Predictors of Low Birth Weight in Bushenyi District, Uganda

ABSTRACT The study sought to establish the factors that lead to low birth weight (LB W) of children born in the health units in Bushenyi district. The objectives were to establish the prevalence of LBW of babies born in the health units and to establish the relationship between LBW and selected risk factors. The first four hundred and ninety five ( 495) mothers who delivered in the selected health units during July - August 2008 were considered for the study. The study was carried out from three hospitals, 5 health centre !Vs and 7 health centre Ills. Analytical cross-sectional study design was used to establish the relative interaction of various independent variables in predicting the dependent variable. Data was collected through an interview using structured questionnaire, observations of mothers at period of delivery, and taking the weights of babies soon after delivery. The data collected was computed into summaries and frequencies for continuous and categorical variables respectively. Spearman's rho correlation was used to establish the relationship between LBW and socio-economic status, while multiple linear regression analysis was used to determine the prediction of soco-demographic, health, behavioral and lifestyle of mothers on LBW status. The prevalence of LBW was found to be l 0.5%. The following factors; mothers aged below 21 years, smoking during pregnancy. alcohol consumption. poor health of mother and poor health seeking behavior were found to be significantly related to low birth weight. The parity of the mother/ family size, education, and socio-economic status were not significantly related to LBW. The major recommendations were: to strengthen programmes that prevent early pregnancies, especially for the teenagers and youth; Xlll strengthen antenatal services; maintain and strengthen malaria control activities; strengthen 1-IIV I AIDS services and intensify family planning services to limit the number of children per woman.

TABLE OF CONTENTS

Page

Table of contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . u

Declaration .. . . .. . .. . . . . . . .. . .. .. . .. . . .. . . . . .. . .. . .. . . . . .. . . . .. . . . . . . . . . .. .. . v

Approval . . . . . .. . . . . . . . . .. . .. . . . . .. . . . . . . . . . . . . . .. .. .. . . . .. . . . . . . . . .. . . . .. ... VI

Dedication .. . . . . . .. . . . . . . . . .. .. . .. .. . .. . .. . . . . .. . .. .. .. . . .. .. .. . . . . .. . .. . . .. vii

Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

List of tables . . . . . .. . . . .. .. . .. . . . . .. .. .. . . .. .. . . . .. .. .. . . . .. . .. .. .. . .. . . .. . . lX

List of figures............................................................. x

List of abbreviations . . . . . .. .. . .. .. . . . . .. . . . . .. .. .. .. . . .. .. . .. . . . . .. ... Xi

Abstract .. . . . . . . . . . . . . . . . . . . .. . . .. .. .. .. .. .. .. .. .. .. . .. .. .. . .. . . . .. . . . .. . . .. . xii

CHAPTER ONE:

Introduction ...... ........ ........... ...... ............................... ... 1

Background to the study .................................................. .

Problen1 Staten1ent . . . . . . . .. . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 3

Purpose of the study . . . . .. . . . . . . . . . .. . . . . . .. . . . . .... . . . .. . . . . . . . . . . . .. . . . . . 3

Broad objectives............................................................ 4

Specific objectives .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . 4

Hypothesis . . . . . . ... . .. . . . ... . .. .... . . ... .. . ... . . . ...... . .. .. . .... . . ... .. . ... 4

Justification for the study . . .. . . . . . .. . .. . . . . .. .. .. . . . .. .. . .. .. . . .. . . .. .. . . .. 4

Conceptual framework . . . .. . . .. .. . .. . .. . .. . . . . .. . .. . . . . .. . .. .. . . .. .... .. .. 5

CHAPTER TWO

Literature Review ...... .................. ........................ ....... 6

Socio-economic factors .. . . .. . .. .. . .. .. . . .. . . . . .. . .. . . . . .. . .. .. . .... . . .. .. 7

Socio-demographic and health factors................................... 8

Behavioral conditions/ lifestyle and socio support.................. l 0

CHAPTER THREE

Methodology . .. ... .. . .. . .. .... ...... . .. ... ......... ...... ............ .......... 12

Research design . . . . . . . . . . . . . . . .. . . . . .. . . .. . . . .. . .. .. . . . .. .. . . .. . . . . . . .. . .. . . . .. 12

Study Population . .. . . . . .. . .. . .. . . . .. .. .. . .. .. .. .. .. . . . .. . . . . .. .. . . . .. . . .. .. 12

Study area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Sampling technique .. . .. . . . . . .. . . . .. . . . . . . . .. .. .. . . . .. . . . . .. . .. . . . .. . . . .. . . .. 14

Sample size . . . . . . . . . . . . . . . . .. . . . .. . . . . .. .. .. . . . .. .. .. . . . .. . . .. . . . . .. .. . . . . .. . .. .. 15

Data collection methods . .. . .. . . . .. . .. . . . . .. . .. . . . . .. . . . . .. . .. . . .. .. . .. . .. .. . .. 15

Selection of mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Exclusion criteria . .. . .. . . . .. . . . . .. .. .. . . . .. . . . . . . .. .. . . . . .. . .. .. . .. . .. . . . .. . .. 16

Validity of questionnaire . . . ... . . . ..... . . . .... . . . . . . .. . . . ... . ... . .. . . . .. . .. . . . .. 16

Reliability of . .. . . . .. . .. . . . .. . . .. . .. . . .. . .. . . . .. .. .. . . . .. . . . .. . . .. . . . .. . . . .. .. . . . . 17

Data analysis . .. . . . .. . . .. . .. . . . .. . . . . .. . .. . . . . .. .. .. . . . .. . . . .. . . .. . .. . . . . . . . .. . . . . 17

Ethical considerations .. . .. . . . .. .. . . . . . . .. . . . . . .. .. . .. .. .. .. . . . .. . . .. . . . .. . .. . . .. 18

Limitations .. . .. . .. . .. . . . . . . . . . . . . .. .. . . . .. . . . . .. .. .. .. .. .. .. .. . . .. . . .. . . .. . . .. ... 18

CHAPTER FOUR

Presentation, Analysis, Discussion and Interpretation of Results ...... 19

Presentation and analysis of results ............................................ 19

Summaries for continuous variables.......................................... 19

Frequencies for categorical variables........................................ 19

Description of factors influencing low birth weight by frequencies and

Percentages .. . .. . . .. .. . .. . .. . .. . . . .. .. . . .. . . .. . .. . .. . .. .. .. . 26

Cross tabulation of variables with birth weight status..................... 29

Prevalence ofLBW of babies born in Bushenyi district.................. 35

Birth weight by age of mother................................................. 35

Birth weight by health sub district.......................................... 36

Birth weight by religion of mother............................................ 37

Correlation of socio-economic status with birth weight................... 38

Correlation of socio- demographic factors with birth weight.............. 39

ll1

Correlation of health factors with birth weight.............................. 41

Correlation of behavioral/lifestyle factors and birth weight . . . . . . . . . . . . 44

Discussion and interpretation................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 45

Prevalence of low birth weight in Bushenyi district........................ 45

Socio- economic factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 7

Socio- demographic factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 7

Health factors . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . .. 48

Behavioral and lifestyle factors ................................................. 52

CHAPTER FIVE

Conclusions and recommendations ...... ,................................ 54

Conclusions . . . . . . . . . .. . .. . .. . . .. .. . . . . .. . . . . .. .. .. . . . .. . . . . .. . .. .. . .. . .. . . .. ... 54

Recommendations . .. . . . . . . .. . .. . . . . .. . . . . .. .. .. . . . .. . . . .. .. . .. .. . .. . .. . .. . . . . 55

Area for further research . .. . . . .. .. .. .. . .. . . . . .. . .. . .. .. . . .. . . . . .. . .. . .. . . .. .. 55

REFERANCES ............................................................... 56

APPENDICES:

Appendix I -Regional mortality picture for Uganda . . . . . . . . . . . . . . . . . . . . . . 60

Appendix 2- Conceptual framework .. ...... .. .. .. .... .... .. .... .. .... .. 61

Appendix 3 - Identified health units for study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

Appendix4- Deliveries in Bushenyi district (July 2007-June 2008) . . . 63

Appendix 5- Deliveries conducted in selected health units . . . . . . . . . . . . . . . . 64

Appendix 6- Validity of the questionnaire................................ 65

Appendix 7- Reliability of the questionnaire .. .. .. .. .. .. .. .. .. .. . .. .. .. .. .. 66

Appendix 8 - Statement of consent .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 68

Appendix 9 -The interview schedule .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . 69

Appendix 10- Variables of the study..................................... 76

Appendix II - Letter of clearance and introduction .. .. .. .. .. .. .. .. .. .. . 78

Appendix 12 - Invitation to train research assistants .. .. .. .. .. .. .. .. .. . 79