Incidence and Risk Factors for Low Birthweight and Preterm Birth in Post-Conflict Northern Uganda: A Community-Based Cohort Study

Abstract

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.

Prevalence of Low Birth Weight and its Association With Anemia in White Nile State, Sudan: A Cross-Sectional Study

“…Another notable finding of the current study was that maternal anemia increased the risk of LBW by 4.7 times. Several studies have also reported similar findings for other regions of Sudan and Africa—Wad Mani in Central Sudan ( Elhassan et al, 2010 ), Kassala in Eastern Sudan ( Ali et al, 2011 ), Darfur in Western Sudan ( Haggaz et al, 2010 ), Ethiopia ( Deriba and Jemal, 2021 ; Tadesse et al, 2023 ), Somalia ( Barut and Mohamud, 2023 ), Sierra Leone ( Kargbo et al, 2021 ), Uganda ( Odongkara et al, 2022 ), and Ghana ( Mohammed et al, 2019 ). This association was further corroborated by several meta-analyses that have shown that anemic pregnant women are at a higher risk of delivering newborns with LBW ( Rahman et al, 2016 ; Young et al, 2019 , 2023 ).…”

“…Similar to previous studies from Sudan ( Elhassan et al, 2010 ; Haggaz et al, 2010 ), the current study did not report any association between certain maternal factors, such as age, parity, education level, and anthropometrics, and LBW. On the other hand, a maternal age of ≥35 years in Uganda was reportedly associated with LBW ( Odongkara et al, 2022 ). Likewise, parity and LBW were found to be associated in studies from Ghana ( Mohammed et al, 2019 ) and Tanzania ( Kamala et al, 2018 ).…”

“…Despite continuing preventive measures, there is still a high prevalence of LBW in different countries in the sub-Saharan African region, including Sudan ( Adam et al, 2008 ; Ahenkorah et al, 2022 ; Ahmed, 2022 ; Barut and Mohamud, 2023 ; Elhassan et al, 2010 ; Haggaz et al, 2010 ; Kamala et al, 2018 ; Kargbo et al, 2021 ; Odongkara et al, 2022 ; Tadesse et al, 2023 ; Wondemagegn et al, 2022 ). Several maternal factors, such as age ( Odongkara et al, 2022 ), parity, level of antenatal care (ANC; Kamala et al, 2018 ), anemia ( Barut and Mohamud, 2023 ; Kargbo et al, 2021 ; Odongkara et al, 2022 ; Tadesse et al, 2023 ), malarial infection ( Odongkara et al, 2022 ), and malnutrition ( Ahmed, 2022 ; Wondemagegn et al, 2022 ), as well as the neonate's gestational age ( Ahenkorah et al, 2022 ; Ahmed, 2022 ), are reportedly associated with LBW in sub-Saharan Africa.…”

Preterm Birth and Its Associated Factors among Mothers Delivered at Lira Regional Referral Hospital in Lira District

“…Though many studies have been carried out elsewhere, Little data and literature have been done about preterm birth in Uganda, especially at Lira Regional Referral Hospital therefore, this study will make a significant contribution to assessing the prevalence of preterm birth and its associated factors among mothers delivered at Lira Regional Referral Hospital. Many mothers have had or experienced a preterm birth in their lives which poses a threat to their lives and babies, though the Ministry of Health has tried in its efforts to reduce the prevalence of preterm birth by improving healthcare systems [10], the problem is still evident and on the rise. Globally, 15 million babies are born preterm of which 60% of the cases occur in Africa and Asian countries.…”