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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 2  |  Page : 729-734

Maternal sociodemographic and antenatal factors as predictors of low-birth weight in Ghana


Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana

Date of Submission27-Sep-2020
Date of Decision20-Oct-2020
Date of Acceptance25-Oct-2020
Date of Web Publication30-Jun-2021

Correspondence Address:
Alhassan A Rauf
BSC, MPH, Department of Surgery, Tamale Teaching Hospital. P.O. Box TL 16, Tamale
Ghana
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_353_20

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  Abstract 


Introduction
Globally, neonates with lower birth weight (LBW) are at higher risk of death as compared with those with normal birth weight, yet in Ghana, little is known about the nationwide predictors of LBW in terms of maternal demographic and antenatal factors.
Aim
To identify maternal sociodemographic and antenatal factors as a predictors of LBW in Ghana.
Patients and methods
A descriptive cross-sectional design was adopted for this study using Ghana Maternal Health Survey data for 2017. The data analysis was done using SPSS. χ2 and binary logistics regression model was used for associations at significance of P value less than 0.05.
Results
The average age of the women was 29.5 ± 9.8 years. The study recorded prevalence of LBW to be 7.4%. With significance at 95%, the following factors predicted absence of LBW: maternal age, 20–24 years [adjusted odds ratio (AOR)=1.8], 25–29 years (AOR = 2.4), and more than or equal to 30 years (AOR = 2.9), with 15–19 years as the reference category; unmarried mothers (AOR = 0.8); ethnicity, Ewe/Akan (AOR = 1.9) and Guan/Akan (AOR = 2.3); regional zone of the mother, Savanna/Coastal (AOR = 0.7); and antenatal medication, tetanus injection and iron table intake (AOR = 0.7 and AOR = 0.7, respectively).
Conclusion
The maternal factors identified as a predictor of LBW were maternal age, marital status, ethnicity, and regional belt or zone. Antenatal tetanus injection and iron table intake predicted LBW.

Keywords: antenatal, birth, low, predictors, sociodemographic, weight


How to cite this article:
Rauf AA, Sulemana MA. Maternal sociodemographic and antenatal factors as predictors of low-birth weight in Ghana. Menoufia Med J 2021;34:729-34

How to cite this URL:
Rauf AA, Sulemana MA. Maternal sociodemographic and antenatal factors as predictors of low-birth weight in Ghana. Menoufia Med J [serial online] 2021 [cited 2024 Mar 28];34:729-34. Available from: http://www.mmj.eg.net/text.asp?2021/34/2/729/319720




  Introduction Top


Globally, neonates with lower birth weight (LBW) are at higher risk of death as compared with those with normal birth weight. LBW babies are more vulnerable to birth asphyxia, trauma, hypothermia, hypoglycemia, respiratory disorders, and infections [1–4]. In the year 2015, the global prevalence of LBW was 14.6% [5]. The prevalence of LBW in Sub-Saharan Africa ranges from 13 to 15% [2]. LBW prevalence in Ghana is reported to be 10% according to the 2014 Ghana Demographic and Health Survey report [6].

Babies born with a birth weight below 2.5 kg are referred to as babies with LBW, regardless of their gestational age [2]. These babies are at high risk of death in their first month of life or face lifelong complications such as stunted growth, lower intelligence quotient, and later adult life complication such as obesity and diabetes [5].

LBW is associated with either less than 37 weeks of completed gestational age or intrauterine limited fetal growth, and these two factors have varied mortality or morbidity risk [4]. The global burden of intrauterine fetal growth restriction leading to LBW is substantial. In 1998 and 2010, respectively, there were 13.6 million and 10.6 million LBW associated with limited intrauterine growth in low-income and middle-income countries [4]. LBW has long-standing consequences in the form of growth inhibition, impairment of cognitive development, an increased incidence of chronic diseases such as type 2 diabetes, hypertension, and cardiovascular diseases [2],[7]. Furthermore, the results of the 2014 Ghana Demographic and Health Survey indicated that babies with LBW had a higher risk of early childhood death [6].

Among ∼18 million LBW babies born each year, ∼59% of them are related to limited intrauterine growth and 41% are associated with preterm [4]. Many studies have reported significant relations between LBW and maternal factors such as socioeconomic status, increasing parity, maternal age, educational status, diet, disease conditions such as malaria and general morbidity [8],[9]. Additional significant factors associated with newborn weight are maternal hemodynamics, folic acid intake, and quality of antenatal visit and quality of care [8],[9].

Several studies in low-income and middle-income countries have shown empirical support for the link that exists between maternal factors and child birth weight [10–13]. Evidence from a study in Ghana by Mohammed et al.[14] revealed that maternal factors such as educational level, residence, hemoglobin level, parity, number of antenatal care visits, and gestational age are associated with LBW. Another study in Ghana by Agorinya et al.[15] revealed that factors such as the female sex of the neonate, age of the mother, low economic status, and marital status predicted LBW in the district. The studies by Mohammed and colleagues and Agorinya and colleagues Ghana were both district based and not a national-wide study; hence, this paper aimed to identify maternal sociodemographic factors and antenatal services as a predictor of LBW in the whole of Ghana using the data from the national maternal health survey. This study result helped to identify nationwide predictors of LBW with consideration of maternal ethnicity and regional location. This will help with holistic nationwide policy to tackle the problem of LBW in Ghana.


  Patients and methods Top


This was a descriptive cross-sectional survey relying on data from Ghana Maternal Health Survey (GMHS) 2017. The 2017 GMHS was achieved by the Ghana Statistical Service with technical support from ICF through the Demographic and Health Survey program from June 15 through October 12, 2017. The sampling frame assumed was from the Ghana 2010 Population and Housing Census. This encompassed all women aged 15–49 years who were permanent occupants of selected households or visitors who stayed in selected households the night before the survey. The details of the survey procedures and the questionnaires used can be found in the final report [16].

The study encompassed all the survey participants (25 062), and women with history of child birth (8211) were used for the birth weight analysis. The main dependent variable of the study was LBW. The independent variables included maternal sociodemographic characteristics and antenatal services.

The ICF Institutional Review Board (IRB) approved the protocol for the use of the 2017 GMHS data set for this study. Ethical approval was not necessary for this study because it involved a secondary analysis of a data set without publicity to the identity of the participants and their households. Even so, authorization was obtained from ICF through the Demographic and Health Survey program for the use of the data sets for this study, and the rules of data use were observed.

Statistical analysis

Statistical analysis was accomplished by using SPSS, version 20 (2011; IBM Corp., New York, New York, USA). Categorical variables results were presented using frequencies and percentages using tables and figures. Continuous variables were presented using means, median, and modes. Birth weights below 2.5 kg were classified as LBW. The association between dependent and independent variables was done using χ2. The binary logistics regression model was used to identify predictor variables of LBW. Statistical significance was set at a P value of less than 0.05 for 8211 women with history child birth out of 25 062 study participants.


  Results Top


There were 25 062 respondents (women aged from 15 to 49 years) in this survey; the average age of the women was 29.5 ± 9.8, with a modal age of 15 years. The majority (74.0%) of the respondents were educated with at least primary level education. In terms of ethnicity, the majority (35.3%) were Akan. At the time of the survey, most respondents were married (43.4%). The religion that dominated among the respondents was Christianity (70.8%) and residency was almost the same for urban and rural (50.1 and 49.9%, respectively). The study was across the three regional belts of Ghana, and most (38.0%) were from the Savanna belt [Table 1].
Table 1: Demographic characteristics of the respondents'

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Of the total respondents (25 062), 8211 were those with history of child birth, and the rate of antennal attendance among the respondents (8211) was 98.1%. Most (99.4%) of the respondents had their blood pressure checked during antenatal, 96.1% had their urine tested, 97.9% had their blood sample taken for investigation, 99.4% had weight checked, 87.2% had tetanus injection, 93.9% had an iron tablet, and 99.0% had SP medication [Table 2].
Table 2: Antenatal services mother received

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The average birth weight recorded in the study was 3.8 kg, with minimum and maximum weight of 0.5 and 10.0 kg, respectively. The modal birth weight recorded was 3.0 kg. The prevalence of LBW according to study result was 7.4%. Maternal sociodemographic factors associated with LBW at the bivariate analysis were age of the mother (χ2 = 69.5858, P ≤ 0.001), marital status (χ2 = 16.537, P ≤ 0.001), ethnicity (χ2 = 21.644, P = 0.006) and regional belt (χ2 = 8.867, P = 0.012) [Table 3].
Table 3: χ2 analysis of maternal sociode mographic factors and lower birth weight

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Antenatal services associated with LBW bivariate analysis were maternal blood testing (χ2 = 5.37, P = 0.02), tetanus injection (χ2 = 14.853, P ≤ 0.001), and taking of iron tablet (χ2 = 8.688, P = 0.003) [Table 4].
Table 4: χ2 analysis of antenatal services association with lower birth weight

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At the multivariate analysis, the odds of no LBW increased with increased maternal age, 20–24 years [adjusted odds ratio (AOR)=1.8; 95% confidence interval (CI), 1.34–2.63], 25–29 years (AOR = 2.4; 95% CI, 1.70–3.37), and more than or equal to 30 years (AOR = 2.9; 95% CI, 2.07–4.00), with 15–19 years as the reference category. The odds for no LBW were less likely for unmarried mothers (AOR = 0.8; 95% CI, 0.59–0.99). Ethnicity also predicted LBW absence, such as Ewe (AOR = 1.9; 95% CI, 1.28–2.84) and Guan (AOR = 2.3; 95% CI, 1.22–4.33), with Akan group as a reference group. Regional zone or belt of the mother predicted LBW; the odds of LBW absence were less likely for those in the Savanna belt as compared with those in the Coastal belt (AOR = 0.7; 95% CI, 0.48–0.94). Regarding antenatal medication, tetanus injection and iron table intake predicted LBW absence (AOR = 0.7; 95% CI, 0.53–0.86 and AOR = 0.7; 95% CI, 0.45–0.97, respectively). The logistic regression model appropriately explained the outcome variable (LBW) because the Hosmer-Lemeshow goodness-of-fit test P value was more than 0.05 (χ2 (8)=9.229, P = 0.323); hence, the model fits the study data [Table 5].
Table 5: Multivariate analysis of factors associated with low-birth weight

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  Discussion Top


The prevalence of LBW according to the study results was 7.4%. The result of the study is low as compared with other studies in Ghana, including the report from UNICEF, 2013 [9],[14],[17].

The age of the mother predicted LBW as the chance of LBW decreased with increased maternal age. This study finding is in line as compared with other studies, which indicated that lower maternal age was a predictor factor for LBW [18–22].

The odds of no LBW were less likely 0.8 times for babies of the unmarried mothers as compared with those of married mothers. A similar study revealed that married mothers had higher odds of having babies with LBW as compared with unmarried mothers (OR = 1.25; 95% CI, 1.02–1.53) [23]. However, another study revealed that mothers' unmarried status was associated with an increased risk of LBW [24].

Ethnicity also predicted LBW; Ewes were likely almost two times to have none LBW babies as compared with Akan's, and Guan's were likely 2.3 times to have babies with absence of LBW when compared with Akan's. Additionally, in the regional zone or belt of the mother predicted LBW, the odds of LBW absence were less likely 0.7 times for those in the Savanna belt as compared with those in the Coastal belt. This further explains the prediction of Ewes and Guans to have LBW, as they form part of the coastal zone. This is similar to the study by Fulda et al. [23], in which ethnicity predicted LBW (OR = 1.65; 95% CI, 1.15–2.36).

The prevalence of antenatal attendance among the respondents was 98.1%. The result of this study is good because according to the world health organization, ∼70% of women worldwide ever receive antenatal service whereas for the developed the prevalence is 95% [25]. Antenatal services associated with LBW from bivariate analysis were maternal blood testing, tetanus injection, and taking of iron tablet (P < 0.05). Moreover, antenatal medications such as tetanus injection and iron table intake predicted LBW Absence. LBW was less likely for ∼30% for mothers of babies who were not taking tetanus injection and taking the iron tablet. A study by Zhou et al.[26] revealed that antenatal services such as weight measurement, blood pressure, blood test, urine test, B-scan ultrasound, and folic acid supplement were related to LBW. An animal study has revealed that iron deficiency during pregnancy was related to LBW [27]. Equally, a study revealed that antenatal iron intake was related to LBW [28]. However, other studies have equally revealed that maternal high intake of iron leads to high hemoglobin concentration which is related to increased risk of LBW [29]. Moreover, Peña-Rosas et al.[30] indicated in their study that pregnant women on iron tablets during pregnancy were on average more likely to have a higher concentration of iron at term or in their postpartum period.

This study is not without limitations. The study was unable to explore all factors known to be associated with LBW. Moreover, the data used for this study have to do with the remembrance of information from the past, hence the chance of recall bias.


  Conclusion Top


This study aimed to identify maternal sociodemographic and antennal factors as predictors of LBW in Ghana. The maternal factors identified as a predictor of LBW were maternal age, marital status, ethnicity, and regional belt or zone. Antenatal tetanus injection and iron table intake predicted LBW.

Recommendation

This current study used retrospective data, so nationwide prospective study is recommended for future study to limit study bias. Also, prospective study on iron intake and LBW should be conducted in Ghana for detail clarification of the relationship.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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