Growth monitoring and mortality risk in low birthweight infants: a birth cohort study in Burkina Faso

Abstract

Background: Wasting and underweight in infancy is an increasingly recognised problem but consensus on optimum assessment is lacking. In particular, there is uncertainty on how to interpret anthropometry among low birth weight (LBW) infants who may be growing normally. This research aimed to determine growth of infants from birth to two months (around age of vaccination) and the mortality risk of underweight LBW infants compared to normal birth weight (NBW) infants at two and six months age. Methods: A secondary analysis of a birth cohort of 1103 infants in Burkina Faso was conducted. Anthropometry was performed monthly from 0 to 12 months. We assessed associations with mortality using Cox proportional hazards models and assessed discriminatory values using area under receiver operating characteristics curves. Results: Eighty-six (7.8%) children died by age one year, 26/86 (30%) and 51/86 (59%) within two and six months, respectively. At age two months, weight gain since birth did not better discriminate mortality risk than current weight-for-age (P=0.72) or mid-upper arm circumference (P=0.21). In total, 227 (21%) LBW infants had increased risk of mortality: adjusted hazards ratio (aHR) 3.30 (95%CI 2.09 to 4.90). Among infants who were underweight at two and six months, LBW infants (64% and 49%, respectively) were not at reduced risk of death compared to NBW infants (aHR 2.63 (95%CI 0.76 to 9.15) and 2.43 (95%CI 0.74 to 7.98), respectively). Conclusion: Assessing weight gain since birth does not offer advantages over immediate anthropometry for discriminating mortality risk. LBW infants who are later identified as underweight require care to help prevent mortality.

Stunting in the first year of life: Pathway analysis of a birth cohort

“…The study enrolled pregnant women attending antenatal care (ANC) and their infants at four rural health facilities: Foube, Basma, Barsalogho and Dablo in Barsalogho District, Burkina Faso. Data were collected in 2004, as previously detailed [14,15]. In brief, the primary birth cohort recruited pregnant women attending ANC regardless of whether they delivered in the health facility or at home and infants were followed-up monthly for one year after birth [16].…”

“…If severe wasting was PLOS GLOBAL PUBLIC HEALTH detected, the infant was referred to the district hospital for treatment according to the WHO protocol in place at that time. For this analysis data were accessed in June 2017 and since then it has been used to publish several papers [14,15].…”