ABSTRACT
Introduction: Low
Birth Weight which is birth weight of less than 2500g remains a significant
public health problem from short to long term consequences. It is responsible
for significant neonatal morbidities, mortalities and disability in infancy and
childhood which is associated with long term impact on health outcomes in later
life
General Objective: The
general objective of this study was to determine the factors influencing low
birth weight among postpartum mothers in University of Uyo Teaching Hospital.
Methodology: The
study used facility based cross sectional study design that involved 285
postpartum mothers and 285 newborns in University of Uyo Teaching Hospital, Akwa
Ibom state. Sample size was determined using Kish Leslie’s formula of 1965.
Purposive sampling technique was used to sample postpartum mothers at birth.
Key Informants (10) were purposively selected from the hospital and data was
collected using semi-structured questionnaire and key informant interview guide
(KIIG). Data was entered into Epi-Info v3.3.1 and exported to SPSS version 20
for statistical analysis at 95% confidence interval. Chi-square test and Fisher’s
exact test were used to analyze the relationship between independent and
dependent variables. Statistically significant variables with probability
values less than 0.05 were re-analyzed at multivariable logistic regression
into odds ratios with subsequent 95% confidence intervals. Meanwhile,
qualitative data were organized in ATLAS Ti and content analyzed into themes to
aid triangulation.
Results: There
were 285 mothers studied with mean age of 25 years, most mothers were aged
between 20-24 and 25-29, 84(29.5% and 83(29.1%) respectively. Majority
219(76.8%) were married. LBW prevalence of 23.5% (67) [N=285, 95% CI:
0.187-0.287] while the majority 218(76.5%) of the postpartum mothers had normal
weight babies.
In Multivariable logistic regression, mothers aged 25-29
(AOR=7.17, 95%CI: 1.176-43.765, p=0.033), those aged 30-34 (AOR=10.73, 95%CI:
1.629-70.743, p=0.014) and those ≥35 years (AOR=4.34 95%CI: 0.622-30.292,
p=0.138) were significantly associated with LBW. Business women (AOR=0.19
95%CI: 0.055-0.682, p=0.011) and those in salaried employment (AOR=0.19 95%CI:
0.039-0.921, p=0.039) were less likely to have LBW babies. Low social support
was significantly associated with LBW (AOR=3.65 95%CI: 1.77-7.525, p<0.001).
Surprisingly, mothers with >4 ANC attendance were 68.99
times more likely to produce LBW compared to those with less than four visits
(AOR=68.99 95%CI: 1.021-4661.183, p=0.049). Mothers with no pregnancy
complication experience were less likely to bear LBW was (AOR=0.42 95%CI:
0.181-0.994, p=0.048). Mothers who did not take folic acid (AOR=4.82, 95%CI:
2.233-10.392 p<0.001) and antibiotics (AOR=8.74 95%CI: 3.597-21.248
p<0.001) during pregnancy were 4.82 and 8.74 times more likely to give birth
to LBW babies compared to those who were given and consumed it.
Conclusion: Low
Birth Weight was high at 23.5%, late reproduction, low social support,
pregnancy complications, lack of social support, not taking folic acid and
antibiotics increased prevalence of LBW. Reproducing at right age, providing
social support, preventing pregnancy complications, ensuring access and intake
of folic acid and antibiotics during ANC at health facility and during
community outreaches can have valuable influence on pregnancy outcome.
TABLE OF CONTENTS
CHAPTER ONE
INTRODUCTION
1.0. Introduction
1.1. Background
to the Study
1.2. Statement
of the problem
1.3. Objectives
of the study
1.3.1 Overall
objective
1.3.2 Specific
objectives
1.4 Research
Question
1.4.1 Specific
Questions
1.5. Significance
of the Study
CHAPTER
TWO
LITERATURE
REVIEW
2.0 Introduction
2.1. Prevalence
of Low Birth Weight
2.2. Socioeconomic
factors and Low Birth Weight
2.3. Individual
factors and Low Birth Weight
2.4. Nutritional
factors and Low Birth Weight
2.5. Health
services related factors and Low Birth Weight
CHAPTER
THREE
RESEARCH
METHODOLOGY
3.0. Introduction
3.1. Study
Design
3.2. Sources
of Data
3.3. Study
Population
3.4. Sample
size Calculation
3.5. Sampling
procedure
3.6. Dependent
variable
3.7. Independent
variables
3.8 Data
collection techniques
3.9. Data
collection tools
3.10. Data
Analysis procedure
3.11. Quality
Control Issues
3.12. Ethical
Issues
3.13. Limitations
to the Study
3.14. Plan
for dissemination
CHAPTER
FOUR
PRESENTATION
OF RESULTS
4.0. Introduction
4.1. Prevalence
of Low Birth Weight
4.2.1. Univariate
analysis of socioeconomic factors
4.2.2. Bivariate
Analysis between socioeconomic factors and Low Birth Weight
4.3.1 Univariate
analysis of individual factors of the postpartum mothers
4.3.2. Bivariate
Analysis between Individual factors and Low Birth Weight
4.4.1. Univariate
analysis of nutritional factors
4.4.2. Bivariate
Analysis between Nutritional factors and Low Birth Weight
4.5.1. Univariate
analysis of health services factors
4.5.1. Bivariate
Analysis between health services factors and low birth weight
4.6. Multivariate
analysis (Multiple Logistic Regression Analysis for significant variables)
CHAPTER
FIVE
DISCUSSION
OF RESULTS
5.0 Introduction
5.1. Prevalence
of Low Birth Weight
5.2. Socioeconomic
factors and Low Birth Weight
5.3. Individual
factors and Low Birth Weight
5.4. Health
services factors and Low Birth Weight
CHAPTER
SIX
CONCLUSION
AND RECOMMENDATIONS
6.0. Introduction
6.1. Conclusions
6.2. Recommendations
6.2.3. Health
services factors
REFERENCES
STRUCTURED QUESTIONNAIRE
KEY INFORMANTS INTERVIEW GUIDE
CHAPTER ONE
INTRODUCTION
1.0. Introduction
Low birth weight is weight at birth of less than 2500 grams
or 5.5 pounds. This definition is founded on the epidemiological evidence that
infants born less than 2,500 g are about 20 times more likely to die compared
with those more than 2,500 grams (UNICEF
& WHO, 2004).
1.1. Background to the Study
Globally, the prevalence of LBW is at 15.5 percent which
represents nearly 20 million LBW infants born annually, of which 96.5 percent
of them are in developing countries (WHOb,
2018). According to WHOb, (2018), Low birth weight (LBW)
remains a significant public health problem that ranged from short- and
long-term consequences (WHOa, 2014).
It contributes 60 to 80 percent of all neonatal mortalities, morbidity and
disability in infancy and childhood and is associated with long term impact on
health outcomes in adult life. The consequences of poor nutritional status and
inadequate nutrient intake among expectant mother’s impact negatively on birth
weight as well as quality of early development (WHOc, 2018). LBW is thus a major public health concern especially
in developing countries which is related to child morbidity and mortality
(Mahamud, et al, 2018). According to WHOd,
(2012), the goal is to attain a 30 percent reduction of the infants born
with less than 2,500g by the year 2025.
Regionally, prevalence of LBW varies across regions and
within countries but the pronounced majority of low birth weight births occur
in low-and middle-income countries, most particularly in vulnerable populations.
The prevalence was 28% in South Asia, 13% in Sub Saharan Africa and 9% in Latin
America (WHOa, 2014).
In Sub Saharan Africa, prevalence of LBW was estimated at
13 percent with 11 percent in Eastern and Southern Africa while 14 percent for
Western and Central Africa (FAO, 2017).
This means LBW is public health burden both in terms of health and
expenditures. According to
Teklehaimanot et al,
(2014), weight at birth is a good indicator of the newborn’s chances of
survival, long-term health and psychological development. In addition, LBW is a
strong indicator of maternal and newborn health and nutrition (UNICEF, 2014a).
Evidence shows that being undernourished in the womb
increases the risk of death in early months and years of a child’s life. Survivors
tend to have impaired immunity and increased risk of disease; remain
undernourished, have reduced muscle strength, cognitive abilities and IQ all
over their lives and in adult, suffer incidence of heart disease and diabetes (UNICEF, 2014a).
The risk factors of LBW can be prevented by lifespan
approach that is before, during and postbirth to the health of women all in
socioeconomic and environmental as well as medical issues and public education
campaigns (UNICEF, 2002b),
micronutrient supplementation, prevention and treatment of infections,
reduction of teenage pregnancy and maternal education (WHO, 2011). According to WHO
(2014a), LBW incidence reduction should improve maternal nutritional
status, treating pregnancy related conditions and provision of adequate
maternal care, perinatal clinical services including social support.
Akwa Ibom state has maternal
mortality of 2054 per 100,000 live births, infant mortality is extremely high
at 79 per 1000 live births and under five MR at 108 per 1000 live births (UNICEF, 2015c) and the country generally
has limited data on LBW.
This study aimed to determine the prevalence of LBW and
associated factors among postpartum mothers in University of Uyo Teaching
Hospital, Akwa Ibom state.
1.2. Statement of the problem
University of Uyo Teaching Hospital (BSH) has very poor
data in general and especially on LBW. The data between June 2017 to May 2018 (SMOH) shows that 254 deliveries were
conducted in the hospital but no clear records on the number of low birth weight
babies, available records are from Feb 2018 which indicated only a single case
reported in March 2018. A study conducted in Juba Teaching Hospital by Aleyo and Alege (2017, Unpublished)
indicated LBW prevalence of 23% (29 out of 125).
The global nutrition goal is to reduce LBW prevalence by
30% by the year 2025 (WHOd, 2012),
LBW is a strong indicator of maternal and newborn health and nutrition (UNICEF, 2014a), it is therefore an
important indicator for monitoring progress in achieving the internationally
agreed goals (WHO/UNICEF, 2012).
Overall, data on LBW remains limited or unreliable since
many deliveries occur at home or at small health facilities and are not
reported in official figures, which may result in an underestimation of the
prevalence of LBW (WHO, 2014a). In
addition, limited data is available to explain the LBW status at hospital
levels especially in University of Uyo Teaching Hospital.
Despite government interventions to provide maternal health
services, there is still Low birth weight due to prematurity or restricted
growth which leads to newborn and child death including disability and
communicable deaths (USAID, 2015) and
cardiovascular disease in later life (WHO,
2014a). According to CDC, (2018),
LBW newborns may be at more risk compared to those with normal weight and the
LBW babies may become sick in the first six days or develop infections, suffer
from problems related to delayed motor and social development including
learning disabilities.
It is therefore significant to ensure these consequences
are to greater extent averted. A review for 13 relevant studies in 12 countries
that had experienced armed conflict including Iraq, Libya, Israel and Bosnia
showed that mothers were at increased risk of giving births to low birth weight
babies (British Medical Journal, 2017).
However, very limited data or study related to the above is available in Akwa
Ibom state despite Akwa Ibom state being among the countries greatly affected
by protracted conflict.
Therefore, this study aimed to establish the determinants
of low birth weight among postpartum mothers in University of Uyo Teaching
Hospital in Unity State, Akwa Ibom state.
1.3. Objectives of the study
1.3.1 Overall objective
To assess the factors influencing low
birth weight in University of Uyo Teaching Hospital, Akwa Ibom state.
1.3.2 Specific objectives
i.
To determine the prevalence of low birth weight
among babies born in University of Uyo Teaching Hospital, Akwa Ibom state.
ii.
To determine the socioeconomic factors
influencing low birth weight in University of Uyo Teaching Hospital, Akwa Ibom
state.
iii.
To determine the individual factors influencing
low birth weight in University of Uyo Teaching Hospital, Akwa Ibom state. iv. To
determine nutritional factors influencing low birth weight in University of Uyo
Teaching Hospital, Akwa Ibom state.
v. To
determine health services factors influencing low birth weight in University of
Uyo Teaching Hospital, Akwa Ibom state.
1.4 Research Question
What are the factors determining low birth weight among
mothers delivering in University of Uyo Teaching Hospital?
1.4.1 Specific Questions
i.
What is the proportion of babies born with low
birth weight in University of Uyo Teaching Hospital?
ii.
What are the socioeconomic and demographic
factors influencing low birth weight among postpartum mothers delivering in University
of Uyo Teaching Hospital?
iii.
What are the individual factors influencing low
birth weight among postpartum mothers delivering in University of Uyo Teaching
Hospital? iv. What are the nutritional factors influencing low birth
weight among postpartum mothers delivering in University of Uyo Teaching
Hospital?
v. What
are the health service factors influencing low birth weight among postpartum
mothers delivering in University of Uyo Teaching Hospital?
1.5. Significance of the Study
The study determined the proportion of Low Birth Weight
among postpartum mothers in University of Uyo Teaching Hospital. In addition,
the key factors associated with low birth weight which will inform the health
facility management on the findings, academia, and policy makers among
others. The study results may be used to
improve nutritional and other maternal interventions as well as scaling up of
community-based campaigns on low birth weight.
The findings will add to existing literature on prevalence
and knowledge base on low birth weight and factors associated with it among the
postpartum mothers so that further research to close the gaps that this study
would not have addressed. The study results may also inform policy makers and
hospital managers to plan and implement context specific strategies that will
appropriately prevent and reduce the incidence and burden of low birth weight.
1.6. Description of the Conceptual
framework
The conceptual framework illustrates the relationship
between low birth weight with socioeconomic, individual, nutritional and health
service related factors and how those factors may contribute to LBW.
The framework specifically shows that the socioeconomic
variables like marital status, education level, and occupation, place of
residence, average monthly income, type of family and social support may
influence low birth weight among postpartum mothers.
Secondly, the individual variables that may also influence
the prevalence of LBW include; age, age at first birth, duration of gestation,
pregnancy interval, marital status, size of family, health of the mother, life
style, and tribe/religion.
Nutritional factors that may influence LBW like regular
intake of breakfast, number of meals per day, common types of food taken and
nutritional assessment during pregnancy.
Health system factors may also contribute significantly in
determining or influencing the low birth weight of the postpartum mothers. In
this study, the variables being studied are; ANC attendance (Recommended at
least 4 visits per pregnancy), health and nutritional education, folic acid and
iron supplementation, distance to health facility, attitude of health workers,
malaria prophylaxis during pregnancy, mode of delivery and cost of health
care. This study found out the prevalence of low birth weight at University of
Uyo Teaching Hospital was at 23.5%.
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