Incidence and Risk Factors for Low Birthweight and Preterm Birth in Post-Conflict Northern Uganda: A Community-Based Cohort Study
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
International Journal of Environmental Research and Public Health
Abstract
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.
Description
Keywords
Preterm birth, Low birthweight, Risk factors, Community-based, Cohort study
Citation
Odongkara, B.; Nankabirwa, V.; Ndeezi, G.; Achora, V.; Arach, A.A.; Napyo, A.; Musaba, M.; Mukunya, D.; Tumwine, J.K.; Thorkild, T. Incidence and Risk Factors for Low Birthweight and Preterm Birth in Post-Conflict Northern Uganda: A Community- Based Cohort Study. Int. J. Environ. Res. Public Health 2022, 19, 12072. https://doi.org/10.3390/ ijerph191912072