MATERNAL WEIGHT CHANGES IN PREGNANCY AS A MEANS OF PREDICTING LOW BIRTH WEIGHT AND LARGE FOR GESTATIONAL AGE BABIES
ABSTRACT
Introduction: Low Birth Weight which is birth weight of less than 2500g remains a significant public health problem from short to long term consequences. It is responsible for significant neonatal morbidities, mortalities and disability in infancy and childhood which is associated with long term impact on health outcomes in later life
General Objective: The general objective of this study was to determine the factors influencing low birth weight among postpartum mothers in University of Uyo Teaching Hospital.
Methodology: The study used facility based cross sectional study design that involved 285 postpartum mothers and 285 newborns in University of Uyo Teaching Hospital, Akwa Ibom state. Sample size was determined using Kish Leslie’s formula of 1965. Purposive sampling technique was used to sample postpartum mothers at birth. Key Informants (10) were purposively selected from the hospital and data was collected using semi-structured questionnaire and key informant interview guide (KIIG). Data was entered into Epi-Info v3.3.1 and exported to SPSS version 20 for statistical analysis at 95% confidence interval. Chi-square test and Fisher’s exact test were used to analyze the relationship between independent and dependent variables. Statistically significant variables with probability values less than 0.05 were re-analyzed at multivariable logistic regression into odds ratios with subsequent 95% confidence intervals. Meanwhile, qualitative data were organized in ATLAS Ti and content analyzed into themes to aid triangulation.
Results: There were 285 mothers studied with mean age of 25 years, most mothers were aged between 20-24 and 25-29, 84(29.5% and 83(29.1%) respectively. Majority 219(76.8%) were married. LBW prevalence of 23.5% (67) [N=285, 95% CI: 0.187-0.287] while the majority 218(76.5%) of the postpartum mothers had normal weight babies.
In Multivariable logistic regression, mothers aged 25-29 (AOR=7.17, 95%CI: 1.176-43.765, p=0.033), those aged 30-34 (AOR=10.73, 95%CI: 1.629-70.743, p=0.014) and those ≥35 years (AOR=4.34 95%CI: 0.622-30.292, p=0.138) were significantly associated with LBW. Business women (AOR=0.19 95%CI: 0.055-0.682, p=0.011) and those in salaried employment (AOR=0.19 95%CI: 0.039-0.921, p=0.039) were less likely to have LBW babies. Low social support was significantly associated with LBW (AOR=3.65 95%CI: 1.77-7.525, p<0.001).
Surprisingly, mothers with >4 ANC attendance were 68.99 times more likely to produce LBW compared to those with less than four visits (AOR=68.99 95%CI: 1.021-4661.183, p=0.049). Mothers with no pregnancy complication experience were less likely to bear LBW was (AOR=0.42 95%CI: 0.181-0.994, p=0.048). Mothers who did not take folic acid (AOR=4.82, 95%CI: 2.233-10.392 p<0.001) and antibiotics (AOR=8.74 95%CI: 3.597-21.248 p<0.001) during pregnancy were 4.82 and 8.74 times more likely to give birth to LBW babies compared to those who were given and consumed it.
Conclusion: Low Birth Weight was high at 23.5%, late reproduction, low social support, pregnancy complications, lack of social support, not taking folic acid and antibiotics increased prevalence of LBW. Reproducing at right age, providing social support, preventing pregnancy complications, ensuring access and intake of folic acid and antibiotics during ANC at health facility and during community outreaches can have valuable influence on pregnancy outcome.
CHAPTER ONE
INTRODUCTION
1.0. Introduction
Low birth weight is weight at birth of less than 2500 grams or 5.5 pounds. This definition is founded on the epidemiological evidence that infants born less than 2,500 g are about 20 times more likely to die compared with those more than 2,500 grams (UNICEF & WHO, 2004).
1.1. Background to the Study
Globally, the prevalence of LBW is at 15.5 percent which represents nearly 20 million LBW infants born annually, of which 96.5 percent of them are in developing countries (WHOb, 2018). According to WHOb, (2018), Low birth weight (LBW) remains a significant public health problem that ranged from short- and long-term consequences (WHOa, 2014). It contributes 60 to 80 percent of all neonatal mortalities, morbidity and disability in infancy and childhood and is associated with long term impact on health outcomes in adult life. The consequences of poor nutritional status and inadequate nutrient intake among expectant mother’s impact negatively on birth weight as well as quality of early development (WHOc, 2018). LBW is thus a major public health concern especially in developing countries which is related to child morbidity and mortality (Mahamud, et al, 2018). According to WHOd, (2012), the goal is to attain a 30 percent reduction of the infants born with less than 2,500g by the year 2025.
Regionally, prevalence of LBW varies across regions and within countries but the pronounced majority of low birth weight births occur in low-and middle-income countries, most particularly in vulnerable populations. The prevalence was 28% in South Asia, 13% in Sub Saharan Africa and 9% in Latin America (WHOa, 2014).
In Sub Saharan Africa, prevalence of LBW was estimated at 13 percent with 11 percent in Eastern and Southern Africa while 14 percent for Western and Central Africa (FAO, 2017). This means LBW is public health burden both in terms of health and expenditures. According to
Teklehaimanot et al, (2014), weight at birth is a good indicator of the newborn’s chances of survival, long-term health and psychological development. In addition, LBW is a strong indicator of maternal and newborn health and nutrition (UNICEF, 2014a).
Evidence shows that being undernourished in the womb increases the risk of death in early months and years of a child’s life. Survivors tend to have impaired immunity and increased risk of disease; remain undernourished, have reduced muscle strength, cognitive abilities and IQ all over their lives and in adult, suffer incidence of heart disease and diabetes (UNICEF, 2014a).
The risk factors of LBW can be prevented by lifespan approach that is before, during and postbirth to the health of women all in socioeconomic and environmental as well as medical issues and public education campaigns (UNICEF, 2002b), micronutrient supplementation, prevention and treatment of infections, reduction of teenage pregnancy and maternal education (WHO, 2011). According to WHO (2014a), LBW incidence reduction should improve maternal nutritional status, treating pregnancy related conditions and provision of adequate maternal care, perinatal clinical services including social support.
Akwa Ibom state has maternal mortality of 2054 per 100,000 live births, infant mortality is extremely high at 79 per 1000 live births and under five MR at 108 per 1000 live births (UNICEF, 2015c) and the country generally has limited data on LBW.
This study aimed to determine the prevalence of LBW and associated factors among postpartum mothers in University of Uyo Teaching Hospital, Akwa Ibom state.
1.2. Statement of the problem
University of Uyo Teaching Hospital (BSH) has very poor data in general and especially on LBW. The data between June 2017 to May 2018 (SMOH) shows that 254 deliveries were conducted in the hospital but no clear records on the number of low birth weight babies, available records are from Feb 2018 which indicated only a single case reported in March 2018. A study conducted in Juba Teaching Hospital by Aleyo and Alege (2017, Unpublished) indicated LBW prevalence of 23% (29 out of 125).
The global nutrition goal is to reduce LBW prevalence by 30% by the year 2025 (WHOd, 2012), LBW is a strong indicator of maternal and newborn health and nutrition (UNICEF, 2014a), it is therefore an important indicator for monitoring progress in achieving the internationally agreed goals (WHO/UNICEF, 2012).
Overall, data on LBW remains limited or unreliable since many deliveries occur at home or at small health facilities and are not reported in official figures, which may result in an underestimation of the prevalence of LBW (WHO, 2014a). In addition, limited data is available to explain the LBW status at hospital levels especially in University of Uyo Teaching Hospital.
Despite government interventions to provide maternal health services, there is still Low birth weight due to prematurity or restricted growth which leads to newborn and child death including disability and communicable deaths (USAID, 2015) and cardiovascular disease in later life (WHO, 2014a). According to CDC, (2018), LBW newborns may be at more risk compared to those with normal weight and the LBW babies may become sick in the first six days or develop infections, suffer from problems related to delayed motor and social development including learning disabilities.
It is therefore significant to ensure these consequences are to greater extent averted. A review for 13 relevant studies in 12 countries that had experienced armed conflict including Iraq, Libya, Israel and Bosnia showed that mothers were at increased risk of giving births to low birth weight babies (British Medical Journal, 2017). However, very limited data or study related to the above is available in Akwa Ibom state despite Akwa Ibom state being among the countries greatly affected by protracted conflict.
Therefore, this study aimed to establish the determinants of low birth weight among postpartum mothers in University of Uyo Teaching Hospital in Unity State, Akwa Ibom state.
1.3. Objectives of the study
1.3.1 Overall objective
To assess the factors influencing low birth weight in University of Uyo Teaching Hospital, Akwa Ibom state.
1.3.2 Specific objectives
i. To determine the prevalence of low birth weight among babies born in University of Uyo Teaching Hospital, Akwa Ibom state.
ii. To determine the socioeconomic factors influencing low birth weight in University of Uyo Teaching Hospital, Akwa Ibom state.
iii. To determine the individual factors influencing low birth weight in University of Uyo Teaching Hospital, Akwa Ibom state. iv. To determine nutritional factors influencing low birth weight in University of Uyo Teaching Hospital, Akwa Ibom state.
v. To determine health services factors influencing low birth weight in University of Uyo Teaching Hospital, Akwa Ibom state.
1.4 Research Question
What are the factors determining low birth weight among mothers delivering in University of Uyo Teaching Hospital?
1.4.1 Specific Questions
i. What is the proportion of babies born with low birth weight in University of Uyo Teaching Hospital?
ii. What are the socioeconomic and demographic factors influencing low birth weight among postpartum mothers delivering in University of Uyo Teaching Hospital?
iii. What are the individual factors influencing low birth weight among postpartum mothers delivering in University of Uyo Teaching Hospital? iv. What are the nutritional factors influencing low birth weight among postpartum mothers delivering in University of Uyo Teaching Hospital?
v. What are the health service factors influencing low birth weight among postpartum mothers delivering in University of Uyo Teaching Hospital?
1.5. Significance of the Study
The study determined the proportion of Low Birth Weight among postpartum mothers in University of Uyo Teaching Hospital. In addition, the key factors associated with low birth weight which will inform the health facility management on the findings, academia, and policy makers among others. The study results may be used to improve nutritional and other maternal interventions as well as scaling up of community-based campaigns on low birth weight.
The findings will add to existing literature on prevalence and knowledge base on low birth weight and factors associated with it among the postpartum mothers so that further research to close the gaps that this study would not have addressed. The study results may also inform policy makers and hospital managers to plan and implement context specific strategies that will appropriately prevent and reduce the incidence and burden of low birth weight.
Figure 1: Conceptual framework
INDEPENDENT VARIABLES
S
ocioeconomic
factors
Image
Education level
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Marital status
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Occupation
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Religion
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Place of residence
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Social support
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Average monthly income
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Type of family
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Household size
N
utrition
al
factors
Image
Number of meals per day
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Common types of food eaten
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Nutrition assessment during
pregnancy
Health s
ervice
s
factors
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ANC
attendance (
vis
its
)
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Health and nutrition
education
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Infection treatment with
antibiotics
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Folic acid & iron
supplementation
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Distance to health
facility
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Attitude of health
workers
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Malaria prophylaxis
provision
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Mode of deli
ver
y
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Cost of hea
lth care
)
(
ANC services
Low Birth
Weight
S
tat
us
Individu
al
fa
ctors
Image
Age
and age
at first birth
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Parity
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Nature of pregnancy
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Type of pregnancy
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Duration of gestation
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Pregnancy interval
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Health of the mother
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Life style (e.g. smoking,
alcohol consumption)
DEPENDENT VARIABLE
1.6. Description of the Conceptual framework
The conceptual framework illustrates the relationship between low birth weight with socioeconomic, individual, nutritional and health service related factors and how those factors may contribute to LBW.
The framework specifically shows that the socioeconomic variables like marital status, education level, and occupation, place of residence, average monthly income, type of family and social support may influence low birth weight among postpartum mothers.
Secondly, the individual variables that may also influence the prevalence of LBW include; age, age at first birth, duration of gestation, pregnancy interval, marital status, size of family, health of the mother, life style, and tribe/religion.
Nutritional factors that may influence LBW like regular intake of breakfast, number of meals per day, common types of food taken and nutritional assessment during pregnancy.
Health system factors may also contribute significantly in determining or influencing the low birth weight of the postpartum mothers. In this study, the variables being studied are; ANC attendance (Recommended at least 4 visits per pregnancy), health and nutritional education, folic acid and iron supplementation, distance to health facility, attitude of health workers, malaria prophylaxis during pregnancy, mode of delivery and cost of health care.
This study found out the prevalence of low birth weight at University of Uyo Teaching Hospital was at 23.5%.
CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
The literature review consists of what is already known from various studies conducted on low birth weight and associated factors to it. The literature categorically gathered on regarding the; socio-demographic characteristics of mothers, individual, socioeconomic, nutritional and health services related factors. The study also reviewed the views of the key informants on low birth weight and associated factors.
2.1. Prevalence of Low Birth Weight
Nearly 22 million newborns, an estimated 16% of all babies born globally were of low birth weight. Among regions south Asia has the greatest incidence of low birth weight 28% followed by West and central Africa including other least developed countries at 14% and sub Saharan Africa at 13% (UNICEF & WHO, 2013).
A hospital-based study conducted byFosu et al., (2013) in Ghana found prevalence of low birth wieght was at 21.1% with normal mean weight of 4.012±0.062 kg. This study result conducted with reproductive age group mothers had small difference with a study in Uganda Bayo et al., ( 2016) who found LBW prevalence of 25.5 percent. This study however focused on the teenage mothers in Mulago National Referral Hospital. Another facility-based study in Ethiopia by Hailu & Kebede, (2018) that reviewed records of 441 newborns and mothers found LBW prevalence of 33.3%. The prevalence in Ethiopia was higher than that in Uganda.
The difference could be due to the study location, the study in Ethipia was conducted in a rural area with poor socioeconomic conditions as compared to that conducted within the city in Uganda.
In a similar finding, a study in Ethiopia that used 2011 Demographic and Health Survey data of
Ethiopia found LBW prevalence of 32.1% and 68.8% had larger size at birth Betew & Muluneh, 2014). The prevalence of LBW in the EDHS and the facility-based study were close but the health facility-based study was slightly higher than that of EDHS of 2011. The mothers who gave birth at health facility were likely to have attended ANC where counseling and health education is provided including maternal nutrition. This means women will have access to knowledge including nutrition education. The EDHS study was population-based study where some mothers in the community do not attend ANC and other health services hence, they become more predisposed to bearing of low birth weight babies.
In Ethiopia, a study by Teklehaimanot et al., (2014) that was in two districts showed LBW prevalence of 9.9% in Axum and 6.3% in Laelay Maichew districts. The community-based study appears to have low prevalence of LBW compared to health facility-based studies. However, a community-based study in India in 66 villages in West Bengal found high LBW prevalence of 29% (Dasgupta & Bavu, 2011). This difference could be due to study design, sociodemographic characteristics of the community members and accessibility status to preventive and health care services. A study conducted in tertiary hospital in Maseru City; Lesotho by Nwako (2018) found LBW prevalence of 24.75%. Another hospital based study in Ethiopia had slightly lower LBW prevalence of 17% compared to that in Lesotho which was partly attributed to a higher prevalence of complicated pregnancies which led to increased LBW babies (Zeleke et al., 2012). The difference in the two studies could be due to the sample sizes, weighing scales and study design that may be related to the difference as well as the quality or package of services available to the expectant women at the hospitals.
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