Yasmin, Sohely; (1998) Neonatal outcome of low birth weight infants in Bangladesh. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Perinatal and neonatal mortality is used as an important indicator of health status, a country's educational, social and public health system, and standards of obstetric and paediatric care. The formal services reflecting National Health policy for children in Bangladesh is called Maternal and Child Health Care integrated with Family Planning, which emphasizes mostly Family Planning with little attention to children and none for new-born infants. The Bangladesh commitment to 'Health for All by the year 2000' includes significant reductions in infant, child, and maternal mortality. To bring about further reductions in infant mortality we need to understand risk factors for neonatal mortality, especially for high risk, low birth weight (LBW) infants. Birth weight is the single most important determinant for neonatal survival in developing countries. Up to 50% of new-born infants in Bangladesh are born with a birth weight less than 2500g. This study was planned to help health planners with information on the nature and extent of perinatal mortality of LBW infants, important risk factors for LBW stillbirths and neonatal mortality and morbidity, and thereby ideas for programmes to reduce LBW deaths. Aim: This study aims to study the pattern and risk factors for mortality and morbidity of low birth weight infants in Bangladesh. Design: It was a prospective study, with a case control design, of 999 low birth weight live and stillborn infants selected from the labour ward of a large teaching hospital in Dhaka city. All the infants born with birth weight less than 2.5 kg were enrolled from the hospital for the period of May 1994 to September 1995, and followed up at home at 28 days of age. During this period those infants who died and those who were stillborn were taken as cases and those who survived as the controls. Methods: Anthropometric details of infants at birth and follow up were collected. Obstetric and placental details after delivery, socio-economic and morbidity details of the mothers and infants at follow up, and verbal autopsy data for infants who died were used to identify the risk factors for stillbirth, neonatal mortality and morbidity. Results: The overall neonatal mortality rate for LBW infants was 132 per 1000 livebirths, and the perinatal mortality rate 179 per 1000 total births. The overall percentage of low birth weight in this population was 26% and intrauterine growth retardation was 37%, 20% of low birth weight infants were proportionally retarded and 17% disproportionally retarded. The neonatal mortality was highest in the lowest birth weight group (less than 1.5 kgs) at 690 per 1000 live births, and 513 per 1000 live births for infants less than 32 weeks gestation. Most infants died in the first week with early neonatal mortality (114 per 1000) representing 86% of neonatal deaths. After stepwise logistic regression analysis, abnormal placental colour (OR 5.78, Cl 3.13 -10.70), maternal illiteracy (OR 1.45, CI 1.08-1.65), and lower social class (OR 11.72, Cl 0.97-141.99) emerged as independent risk factors for stillbirth. For neonatal death independent risk factors were birth weight < 1.99kg (OR 1.62, CI 0.75-3.47), low mid upper arm circumference (OR 0.29, Cl 0.19- 0.46), maternal anaemia <9gm (OR 3.05; Cl 1.12 - 8.31), young age at marriage (OR 3.60, Cl 1.49-8.72), maternal illiteracy (OR 2.52; Cl 1.33 - 4.75), and no antenatal care (OR 2.31 Cl 1.21-4.41). For poor neonatal growth (defined as those infants below the 25th centile for change in weight standard deviation score over the neonatal period ) independent risk factors were resuscitation time (OR 1.44 Cl 0.53-3.9), gestational age (OR 1.70, Cl 0.79-3.66), diarrhoea (OR 0.28 Cl 0.12-0.64), supplementary feeding (OR 5.46, Cl 2.59-11.49) and length at birth (OR 0.81, Cl 0.69-0.93). Conclusion : The findings show that perinatal and neonatal mortality rates remain high among LBW infants even in this relatively privileged hospital population in Dhaka. Risk factor analysis suggests that some important factors associated with mortality and morbidity are potentially easily preventable and treatable. Special attention should be paid by health planners to care during the first three days. Provision of antenatal care, essential new-born care for infants less than 2.0 kg for the first three days, special attention (perhaps administration of antibiotic therapy) for infants born with abnormal placental colour, iron and folate supplementation to reduce maternal anaemia, and promotion of early breastfeeding are strategies which could significantly reduce low birth weight mortality and morbidity in Bangladesh.

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