Association between out-of-pocket health expenditures and low birth weight in Eastern Ethiopia: a generalized...

Globally, approximately 15% to 20% of newborns are born with low birth weight (LBW), with over 90% of these cases occurring in low- and middle-income countries (LMICs). Although previous research on LBW has largely focused on clinical and nutritional factors, economic barriers associated with LBW remain under-researched. This study aimed to assess the association between out-of-pocket (OOP) payment for antenatal care and LBW in Eastern Ethiopia.

A prospective cohort study followed pregnant women for ten months to examine the incidence of LBW. The cost of ANC and other follow up variables were collected during pregnancy. Direct medical and non-medical costs were summed to calculate total OOP expenditures. Face to face interviews were used to collect baseline and follow-up data. Poisson regression with robust variance was used to assess the independent predictors of LBW. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were computed. The direct and indirect association between OOP and LBW were estimated using Generalized Structural Equation Modeling (GSEM).

A total of 385 women was followed for 10 months. The study found that 10.9% of women gave birth to LBW neonates. After controlling for confounding factors, OOP expenditure (aRR = 3.21, 95% CI: 1.19, 8.64), prenatal depression (aRR = 2.91, 95% CI: 1.65, 5.13), and lack of birth preparedness and complication readiness (BPCR) (aRR = 4.12, 95% CI: 1.52, 11.20), poor wealth status (aRR = 3.30, 95% CI: 1.16, 9.38), incomplete ANC visits (aRR = 2.37, 95% CI: 1.01, 5.53), unplanned pregnancy (aRR = 1.92, 95% CI: 1.14, 3.22) and long travelling time (1.99, 95% CI: 1.15, 3.44) were significantly associated with LBW. In GSEM, prenatal depression (β = 1.30 (95% CI: 0.21, 2.80) and lack of preparation for birth (β = 1.55 (95% CI: 0.29, 2.80) mediated the association between LBW and OOP expenditures, while ANC visits mediated the association between long travelling time and LBW (β = 1.04, 95% CI: 0.04, 1.05).

There was a significant positive association between OOP payment and LBW which was partly mediated by prenatal depression and lack of BPCR. To reduce the incidence of LBW, an integrated approach should be adopted that combines financial risk protection, psychosocial support and geographical accessibility of services.