Maternal Health Services as Determinant Factors for Low Birth Weight in public hospitals of Addis Ababa, Ethiopia: a Case-control Study.

Background: The birth weight of a newborn has a substantial impact on infant mortality, morbidity, development, and long-term health. It is determined by the mother's overall health status. More than 20 million babies are born with low birth weight across the world. In developing countries, almost 17% of all newborns are born with low birth weights, with no exception in Ethiopia. Alleviating this problem, needs a clear understanding of the determinants. Thus, this study was done in Addis Ababa, the most populous city in the country, where the lifestyles of mothers might be affected by the dynamic city life.Method: An unmatched case-control study was applied to assess the risk factors of low birth weight in three randomly selected public hospitals in Addis Ababa, Ethiopia. Data was collected through interviewer-administered structured questionnaires. Data analysis was done using SPSS version 24. Descriptive statistics using frequencies and percentages were used to describe the socio-demographic characteristics of the study participants. Bi-variable and multi-variable logistic regression analyses were used to assess the possible effect of determinant factors on low birth weight, with their respective odds ratios and 95% confidence intervals. P-values of less than 0.05 were considered statistically significant.Result: We enrolled 168 cases and 336 controls; all completed the study with no refusal. Of all pregnancies, 90 (17.8%) were unplanned and unwanted. And, 153 (30.3%) of mothers have a history of prior abortion. Among the factors we studied, maternal age below 18 years (AOR: 2.69, 95% CI: 1.24, 5.84), unwanted and unplanned pregnancy (AOR: 1.25, 95% CI: 1.09, 2.66), ANC visit in the last pregnancy below three (AOR: 3.23, 95% CI: 1.61, 6.49), female neonate (AOR: 1.09, 95% CI: 2.04, 3.20), not supplemented with iron and folic acid (AOR: 3.11, 95% CI: 1.36, 7.11) and hematocrit level of < 30 (AOR: 2.29, 95% CI: 1.00, 5.22) showed a statistically significant association with low birth weight.Conclusion: This study demonstrates that the age of mothers below 18 years, unwanted and unplanned pregnancy, low ANC visits, lack of iron and folic acid supplements, and low maternal hemoglobin level were the significant determinants of low birth weight among term babies. Thus, women of childbearing age should be screened and educated about the risks of pregnancy and should get the necessary care and support when they get pregnant.

Pre-conceptional Maternal Vitamin B12 Supplementation Improves Offspring Neurodevelopment at 2 Years of Age: PRIYA Trial

Background: The first thousand days window does not include the pre-conceptional period. Maternal pre-conceptional health has a profound influence on early embryonic development (implantation, gastrulation, placentation etc). Nutrition provided by B-complex vitamins is important for fetal growth, especially neural development. We report effects of a maternal pre-conceptional vitamin B12 and multi micronutrient (MMN) supplementation on offspring neurodevelopmental performance.Methods: In the Pune Rural Intervention in Young Adolescents trial (PRIYA), adolescents (N = 557, 226 females) were provided with vitamin B12 (2 μg/day) with or without multiple micronutrients, or a placebo, from preconception until delivery. All groups received mandatory iron and folic acid. We used the Bayley's Scale of Infant Development (BSID-III) at 24–42 months of age to investigate effects on offspring neurodevelopment.Results: Participants had similar baseline B12 levels. The levels improved in the B12 supplemented groups during pre-conception and pregnancy (28 weeks gestation), and were reflected in higher cord blood holotranscobalamin (holo-TC) levels compared to the placebo group. Neurodevelopmental outcomes in the B12 alone group (n = 21) were better than the placebo (n = 27) in cognition (p = 0.044) and language (p = 0.020) domains (adjusted for maternal baseline B12 levels). There was no difference in neurodevelopmental outcomes between the B12 + MMN (n = 26) and placebo group. Cord blood Brain Derived Neurotrophic Factor (BDNF) levels were highest in the B12 alone group, though not significant.Conclusion: Pre-conceptional vitamin B12 supplementation improved maternal B12 status and offspring neurodevelopment at 2 years of age. The usefulness of cord BDNF as a marker of brain development needs further investigation. Our results highlight the importance of intervening during pre-conception.

Prevalence and determinants of Anemia among pregnant women in sub-Saharan Africa: a systematic review and Meta-analysis

Background Anemia is one of the world’s leading cause of disability and the most serious global public health issues. This systematic review and meta-analysis was carried out very prudently in order to give up the pooled prevalence and determinants of anemia in Sub-Saharan Africa. Methodology To carry out this ephemeral systematic review and meta-analysis, a correlated literature review was done from various sources, PubMed Medline and Google Scholar Journals. Anemia related searching engine was used to make the study more evocative and intensive. We used modified Newcastle-Ottawa quality assessment scale for cross sectional studies to evaluate the quality of the study in relations of their inclusion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was tracked to conduct this study. The pooled effect size was computed using the review manager and Compressive Meta-analysis software. Results Twenty-fife studies, which encompassed 15,061 pregnant women, were chosen for the analysis. From those an overall prevalence of anemia in pregnancy in SSA was 35.6%. However, the result from meta-analysis showed that women who were infected with intestinal parasite were 3.59 times more likely to develop anemia compared to those who were not infected [OR:3.59, 95% CI (2.44,5.28)].The result showed that women who had no iron and folic-acid supplementation were 1.82 times more likely to develop anemia compared to those women who had iron and folic-acid supplementation {OR:1.82, 95% CI (1.22,2.70]. Women who had women were in third trimester pregnancy were 2.37 times more likely to develop anemia compared to those who were in first and second trimester [OR:2.37, 95% CI (1.78, 3.24)]. Women who had low dietary diversity score were 3.59 times more likely to develop anemia compared to those who had high dietary diversity score [OR: 3.59, 95% CI (2.44, 5.28]. Conclusions Our finding from this systematic review and meta-analysis displays the high case in prevalence of anemia among pregnant women in Sub-Saharan Africa. Predictors for this includes: intestinal parasite, iron and folic-acid supplementation, third trimester pregnancy and dietary diversified intake score were statistically correlated positively with anemia in pregnancy. These need cautious evaluation of impact of prevention effort for operational policy, programs and design nutrition intrusions for refining maternal food consumption during pregnancy. Also, dietary education intrusion requires to be prearranged to satisfy the desires of pregnant women. The finding of this work will be used as an evidences for policy makers of Africa; entirely for maternal and child health care. Lastly, we suggested further investigations to be carried out in the area of the study for more rigorous and comprehensive recommendations.

Maternal Iron-and-Folic-Acid Supplementation and its Association with Low-birthweight and Neonatal Mortality in India

Objective: This study assessed intake of iron-and-folic-acid (IFA) tablet/syrup (grouped into none, <100 days of IFA consumption or <100 IFA, and ≥100 days of IFA consumption or ≥100 IFA) among prospective mothers and its association with various stages of low-birthweight (ELBW: extremely low-birthweight, VLBW: very low-birthweight, and LBW: low-birthweight) and neonatal mortality (death during day 0-1, 2-6, 7-27, and 0-27) in India. Design: The cross-sectional, nationally representative, 2015-2016 National Family Health Survey (NFHS-4) data were used. Weighted descriptive analysis, and multiple binary logistic regression modelling were used. Setting: NFHS-4 covered 640 districts from 37 states/ union territories of India. Participants: A total of 120,374 and 143,675 index children aged 0-59 months were included to analyse LBW and neonatal mortality, respectively. Results: Overall, 30.7% mothers consumed ≥100 IFA in 2015-2016, and this estimate ranged from 0.0% in Zunheboto district of Nagaland state to 89.5% in Mahe district of Puducherry of India. Multiple regression analysis revealed that children of mothers who consumed ≥100 IFA had lower odds of ELBW, VLBW, LBW, and neonatal mortality during day 0-1, as compared to mothers who did not buy/receive any IFA. Consumption of IFA (<100 IFA and ≥100 IFA) had protective association with neonatal death during day 7-27, and 0-27. Consumption of IFA was not associated with neonatal death during day 2-6. Conclusions: While ≥100 IFA consumption during pregnancy was found to be associated with preventing select types of LBW and neonatal mortality, a large variation in coverage of ≥100 IFA consumption across 640 districts is concerning.

Stunting Prevention with Education and Nutrition in Pregnant Women: A Review of Literature

Background : Stunting is a major nutritional problem in children under five years old which has an impact on slowing growth by reducing the number and development of body cells, including brain cells and other organs. Pregnant women are one of the groups who are vulnerable to nutritional problems, related to the process of growth and development of the fetus in the womb. The role of education and nutrition is important during pregnancy because it has implications for the health of mothers and children in later life. The aimed of this review was to identify research about effect stunting prevention and education and nutrition to pregnant women. Methods : A database review undertaken using Pubmed, CHINAHL and Google Scholar from 2011-2021 to collect focused study on education and nutrition research on pregnant women to prevent stunting. A total of 1788 articles were identified. These were scaned and 18 articles were retrieved with 13 articles shortlisted for to in depth review. Results : Education with using audiovisual media, moringa leaf ice cream and early nutrition has proved effective in increasing pregnant women knowledge regarding stunting prevention. Providing nutritional supplements/nutrients for moringa oliefera, folic acid and iron, specific nutrition, LNS, PM2A PROCOMIDA, nutrition before pregnancy, supplements antenatal iron and folic acid, prenatal micronutrients have an effect on reducing children stunting. Conclusion: Audio visual education can convery health knowledge because easily to facilitate the reception of health message for pregnant women. Continuous education and monitoring of the of pregnant women diet every month during pregnancy classes at the posyandu are needed to prevent stunting in children.

Factors associated with iron and folic acid supplementation among pregnant women aged 15-45 years attending Naroosura health centre, Narok County, Kenya

Background: Iron and folic acid are very important nutrients to mothers during pregnancy. Their deficiencies are risk factors for anaemia, preterm delivery and low birth weight. This study aimed to investigate the supplementation of iron and folic acid and the associated factors among pregnant women attending Naroosura health centre, Narok County, Kenya.Methods: This study employed a descriptive cross-sectional study design. Data collection took a period of one month where a total of 123 mothers participated. A self-administered semi-structured questionnaire was used for data collection. Chi-square test was conducted to find associations at a significance level of 0.05.Results: Of the study participants, nearly a third (31.7%) took iron and folic acid supplements daily, over a half (57.7%) indicated that taking iron and folic acid supplements was important to them, about a quarter (24.4%) reported that use of iron and folic acid supplements reduces birth defects and about a third (32%) consumed foods rich in iron and folic acid. Supplementation of iron and folic acid was significantly associated with residence (ꭓ2=4.311, df=1, p=0.038), monthly household income (ꭓ2=10.870, df=4, p=0.028), reduced birth defects (χ2=6.131, df=1, p=0.013) and consumption of iron and folic acid rich foods (χ2=4.163, df=1, p=0.041).Conclusions: The intake as well as supplementation of iron and folic acid is still low. Therefore, both the intake and supplementation of iron and folic acid need to be scaled up.

Factors Influencing the Compliance of Pregnant Women with Iron and Folic Acid Supplementation in the Philippines: 2017 Philippine Demographic and Health Survey Analysis

Anemia in pregnancy, which is a public health concern for most developing countries, is predominantly caused by iron deficiency. At least, 180 days of iron and folic acid (IFA) supplementation is recommended for pregnant women to mitigate anemia and its adverse effects. This study aimed to examine compliance with the recommendation of IFA supplementation and its underlying factors using the 2017 Philippine National Demographic and Health Survey data. The variables assessed included age, highest level of education, occupation, wealth index, ethnicity, religion, residence, number of pregnancies, time of first antenatal care (ANC) visit and number of ANC visits. Compliance with the recommendation of at least 180 days of IFA supplementation was the outcome variable. The study assessed 7983 women aged 15–49 years with a history of pregnancy. Of these participants, 25.8% complied with the IFA supplementation recommendation. Multiple logistic regression analysis showed that pregnant women of Islamic faith and non-Indigenous Muslim ethnicity were less likely to comply with the IFA supplementation recommendation. Being aged between 25 and 34 years, having better education and higher wealth status, rural residency, initiating ANC visits during the first trimester of pregnancy and having at least four ANC visits positively influenced compliance with IFA supplementation. The effect of residence on IFA adherence differed across the wealth classes. Strategies targeted at specific groups, such as religious minorities, poor urban residents, the less educated and young women, should be strengthened to encourage early and regular antenatal care visits for improving compliance.