Maternal Weight Changes In Pregnancy As A Means Of Predicting Low Birth Weight And Large For Gestational Age Babies
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.
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
- To determine the prevalence of low birth weight among babies born in University of Uyo Teaching Hospital, Akwa Ibom state.
- To determine the socioeconomic factors influencing low birth weight in University of Uyo Teaching Hospital, Akwa Ibom state.
- 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.
- 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
- What is the proportion of babies born with low birth weight in University of Uyo Teaching Hospital?
- What are the socioeconomic and demographic factors influencing low birth weight among postpartum mothers delivering in University of Uyo Teaching Hospital?
- 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?
- 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
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%.
Conclusion and Recommendations
This chapter presents the conclusions and recommendations of study on the prevalence and associated factors influencing low birth weight among postpartum mothers in University of Uyo Teaching Hospital, Akwa Ibom state.
Prevalence of low birth weight
The study found out that the prevalence of low birth weight in University of Uyo Teaching Hospital stands at 23.5% which high and requires intervention in order to improve child health and maternal health indicators.
- This study surprisingly found mothers aged 20-24 years have higher likelihood of bearing LBW babies compared to women aged 19 years. This could be due to the fact that most of the mothers were in the above age range.
- Older women are more likely to bear low birth weight babies, which could be attributed to the physiological deterioration associated with aging.
- Business women were less likely to have LBW babies compared to the peasant women.
- Mothers in formal salaried employment were less likely to have LBW babies compared to peasant women hence significantly reduced LBW.
- The study found that age at first birth, social support status and no pregnancy complication experience significantly associated with Low Birth Weight.
- The odds of bearing LBW reduced with increase in the number of meals among the mothers.
Health service factors
- Postpartum mothers who did not take folic acid and antibiotics during pregnancy were likely to give birth to LBW babies.
6.2.1. Socioeconomic factors
- The government in Unity State in partnership with parents should ensure that girls of school going age be encouraged to attend school until they attained better education level so as to reduce early marriage, unwanted pregnancies which is one of the root cause of low birth weight.
- The health care providers should also develop appropriate messages for dissemination at the hospital and at community-based level about the risks of pregnancy outcome among under aged children and older of 35 and above years in regards to low birth weight outcome.
- The community leaders should ensure women engage in income generating activities (business) that can translate to increased income that can be used during before, during and after child birth for proper nutrition, access to health care and other requirements. Women in the communities should also be provided equal opportunity like their male counterparts in employment and be encouraged to join formal employment which has the potential to empower them financially.
- The male partners to the spouses, family members, relatives should be sensitized about the significance of their support to vulnerable pregnant women in the communities so that they get to understand how much their support could be valuable in reducing prevalence of negative pregnancy and newborn outcomes at birth.
6.2.2. Individual factors
The health care providers should conduct health education to women during community based out reaches and at health facility level about pregnancy complications mainly focusing on the likely causes and feasible prevention and mitigation measures.
6.2.3. Health services factors
- The hospital or health facility health care providers should encourage women to attend all the four recommended ANC visits and any additional visits deemed still significant during the pregnancy period. This information can be disseminated during ANC visits and community-based outreaches, churches, women groups and other social gatherings in order to empower people about the significance of the interventions received during the period.
- It is important that health care providers should ensure adequate folic acid tablets are in stock for all expectant women who turn up for ANC. They should be provided and consume them because of the effect on reduction of low birth weight including preterm birth among others. In addition, they should be educated clearly about the reasons for providing them folic acid during pregnancy.
- The health care providers should ensure that expectant women who have any bacterial infection during pregnancy receive the prescribed antibiotics in order to prevent low birth weight among women.
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