Abstract
Adverse birth outcomes remain significant contributors to perinatal mortality as well as developmental disabilities worldwide but limited evidence exists in sub-Saharan Africa based on a conceptual framework incorporating neighborhood context. This study therefore set out to determine the prevalence and risk factors for preterm births and low birthweight in an urban setting from this region. A cross-sectional study of all live births from May 2005 to December 2007 in an inner-city maternity hospital in Lagos, Nigeria. Factors predictive of preterm births and low birthweight were determined by unconditional multivariable logistic regression within a conceptual framework for adverse birth outcomes. Population attributable risk (PAR%) for each factor was also determined. Of the 4,314 newborns enrolled, 859 (19.9%) were preterm and 440 (10.2%) were low birthweight. One-third of mothers received no antenatal care while about 6% had HIV and another 6% had a history of hypertensive disorders. About 43% of the low birthweight infants were born full term. Maternal predictors of preterm delivery and/or low birthweight were marital status, occupation, residential accommodation with shared sanitation facilities, lack of antenatal care, absence of previous cesarean section, hypertensive disorders and antepartum hemorrhage. Gender and intrauterine growth restriction (IUGR) were also predictive of low birthweight. IUGR (PAR = 48.74%) and lack of prior cesarean section (PAR = 41.99%) were the leading contributors to preterm birth and/or low birthweight. The burden of preterm and low birthweight deliveries in this setting is associated with modifiable individual and neighborhood-level risk factors that warrant community-oriented public health interventions.
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References
United Nations Children’s Fund (UNICEF). (2008). The state of the world’s children 2009. New York.
Lawn, J. E., Cousens, S., & Zupan, J. (2005). 4 million neonatal deaths: When? Where? Why? Lancet, 365, 891–900.
Goldenberg, R. L., Culhane, J. F., Iams, J. D., & Romero, R. (2008). Epidemiology and causes of preterm birth. Lancet, 371, 75–84.
United Nations Children’s Fund and World Health Organization. (2004). Low birthweight: Country, regional and global estimates. New York: UNICEF.
Wilcox, A. J. (2001). On the importance—and the unimportance—of birthweight. International Journal of Epidemiology, 30, 1233–1241.
Hertz-Picciotto, I. (2001). Commentary: When brilliant insights lead astray. International Journal of Epidemiology, 30, 1243–1244.
Committee on Nervous System Disorders in Developing Countries, Board on Global Health. (2001). Neurological, psychiatric and developmental disorders: Meeting the challenge in the developing world. Washington, D.C. National Academy Press.
Saigal, S., & Doyle, L. W. (2008). An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet, 371, 261–269.
Durkin, M. (2002). The epidemiology of developmental disabilities in low-income countries. Mental Retardation and Developmental Disabilities Research Review, 8, 206–211.
Ozumba, B. C., & Okafor, H. U. (2004). Low-birthweight babies in Eastern Nigeria. Public Health, 118, 244–246.
Feresu, S. A., Harlow, S. D., Welch, K., & Gillespie, B. W. (2004). Incidence of and socio-demographic risk factors for stillbirth, preterm birth and low birthweight among Zimbabwean women. Paediatric Perinatal Epidemiology, 18, 154–163.
Abrams, E. T., Milner, D. A., Jr., Kwiek, J., et al. (2004). Risk factors and mechanisms of preterm delivery in Malawi. American Journal of Reproductive Immunology, 52, 174–183.
Magadi, M., Madise, N., & Diamond, I. (2001). Factors associated with unfavorable birth outcomes in Kenya. Journal of Biosocial Sciences, 33, 199–225.
Buka, S. L., Brennan, R. T., Rich-Edwards, J. W., Raudenbush, S. W., & Earls, F. (2003). Neighborhood support and the birth weight of urban infants. American Journal of Epidemiology, 157, 1–8.
Culhane, J. F., & Elo, I. T. (2005). Neighborhood context and reproductive health. American Journal of Obstetric and Gynecology, 192(5 Suppl), S22–S29.
Cubbin, C., Marchi, K., Lin, M., et al. (2008). Is neighborhood deprivation independently associated with maternal and infant health? Evidence from Florida and Washington. Maternal and Child Health Journal, 12, 61–74.
United Nations Population Fund. (2007). State of world population 2007: Unleashing the potential of urban growth. New York: UNFPA.
Blondel, B., Kogan, M. D., Alexander, G. R., et al. (2002). The impact of the increasing number of multiple births on the rates of preterm birth and low birthweight: An international study. American Journal of Public Health, 92, 1323–1330.
Olusanya, B. O. (2009). Newborns at risk of sensorineural hearing loss in low-income countries. Archives of Disease in Children, 94, 227–230.
Diez-Roux, A. V. (1998). Bringing context back into epidemiology: Variables and fallacies in multilevel analysis. American Journal of Public Health, 88, 216–222.
Aragão, V. M., da Silva, A. A., de Aragão, L. F., et al. (2004). Risk factors for preterm births in São Luís, Maranhão, Brazil. Cadernos de Saúde Pública, 20, 57–63.
Feresu, S. A., Harlow, S. D., & Woelk, G. B. (2004). Risk factors for prematurity at Harare Maternity Hospital, Zimbabwe. International Journal of Epidemiology, 33, 1194–1201.
Kramer, M. S. (1987). Determinants of low birth weight: Methodological assessment and meta-analysis. Bulletin of the World Health Organization, 65, 663–737.
Olusanya, O., Okpere, E., & Ezimokhai, M. (1985). The importance of social class in voluntary fertility. West African Journal of Medicine, 4, 205–212.
Olowe, S. A. (1981). Standards of intrauterine growth for an African population at sea level. Journal of Pediatrics, 99, 489–495.
Rockhill, B., Newman, B., & Weinberg, C. (1998). Use and misuse of population attributable fractions. American Journal of Public Health, 88, 15–19.
Watson-Jones, D., Weiss, H. A., & Changalucha, J. M. (2007). Adverse birth outcomes in United Republic of Tanzania—Impact and prevention of maternal risk factors. Bulletin of the World Health Organization, 85, 9–18.
Dobbelaere, A., Pattinson, R. C., Makin, J. D., & Quintelier, J. (1996). The potential for preventing the delivery and perinatal mortality of low-birth-weight babies in a black urban population. South Africa Medical Journal, 86, 536–539.
Mavalankar, D. V., Gray, R. H., & Trivedi, C. R. (1992). Risk factors for preterm and term low birthweight in Ahmedabad, India. International Journal of Epidemiology, 21, 263–272.
Kramer, M. S. (2003). The epidemiology of adverse pregnancy outcomes: An overview. Journal of Nutrition, 133(5 Suppl 2), 1592S–1596S.
World Health Organization. (1995). Maternal anthropometry and pregnancy outcomes. A WHO Collaborative Study. Bulletin of the World Health Organization, 73, 1–98.
Iams, J. D., Romero, R., Culhane, J. F., & Goldenberg, R. L. (2008). Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth. Lancet, 371, 164–175.
Bang, A. T., Baitule, S. B., Reddy, H. M., Deshmukh, M. D., & Bang, R. A. (2005). Low birth weight and preterm neonates: Can they be managed at home by mother and a trained village health worker? Journal of Perinatology, 25(Suppl 1), S72–S81.
Spittle, A. J., Orton, J., Doyle, L. W., & Boyd, R. (2008). Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants. Evidence-Based Child Health, 3, 145–206.
Messer, L. C., Vinikoor, L. C., Laraia, B. A., et al. (2008). Socioeconomic domains and associations with preterm birth. Social Sciences and Medicine, 67, 1247–1257.
Luo, Z. C., Wilkins, R., Kramer, M. S., & Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. (2006). Effect of neighborhood income and maternal education on birth outcomes: A population-based study. Canadian Medical Association Journal, 174, 1415–1420.
Li, C. Y., & Sung, F. C. (2008). Socio-economic inequalities in low-birth weight, full-term babies from singleton pregnancies in Taiwan. Public Health, 122, 243–250.
Tuntiseranee, P., Olsen, J., Chongsuvivatwong, V., & Limbutara, S. (1999). Socioeconomic and work related determinants of pregnancy outcome in southern Thailand. Journal of Epidemiology and Community Health, 53, 624–629.
Yunis, K., Beydoun, H., Khogali, M., Alameh, M., Tamim, H., & National Collaborative Perinatal Neonatal Network. (2003). Low socioeconomic status and neonatal outcomes in an urban population in a developing country. Journal of Maternal and Fetal Neonatal Medicine, 14, 338–343.
Wadhwa, P. D., Culhane, J. F., Rauh, V., et al. (2001). Stress, infection and preterm birth: A biobehavioural perspective. Paediatric Perinatal Epidemiology, 15(Suppl 2), 17–29.
Hogue, C. J., Hoffman, S., & Hatch, M. C. (2001). Stress and preterm delivery: A conceptual framework. Paediatric Perinatal Epidemiology, 15(Suppl 2), 30–40.
Rajaratnam, J. K., Burke, J. G., & O’Campo, P. (2006). Maternal and child health and neighborhood context: The selection and construction of area-level variables. Health and Place, 12, 547–556.
Osrin, D., & Costello, A. M. L. (1999). What can be done about intrauterine growth retardation? Seminar in Neonatology, 4, 173–181.
Pattinson, R. C. (2004). Are deaths due to prematurity avoidable in developing countries? Tropical Doctor, 34, 7–10.
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Affiliation of Bolajoko O. Olusanya during the study period: Institute of Child Health & Great Ormond Street Hospital for Children NHS Trust, University College London, 30 Guilford Street, London WC1N 1EH, UK.
An erratum to this article can be found at http://dx.doi.org/10.1007/s10995-010-0676-6
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Olusanya, B.O., Ofovwe, G.E. Predictors of Preterm Births and Low Birthweight in an Inner-City Hospital in Sub-Saharan Africa. Matern Child Health J 14, 978–986 (2010). https://doi.org/10.1007/s10995-009-0528-4
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DOI: https://doi.org/10.1007/s10995-009-0528-4