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Low Birth Weight; Factors; Neonate; Ethiopia

Introduction

Birth weight is the first weight of the fetus or newborn obtained after birth. For live births, birth weight should preferably be measured within the first hour of life, before significant postnatal weight loss has occurred [1]. According to World Health Organization (WHO) defined, Low birth weight is weight at birth less than 2500 g [2] LBW can be further subcategorized as very low birth weight (VLBW) and extremely low birth weight (ELBW)or very low birth weight (VLBW), which is less than 1500 g. and extremely low birth weight (ELBW), which is less than 1000 g [3]. It is a serious public health problem that has been linked to a substantial increase in the risk of mortality and morbidity [4] can be caused by either due to preterm birth (born before 37 weeks of gestation) or the infant being small for gestational age (slow prenatal growth rate) or a combination of both [5].

Birth weight is one of the important indicators to predict the future health and survival of new-born [6]. Infants with low birth weight are at higher risk of dying during their early months and years,in spite being born with LBW is generally recognized as a disadvantage for the infant and LBW infants are at higher risk of early growth retardation, infectious diseases, developmental delay and death during infancy and childhood [7,8].

Low birth weight is more common in developing than developed countries; a birth weight below 2,500 g contributes to a range of poor health outcomes. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength [9].

The great majority of low-birth-weight births occur in low- and middle-income countries and especially in the most vulnerable populations, Regional estimates of low birth weight include 28% in South Asia, 13% in sub-Saharan Africa and 9% in Latin America [10]. According to the Ethiopian Demographic and Health Survey, the prevalence of low birth weight in Ethiopia is 13% [11].

In Ethiopia under-five mortality rate decreased from 91 deaths per 1,000 live births in 1990 to 43 per 1,000 in 2015. However, the decline in neonatal mortality from 1990 to 2015 was slower than that of post neonatal under-five mortality [12]. In Ethiopia, low birth weight is a major public health problem since low birth weight is one of the leading causes of neonatal mortality and morbidity progress of sustainable development goals will be dependent on achieving high coverage of evidence-based interventions that decrease low birth weight and improve survival of newborns [13].

Methods and Materials

Study area and study period

Institution-based cross-sectional study was conducted from November1, 2021, to January, 2022 in Yekatit 12, Gandhi memorial and Ras desta Damtew hospital in Addis Ababa city and they were selected by simple random sampling metheods. And Addis Ababa has 11 subcities containing 117 woredas at an altitude of 7,546 feet (2,300metres). There are five hospitals owned by Addis Ababa Health Bureau, 4 by Federal Ministry of Health, one is under the ministry of Education (AAU), two by the defense force according to Addis Ababa city health office. Those three selected hospitals give delivery service and two of them except Ras Desta hospital have neonatal intensive care unit according the data of Human resource management of each hospital [14].

Source population

All newborn babies delivered in Adiss Abeba city Public Hospital were the source population.

Study participant

All randomly selected newborn babies delivered in Adiss Abeba city Public Hospital during the study period were included.

Inclusion Criteria

All mothers who delivered live newborns during the study period was included in the study.

Exclusion criteria

Multiple births, mothers, or newborns in critical medical conditions were excluded.

Sampling procedure

The study was conducted in three randomly selected public hospitals of Addis Ababa, Ethiopia, from November 2021to January 2022. Total sample sizes of 369 newborn babies was selected from three health institutions. The numbers of newborn/mother pairs surveyed from each health institution were allocated proportionally based on the expected number of deliveries in the study period, which was estimated using the number of l last one month in each health institution [15].

Data collection procedure

Data was collected by using a pretested, semi-structured questionnaire with an interview type of data collection method, medical record was cross-checked to confirm important variables such as patient obstetrics history and antnatal history.The question were prepared in English and translated into Amharic language. The interview was in Amharic language, a commonly used local language.

Data collectors and supervisors

Data collector and supervisor was trained for two days on the objective of the study, relevance of the study procedure during interviewing, confidentiality of client information, eligibility criteria, respondents right informed consent, and ways of approach during interview. Two Nurses who are currently working in the hospital were used as data collectors. The data collection process was closely supervised, and the completeness of each questionnaire was checked daily by the principal investigator, and a logical checking technique was employed to identify errors, finally, double data entry will be performed to check the consistency of the data.

Operational definition/and measuring scale

Low birth weight: is weight at birth less than 2500 g.

Preterm birth: delivery before 37 completed weeks of gestation.

Very low birth weight: birth weight which is less than 1500 g

Data entry and analysis

All filled questionnaire were checked for completeness, consistency, and accuracy. Data was cleaned and entered using EPI data (7.0) and then exported to version 20SPSS software. Descriptive statics were used to determine frequencies, percentages, means (SD), (table, pie chart) were used to describe the study population in relation to the relevant variables. Bivariate logistic regression was used to check variables having association with the dependent variables. Then those variables found to have p-value less than 0.2 were fitted to multvariete logistic regression for controlling the effect of confounders. Odds ratio with their 95% of CI was computed and variables having p-value less than 0.05 in the multiple logistic regression models were considered as significantly associated with the dependent variable and model fitness were checked by Hosmer Lemeshow goodness-of-fit test.

Results

Socio-demographic factors of respondents

A total of 369 new born baby mothers participated in the study constituting a response rate of 100%.More than half of the respondents (63.4%) were found in the age group of 20-35.More than three-quarters of the mother 342(92.7%) were married and 52.6% of the mother were urban residence. Regarding maternal educational status, 140(37.9%) of the respondents were primary education and almost half of them (49.9%) were house wives (Table 1).

Table 1: Socio-demographic factors of the mothers in Addis ababa city Public Hospitals, Addis Ababa, Ethiopia, 2021/2022.

Maternal factors

Half 187(50.7%) of the respondents were prim parous and one hundred thirty (30.6)of the respondents were multi parous.Two hundred forty-one (65.3%) of the respondents were categorized above or equal to two-year with regard to birth interval and 128(34.7%) of the respondent were below 24 month birth interval. Two hundred ninetyfour (79.7%) pregnancies were intended. Three hundred thirty (89.4%) have no history of low birth weight. With regard to current pregnancy complication only 58(15.7%) developed a complication. Three hundred fourth seven (94.0%) of the mothers were having ANC follow-up. Of which182 (49.3%)had four and above ANC follow-up (Table 2).

Table 2: Maternal factors of the respondent in Addis Ababa city Public Hospitals, Addis Ababa ,Ethiopia, 2021/2022.

Nutritional status and behavioral factors

Two hundred fourthy nign (67.5%) of the mothers were counseled about dietary intake during antenatal care follow-up. Two hundred twenty-two (60.2%)of them took an extra meals during pregnancy. Three hundred fifty-nine (97.3%) of the respondents did not smoke during pregnancy. Regarding alcohol drinking, three fifty (85.4%) of the respondents did not drink alcohol during their pregnancy. Additionally, eighty(4.9%) of the mothers had chewed chat during pregnancy (Table 3).

Table 3: Nutritional and behavioral factors of the respondents in Addis Ababa city Public Hospitals, Addis Ababa, Ethiopia, 2021/2022.

Low birth weight and other health condition of newborns

Among the three hundred sixty nign newborns 213(57.7%) were females and 156(42.3) were male newborn. 19(5.1) of the new born babies had visible birth defect. The prevalence of low birth weight among newborn babies in Adiss Abeba city Public Hospitals was found 15.2% at 95%CI=(11.7-18.7) (n=369) (Figure 1).

Figure 1: The prevalence of low birth weight among new born babies in Addis Ababa city Public Hospitals, Addis Ababa, Ethiopia2021/22.

Factors associated with low birth weight

In multivariate logistic regression analysis, place of residence,pregnancy interval, pregnancy complications, gestational age, antenatal care, follow-up during pregnancy, and sex of the new-born baby were found to be independent predictors of low birth weight.

Residence of the mother was strongly associated with low birth weight; mothers living in rural areas were 2.5 times more likely to have LBW babies when compared to those mothers who lived in urban(AO R=2.50(95%CI=(1.078-5.148).

Mothers who had a pregnancy interval <24month where 2.5 times more likely to have LBW babies when compared to those Mothers >24 month pregnancy interval (AOR=2.531, 95% CI = (1.422-4.507). Mothers who had a pregnancy complications were 13 times more likely to have LBW babies when compared to those mothers who do not have a pregnancy complications (AOR=13.530, 95% CI =(6.080-30.105). New born babies were 5 times higher to develop LBW in mothers who had no antenatal care during pregnancy when compared to mothers having antenatal care follow up (AOR = 5.14(95% CI =(1.260-21.017) and who were delivered before gestational age of 37 weeks were 7 times higher to develop low birth weight When compared to babies born at gestational age of 37 weeks and more (AOR = 7.446(95% +CI = (3.104-17.862). Additionally, female new born babies were three times more likely to have LBW than their male counter parts (AOR=3.24(95%CI=(1.354-7.7561) (Table 4).

Table 4: Factors associated with low birth weight of neonates (n=369).

Discussion

The finding of this study showed that 15.2% of new-borns were birth weight < 2500 g. rural place of residence, birth interval <24 months, lack of ANC, follow-up, pregnancy complications, preterm birth (gestational age <37 weeks) and being female new born were significantly associated variables to LBW.

The prevalence of low birth weight was 56(15.2%) at 95%CI = (11.7- 18.7) this finding was consistent with study’s conducted in dessie town referral hospital which was a study’s conducted in wolita sodo teaching and referral hospital. This similarity might be due to both reference population living in the same geographical area, study Time and The same socio economic stutus.

The reported value is higher than the study finding done in Colombia 8.7% (17)., Nigeria 6.3%. LBW in Burkina Faso, Ghana, Malawi, and Uganda ranges from respectively, 13.4%, 10.2%, 12.1%, and 10%. South west iran9.4%. This difference might be due to difference in study time, difference in socio economic, differences in the study population, sample size, and handling of potentially confounding variables.

However the prevalence of LBW in this was found to be lower than studys doned in Wolita Sodo 15.8%, Harar 23.3%, Hadiya zone 17.4%, Wello 17.4%. Dire dawa 21%, Dilla 34.1%, Ethiopia 17.3%, Gojjam 26.3%. This might be due to variation in characteristics of socio-demographic, economic, health care seeking behavior, study setup,study time,study population.

This study indicated a significant difference among urban and rural resident mothers regarding delivering a low birth weight babies. Mothers who reside in rural were higher odds of delivering a low birth weight babies compared to urban residents. This result is in line with studys done Tigraye city Northern Ethiopia. Study conducted in Dilla Town. and a study conducted in debre tabor Hospital, amhara regional state Ethiopia . and A studys conducted at hospitals in Kambata- Tembaro zone, southern Ethiopia. A possible reason would be people in rural live, a life characterized by greater hardship due to low infrastructure, harder physical work, and less access to basic services than the urban . And it might also be due to the accessibility of health services, health information, and nutritional awareness which were more prominent as the women resided in urban areas than rural areas. Moreover, female newborns were more likely to be low birth weight compared to male newborns. This study is comparable with studies done in Ataye primary hospital. A study conducted on Prevalence of Low Birth Weight and Associated Factors among Women Delivered in Debre Markos Referral Hospital, East Gojam, and Ethiopia. A study conducted in gonder Town. Studies conducted in IRAN. The possible explanation would be that female fetuses are insulin resistant than boys so that females would not use glucose properly as males during the intrauterine period.

Limitations of the study

In this study, the inability to include mothers who delivered at home. And Private health facilities were not included, which might undermine the generalizing result to the general population.

Conclusion

This study shows that the prevalence of LBW in Adiss Abeba town governmental hospital, Adiss Abeba, Ethiopia, was found to be 15.2%.

It was found to be affected by rural place of residence, birth interval <24 months, lack of ANC, follow-up, pregnancy complications, preterm birth (gestational age <37 weeks) and being female new born. And it is better to give more emphasis on focused antenatal care to ensure the risk of low birth weight is detected early and treated appropriately. Health care providers should undertake prevention strategies for preterm delivery.

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