Incidence and Risk Factors for Low Birthweight and Preterm Birth in Post-Conflict Northern Uganda: A Community-Based Cohort Study
Abstract
:1. Background
2. Methods
2.1. Study Procedures
2.2. Statistical Analysis
3. Results
3.1. Study Profile
3.2. Baseline and Clinical Characteristics of Study Participants
3.3. The Incidence of Low Birthweight and Preterm Birth
3.3.1. Low Birthweight
3.3.2. Preterm Birth
Crude Incidence of Preterm Birth (95% CI) | Cluster and Adjusted Incidence of Preterm Birth (95% CI) | |
---|---|---|
Using the original New Ballard Score | 4.1% (3.0–5.8%) | 5.0% (3.2–7.7%) |
Subtracting 1 score point from the New Ballard Score | 5.5% (4.4–6.9%) | 6.4% (4.4–9.2%) |
Subtracting 2 score points from the New Ballard Score | 7.8% (6.5–9.6%) | 8.6% (6.1–12.2%) |
Subtracting 3 score points from the New Ballard Score | 12.1% (10.4–14.0%) | 13.1% (10.0–16.9%) |
Subtracting 4 score points from the New Ballard Score | 17.1% (15.2–19.3%) | 17.8% (14.6–21.4%) |
3.4. Risk Factors for Low Birthweight and Preterm Birth
3.4.1. Low Birthweight
Characteristics | All N = 1556 n (%) | LBW N = 121 n (%) | Crude RR (95% CI) N = 1556 | p Value | Adjusted RR (95% CI) N = 1556 | p Value |
---|---|---|---|---|---|---|
Maternal characteristics | ||||||
Maternal age | ||||||
12–19 years | 415 (26.7) | 40 (33.1) | 1.4 (1.0–2.0) | 0.048 | 1.3 (0.8–2.1) | 0.351 |
20–34 years | 982 (63.1) | 67 (55.4) | Ref | |||
≥35 years | 159 (10.2) | 14 (11.6) | 1.3 (0.9–1.9) | 0.183 | 1.9 (1.1–3.4) | 0.021 |
Maternal education | ||||||
0–6 years | 1246 (80.1) | 91 (75.2) | Ref | |||
≥7 years | 310 (19.9) | 30 (24.8) | 1.3 (0.9–2.0) | 0.190 | 1.4 (0.9–2.3) | 0.102 |
Maternal vocational education | ||||||
No | 1371 (88.1) | 103 (85.1) | Ref | |||
Yes | 185 (11.9) | 18 (14.9) | 1.3 (0.8–2.1) | 0.297 | ||
Marital status | ||||||
Married | 1417 (91.1) | 110 (90.9) | 1.0 (0.5–1.8) | 0.951 | ||
Single/separated/divorced/widowed | 139 (8.9) | 11 (9.1) | Ref | |||
Wealth index groups | ||||||
Lower 40% | 708 (45.5) | 62 (51.2) | Ref | |||
Middle 40% | 547 (35.2) | 40 (33.1) | 0.8 (0.6–1.3) | 0.379 | 0.8 (0.6–1.3) | 0.402 |
Upper 20% | 301 (19.3) | 19 (15.7) | 0.7 (0.5–1.2) | 0.171 | 0.7 (0.4–1.2) | 0.255 |
Father’s occupation | ||||||
Farmer | 1058 (68.0) | 87 (71.9) | Ref | |||
Employed | 348 (22.4) | 22 (18.2) | 1.0 (0.5–1.8) | 0.929 | ||
Unemployed | 150 (9.6) | 12 (9.9) | 0.8 (0.5–1.2) | 0.237 | ||
Domestic water source | ||||||
Tap/Borehole | 977 (62.8) | 72 (59.5) | Ref | |||
Spring/river/well/stream/pond | 579 (37.2) | 49 (40.5) | 1.1 (0.8–1.7) | 0.476 | ||
Intervention | ||||||
No | 740 (47.6) | 60 (49.6) | Ref | |||
Yes | 816 (52.4) | 61 (50.4) | 0.9 (0.6–1.3) | 0.656 | 0.9 (0.6–1.4) | 0.716 |
Facility Delivery | ||||||
No | 482 (31.1) | 42 (34.7) | ||||
Yes | 1070 (68.9) | 79 (65.3) | 0.8 (0.6–1.1) | 0.251 | ||
Maternal clinical characteristics | ||||||
History of a small infant | ||||||
No | 218 (14.0) | 19 (15.7) | Ref | |||
Yes | 985 (63.3) | 68 (56.2) | 1.3 (0.7–2.1) | 0.386 | 2.1 (1.2–3.7) | 0.014 |
Prime gravida | 353 (22.7) | 34 (28.1) | 1.4 (0.9–2.1) | 0.090 | 1.1 (0.6–1.8) | 0.778 |
Parity | ||||||
Prime gravida | 353 (22.7) | 34 (28.1) | Omitted | |||
1–6 | 1043 (67.0) | 77 (63.6) | Ref | |||
7 or more | 160 (10.3) | 10 (8.3) | 0.8 (0.5–1.5) | 0.573 | 0.6 (0.3–1.4) | 0.226 |
Maternal HIV infection | ||||||
No | 1455 (93.5) | 116 (95.9) | Ref | |||
Yes | 73 (4.7) | 5 (4.1) | 0.9 (0.4–2.0) | 0.723 | 0.9 (0.4–1.8) | 0.719 |
Unknown | 28 (1.8) | 0 (0.0) | Not applicable | |||
Antennal attendance | ||||||
No | 352 (22.6) | 30 (24.8) | Ref | |||
Yes | 1204 (77.4) | 91 (75.2) | 0.9 (0.6–1.3) | 0.522 | ||
IPT for malaria in pregnancy | ||||||
No | 704 (45.2) | 69 (57.0) | Ref | |||
Yes | 852 (54.8) | 52 (43.0) | 0.6 (0.4–0.8) | 0.003 | 0.6 (0.4–0.8) | 0.001 |
Malaria in pregnancy | ||||||
No | 502 (32.3) | 25 (20.7) | Ref | |||
Yes | 388 (24.9) | 32 (26.4) | 1.7 (1.01–2.7) | 0.046 | 1.7 (1.01–2.9) | 0.045 |
Unknown | 666 (42.8) | 64 (52.9) | 1.9 (1.2–3.0) | 0.005 | 1.9 (1.1–3.2) | 0.020 |
Infant sex | ||||||
Female | 757 (48.7) | 63 (52.1) | Ref | |||
Male | 799 (51.3) | 58 (47.9) | 0.9 (0.6–1.2) | 0.393 | 0.9 (0.7–1.2) | 0.463 |
3.4.2. Preterm Birth
Characteristics | All N = 1279 n (%) | PB N = 53 n (%) | Crude RR (95% CI) N = 1279 | p Value | Adjusted RR (95% CI) N = 1279 | p Value |
---|---|---|---|---|---|---|
Maternal characteristics | ||||||
Maternal age | ||||||
12–19 years | 330 (25.8) | 18 (34.0) | 1.6 (0.9–2.9) | 0.142 | 2.0 (1.0–4.3) | 0.050 |
20–34 years | 815 (63.7) | 28 (52.8) | Ref | |||
≥35 years | 134 (10.5) | 7 (13.2) | 1.5 (0.7–3.5) | 0.295 | 1.2 (0.6–2.6) | 0.612 |
Maternal education | ||||||
0–6 years | 1032 (80.7) | 50 (94.3) | Ref | |||
≥7 years | 247 (19.3) | 3 (5.7) | 0.2 (0.1–0.8) | 0.022 | 0.3 (0.1–0.98) | 0.047 |
Maternal vocational education | ||||||
No | 1131 (88.4) | 45 (84.9) | ||||
Yes | 148 (11.6) | 8 (15.1) | ||||
Marital status | ||||||
Married | 1166 (91.2) | 47 (88.7) | 0.7 (0.3–1.5) | 0.393 | ||
Single/separated/divorced/widowed | 113 (8.8) | 6 (11.3) | Ref | |||
Wealth index | ||||||
Lower 40% | 574 (44.9) | 26 (49.1) | Ref | |||
Middle 40% | 465 (36.3) | 18 (34.0) | 0.8 (0.5–1.4) | 0.513 | 0.9 (0.6–1.5) | 0.815 |
Upper 20% | 240 (18.8) | 9 (17.0) | 0.8 (0.4–1.9) | 0.650 | 1.1 (0.5–2.5) | 0.847 |
Father’s occupation | ||||||
Farmer | 883 (69.0) | 38 (71.7) | Ref | |||
Employed | 274 (21.4) | 8 (15.1) | 1.4 (0.7–2.9) | 0.342 | ||
Unemployed | 122 (9.5) | 7 (13.2) | 0.7 (0.4–1.4) | 0.305 | ||
Domestic water source | ||||||
Tap/Borehole | 802 (62.7) | 27 (50.9) | Ref | |||
Spring/river/well/stream/pond | 477 (37.3) | 26 (49.1) | 1.1 (0.8–1.7) | 0.476 | 1.5 (0.9–2.6) | 0.121 |
Intervention | ||||||
No | 601 (47.0) | 23 (43.4) | Ref | |||
Yes | 678 (53.0) | 30 (56.6) | 1.1 (0.6–2.1) | 0.670 | 1.2 (0.7–2.2) | 0.517 |
Facility Delivery | ||||||
No | 397 (31.0) | 23 (4.4) | Ref | |||
Yes | 882 (69.0) | 30 (56.6) | 0.6 (0.3- 1.01) | 0.054 | 0.6 (0.4–1.0) | 0.045 |
Maternal clinical factors | ||||||
History of a small infant | ||||||
No | 964 (75.4) | 39 (73.6) | Ref | |||
Yes | 40 (3.1) | 2 (3.8) | 1.2 (0.2–5.7) | 0.927 | 1.0 (0.2–5.2) | 0.986 |
Prime gravida | 275 (21.5) | 12 (22.6) | 1.1 (0.5–2.0) | 0.884 | 0.8 (0.3–1.8) | 0.557 |
Parity | ||||||
Prime gravida | 275 (21.5) | 12 (22.6) | Ref | |||
1–6 | 872 (68.2) | 34 (64.2) | 1.1 (0.6–2.1) | 0.790 | ||
7 or more | 132 (10.3) | 7 (13.2) | 1.4 (0.7–2.6) | 0.346 | ||
Maternal HIV infection | ||||||
No | 1205 (94.2) | 47 (88.7) | Ref | |||
Yes | 61 (4.8) | 6 (11.3) | 2.2 (0.9–5.6) | 0.094 | 2.9 (1.1–7.3) | 0.026 |
Unknown | 13 (1.0) | 0 (0.0) | NA | |||
Antenatal attendance | ||||||
No | 283 (22.1) | 14 (26.4) | Ref | |||
Yes | 996 (77.9) | 39 (73.6) | 0.8 (0.4–1.4) | 0.451 | ||
IPT for malaria in pregnancy | ||||||
No | 695 (54.3) | 29 (54.7) | Ref | |||
Yes | 584 (45.7) | 24 (45.3) | 0.9 (0.5–1.6) | 0.832 | 1.0 (0.6–1.8) | 0.886 |
Malaria in pregnancy | ||||||
No | 330 (25.8) | 15 (28.3) | Ref | |||
Yes | 342 (26.7) | 13 (24.5) | 0.8 (0.5–1.5) | 0.568 | ||
Unknown | 607 (47.5) | 25 (47.2) | 0.9 (0.5–1.6) | 0.785 | ||
Infant sex | ||||||
Female | 620 (48.5) | 20 (37.7) | Ref | |||
Male | 659 (51.5) | 33 (62.3) | 1.6 (0.9–2.7) | 0.117 | 1.6 (1.0–2.8) | 0.070 |
4. Discussion
5. Limitations and Strengths
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Low Birthweight | Preterm Birth | ||||||
---|---|---|---|---|---|---|---|---|
All N = 1877 n (%) | Analysed N = 1556 n (%) | Excluded N = 321 n (%) | p Value | All N = 1877 n (%) | Analysed N = 1279 n (%) | Excluded N = 598 n (%) | p Value | |
Maternal characteristics | ||||||||
Maternal age | ||||||||
12–19 years | 510 (27.2) | 415 (26.7) | 95 (29.6) | 510 (27.2) | 330 (25.8) | 180 (30.1) | ||
20–34 years | 1174 (62.5) | 982 (63.1) | 192 (59.8) | 0.325 | 1174 (62.5) | 815 (63.7) | 359 (60.0) | 0.017 |
≥35 years | 193 (10.3) | 159 (10.2) | 35 (10.6) | 193 (10.3) | 134 (10.5) | 59 ( 9.9) | ||
Maternal education | ||||||||
0–6 years | 1515 (80.7) | 1246 (80.1) | 269 (83.8) | 1515 (80.7) | 1032 (80.7) | 483 (80.8) | ||
≥7 years | 362 (19.3) | 310 (19.9) | 52 (16.2) | 0.117 | 362 (19.3) | 247 (19.3) | 115 (19.2) | 0.896 |
Maternal vocational education | ||||||||
No | 1663 (88.6) | 1371 (88.1) | 292 (92.0) | 1663 (88.6) | 1131 (88.4) | 532 (89.0) | ||
Yes | 214 (11.4) | 185 (11.9) | 29 ( 8.9) | 0.224 | 214 (11.4) | 148 (11.6) | 66 (11.0) | 0.700 |
Marital status | ||||||||
Married | 1708 (91.0) | 1417 (91.1) | 291 (90.7) | 0.495 | 1708 (91.0) | 1166 (91.2) | 542 (90.6) | 0.557 |
Single/separated/divorced/widow | 169 ( 9.0) | 139 ( 8.9) | 30 ( 9.3) | 169 ( 9.0) | 113 (8.8) | 56 ( 9.4) | ||
Wealth index | ||||||||
Lower 40% | 837 (44.6) | 708 (45.5) | 129 (40.2) | 837 (44.6) | 574 (44.9) | 263 (44.0) | ||
Middle 40% | 665 (35.4) | 547 (35.2) | 118 (36.8) | 0.329 | 665 (35.4) | 465 (36.4) | 200 (33.4) | 0.139 |
Upper 20% | 375 (20.0) | 301 (19.3) | 74 (23.0) | 375 (20.0) | 240 (18.8) | 135 (22.6) | ||
Father’s occupation | ||||||||
Farmer | 1275 (67.9) | 1058 (68.0) | 217 (67.6) | 1275 (67.9) | 883 (69.1) | 392 (65.5) | ||
Employed | 390 (20.8) | 348 (22.4) | 42 (13.1) | 0.022 | 390 (20.8) | 274 (21.4) | 116 (19.4) | 0.688 |
Unemployed | 168 ( 9.0) | 150 ( 9.6) | 18 ( 5.6) | 168 ( 9.0) | 122 ( 9.5) | 46 ( 7.7) | ||
Missing | 44 ( 2.3) | 0 ( 0.0) | 44 (13.7) | 44 ( 2.3) | 0 ( 0.0) | 44 ( 7.4) | ||
Domestic water source | ||||||||
Tap/Borehole | 1188 (63.3) | 977 (62.8) | 211 (65.7) | 0.459 | 1188 (63.3) | 802 (62.7) | 386 (64.6) | 0.268 |
Spring/river/well/stream/pond | 689 (36.7) | 579 (37.2) | 110 (34.3) | 689 (36.7) | 477 (37.3) | 212 (35.4) | ||
Intervention | ||||||||
No | 855 (47.2) | 740 (47.6) | 145 (45.2) | 885 (47.2) | 601 (47.0) | 284 (47.5) | ||
Yes | 992 (52.9) | 816 (52.4) | 176 (54.8) | 0.625 | 992 (52.8) | 678 (53.0) | 314 (52.5) | 0.956 |
Facility Delivery | ||||||||
No | 644 (34.3) | 484(31.1) | 160 (49.8) | 644 (34.3) | 397 (31.0) | 247 (41.3) | ||
Yes | 1233 (65.7) | 1072(68.9) | 161 (50.2) | 0.000 | 1233 (65.7) | 882 (67.0) | 351 (58.7) | 0.000 |
Maternal clinical characteristics | ||||||||
History of small infant | ||||||||
No | 1131 (60.2) | 985 (63.3) | 146 (45.5) | 1131 (60.3) | 964 (75.4) | 167 (30.2) | ||
Yes | 317 (16.9) | 218 (14.0) | 99 (30.8) | 0.000 | 317 (16.9) | 40 ( 3.1) | 277 (50.0) | 0.000 |
Prime gravida | 429 (22.9) | 353 (22.7) | 76 (23.7) | 429 (22.9) | 275 (21.5) | 154 (27.8) | ||
Parity | ||||||||
Prime gravida | 429 (22.9) | 353 (22.7) | 76 (23.7) | 429 (22.9) | 275 (21.5) | 154 (25.7) | ||
1–6 | 1257 (67.0) | 1043 (67.0) | 214 (66.8) | 0.857 | 1257 (67.0) | 872 (68.2) | 385 (64.4) | 0.025 |
7 or more | 191 (10.2) | 160 (10.3) | 31 ( 9.7) | 191 (10.2) | 132 (10.3) | 59 ( 9.9) | ||
Maternal HIV infection | ||||||||
No | 1708 (91.0) | 1455 (93.5) | 253 (78.8) | 1708 (91.0) | 1205 (94.2) | 503 (84.1) | ||
Yes | 83 ( 4.4) | 73 ( 4.7) | 10 ( 3.1) | 0.000 | 83 ( 4.4) | 61 ( 4.8) | 22 ( 6.7) | 0.000 |
Unknown | 86 ( 4.6) | 28 ( 1.8) | 58 (18.1) | 86 ( 4.6) | 13 ( 1.0) | 73 (12.2) | ||
Antenatal attendance | ||||||||
No | 395 (21.0) | 352 (22.6) | 43 (13.4) | 395 (21.0) | 283 (22.1) | 112 (18.7) | ||
Yes | 1482 (79.0) | 1204 (77.4) | 278 (86.6) | 0.000 | 1482 (79.0) | 996 (77.9) | 486 (81.3) | 0.088 |
IPT a for malaria in pregnancy | ||||||||
No | 764 (40.7) | 704 (45.2) | 60(18.7) | 764 (40.7) | 695 (54.3) | 69 (11.5) | ||
Yes | 1113 (59.3) | 852 (54.8) | 261 (81.3) | 0.000 | 1113 (59.3) | 584 (45.7) | 529 (88.5) | 0.000 |
Maternal malaria in pregnancy | ||||||||
No | 602 (32.1) | 502 (32.3) | 100 (31.2) | 602 (32.1) | 272 (45.5) | 330 (25.8) | ||
Yes | 459 (24.4) | 388 (24.9) | 71 (22.1) | 0.245 | 459 (24.4) | 117 (19.6) | 342 (26.7) | 0.000 |
Unknown | 816 (43.5) | 666 (42.8) | 150 (46.7) | 816 (43.5) | 209 (35.0) | 607 (47.5) | ||
Infant sex | ||||||||
Female | 892 (47.5) | 757 (48.7) | 135 (42.0) | 892 (47.5) | 620 (48.5) | 272 (45.5) | ||
Male | 943 (50.2) | 799 (51.3) | 144 (44.9) | 0.950 | 943 (50.2) | 659 (51.5) | 284 (47.5) | 0.816 |
Missing | 42 ( 2.3) | 0 ( 0.0) | 42 (13.1) | 42 (2.2) | 0 (0.0) | 42 (7.0) |
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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
Odongkara B, Nankabirwa V, Ndeezi G, Achora V, Arach AA, Napyo A, Musaba M, Mukunya D, Tumwine JK, Thorkild T. Incidence and Risk Factors for Low Birthweight and Preterm Birth in Post-Conflict Northern Uganda: A Community-Based Cohort Study. International Journal of Environmental Research and Public Health. 2022; 19(19):12072. https://doi.org/10.3390/ijerph191912072
Chicago/Turabian StyleOdongkara, Beatrice, Victoria Nankabirwa, Grace Ndeezi, Vincentina Achora, Anna Agnes Arach, Agnes Napyo, Milton Musaba, David Mukunya, James K. Tumwine, and Tylleskar Thorkild. 2022. "Incidence and Risk Factors for Low Birthweight and Preterm Birth in Post-Conflict Northern Uganda: A Community-Based Cohort Study" International Journal of Environmental Research and Public Health 19, no. 19: 12072. https://doi.org/10.3390/ijerph191912072