in India were similar to those described for CKDu in Central America and Sri Lanka.

Regional with urban-rural variation in low birth weight and its determinants of Indian children: findings from National Family Health Survey 5 data

BACKGROUND

Low birth weight is a key indicator for child health, especially a concern in low-middle-income countries. However, health and medically-related reforms are being actively implemented in some middle-income countries like India. Identifying low birth weight (LBW) babies with their determinants across the whole country is essential to formulate regional and area-specific interventions. The objective of this study was to find out the burden and determinants of LBW on the regional and residential (rural-urban) divisions of India.

METHODS

The present study was based on the NFHS-5 dataset (2019-21), a nationally representative survey in India. A total of 209,223 births were included in this study. A newborn weighing less than 2500 g was considered as LBW. According to the objectives, we used frequency distribution, chi-square test and binary logistic regression analysis for analysing the data.

RESULTS

About 18.24% of the babies were LBW in India, significantly higher in rural areas than in urban areas (18.58% vs 17.36%). Regionally prevalence was more frequent in western (20.63%) and central (20.16%) rural areas. Regarding maternal concerns, in the eastern and southern regions of India, mothers aged 25-34 were less likely to have LBW children than mothers aged 35-49 years. It was found that the risk of LBW was more likely among the children born out of unintended pregnancies in almost all regions except for eastern part. In rural India, women who delivered children at home were more likely to have LBW children in India (AOR = 1.19, CI: 1.12-1.28, p < 0.001) and its central, northern, and southern regions than those who gave birth in institutions. The study indicates that LBW coexists with lower maternal education levels and poor household wealth index across all regions. About 58% and 57% of cumulative effects of independent variables on LBW can be distinguished in urban and rural India, respectively.

CONCLUSIONS

Targeted-specific strategies need to be undertaken as per region and geographical variations. Then only India should be able to decline LBW as proposed by National Health Policy.

Facility-based care for moderately low birthweight infants in India, Malawi, and Tanzania

Globally, increasing rates of facility-based childbirth enable early intervention for small vulnerable newborns. We describe health system-level inputs, current feeding, and discharge practices for moderately low birthweight (MLBW) infants (1500-<2500g) in resource-constrained settings. The Low Birthweight Infant Feeding Exploration study is a mixed methods observational study in 12 secondary- and tertiary-level facilities in India, Malawi, and Tanzania. We analyzed data from baseline facility assessments and a prospective cohort of 148 MLBW infants from birth to discharge. Anthropometric measuring equipment (e.g., head circumference tapes, length boards), key medications (e.g., surfactant, parenteral nutrition), milk expression tools, and human milk alternatives (e.g., donor milk, formula) were not universally available. MLBW infants were preterm appropriate-for-gestational age (38.5%), preterm large-for-gestational age (3.4%), preterm small-for-gestational age (SGA) (11.5%), and term SGA (46.6%). The median length of stay was 3.1 days (IQR: 1.5, 5.7); 32.4% of infants were NICU-admitted and 67.6% were separated from mothers at least once. Exclusive breastfeeding was high (93.2%). Generalized group lactation support was provided; 81.8% of mother-infant dyads received at least one session and 56.1% had 2+ sessions. At the time of discharge, 5.1% of infants weighed >10% less than their birthweight; 18.8% of infants were discharged with weights below facility-specific policy [1800g in India, 1500g in Malawi, and 2000g in Tanzania]. Based on descriptive analysis, we found constraints in health system inputs which have the potential to hinder high quality care for MLBW infants. Targeted LBW-specific lactation support, discharge at appropriate weight, and access to feeding alternatives would position MLBW for successful feeding and growth post-discharge.

Association between inadequate prenatal care and low birth weight of newborns in Peru: Evidence from a peruvian demographic and health survey

Objective

To assess the association between inadequate prenatal care (IPNC) and Low birth weight (LBW) in newborns of singleton gestation mothers in Peru.

Methods

We performed a secondary analysis of data from the 2019 Demographic and Health Survey. We included a total of 10,186 women of reproductive age (15 - 49 years) who had given birth to a singleton child in the last 5 years. The dependent variable was LBW (< 2500 g). The independent variables were IPNC (inadequate: when at least one of the IPNC components was absent [number of PNC visits ≥ 6, first PNC visit during the first trimester, compliance with PNC visit contents, and PNC visits provided by trained health personnel]) and each of its components. We evaluated the association using logistic regression models to estimate crude odds ratios and adjusted odds ratios (aOR) and their respective 95% confidence intervals (95% CI).

Results

We found that approximately six out of 100 live births had LBW and that seven out of 10 women had received IPNC. We observed that receiving IPNC (aOR: 1.39; 95% CI: 1.09 - 1.77) and having less than six prenatal control visits (aOR: 3.20; 95% CI: 2.48 - 4.13) were associated with higher odds of LBW regardless of the mother's age, educational level, occupation, wealth, region, rural origin, ethnicity, sex of the newborns, and place of delivery. While, regarding to the other PNC components, first prenatal control in the first trimester (aOR: 0.99; 95% CI: 0.76 - 1.28) and compliance with prenatal control contents (aOR: 1.07; 95% CI: 0.86 - 1.34), they were associated with lower and higher odds of LBW, respectively, regardless of the same adjustment variables, but it was not statistically significant.

Conclusions

IPNC and having less than six PNC visits were associated with higher odds of LBW. Therefore, it is very important to implement strategies that ensure access to quality prenatal care is necessary to reduce the consequences of LBW.

Factors Influencing Undernutrition among Female Adolescent Students in Darchula District, Nepal

Failure to understand and address the problem of malnutrition and its associated factors among female adolescents could lead to a vicious cycle of intergenerational malnutrition. A cross-sectional study was conducted in six secondary schools of four rural municipalities in Darchula District, Nepal. Data collection for the study was conducted from November 2021 to February 2022. Four hundred female adolescent students aged 15 to 19 years old were selected using quota sampling. The study aims to examine the prevalence of malnutrition by assessing different levels of body mass index (BMI) that is thinness (BMI less than 18.5 kg/m2), normal (18.5 kg/m2 to 24.9 kg/m2), overweight (25 kg/m2 to 29.9 kg/m2) and obese (BMI more than or equal to 30 kg/m2). Along with BMI, factors associated with undernutrition, here identified as thinness, are assessed using a structured questionnaire. Additionally, key informant interviews and review of interventions was performed to understand the gaps in nutrition-related policies and programs of school going adolescents in the study district. Quantitative data analysis included a prevalence study and chi-square test along with simple and multiple logistic regression to obtain crude and adjusted odds ratio at 95% confidence interval for the significant factors with p < 0.05 identified in the chi-square test. Thematic analysis and reviews were used for the synthesis of qualitative data. The results show a 24.7% prevalence of thinness in the study participants. Pre-mensuration status (OR = 5.015, CI = 1.257–20.011, p < 0.022), father having a monthly paying job (OR = 4.384, CI = 1.135–16.928, p < 0.032), father’s foreign employment (OR = 6.96, CI = 1.649–29.377, p < 0.008), household (HH) food insecurity status (OR = 2.079, CI = 1.182–3.658, p < 0.011) and grain/roots/tuber as most commonly bought food (OR = 9.487, CI = 1.182–76.138, p < 0.034) were found to be significantly associated with thinness. Information from the qualitative part identified gaps in existing interventions for an improved nutritional outcome among school going adolescent females. Further studies to understand the nutritional practices and its contributory factors in relation to thinness is encouraged. Stakeholders are urged to effectively address the shortcomings in existing interventions and adopt a more adolescent-centered approach to enhance the nutritional status of female adolescents.

Prevalence and Determinants of Low Birth Weight in India: Findings From a Nationally Representative Cross-Sectional Survey (2019-21)

INTRODUCTION

Low birth weight (LBW) is an important public health indicator extensively linked to infant and child mortality, especially in lower-middle-income countries (LMICs). Globally, 15.5% of all infants are born with LBW while 95% of these occur in LMICs. This study aims to examine the prevalence and determinants of LBW in India.

METHODS

Data were obtained from the fifth National Family Health Survey (NFHS) round conducted during 2019-2021. The study sample included women aged 15-49 years who had a singleton pregnancy in the five years preceding the survey (N=175,240). A bivariate analysis was carried out and a logistic regression model was fitted to assess the maternal determinants affecting the birth weight among newborns.

RESULTS

A total of 175,240 mothers were included in the present study. The proportion of newborns with LBW was 17.29% (n=26366, 95% confidence interval [CI] 17.01, 17.57), of which 6% (n=1450, 95% CI 5.61, 6.41) had very low birth weight (less than 1500 g). An increase in the education level of women or wealth index also resulted in significantly reduced odds of LBW in the newborn. However, the number of antenatal care (ANC) visits lacked any statistically significant association with the odds of having a newborn with LBW.

CONCLUSIONS

The burden of LBW in India in recent years has remained stable despite impressive economic growth and increased public health spending on food security and nutritional supplementation. Strengthening the quality of ANC services for pregnant women with a focus on sensitization and awareness generation for improving maternal nutrition requires high prioritization.

The Association of Periodontal Disease with Low Birth Weight Infants: A Case Control Study

OBJECTIVE

To determine the association between periodontal disease and low birth weight among pregnant women.

METHODS

Data for this case-control study was collected from June 2019 till February 2020. All women in the Gynecology Department of Lady Willingdon Hospital, Lahore, who had delivered a baby within the last 24 h were invited to participate. Women who delivered babies less than 2.5 kg were considered as 'cases' (having low birth weight - LBW - infants) and those having babies of 2.5 kg or more were categorized as 'controls' (normal birth weight infants). The selected sample was matched for age, general health (indicated by mean upper arm circumference) and Hemoglobin levels. Intraoral examination was conducted and gingival color and appearance; calculus, bleeding on probing, CPITN (Community Periodontal Index of Treatment Needs) and CAL (clinical attachment loss) were recorded. A binary logistic regression analysis was conducted to determine the predictors of LBW infants. The predictors were further confirmed by applying chi-squared test for categorical variables and independent sample T test for quantitative variables.

RESULTS

A total of 60 cases and 120 controls were recruited. The logistic regression model suggested that CPITN score (OR 14.893, 95% CI 4.896, 45.301); CAL (OR 2.148, 95% CI 1.271, 3.631); calculus (OR 25.099, 95% CI 1.916, 328.771); mode of delivery (OR 0.175 95% CI 0.060, 0.514); and gingival recession (OR 0.237, 95% CI 0.078, 0.715) were significant predictors of LBW.

CONCLUSION

Periodontal disease was found to be a significant predictor of LBW infants.

Longitudinal Sleep Study in Pregnancy: Cohort Profile and Prevalence and Risk Factors for Sleep Symptoms in the First Trimester

Sleep disorders could influence pregnancy outcomes but evidence for longitudinal associations is scarce. We established a prospective cohort of women to determine incident sleep issues and their adverse health outcomes during pregnancy and beyond, and present here the baseline cohort profile. Antenatal women in gestational weeks 8-12 were recruited (n = 535) and followed-up in each trimester and at 5-6 weeks postpartum (no attrition). Sleep symptoms and disorders were measured using STOP-Bang and Berlin questionnaires and Pittsburgh Sleep Quality Index. Incident health outcomes were extracted from clinical records. At the time of recruitment, habitual snoring was present in 13.8% of participants; "excessive sleepiness during the day" (EDS) in 42.8%; short (<7 h) sleep duration in 46.4%; "having trouble sleeping" in 15.3%; and "poor subjective sleep quality" in 8.6%. Habitual snoring was strongly associated with irregular menstrual periods for one year preceding pregnancy (p = 0.014) and higher BMI (p < 0.001). Higher age was associated with less "trouble sleeping" (OR 0.9, p = 0.033) and longer sleep duration was associated with better "subjective sleep quality" (OR 0.8, p = 0.005). Sleep issues were highly prevalent at baseline and associated with age, irregular menstruation, and obesity. This cohort will provide a robust platform to investigate incident sleep disorders during pregnancy and their effects on adverse pregnancy outcomes and long-term health of women and their offspring.

Epidemiology of neonatal mortality: a spatial and multilevel analysis of the 2019 mini-Ethiopian demographic and health survey data

BACKGROUND

Sub-Saharan African countries are a high-burden region of neonatal mortality and showed slow progress in its reduction. In developing countries, as long as the current trend of mortality persists, achieving a sustainable development target for neonatal mortality would be challenging. The aim of this study was to detect significant geographic areas and identify community and individual-level predictors of neonatal mortality in Ethiopia to draw attention to a policy.

METHODS

A weighted total sample of 24,136 mothers from the 2019 mini-Ethiopian demographic and health survey data were included in the analysis. Global Moran's I statistics was run to check the clustering of neonatal mortality and then kriging interpolation was done to predict the magnitude of neonatal mortality in Ethiopia. In addition, SaTScan analysis was also executed to identify hot spot clusters of neonatal mortality. Finally, a multilevel mixed-effect logistic regression model was used to identify community and individual-level predictors of early neonatal and neonatal mortality.

RESULTS

The lifetime early neonatal and neonatal mortality among mothers in Ethiopia was 5.08 (95% CI: 4.13-6.03) and 6.54 (5.55, 7.52) per 1000 births respectively. Neonatal mortality was spatially clustered in the country and the SaTScan analysis identified significant hotspot areas of neonatal mortality in the Amhara and Afar regions and some areas of the Somali and Oromia regions. Its predicted magnitude was > 8 per 1000 births in wide areas of the Amhara and Benishangul regions. A multilevel mixed-effect logistics regression analysis identified that a lower level of maternal education, being a twin neonate, and being a male neonate were predictors of both early neonatal and neonatal mortality. Whereas, the younger age of mothers predicted neonatal mortality.

CONCLUSIONS

Neonatal mortality in Ethiopia is geographically clustered and sociodemographic and obstetric factors played a significant role. Policy direction should focus on evidence-based practices like midwives-led community and facility-based continuum of care from preconception to postnatal periods to possibly reduce neonatal mortality.

Maternal risk factors associated with term low birth weight in India: A review

Low birth weight is one of the leading factors for infant morbidity and mortality. To a large extent affect, various maternal risk factors are associated with pregnancy outcomes by increasing odds of delivering an infant with low birth weight. Despite this association, understanding the maternal risk factors affecting term low birth weight has been a challenging task. To date, limited studies have been conducted in India that exert independent magnitude of these effects on term low birth weight. The aim of this review is to examine the current knowledge of maternal risk factors that contribute to term low birth weight in the Indian population. In order to identify the potentially relevant articles, an extensive literature search was conducted using PubMed, Goggle Scholar and IndMed databases (1993 – Dec 2020). Our results indi­cate that maternal age, educational status, socio-economic status, ethnicity, parity, pre-pregnancy weight, maternal stature, maternal body mass index, obstetric history, maternal anaemia, gestational weight gain, short pregnancy outcome, hypertension during pregnancy, infection, antepartum haemorrhage, tobacco consumption, maternal occupation, maternal psychological stress, alcohol consumption, antenatal care and mid-upper arm circumference have all independent effects on term low birth weight in the Indian pop­ulation. Further, we argue that exploration for various other dimensions of maternal factors and underlying pathways can be useful for a better understanding of how it exerts independent association on term low birth weight in the Indian sub-continent.

Identification of anthropometric surrogate measurements and their cut-off points for the detection of low birth weight and premature newborn babies using ROC Analysis

Despite the fact that health facilities in Ethiopia are being built closer to communities in all regions, the proportion of home deliveries remains high, and there are no studies being conducted to identify low birth weight (LBW) and premature newborn babies using simple, best, alternative, and appropriate anthropometric measurement in the study area. The objective of the present study was to find the simple, best, and alternative anthropometric measurement and identified its cut-off points for detecting LBW and premature newborn babies. A health facility-based cross-sectional study was conducted in the Dire Dawa city administration, Eastern Ethiopia. The study included 385 women who gave birth in health facility. To evaluate the overall accuracy of the anthropometric measurements, a non-parametric receiver operating characteristic curve was used. Chest circumference (AUC = 0⋅95) with 29⋅4 cm and mean upper arm circumference (AUC = 0⋅93) with 7⋅9 cm proved to be the best anthropometric diagnostic measure for LBW and gestational age, respectively. Also, both anthropometric measuring tools are achieved the highest correlation (r = 0⋅62) for LBW and gestational age. Foot length had a higher sensitivity (94⋅8 %) in detecting LBW than other measurements, with a higher negative predictive value (NPV) (98⋅4 %) and a higher positive predictive value (PPV) (54⋅8 %). Chest circumference and mid-upper arm circumference were found to be better surrogate measurements for identifying LBW and premature babies in need of special care. More research is needed to identify better diagnostic interventions in situations like the study area, which has limited resources and a high proportion of home deliveries.

Study on low birth weight and its associated factors among newborns delivered in a tertiary care hospital of Banda district, Uttar Pradesh

Background: Low birth weight is associated with higher morbidity and mortality including impaired growth and development, malnutrition etc. Worldwide, one- fifth of newborns delivered are low birth weight. Aims & objectives: To estimate frequency of low birth weight & its associated factors among newborns delivered in a tertiary care hospital. Materials & Methods: A cross sectional analysis of 290 newborns delivered in tertiary care hospital, Banda, Uttar Pradesh during period of 15th February 2021 to 31st December 2021 was done for estimating low birth weight frequency & its associated factors including child characteristics, mother characteristics & father characteristics using data from medical record section of hospital. Frequency, percentages, mean, standard deviation, chi square test & independent t- test was used. P value <0.05 was considered significant. Results: 91 out of 290 newborns delivered were low birth weight (27.9%, 95% CI- 23.1%- 33.4%). The following factors were shown to have a significant association with low birth weight: education of mother (p=0.04), education of father (p=0.03), occupation of father (p=0.02), and duration of pregnancy (p<0.001). Conclusion: This study demonstrated that education of mother, education of father, occupation of father, and duration of pregnancy had significant association with low birth weight frequency that suggests that improving literacy status can help in decreasing burden of low birth weight apart from other factors.

Maternal hemoglobin and risk of low birth weight: A hospital-based cross-sectional study in Nepal

Background

Maternal hemoglobin during pregnancy is an important predictor of neonatal outcomes such as birth weight. The newborn weight of an infant is considered a crucial factor for morbidity and mortality. This study aimed to assess the association between maternal hemoglobin concentration and newborn weight at term pregnancy.

Methods

A hospital-based cross-sectional study was conducted at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from 14^th April 2018 to 13^th April 2019. Term singleton pregnant women who were admitted for delivery in the labor room of TUTH were included in this study. Maternal characteristics such as age, parity, birth space, ethnicity, education level, dietary habit, body mass index (BMI), and hemoglobin level were recorded. The newborn weight was taken immediately after delivery. The main outcome of this study was the birth weight. The association between hemoglobin level and newborn weight was analyzed using bivariate and multivariable logistic regression analysis.

Results

Of 2,418 term pregnant women, the prevalence of low hemoglobin and high hemoglobin levels were 24% (95% CI: 22-25.4), and 17% (95% CI: 15.7-18.7), respectively. The prevalence of low birth weight (LBW) was 12.9% (95% CI: 11.7-14.4). Multivariable logistic regression analysis showed that those mothers who had low hemoglobin concentration (adjusted Odds Ratio/aOR = 3.77, 95% CI: 2.84-5.01), and high hemoglobin concentration (aOR = 3.07, 95% CI: 2.23-4.24) had higher odds of having LBW compared to mothers having normal hemoglobin level. Mothers with both young age pregnancy (aged 16-20 years) and older pregnancy (aged ≥31 years) (aOR = 1.60, 95% CI: 1.01-2.52) and (aOR = 1.60, 95% CI: 1.06-2.41), respectively had higher odds of LBW compared to mothers aged 21-25 years. Those mothers who attended a primary level of education had higher odds of (aOR = 1.93, 95% CI: 1.05-3.55) LBW compared to those mothers with a higher level of education. Moreover, mothers who belonged to Janajati ethnic group (aOR = 0.47, 95% CI: 0.34-0.65) compared to the Brahmin/Chhetri ethnic group, and mothers with a birth space of more than three years (aOR = 0.63, 95% CI: 0.41-0.97) compared to those who had less than three years of birth spacing and mothers who were overweight/obese (aOR = 0.74, 95% CI: 0.55-0.99) compared to normal nutritional status had lower odds of having LBW.

Conclusions

Our study concludes that both low and high hemoglobin had an increased risk of having low birth weight. Policies and programs can benefit by adopting the findings of this study. More empirical research is critical to understanding the impact of hemoglobin levels on birth weight.

Analysing outlier communities to child birth weight outcomes in Malawi: application of multinomial logistic regression model diagnostics

Studies have reported significant effect of geographically shared variables on new-born baby weight. Although there is growing use of community-based child health interventions in public health research, such as through provinces, schools, or health facilities, there has been less interest by researchers to study outlying communities to child birth weight outcomes. We apply multinomial logistic regression model diagnostics to identify outlier communities to child birth weight in Malawi. We use a random sample of 850 clusters, each with at least 7 households based on 2015-16 Malawi demographic and health survey data. There were a total of 11,680 children with measured birth weight, that was categorised as either low ([Formula: see text] grams), normal ([Formula: see text] grams) or high ([Formula: see text] grams). The analyses were done in STATA version 15 and R version 3.6.3. Based on a multinomial logit model with various socio-demographic factors associated with child birth weight, the results showed that two clusters from rural parts of Southern region of Malawi had overly influence on estimated effects of the factors on birth weight. Both clusters had normal to high birth weight babies, with no child having low birth weight. There could be some desired motherhood practices applied by mothers in the two rural clusters worth learning from by policy makers in the child healthcare sector.

Drivers and distribution of the household-level double burden of malnutrition in Bangladesh: analysis of mother-child dyads from a national household survey

OBJECTIVE

The double burden of malnutrition (DBM) has become an emerging public health issue in many low- and middle-income countries. This study aims to provide important evidence for the prevalence of different types of DBM at the national and subnational levels in Bangladesh.

DESIGN

The study utilised data from the latest Bangladesh Demographic and Health Survey (BDHS) 2017-2018. Multivariable logistic regression was performed to identify the sociodemographic factors associated with DBM.

SETTING

Nationally representative cross-sectional survey.

PARTICIPANTS

8697 mothers aged 15 to 49 years with <5 children.

RESULTS

The overall prevalence of the DBM was approximately 21 %, where the prevalence of overweight mother (OWM) & stunted child/wasted child/underweight child (SC/WC/UWC) and underweight mother (UWM) & overweight child (OWC) was 13·35 % and 7·69 %, respectively, with a higher prevalence among urban households (OWM & SC/WC/UWC = 14·22 %; UWM & OWC = 10·58 %) in Bangladesh. High inequality was observed among UWM & OWC dyads, concentration index (CI) = -0·2998, while low level of inequality of DBM were observed for OWM & SC (CI = 0·0153), OWM & WC (CI = 0·1165) and OWM & UWC (CI = 0·0135) dyads. We observed that the age and educational status of the mother, number of children, fathers' occupation, size and wealth index of the household, and administrative division were significantly associated with all types of DBM.

CONCLUSIONS

Health policymakers, concerned authorities and various stakeholders should stress the prevalence of DBM issues and take necessary actions aimed at identifying and addressing the DBM in Bangladesh.

Association of geographic distribution and birth weight with sociodemographic factors of the maternal and newborn child of hilly and mountain regions of eastern Nepal: a cross-sectional study

OBJECTIVES

To determine the association of geographic distribution, and birth weight with sociodemographic factors of the maternal and newborn child of hilly region (lower altitude) and mountain region (high altitude) of eastern Nepal as well as the prevalence of low birth weight (LBW) and large for gestational age (LGA) among term singleton deliveries in eastern Nepal.

METHODOLOGY

A cross-sectional study was conducted in the district-level hospitals of Dhankuta, Tehrathum, Solukhumbu and Taplejung districts of eastern Nepal of Province 1. Mothers with preterm or post-term delivery, multiple pregnancies, stillbirth/intrauterine fetal death and incomplete records were excluded from the study with only 1386 term pregnancies (37-42 weeks) delivered at the respective facilities between 17 July 2019 and 16 July 2020 were included. The appropriate data were entered in Microsoft Excel 2019 V.16.0 and statistical analysis was performed by using the statistical package for social sciences, IBM SPSS V.29.

RESULTS

The low maternal age, Dalit ethnic group, low gravidity, low parity, higher antenatal care (ANC) visits (≥4), incomplete deworming and dT vaccination status, breech deliveries and LBW newborns were significantly attributed to hilly region (lower altitude) (p value <0.05). Similarly, the hilly region, lower and/or no ANC visits and early term gestation had significant negative association with birth weight at the lower quantiles only. Meanwhile, the female newborn had significant and negative association with birth weight distribution at all seven quantiles. The prevalence of the LBW, average for gestational age and LGA newborn child among term singleton deliveries in Eastern Nepal is 6.6%, 85.8% and 7.6%, respectively.

CONCLUSIONS

The local organisations should focus on adequate antenatal care visits in mountain region and coverage of dT vaccine and deworming medications in hilly region. Appropriate measures and programmes should be initiated to bring down LBW in hilly region.

Factors Associated with Low Birthweight in Low-and-Middle Income Countries in South Asia

Child with Low Birth Weight (LBW) has a higher risk of infant mortality, learning difficulties in childhood due to stunted growth and impaired neurodevelopment, is more likely to develop heart diseases and diabetes in adulthood. This study aimed to evaluate the latest demographic and health surveys (DHSs) across multiple countries in South Asia to determine the factors associated with LBW among these countries. Latest available DHS data across Afghanistan (2015, n = 29,461), Bangladesh (2018, n = 20,127), Nepal (2016, n = 12,862), and Pakistan (2018, n = 15,068) were analysed. Complex survey adjusted generalized linear models were fitted to investigate the association of birth weight with sociodemographic and decision-making factors. Pakistan had the highest proportion of LBW at 18% followed by Afghanistan and Bangladesh at around 14% and Nepal had the lowest (13%). Children born in Pakistan were more likely to have LBW children than Afghanistan (AOR = 2.17, 95% CI = 1.49-3.14). Mothers living in rural areas (AOR = 0.77, 95% CI = 0.61-0.97), with highly educated partners and belonging to richer families were less susceptible to having child with LBW. To reduce 30% LBW in-line with the World Health Organisation's 2025 goal, policymakers in SA should focus on women in urban areas with low-educated partners belonging to poor households to ease LBW burden.

Gains in body mass and body water in pregnancy and relationships to birth weight of offspring in rural and urban Pune, India

Maternal size, weight gain in pregnancy, fetal gender, environment and gestational age are known determinants of birth weight. It is not clear which component of maternal weight or gained weight during pregnancy influences birth weight. We evaluated the association of maternal total body water measured by the deuterium dilution technique (TBW-D₂O) at 17 and 34 weeks of gestation with birth weight. A secondary aim was to examine the utility of bioimpedance spectroscopy (BIS) to determine total body water (TBW-BIS) in pregnancy. At 17 and 34 weeks of pregnancy, ninety-nine women (fifty-one rural and forty-eight urban) from Pune, India had measurements of body weight, TBW-D₂O, TBW-BIS and offspring birth weight. At 17 weeks of gestation, average weights for rural and urban women were 45⋅5 ± 4⋅8 (sd) and 50⋅7 ± 7⋅8 kg (P < 0⋅0001), respectively. Maternal weight gains over the subsequent 17 weeks for rural and urban women were 6⋅0 ± 2⋅2 and 7⋅5 ± 2⋅8 kg (P = 0⋅003) and water gains were 4⋅0 ± 2⋅4 and 4⋅8 ± 2⋅8 kg (P = 0⋅092), respectively. In both rural and urban women, birth weight was positively, and independently, associated with gestation and parity. Only for rural women, between 17 and 34 weeks, was an increase in dry mass (weight minus TBW-D₂O) or a decrease in TBW-D₂O as a percentage of total weight associated with a higher birth weight. At both 17 and 34 weeks, TBW-BIS increasingly underestimated TBW-D₂O as the water space increased. Differences in body composition during pregnancy between rural and urban environments and possible impacts of nutrition transition on maternal body composition and fetal growth were demonstrated.

Machine learning algorithms for predicting low birth weight in Ethiopia

Background

Birth weight is a significant determinant of the likelihood of survival of an infant. Babies born at low birth weight are 25 times more likely to die than at normal birth weight. Low birth weight (LBW) affects one out of every seven newborns, accounting for about 14.6 percent of the babies born worldwide. Moreover, the prevalence of LBW varies substantially by region, with 7.2 per cent in the developed regions and 13.7 per cent in Africa, respectively. Ethiopia has a large burden of LBW, around half of Africa. These newborns were more likely to die within the first month of birth or to have long-term implications. These are stunted growth, low IQ, overweight or obesity, developing heart disease, diabetes, and early death. Therefore, the ability to predict the LBW is the better preventive measure and indicator of infant health risks.

Method

This study implemented predictive LBW models based on the data obtained from the Ethiopia Demographic and Health Survey 2016. This study was employed to compare and identify the best-suited classifier for predictive classification among Logistic Regression, Decision Tree, Naive Bayes, K-Nearest Neighbor, Random Forest (RF), Support Vector Machine, Gradient Boosting, and Extreme Gradient Boosting.

Results

Data preprocessing is conducted, including data cleaning. The Normal and LBW are the binary target category in this study. The study reveals that RF was the best classifier and predicts LBW with 91.60 percent accuracy, 91.60 percent Recall, 96.80 percent ROC-AUC, 91.60 percent F1 Score, 1.05 percent Hamming loss, and 81.86 percent Jaccard score.

Conclusion

The RF predicted the occurrence of LBW more accurately and effectively than other classifiers in Ethiopia Demographic Health Survey. Gender of the child, marriage to birth interval, mother’s occupation and mother’s age were Ethiopia’s top four critical predictors of low birth weight in Ethiopia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-01981-9.

Demographic, socio-economic, obstetric, and behavioral factors associated with small-and large-for-gestational-age from a prospective, population-based pregnancy cohort in rural Nepal: a secondary data analysis

BACKGROUND

In South Asia, a third of babies are born small-for-gestational age (SGA). The risk factors are well described in the literature, but many studies are in high-and-middle income countries or measure SGA on facility births only. There are fewer studies that describe the prevalence of risk factors for large-for-gestational age (LGA) in low-income countries. We aim to describe the factors associated with SGA and LGA in a population-based cohort of pregnant women in rural Nepal.

METHODS

This is a secondary data analysis of community-based trial on neonatal oil massage (22,545 women contributing 39,479 pregnancies). Demographic, socio-economic status (SES), medical/obstetric history, and timing of last menstruation were collected at enrollment. Vital signs, illness symptoms, and antenatal care (ANC) attendance were collected throughout the pregnancy and neonatal weight was measured for live births. We conducted multivariate analysis using multinomial, multilevel logistic regression, reporting the odds ratio (OR) with 95% confidence intervals (CIs). Outcomes were SGA, LGA compared to appropriate-for-gestational age (AGA) and were multiply imputed using birthweight recalibrated to time at delivery.

RESULTS

SGA was associated with nulligravida (OR: 2.12 95% CI: 1.93-2.34), gravida/nulliparous (OR: 1.86, 95% CI: 1.26-2.74), interpregnancy intervals less than 18 months (OR: 1.16, 95% CI: 1.07-1.27), and poor appetite/vomiting in the second trimester, (OR: 1.27, 95% CI: 1.19-1.35). Greater wealth (OR: 0.78, 95% CI: 0.69-0.88), swelling of hands/face in the third trimester (OR: 0.81, 95% CI: 0.69-0.94) parity greater than five (OR: 0.77, 95% CI: 0.65-0.92), male fetal sex (OR: 0.91, 95% CI: 0.86-0.98), and increased weight gain (OR: 0.93 per weight kilogram difference between 2^nd and 3^rd trimester, 95% CI: 0.92-0.95) were protective for SGA. Four or more ANC visits (OR: 0.53, 95% CI: 0.41-0.68) and respiratory symptoms in the third trimester (OR: 0.67, 95% CI: 0.54-0.84) were negatively associated with LGA, and maternal age < 18 years (OR: 1.39, 95% CI: 1.03-1.87) and respiratory symptoms in the second trimester (OR: 1.27, 95% CI: 1.07-1.51) were positively associated with LGA.

CONCLUSIONS

Our findings are in line with known risk factors for SGA. Because the prevalence and mortality risk of LGA babies is low in this population, it is likely LGA status does not indicate underlaying illness. Improved and equitable access to high quality antenatal care, monitoring for appropriate gestational weight gain and increased monitoring of women with high-risk pregnancies may reduce prevalence and improve outcomes of SGA babies.

TRIAL REGISTRATION

The study used in this secondary data analysis was registered at Clinicaltrials.gov NCT01177111.

Effectiveness of Integrated Maternal Nutrition Intervention Package on Birth Weight in Rwanda

Inadequate maternal nutrition before and during pregnancy is a principal risk factor for poor fetal development, resulting in low birth weight (LBW) and subsequently, poor child growth. Most studies focus on the impact of nutritional interventions after birth while only a few interventions consider integrated nutrition service packages. Therefore, there is limited evidence on whether integrated maternal nutrition interventions have a positive effect on birthweight. Thus, a post-program quasi-experimental study was carried out to determine the effectiveness of the integrated maternal nutrition intervention package on low birth weight in Rwanda. A total of 551 mother–baby pairs from the intervention and 545 controls were included in the analysis. Data regarding socio-demographic, maternal anthropometric parameters, and dietary diversity were collected using a structured questionnaire. Birth weight was assessed right after delivery, within 24 h. Logistic regression, linear regression, and path analysis were fitted to determine the effectiveness of the intervention on birth weight. The study found that the intervention reduced LBW by 66.99% (p < 0.001) and increased average birth weight by 219 g (p < 0.001). Logistic regression identified reduced risk of LBW among the intervention group (AOR = 0.23; 95%CI = 0.12–0.43; p < 0.001). It was also observed that the direct effect of the intervention on birth weight was 0.17 (β = 0.17; p < 0.001) and the main indirect mediator was maternal MUAC (β = 0.05; p < 0.001). Moreover, maternal passive smoking exposure and MUAC < 23 cm were found as risk factors for LBW. This study has demonstrated that an integrated maternal nutritional intervention package can significantly reduce LBW in low-income settings and should, therefore, be considered to improve birth weight.

Household food insecurity and physically demanding work during pregnancy are risk factors for low birth weight in north Shewa zone public hospitals, Central Ethiopia, 2021: a multicenter cross-sectional study

BACKGROUND

Despite numerous efforts to improve the quality of maternal and child health medical services, over 20 million babies are born with low birth weights each year globally. However, factors related to low birth weight like physically demanding work during pregnancy, intimate partner violence, and food insecurity have not been explored well in Ethiopia. Thus, this study aimed to assess the prevalence of low birth weight and associated factors among neonates born in public Hospitals in North Shewa Zone, Central Ethiopia.

METHODS

A hospital-based cross-sectional study design was conducted from June 15 -to July 15, 2021, in North Shewa public hospitals. A total of 441 mothers and newborn pairs were selected by systematic random sampling. Data were collected using a pretested and structured interviewer-administered questionnaire with chart reviewing. Data entry and analysis were done using Epi Data version 3.1 and Statistical Package for the Social Sciences version 26 respectively. Binary logistic regression was done to identify factors associated with low birth weight. Adjusted odds ratio with its 95% confidence interval and a p-value less than 0.05 was considered to declare the statistically significant association.

RESULTS

The prevalence of low-birth-weight was 17.7% (95% CI: 14.3, 21.5). Pregnancy-related complication [AOR = 2.16; 95% CI:(1.12,4.18)], grand-multiparty [AOR = 2.57; 95% CI:(1.12,5.88)], physically demanding work during pregnancy [AOR = 2.19; 95% CI:(1.11,4.33)], midd-upper arm circumference less than 23 cm [AOR = 2.54; 95% CI:(1.26,5.10)], partner violence during pregnancy [AOR = 3.77; 95% CI:(1.81,7.88)], and being member of household with food insecure [AOR = 2.31; 95% CI:(1.12,4.75)] were factors significantly associated with low birth weight.

CONCLUSIONS

This study showed that the magnitude of low birth weight was relatively high. Women with pregnancy-related complications, grand multiparty, physically demanding work during pregnancy, intimate partner violence, mid-upper arm circumference less than 23 cm, and food insecurity should be prioritized for mitigating LBW. Health care professionals should focus on Screening pregnant women for intimate partner violence, physically demanding activities, undernutrition and providing appropriate treatment during all maternal continuum of care might be helpful.

Determinants of Low Birth Weight Occurrence in Bahteramas Regional General Hospital, Southeast Sulawesi Province, Indonesia

Objective: This study aims to identify the determinants of Low Birth Weight (LBW) in Bahteramas General Hospital, Southeast Sulawesi Province, Indonesia. Method: This research uses an institutional-based Case-Control Study design from May to June 2021 at the Bahteramas Hospital, Southeast Sulawesi Province. Data were collected from 134 samples of mothers giving birth, with 67 of them having babies with birth weight <2500 g (cases) and 67 of them having birth weights >2500 g (controls) using secondary data, namely medical records. Data were analyzed by univariate, bivariate with odds ratio test, and multivariate analysis with multiple logistic regression to identify the determinants of LBW.. Result: Based on the logistic regression analysis, it found that the mother's educational status variable was ≤12 years [AOR 0.19 (95% CI 0.06-0.62)]; mothers with parity one or >3 [AOR 0.06 (95% CI 0.01-0.21)]; birth spacing <2 years [AOR 4.49 (95% CI 1.37-14.74)], mothers who had a history of hypertension during pregnancy [AOR 0.07 (95% CI 0.02-0.23)]; and mothers who had a history of anemia during pregnancy [AOR 0.10 (95% CI 0.03-0.31)] with parameter significance in the partial test, each p<0.05, shown to be associated with the incidence of LBW. Conclusions: This study concludes that the mother's low educational status, parity, birth spacing, history of hypertension, and history of anemia were found to be predictors of LBW. It is necessary to improve the knowledge, maintain birth interval, and routinely carry out ANC visits for early detection of pregnancy complications. Keywords: LBW; education status, parity; birth interval; history of hypertension; history of anemia.

Socio-economic and cultural determinants of mothers and fathers for low birth weight newborns in the region of Marrakech (Morocco): A case-control study

Background

Low birth weight (LBW) is defined as a birth weight less than 2500 g. It is an important predictor of early neonatal mortality, morbidity, and long-term health outcomes. The aim of this study was to identify risk factors for low birth weight in Marrakech Morocco.

Methods

A retrospective based case-control study was conducted from July 2018 to July 2019. 462 mother infant pairs (231 low birth weight babies as cases and 231 normal birth weights as controls) were included in the study. Data were collected through face to face interview using a structured and pretested questionnaire. The collected data were managed with Statistical Package for Social Science (SPSS) version 20. Bivariate and multivariate binary logistic regression were used to identify factors associated with low birth weight at p-value < 0.05 with their respective odds ratios and 95% confidence interval.

Results

The univariate analysis revealed the effect of the following determinants on the LBW: rural residence, father’s age, father’s professional activity, consanguinity, family type, mother’s low educational level, and mother’s intense physical activity. After the multivariate analysis, the risk factors identified were: rural residence (P = 0.017), father’s professional activity (temporarily working) (P = 0.000), absence of the consanguinity link (P = 0.016), and mother’s intense physical activity (P = 0.014).

Conclusion

Results show father’s professional activity (temporarily working), rural residence, absence of the consanguinity link and mother’s intense physical activity are independent predictors of low birth weight. The current findings add substantially to the growing literature on the influence of parent’s socio-demographic and cultural factors on LBW in resource-constrained settings and provide empirical data for public health interventions to reduce low birth weight.

Risk factors associated with low birth weight

OBJECTIVES

Low birth weight (LBW) is one of the major factors affecting child morbidity and mortality worldwide. Every day, approximately 800 women die from causes related to pregnancy and childbirth worldwide. Maternal ill health increases the risk of LBW. This study seeks to investigate determinants and incidence of LBW.

METHODS

This study was conducted based on the medical records of mothers and their 1,946 infants born in 2016-2019 at the Department of Gynaecology and Obstetrics of Louis Pasteur University Hospital in Košice. Data on mothers and newborn infants were obtained from the Reports on mothers at childbirth. The inclusion criteria were singleton births and birth weight > 500 g. The exclusion criteria were twins or multiple births, congenital anomalies and stillbirths, birth weight ≥ 4,000 g or ≤ 500 g, and Roma ethnicity. Roma children are more likely to be born prematurely, with low birth weight. Roma mothers have different lifestyle. Univariate analysis was employed to evaluate the association between the independent variables and LBW. Variables that were found to be statistically significant were then further analysed using multivariable logistic analysis for each dependent variable. The implementation of the research was approved by the Ethics Committee.

RESULTS

Of 1,946 newborns, 271 (13.90%) have low birth weight. The mean of birth weight at delivery was 3,068.62 (SD 671.16) grams. Factors that were associated with LBW were primary maternal education (OR = 2.98, 95% CI: 1.08-8.21, p = 0.034), marital status single (OR = 2.88, 95% CI: 1.68-4.94, p < 0.001), number of prenatal care visits less than 8 (OR = 1.62, 95% CI: 1.01-2.61, p = 0.047), and preterm birth (OR = 74.94, 95% CI: 45.44-123.61, p < 0.001).

CONCLUSION

The reducing of LBW requires strategies to improve maternal lifestyle, maternal care before, during and after birth and to strengthen social support.

The Influence of Maternal Factors on Neonatal Intensive Care Unit Admission and In-Hospital Mortality in Premature Newborns from Western Romania: A Population-Based Study

Background and Objectives: Neonatal mortality is a global public health issue, disproportionately affecting low- and middle-income nations. Although Romania is a high-income nation, according to the European Union’s most recent demographic data, it had the second-highest infant death rate in 2019. Although significant progress has been made in the last three decades in lowering newborn mortality, more initiatives to accelerate progress are required to meet the 2030 Sustainable Development Goals (SDG) objective. Therefore, we aimed to develop an observational study to determine the influence of maternal factors on in-hospital neonatal intensive care unit admission and mortality in premature infants born in western Romania. While newborn mortality has decreased globally, the pace of decline is far less than what is desired. Materials and Methods: A retrospective study comprising 328 premature patients and 422 full-term newborns, was developed at a tertiary obstetrics and gynecology clinic in western Romania, comprising the period of the last 24 months before the COVID-19 pandemic and the first 24 months of the pandemic. Results: The following variables were identified as statistically significant risk factors for neonatal intensive care unit admission: age > 35 years, OR = 1.59; twin births, OR = 1.14; low gestational age, OR = 1.66; preeclampsia, OR = 2.33; and peripartum infection, OR = 2.25. The same risk factors, with the exception of twin births, were significantly associated with in-hospital neonatal mortality. Except for a longer duration of maternal hospitalization and neonatal therapy with surfactant, steroids, and antibiotics, the COVID-19 pandemic did not cause significant differences in the evolution and outcomes of preterm newborns. Conclusions: The major maternal risk factors for NICU admission were advanced age, twin pregnancy, low gestational age, preeclampsia, and peripartum infection. Additionally, these characteristics contributed to a high likelihood of death, despite adequate access to medical care and advanced life support for the neonates. Understanding the causes of morbidity and death in neonates admitted to the neonatal intensive care unit enables better prioritization and planning of health services, resource reallocation, and care quality improvement.

Predicting risks of low birth weight in Bangladesh with machine learning

Background and objective

Low birth weight is one of the primary causes of child mortality and several diseases of future life in developing countries, especially in Southern Asia. The main objective of this study is to determine the risk factors of low birth weight and predict low birth weight babies based on machine learning algorithms.

Materials and methods

Low birth weight data has been taken from the Bangladesh Demographic and Health Survey, 2017–18, which had 2351 respondents. The risk factors associated with low birth weight were investigated using binary logistic regression. Two machine learning-based classifiers (logistic regression and decision tree) were adopted to characterize and predict low birth weight. The model performances were evaluated by accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve.

Results

The average percentage of low birth weight in Bangladesh was 16.2%. The respondent’s region, education, wealth index, height, twin child, and alive child were statistically significant risk factors for low birth weight babies. The logistic regression-based classifier performed 87.6% accuracy and 0.59 area under the curve for holdout (90:10) cross-validation, whereas the decision tree performed 85.4% accuracy and 0.55 area under the curve.

Conclusions

Logistic regression-based classifier provided the most accurate classification of low birth weight babies and has the highest accuracy. This study’s findings indicate the necessity for an efficient, cost-effective, and integrated complementary approach to reduce and correctly predict low birth weight babies in Bangladesh.

Neonatal Mortality Rate and Its Determinants: A Community-Based Panel Study in Ethiopia

Background

The Sustainable Development Goals specifically target a reduction in neonatal mortality rates. However, the highest neonatal mortality rates occur in sub-Saharan Africa, including Ethiopia. Although several factors contributing to these high rates have been explored, there continues to be a general dearth of studies and inconsistencies of factors to understand the problem. Therefore, this study aimed to identify the prevalence and factors associated with neonatal mortality in Ethiopia.

Methods

A panel study was conducted among 2,855 pregnant or recently postpartum women selected using the multistage cluster sampling technique from October 2019 to September 2020. Data were collected by experienced and trained female resident enumerators and coded, cleaned, and analyzed using STATA version 16.1 software. We used the Kaplan-Meier survival curve to show the pattern of neonatal deaths during the first 28 days of life. Frequencies and rates were reported along with the percentages and using a 95% confidence interval, respectively. The Cox proportional hazard regression model was used to explore the association of explanatory and outcome variables. Finally, an adjusted hazard ratio with a 95% confidence interval was used to report the results, with a p < 0.05 to declare statistical significance.

Results

The neonatal mortality rate was 26.84 (95% CI: 19.43, 36.96) per 1,000 live births. Neonates born to rural resident mothers (AHR = 2.18, 95% CI: 1.05, 4.54), mothers of advanced age (AHR = 2.49, 95% CI: 1.19, 5.21), and primipara mothers (AHR = 3.16, 95% CI: 1.52, 6.60) had a higher hazard of neonatal mortality. However, neonates born to women who attended technical and vocational level education (AHR = 0.08, 95% CI: 0.01, 0.62) had a lower hazard of neonatal mortality.

Conclusions

The neonatal mortality rate in Ethiopia is high, with increased risk among specific subsets of the population. The findings highlight that neonatal survival can be improved through tailored interventions for rural residents, emerging regions, and primipara women by improving female education and avoiding pregnancy at an advanced maternal age to achieve Sustainable Development Goal target 3.2.

Antenatal care attendance and low birth weight of institutional births in sub-Saharan Africa

BACKGROUND

Low birth weight (LBW) remains a major health problem that affects newborns worldwide. However, there has been growing evidence that antenatal care (ANC) is associated with LBW. Yet, there is a dearth of research investigating the association between ANC attendance and LBW in sub-Saharan Africa (SSA). This study examined the association between the number of ANC visits and LBW using data from 10 sub-Saharan African countries.

METHODS

This study pooled data from the recent Demographic and Health Survey (DHS) of 10 sub-Saharan African countries conducted from 2018 to 2020. A total of 33,585 women aged 15-49 who had live births in the five years preceding the survey were included in this study. Bivariable and multivariable multilevel regression models were fitted to show the association between the number of ANC visits and LBW. Crude odds ratio (cOR) and adjusted odds ratio (aOR) at 95% confidence intervals (CIs) were used in presenting the results of the regression analysis.

RESULTS

The pooled prevalence of LBW was 5.7%. The highest prevalence of LBW was recorded in Gambia (7.2%) with the lowest found in Sierra Leone (2.9%). In terms of eight or more ANC visits, the overall prevalence was 14.5%. Nigeria had the highest prevalence of eight or more ANC visits (43.5%) with the lowest in Rwanda (0.2%). We found a statistically significant association between the number of ANC visits and LBW. Mothers who had eight or more ANC visits were less likely to have LBW children compared to mothers who had less than eight ANC visits [cOR = 0.66; CI = 0.55 - 0.79] and this persisted after controlling for the covariates [aOR = 0.68; CI = 0.56 - 0.82]. Covariates associated with LBW were maternal age, marital status, level of education, age of child, and wealth index.

CONCLUSION

This study has shown a statistically significant association between ANC and LBW in SSA, with women who had eight or more ANC visits being at lower risks of giving birth to children with LBW. We found that eight or more ANC attendance was a protective factor against LBW in SSA. Therefore, it is important for sub-Saharan African countries with low prevalence of eight or more ANC attendance and high LBW prevalence to channel their efforts towards promoting more ANC attendance.

Association between Wood and Other Biomass Fuels and Risk of Low Birthweight in Uganda: A Cross-Sectional Analysis of 2016 Uganda Demographic and Health Survey Data

In utero exposure to household air pollution (HAP) from polluting cooking fuels has been linked to adverse pregnancy outcomes including low birthweight (LBW). No previous study in Uganda has attempted to investigate the association between the different types of biomass cooking fuels and LBW. This study was conducted to investigate the association between wood and other biomass cooking fuel use with increased risk of LBW, using the 2016 Uganda Demographic and Health Survey for 15,270 live births within five years prior to interview. LBW, defined as birthweight of <2500 g, was estimated from maternal recall and health cards. Association between household exposure to the different solid biomass cooking fuels and LBW was determined using multivariable logistic regression. Biomass cooking fuels were used in 99.6% of the households, with few (0.3%) using cleaner fuels and 0.1% with no cooking, while the prevalence of LBW was 9.6% of all live-births. Although the crude analysis suggested an association between wood fuel use and LBW compared to other biomass and kerosene fuel use (AOR: 0.82; 95% CI: 0.67−1.00), after adjusting for socio-demographic and obstetric factors, no association was observed (AOR: 0.94; 95% CI: 0.72−1.22). LBW was significantly more likely among female neonates (AOR: 1.32 (95% CI: 1.13−1.55) and neonates born to mothers living in larger households (AOR: 1.03; 95% CI: 1.00−1.07). LBW was significantly less likely among neonates delivered at term (AOR: 0.39; 95% CI: 0.31−0.49), born to women with secondary or tertiary level of education (AOR: 0.80; 95% CI: 0.64−1.00), living in households with a higher wealth index (AOR: 0.69; 95% CI: 0.50−0.96), Eastern (AOR: 0.76; 95% CI:0.59−0.98) and Northern (AOR: 0.75; 95% CI: 0.57−0.99) regions. The study findings suggest inconclusive evidence regarding the association between the use of wood compared to other biomass and kerosene cooking fuels and risk of LBW. Given the close observed association between socioeconomic status and LBW, the Ugandan government should prioritize public health actions which support female education and broader sustainable development to improve household living standards in this setting.

The intergenerational relationship between conditional cash transfers and newborn health

Background

Lack of nutrition, inadequate housing, low education and limited access to quality care can negatively affect children’s health over their lifetime. Implemented in 2003, the Bolsa Familia (“Family Stipend”) Program (PBF) is a conditional cash transfer program targeting poor households in Brazil. This study investigates the long-term benefits of cash transfers through intergenerational transmission of health and poverty by assessing the early life exposure of the mother to the PBF.

Methods

We used data from the 100M SINASC-SIM cohort compiled and managed by the Center for Data and Knowledge Integration for Health (CIDACS), containing information about participation in the PBF and socioeconomic and health indicators. We analyzed five measures of newborn health: low (less than 2,500 g) and very low (less than 1,500 g) birth weight, premature (less than 37 weeks of gestation) and very premature (less than 28 weeks of gestation) birth, and the presence of some type of malformation (according to ICD-10 codes). Furthermore, we measured the early life exposure to the PBF of the mother as PBF coverage in the previous decade in the city where the mother was born. We applied multilevel logistic regression models to assess the associations between birth outcomes and PBF exposures.

Results

Results showed that children born in a household where the mother received BF were less likely to have low birth weight (OR 0.93, CI; 0.92-0.94), very low birth weight (0.87, CI; 0.84-0.89), as well as to be born after 37 weeks of gestation (OR 0.98, CI; 0.97-0.99) or 28 weeks of gestation (OR 0.93, CI; 0.88-0.97). There were no significant associations between households where the mother received BF and congenital malformation.

On average, the higher the early life exposure to the PBF of the mother, the lower was the prevalence of low birth weight, very low birth weight and congenital malformation of the newborn. No trend was noted for preterm birth.

Conclusion

The PBF might have indirect intergenerational effects on children’s health. These results provide important implications for policymakers who have to decide how to effectively allocate resources to improve child health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12565-7.

Outcomes and Disease Spectrum of LBW Neonates in a Secondary Health Facility

Globally, 30 million low birth weight (LBW) babies are born every year and 95% of them are from developing countries. LBW neonates are at a high risk of mortality, morbidity, and long-term disability. The objective of this study is to investigate outcomes and disease spectrum among low birth weight neonates. This is a prospective, observational study conducted on 540 neonates admitted in the Mother and Child Hospital, Akure, Ondo State, Nigeria, from 2017 to 2018. Questionnaire, interview, clinical, and diagnostic procedures were used as research tools. There were 137 low birth weight (LBW) neonates, with the mean mothers’ age of 31.92 ± 6.60. Of the 540 neonates, 69 (50.4%) and 68 (49.6%) were term and preterm, respectively. There were 64 female neonates (46.7%) and 73 male neonates (53.3%). The mean weight of the neonates was 1.82 ± 0.44 kg, and mean number of days on admission was 6.42 ± 6.75 days. Neonatal sepsis (NNS) was the highest morbidity 51 (37.2%) among the LBW neonates, followed by prematurity 47 (34.4%) and neonatal jaundice (NNJ) 18 (13.1%). Sex (χ2 = 3.584, $p=0.310$ ), mode of delivery (χ2 = 4.669, $p=0.198$ ), and gestational age (χ2 = 3.904, $p=0.272$ ) were not a significant determinant of outcome among LBW neonates. Men were 2.36 times more likely to be preterm (OR = 2.36, 95% CL = 1.01–5.54, $p=0.048$ ) among LBW neonates. Outcomes of LBW neonates who were delivered by SVD were not significant compared to preterm delivered by CS (OR = 0.46, 95% CL = 0.13–1.65, $p=0.096$ ). Sixty percent (60%) of the mothers had Prolonged Rupture of Membranes (PROM). Morbidities such as hypothermia (72.2%), apnoea (63.6%), haemorrhagic disease of the newborn (HDN) (66.7%), and respiratory distress syndrome (RDS) (66.7%) were more observed with preterm LBW neonates. Importance of qualitative antenatal care (ANC) should be emphasized; anticipation and prevention of LBW births can help mitigate some of the problems they are prone to.

Impact of Scaling and Periodontal Treatment during Pregnancy on the Risk of Adverse Birth Outcomes

Background: Adverse pregnancy outcomes (APOs) are associated with periodontal disease owing to the induction of a chronic systemic inflammatory response. Hence, knowledge of periodontal status during pregnancy is important in order to reduce the risk of APOs. The aim of this study was to compare the risk of APOs in women with and without periodontal disease to ascertain whether regular scaling performed prior to pregnancy improves the risk of APOs. Method: This case-control study enrolled1,386,887 pregnant women from the National Health Insurance Research Database who gave birth to their first child between 1 January 2004 and 31 December 2014. The study population included mothers who gave birth to low birth weight (LBW) and non-LBW newborns, totaling 86,958 and 1,299,929, respectively. Scaling and periodontal emergency treatment during and before pregnancy were assessed. Univariable and multivariable logistic regression analyses were performed to identify the associations between periodontal treatment and LBW risk. Results: Compared with the comparison cohort, the pregnant women who didnot have periodontal emergency treatment or scaling treatment during pregnancy exhibited a significantly increased risk of LBW than those who had treatment. Women who underwent scaling within the2 years before pregnancy or during pregnancy had a lower risk of delivering a LBW baby (odds ratio (OR), 0.93; 95% confidence interval (CI), 0.91–0.94). In the normal group, the mothers who had periodontal emergency treatment within the2 years before pregnancy or during pregnancy had a higher risk of delivering a LBW baby (OR, 1.05; 95% CI, 1.02–1.08). In those who had scaling treatment, a lower risk of delivering a LBW baby was noted (OR, 0.95; 95% CI, 0.93–0.97). Conclusion: The risk of LBW was significantly increased in women who underwent periodontal treatment, and our findings suggested that periodontal disease is an important risk factor for preterm LBW babies in an East Asian population.

The effect of age at first marriage on the incidence of labor complications and babies with low birth weight in Indonesia

Purpose

This study investigated the effect of a woman's age at first marriage (AFM) on the incidence of labor complications and babies with low birth weight (LBW).

Methods

This study used data from the 2017 Indonesian Demographic and Health Survey (IDHS) on women aged 15-49 years who gave birth to their first child within the previous 5 years. Data analysis was conducted using binary logistic regression for labor complications and the binomial probit method for the incidence of LBW.

Results

The analysis showed that AFM affected the likelihood of childbirth complications and LBW babies. An increase in AFM tended to reduce the risk of childbirth complications, although poor economic conditions increased the risk of complications in mothers with a higher AFM. In addition, a low or high AFM increased the chances of delivering a baby with LBW.

Conclusion

A low AFM was associated with an increased likelihood of women experiencing birth complications when delivering their first child and delivering babies with LBW, underscoring the importance of delaying childbirth until a more mature age.

Exposure to armed conflict as a factor associated with very low birthweight: case-control population study

INTRODUCTION

Very low birthweight (VLBW) is a multifactorial etiology public health problem that includes poverty and violence aspects. The study aimed to determine the association between armed conflict and VLBW.

MATERIAL AND METHODS

Case-control population study matched by year of delivery conducted in Cauca, Colombia, between 2010 and 2016. Cases of VLBW, with weights between 500-1,499 g and controls weighing between 2,500-3,999 g. Cases and controls were identified through the vital statistics registry, and exposure was determined using a multidimensional index designed by the Colombian State. Multiple gestations were excluded. Conditional logistic regression for matched data was used, adjusting for confounding variables.

RESULTS

Overall, 7,068 matched participants (1,767 cases and 5,301 controls) were included. Cases and controls had similar baseline characteristics. Participants were predominantly women in the second and third decades of life, 46% were exposed to armed conflict, and 25% were of African-Colombian or indigenous ethnicity. Maternal exposure to armed conflict significantly increased the odds of VLBW among women with rural birth (aOR 3.86; 95%CI 2.74-5.45) and inadequate prenatal care (aOR 10.38; 95%CI 8.20-13.12).

CONCLUSIONS

Exposure to armed conflict increases the odds of VLBW neonates. This factor needs to be considered in prenatal care.

Mixed-methods, descriptive and observational cohort study examining feeding and growth patterns among low birthweight infants in India, Malawi and Tanzania: the LIFE study protocol

INTRODUCTION

Ending preventable deaths of newborns and children under 5 will not be possible without evidence-based strategies addressing the health and care of low birthweight (LBW, <2.5 kg) infants. The majority of LBW infants are born in low- and middle-income countries (LMICs) and account for more than 60%-80% of newborn deaths. Feeding promotion tailored to meet the nutritional needs of LBW infants in LMICs may serve a crucial role in curbing newborn mortality rates and promoting growth. The Low Birthweight Infant Feeding Exploration (LIFE) study aims to establish foundational knowledge regarding optimal feeding options for LBW infants in low-resource settings throughout infancy.

METHODS AND ANALYSIS

LIFE is a formative, multisite, observational cohort study involving 12 study facilities in India, Malawi and Tanzania, and using a convergent parallel, mixed-methods design. We assess feeding patterns, growth indicators, morbidity, mortality, child development and health system inputs that facilitate or hinder care and survival of LBW infants.

ETHICS AND DISSEMINATION

This study was approved by 11 ethics committees in India, Malawi, Tanzania and the USA. The results will be disseminated through peer-reviewed publications and presentations targeting the global and local research, clinical, programme implementation and policy communities.

TRIAL REGISTRATION NUMBERS

NCT04002908 and CTRI/2019/02/017475.