Incidence and Risk Factors for Low Birthweight and Preterm Birth in Post-Conflict Northern Uganda: A Community-Based
Beatrice Odongkara1,2,3, Victoria Nankabirwa4, Grace Ndeezi3
1Department of Paediatrics and Child Health, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda.
Insights
In Uganda, 7.3% of infants had low birthweight (LBW) and 5.0% were born preterm. Maternal malaria, HIV, and older age increased risks, while education and malaria treatment reduced them.
Area of Science:
- Public Health
- Epidemiology
- Maternal and Child Health
Background:
- Globally, millions of low birthweight (LBW) and preterm births (PB) occur annually, with significant data gaps from low-income countries.
- LBW and PB are leading causes of neonatal and under-five mortality, necessitating localized data.
- This study addresses the need for data on LBW and PB incidence and risk factors in Northern Uganda.
Purpose of the Study:
- To determine the incidence of LBW and preterm birth in Lira district, Northern Uganda.
- To identify key risk factors associated with LBW and preterm birth in this population.
- To inform targeted interventions for improving infant health outcomes in the region.
Main Methods:
- A community-based cohort study was conducted within a cluster-randomized trial.
- 1877 pregnant women were recruited and followed from 28 weeks gestation.
- Birthweight and preterm status (using New Ballard Score) were assessed for 1556 and 1279 infants, respectively. Risk factors were analyzed using multivariable generalized estimation equations.
Main Results:
- The incidence of LBW was 7.3% and preterm birth was 5.0%.
- Risk factors for LBW included maternal age ≥35 years, history of a small newborn, and maternal malaria. Intermittent preventive treatment for malaria reduced LBW risk.
- Maternal HIV infection increased preterm birth risk, while maternal education of ≥7 years reduced it.
Conclusions:
- Significant proportions of LBW (7.3%) and preterm births (5.0%) were observed in post-conflict Northern Uganda.
- Maternal malaria, older maternal age, and prior small newborns are risk factors for LBW, with malaria prevention showing protective effects.
- Maternal HIV infection is a risk factor for preterm birth, whereas higher maternal education is protective. Interventions should focus on education, malaria, and HIV management.
Background:
Annually, an estimated 20 million (13%) low-birthweight (LBW) and 15 million (11.1%) preterm infants are born worldwide. A paucity of data and reliance on hospital-based studies from low-income countries make it difficult to quantify the true burden of LBW and PB, the leading cause of neonatal and under-five mortality. We aimed to determine the incidence and risk factors for LBW and preterm birth in Lira district of Northern Uganda.
Methods:
This was a community-based cohort study, nested within a cluster-randomized trial, designed to study the effect of a combined intervention on facility-based births. In total, 1877 pregnant women were recruited into the trial and followed from 28 weeks of gestation until birth. Infants of 1556 of these women had their birthweight recorded and 1279 infants were assessed for preterm birth using a maturity rating, the New Ballard Scoring system. Low birthweight was defined as birthweight <2.5kg and preterm birth was defined as birth before 37 completed weeks of gestation. The risk factors for low birthweight and preterm birth were analysed using a multivariable generalized estimation equation for the Poisson family.
Results:
The incidence of LBW was 121/1556 or 7.3% (95% Confidence interval (CI): 5.4-9.6%). The incidence of preterm births was 53/1279 or 5.0% (95% CI: 3.2-7.7%). Risk factors for LBW were maternal age ≥35 years (adjusted Risk Ratio or aRR: 1.9, 95% CI: 1.1-3.4), history of a small newborn (aRR: 2.1, 95% CI: 1.2-3.7), and maternal malaria in pregnancy (aRR: 1.7, 95% CI: 1.01-2.9). Intermittent preventive treatment (IPT) for malaria, on the other hand, was associated with a reduced risk of LBW (aRR: 0.6, 95% CI: 0.4-0.8). Risk factors for preterm birth were maternal HIV infection (aRR: 2.8, 95% CI: 1.1-7.3), while maternal education for ≥7 years was associated with a reduced risk of preterm birth (aRR: 0.2, 95% CI: 0.1-0.98) in post-conflict northern Uganda.
Conclusions:
About 7.3% LBW and 5.0% PB infants were born in the community of post-conflict northern Uganda. Maternal malaria in pregnancy, history of small newborn and age ≥35 years increased the likelihood of LBW while IPT reduced it. Maternal HIV infection was associated with an increased risk of PB compared to HIV negative status. Maternal formal education of ≥7 years was associated with a reduced risk of PB compared to those with 0-6 years. Interventions to prevent LBW and PBs should include girl child education, and promote antenatal screening, prevention and treatment of malaria and HIV infections.
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