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

Alain Ahishakiye¹, Marie Claire Abimana², Kathryn Beck²

¹Rwinkwavu District Hospital, Ministry of Health, Rwinkwavu, RW.

Annals of Global Health

|December 25, 2019

Insights

Preterm and/or low birth weight (LBW) infants born in rural Rwanda showed higher rates of developmental delay. Stunting was the primary predictor of this delay, highlighting the need for nutritional and developmental interventions.

Area of Science:

Global Health
Pediatric Development
Neonatal Outcomes

Background:

Improving neonatal care in low-resource settings increases survival rates for preterm and low birth weight (LBW) infants.
Long-term developmental outcomes for these survivors remain understudied globally.
Preterm and/or LBW infants face heightened risks of mortality, malnutrition, and developmental delays.

Purpose of the Study:

To compare developmental outcomes at 24-36 months in rural Rwandan children born preterm and/or LBW versus those born term or normal birth weight (term/NBW).
To identify factors associated with poor developmental outcomes in this cohort.

Main Methods:

A cross-sectional study utilizing secondary data analysis from 2014 datasets.
Developmental assessment employed the Ages and Stages Questionnaire (ASQ-3).
Nutritional status (stunting, wasting) and demographic/clinical factors were analyzed using multivariable logistic regression.

Main Results:

Of 445 children, 52.6% experienced developmental delay; 67.5% of preterm/LBW infants versus 51.1% of term/NBW infants (p=0.048).
Stunting significantly increased odds of developmental delay in term/NBW children (OR 2.05).
Preterm/LBW status combined with no stunting predicted delay; stunting was the primary predictor.

Conclusions:

Developmental delay affects half of the children studied in rural Rwanda.
Preterm/LBW infants are more prone to developmental delay, with stunting being a key predictor across birth weight groups.
Urgent interventions are needed to reduce undernutrition, prevent prematurity/LBW, and promote early stimulation for optimal child development.

Read full analysis

Abstract

Background:

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

Objectives:

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

Methods:

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

Findings:

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

Conclusion:

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

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