Characteristics of Mothers who Born Low Birth Weight Newborn in Bangladesh

Shanzida Khatun1*, Manju Ara Khatun2 , Lipika Rani Biswas3

1PhD, MNSc, RN, Faculty, National Institute of Advanced Nursing Education and Research, Dhaka

2MSN, RN, Nursing Instructor, Dhaka Nursing College, Dhaka

3MNSc, RN, Nursing Instructor, Sylhet Nursing College, Sylhet

*Corresponding author: Shanzida Khatun, PhD, MNSc, RN, Faculty, National Institute of Advanced Nursing Education and Research, Dhaka. Email: sanzidaadib@yahoo.com

Citation: Khatun S, Khatun MA, Biswas LR. Characteristics of Mothers who Born Low Birth Weight Newborn in Bangladesh. Int J Nursing Sci Clinical Practices. 2020;1(1):20-25.

Received Date: July 17, 2020; Accepted Date: November 10, 2020; Published Date: November 20, 2020

Abstract

Background and Objective: In Bangladesh, at least 22.6% of babies are born with less than 2500 grams that is the highest incidence in Asia. The purpose of the study was to examine the characteristics of mothers who had low birth weight babies.

Methods: A descriptive cross-sectional study design was conducted. Using G*power analysis the total 108 postnatal mothers were recruited conveniently. However, the final 91 participants were used to analyze the data. Three sets of questionnaire including (1) socio-demographic characteristics, (2) maternal pregnancy related characteristics, and (3) newborn birth weight < 2500 grams were used to collect the data. Content validity of the instruments was done by the experts. This study was approved from the Institutional Review Board, NIANER. Informed consent was obtained from each participant prior to the study. Both descriptive and inferential analysis was performed to determine the characteristics of mothers who had low birth weight babies.

Results: The mean age of mother was 25.71±6.21 years. The average birth weight of low birth weight babies was 1967.03±339.95 grams ranging from 1100-2400grams. Among the socio-demographic and maternal pregnancy related characteristics, a significant association was found between those factors including maternal age, education, anemia, number of antenatal care visit, maintain personal hygiene, period of amenorrhea (PoA), and low birth weight of newborn. Multiple regression analysis revealed that maternal education, period of amenorrhea, maintain personal hygiene, and number of antenatal care visit together explained that there was 27% of the variance in the low birth weight of newborn (R2=.273, F (4, 86) =8.055, p< 0.001).

Conclusion: The findings of this study provided information that could be used in a further intervention study to evaluate the effect of intervention on maternal and child health outcomes.

Keywords: Low Birth Weight; Newborn; Mothers

Introduction

Low birth weight (LBW) has been defined as birth weight < 2500 grams (2.5kg) at the time of birth [1], predicts normal growth during infancy and childhood [2]. Globally, more than 20 million infants are born with low birth weight [3], and more than 95 % of are born in developing countries [4]. The rate of low birth weight in Bangladesh is 33 per 1000 live births [5]. National low birth weight survey reported that about 22.6% low birth weight in Bangladesh [6]. LBW is the most important cause of infant mortality in the past 2 decades [7].

The infant mortality rate is about 20 times higher for all low birth weight babies than other babies [8]. Moreover, LBW is a higher risk of morbidity and disability during early life and infancy [9]. It has been established that low birth weight infants are at increased risk for certain diseases such as cardiovascular and metabolic disease in adulthood [10]. Low birth weight is an important indicator in determining child survival, future physical growth, and mental development [11]. Therefore, LBW is one of the most serious challenges for mothers and child health.

LBW babies are linked to maternal socio-demographic characteristics and health status of mothers [12]. Maternal characteristics have been variously shown to impact on the birth weight [13], such as maternal socio-demographic characteristics and medical conditions including maternal age, education, income, heavy work, nutritional status, multiple pregnancies, anemia, placenta prevea, gestational age ≤ 37 weeks, and parity ≥ 2 are strongly associated with low birth weight [14-16].

There is a considerable works done on this topic in others area of developing countries. The majority of previous studies have primarily focused on the rates and predictors of impaired outcomes. In addition, limited evidence has shown that maternal characteristics such as postnatal depression and maternal eating habits infl uence infant weight gain [17]. A little research related to examine the relationship between characteristics of mothers and low birth weight of babies in Bangladesh. That is why it is important to study this phenomenon. Eventually, this may help to decrease the incidence of low birth weight and improve mothers and newborn health and achieve the Sustainable Development Goals (SDGs).

Methods

Study Design

The present cross-sectional study was undertaken at Dhaka Medical College Hospital (DMCH) situated in the central Dhaka. As the biggest and tertiary hospital, the majority of the mothers come to receive postnatal care.

Participants and Sampling

The participants of the study were the postpartum mothers admitted in the DMCH. The sample size for the study was calculated using G*power analysis for multiple regression at the level of significance (α) .05, power .80, and a medium effect size f2=0.15 [18]. It was suggested that 86 participants were required for the study. By considering the rate of elimination 20%, the number of total participants was 108 postpartum mothers. The participants of this study were selected using convenient sampling technique. The inclusion criteria were mothers who delivered babies with birth weight less than 2500 grams at post natal ward in the selected hospital.

A total of 108 neonate/mother pairs participated in the study constituting a response rate of 84%. A total of 17 clients were excluded due to having delivered more than 2500 grams of baby’s birth weight.

Instruments

Data were collected by using three questionnaires:

  1. The Socio-demographic Characteristics and
  2. Maternal Pregnancy related Characteristics,
  3. Newborn Birth Weight < 2500 grams.

The Socio-demographic Characteristics: The socio-demographic characteristics questionnaire was developed by the researchers based on the literature reviewed. The socio-demographic characteristics consisted 8 items including mothers’ age, living place, religion, edu-cational level, occupation, monthly family income, and type of family and newborn birth weight.

Maternal Pregnancy related Characteristics: Maternal pregnancy related characteristics were developed by the researchers based on the literature reviewed. It consisted maternal anemia, number of received antenatal care visit, iron and vitamin supplementation, smoking or chewing, maintain personal hygiene, proper water supplementation, and proper sanitation, parity, previous low birth weight of babies, previous miscarriages, period of amenorrhea (POA) at delivery, multiple pregnancies, inter pregnancy interval, medical conditions during pregnancy.

Newborn Birth Weight: Newborn birth weight < 2500 grams was collected from the postpartum mothers’ record file.

The content validity of the instruments was confirmed by referring to the standard literature and by the three experts (PhD holder nursing faculties) from NIANER and Obstetric & Gynecologist.

Data Collection

This study was conducted from September to December 2018 at inpatients department for child birth care delivery. This study was approved from the institutional review board (IRB) (Exp.NIA-F-2018-8), NIANER, Dhaka. After getting permission from the Directors, Dhaka Medical College Hospital, the researcher met with the nurse incharge (Head Nurse) of the selected ward and the participants. After getting written consent form the participants the researchers asked to provide answers in accordance with the questions being asked. All mothers’ received sufficient information about the purpose of the study, the methods, and data collection procedure. Mothers were informed that they had the right to withdraw from the study at any time. Moreover, mothers were assured that their refusal to participate or withdrawal from the study would not affect the care provided to their children. All participants were received small gifts as an acknowledgement of their participations. The interview time was 30-40 minutes.

Data Analysis

Descriptive statistics were used to analyze the characteristics of the postpartum mothers. Continuous variables were presented as mean and standard deviations (SD), and categorical data were presented based on frequency and percentage. T-test, ANOVAs, Pearson’s product moment correlation coefficients, and multiple regression analysis were used to identify the characteristics of mothers who had low birth weight of babies.

Results

Socio-demographic and Pregnancy related Characteristics of the Mothers who had Low Birth Weight of Babies

Table 1 summarizes the socio-demographic characteristics of mothers who had low birth weight of babies. The mean age of mothers was 25.71±6.21 years. Most of the mothers (81.3%) were below 30 years of old. Majority of mothers (60.4%) were lived at urban area. Around seventy nine percent of mothers (78.7%) had below secondary education. Almost all of them (97.2%) were Muslim. A large number of mothers (93.5%) had no paid employment. The average monthly family income of mothers was 15670.33±8948.07 taka. The mean birth weight of babies was 1967.03±339.95 grams ranging from 1100-2400gms.

Table 1. Distribution of general characteristics of mothers who had low birth weight of newborn (N =91)

Characteristics

Categories

n

%

M±SD

Age(years)

18-25 years
26- 30 years
≥ 30 years

47
27
17

51.6
29.7
18.7

25.71±6.21
(min=18, max=40)

Living place

Urban
Rural

55
36

60.4
39.6

Religion

Muslim
Non-Muslim

88
3

96.7
3.3

Education level

Illiterate
≤ secondary
≥ secondary

9
26
56

9.9
28.6
61.5

Employment status

Employed
Housewife

5
86

5.5
94.5

Monthly family income (TK)

 

≤ 15000
15000+

45
46

49.5
50.5

15670.33±8948.07
(min=5,000, max=50,000)

Type of family

Nuclear family
Joint family

48
43

52.7
47.3

Birth weight (gm)

 

 

1967.03±339.95
(min=1100, max=2400)

Table 2 summarizes the maternal pregnancy related characteris-tics of mothers who had low birth weight of babies. Above half of the mothers (58.2%) had no anemia. Majority of them (73.6) received antenatal care visits more than two times. Around seventy two percent of mothers (71.4%) took iron and vitamin supplementation during antenatal period. Most of the mothers (95.6%) did not smoke. Almost all of them (98.9%) had maintained personal hygiene. More than half of them (54.1%) were multiparous mothers. Almost all of them (89%) had no multiple pregnancies. Around fifty three percent of mothers’ (52.7%) period of amenorrhea at delivery (POA) had < 37 weeks. About half of the mothers’ (51.6%) inter pregnancy interval were >2 years. Around half of mothers (52.7%) had medical problems.

Table 2. Distribution of maternal pregnancy related characteristics (N=91)

Characteristics

Categories

 

n

%

Characteristics

Categories

n

%

Maternal anemia

Yes
No

38
53

41.8
58.2

Parity

Primipara
Multiparous

41
50

45.1
54.9

Number of antenatal visit

≤ 2visits
≥ 2 visits

24
67

26.4
73.6

Previous LBW babies

Yes
No

14
77

15.4
84.6

Iron and vitamin supplementation

Yes
No

65
26

71.4
28.6

Multiple pregnancies

Yes
No

10
81

11
89

Smoking or chewing

Yes
No

4
87

4.4
95.6

Previous miscarriages

Yes
No

21
70

23.1
76.9

Maintain personal hygiene

Yes
No

90
1

98.9
1.1

Period of amenorrhea at delivery
(PoA)

≤ 37 weeks
37–40weeks
≥ 40weeks

48
41
2

52.7
45.1
2.2

Proper water supply

Yes
No

86
5

94.5
5.5

Inter pregnancy interval

≤ 2 years
≥ 2 years

44
47

48.4
51.6

Proper sanitation

Yes
No

86
5

94.5
5.5

Medical conditions/ problems

Yes
No

48
43

52.7
47.3

Differences in Maternal Socio-demographic Characteristics, Pregnancy related Characteristics, and Baby’s Birth Weight

Table 3 showed the relationship between maternal characteristics and baby’s low birth weight. The results of bivariate analysis indicated a significant association with maternal socio-demographic characteristics and maternal pregnancy related characteristics. There was a statistically signifi cant difference between maternal age, education, and low birth weight of newborn. The mothers who were above 30 years old had higher trend of low birth weight of newborn (t=1.88, p=0.04). Illiterate mothers had greater tendency of low birth weight than those of literacy mothers (t=.164, p=0.01). There was a significantly mean difference between maternal anemia and low birth weight. Anemic mothers had higher trend of low birth weight (t=-3.181, p=0.002). A statistically significant association was found between mothers who received antenatal visit than those of did not (t=-2.77, p=0.009). Mothers who maintained personal hygiene had greater tendency of increased birth weight of their babies which was statistically significant (t=2.006, p=0.04). There was a statistically significant difference between mothers who had multiple pregnancies than those of not (t=-3.032, p=0.003).

Influencing Effects of Maternal Socio-demographic

Table 3. Relationship between maternal characteristics and baby’s low birth weight (N =91)

Related Factors

Categories

Low Birth Weight (gm)

Related Factors

Categories

Low Birth Weight (gm)

M±SD

t/f/r/ᵡ2

p

 

M±SD

t/f/r/ᵡ2

p

Maternal socio-demographic characteristics 

Age in years

≤30years

1998.65±319.87

-0.107

0.31

Proper water supply

Yes

1981.40±328.10

1.689

0.09

≥30years

1829.41±398.06

1.88

0.04

No

1720.±481.664

 

 

Living place

Urban

2000.00±343.18

-1.145

0.25

Proper sanitation

Yes

1969.77±346.77

0.317

0.75

Rural

1916.67±333.38

 

 

No

1920.00±204.93

 

 

Religion

Muslim

1971.59±344.40

0.691

0.49

Parity

Primipara

1914.6±369.16

-1.337

0.18

Non-Muslim

1833.33±115.47

 

 

Multiparous

2010.00±311.19

 

 

Education level

Illiterate

1711.11±437.16

0.164

0.01

Previous LBW babies

Yes

1935.71±300.27

-0.373

0.71

Literate

1995.12±318.52

No

1972.73±348.17

 

Employment status

Housewife

1962.79±346.07

-0.492

0.62

Multiple pregnancies

Yes

1830.00424.395

-1.357

0.18

Employed

2040.00±219.90

 

 

No

1983.95±327.28

 

 

Monthly income

≤ 15000 taka

1917.78±339.98

0.114

0.28

Previous miscarriages

Yes

1895.24±310.60

-1.105

0.27

≥15000 taka

2015.22±336.63

-1.374

0.17

No

1988.57±347.47

 

Type of family

Nuclear family

1958.33±338.55

0.257

0.79

Period of Amenorrhea at delivery

≤37week

1875.00±326.49

-3.032

0.003

Joint family

1978.74±344.92

 

 

≥37week

2080.49±309.20

 

 

Maternal pregnancy related characteristics 

Maternal anemia

Yes

1839.47±358.33

-3.181

0.002

Inter pregnancy interval

≤ 2 years

1936.36±348.47

-0.831

0.41

No

2058.49±297.06

 

 

 

≥ 2 years

1995.74±332.74

 

 

Number of antenatal care visit

≤ 2visit

1783.33±406.11

-2.77

0.009

Medical condition/Problems during pregnancy

Yes

1965.38±312.41

-0.053

0.96

≥ 2visit

2031.84±288.88

 

 

No

1969.23±377.77

 

 

Iron and vitamin supplement

Yes

1990.77±344.02

 

 

No

1907.69±328.54

 

 

Smoking or chewing

Yes

1950.00±173.20

-0.102

0.92

No

1967.82±346.24

 

 

Maintain personal hygiene

Yes

1974.44±334.38

2.006

0.04

No

 1300.00±00.00

 

 

Characteristics and Maternal Pregnancy related Characteristics on Baby’s Low Birth Weight

After testing the assumption of regression analysis and it was found that all of the variables were acceptable, low birth weight of newborn was regressed on socio-demographic characteristics and maternal pregnancy related characteristics. Multiple regression analysis was performed to identify the main factors affecting including maternal socio-demographic characteristics, pregnancy related characteristics, and low birth weight of newborn. The model included the variables that had p-value less than 0.05 including maternal age, education, maternal anemia, period of amenorrhea (POA), maintain personal hygiene, number of antenatal care visit, and low birth weight of newborn. The results indicated that maternal socio-demographic characteristics and maternal pregnancy related characteristics explained that there was 27% of the variance in the low birth weight of newborn (R2=0.273, F (4, 86) =8.055, p< 0.001). It was found that number of antenatal care visit, maintain personal hygiene, period of amenorrhea (POA) at delivery, and maternal education independent and significant predictors of low birth weight of newborn. The regression coefficient of number of antenatal care visit was β=0.272 (t=2.898, p=0.005), maintain personal hygiene β=-0.260 (t=-2.809, p=0.006), Period of amenorrhea (POA) β=0.267 (t=2.841, p=0.006), and Maternal education β= 0.251 (t=2.680, p=0.009) (Table 4).

Table 4. Factors related to baby’s low birth weight (N=91)

Independent Variables

B

β

t(p)

R2

F(p)

Number of antenatal care visit

208.926

0.272

2.898 (0.005)

0.273

8.055 p<0.001)

Maintain personal hygiene

-843.633

-0.26

-2.809 (0.006)

Period of amenorrhea (POA)

166.413

0.267

2.841(0.006)

Maternal education

284.195

0.251

2.680(0.009)

 

 

Adjusted R Square=0.239

Discussion

The general profile the sample comprised mothers with a mean age of 25.71 years and most of them were housewives comparable with the earlier studies [19,20]. The majority of mothers family income had less than the average income of Bangladeshi people (< 15,988 BDT [21] which was found in the prior research [12].

In the bivariate analysis, among the socio-demographic and maternal pregnancy related characteristics, a significant association was found between those factors including maternal age, education, anemia, number of antenatal care visit, maintain personal hygiene, period of amenorrhea (PoA), and low birth weight of newborn. The findings of the study were agreement with those of many similar studies [12,14,16,20], After performing the hierarchical multiple regressions, number of antenatal care visit, maintain personal hygiene, period of amenorrhea (PoA) at delivery, and maternal education were independently and significantly predicted newborns low birth weight. Consistent with other studies [12,22,23]. Nonetheless, the other potential factors included in the study failed to be predicted with low birth weight of newborn which is comparable with the prior research [24].

Maternal Education

The study results established that the newborn low birth weight was statistically significantly predicted by maternal education. It was found that newborn birth weight increases with higher maternal education [12], showed that mothers who had low level of education had higher tendency to LBW. Another study reported that mothers having low birth weight babies had no education [25]. On the other hand, the result of this study is incongruent with other studies showed that maternal education did not establish any significant association with the babies low birth weight [14,26].

Number of Antenatal Care Visit

The number of antenatal care (ANC) visit had a strong influence on baby’s low birth weight. Mothers with less than two antenatal care visits had almost two times higher risk of having a low birth weight of baby in comparison to mothers who had more than two antenatal care visits. Similar results have been reported in various studies [20,22,23,27], showed that proportion of LBW was maximum in mothers who received ANC less than 2 before birth. This result inconsistent with the study of [19], found that number of ANC visit did not show any significant relationship with LBW.

Maintain Personal Hygiene

The results of this study showed that maintain personal hygiene significantly associated with low birth weight of newborn. Mothers who maintained personal hygiene 2.8 times more increases baby’s birth weight.

Period of Amenorrhea (PoA) at Delivery

Babies low birth weight was significantly influenced by period of amenorrhea (PoA) at delivery. Mothers whose period of amenorrhea at delivery had < 37 weeks were more prone to deliver a low birth weight of newborn. This finding is inconsistent with the study of [16].

In the bivariate analysis showed there was a significant relationship between maternal age and low birth weight of newborn. Nevertheless, after applying multivariate analysis maternal age was found to be insignificant with the low birth weight is similar to the prior studies [14,28]. In the present study, maternal anemia did not showed any significant association with baby’s low birth weight comparable with a study of [29]. Incongruent with another study showed that anemia contributed with high prevalence of LBW [16, 30]. Other studies reported that maternal hemoglobin status shows associated with the prevalence of LBW neonates [27,31].

The study experienced a number of limitations. Being a cross-sectional study, it was not possible to show seasonal variation in low birth weight of newborn. This study was conducted at one tertiary level hospital, and therefore it was not possible to generalize the results to a particular population as compared to population based studies. The instruments of the study were developed by the researchers based on the literature reviewed.

Conclusion

The objective of the study was to identify the factors affecting low birth weight of newborn. It can be implicated in maternity care in nursing practice and used to enhance the current knowledge of health care providers especially through nursing and midwifery education. The results provide further scientific evidence that healthcare workers and public health professionals will be able to use for introducing intervention programs to increasing birth weight of infants in Bangladesh. Further study will be recommended by using the present instruments with the mothers who admitted at post-partum ward in diverse setting and culture.

Acknowledgement

The authors extended their gratitude to the postpartum mothers who gave consent for collecting the data. The authors would like to thanks to the hospital Director and nursing superintendent for giving permission for data collection.

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