title: Prevalence of low birth weight, macrosomia and stillbirth and their relationship to associated maternal risk factors in Hohoe Municipality, Ghana.
abstract: BACKGROUND
  birth weight is vital to the development potential of the newborn. Abnormal birth weight (such as low birth weight and macrosomia) is an important determinant of child survival, disabilities, stunting, and long-term adverse consequences for the onset of non-communicable diseases in the life course and therefore demands appropriate public health interventions. Stillbirths are also considered one of the most important, but most poorly understood and documented adverse outcomes of pregnancy. Therefore, this study aimed to assess the prevalence of abnormal birth weight and related maternal risk factors, as well as pregnancy outcomes, such as stillbirth.
  
  
  METHODS
  a retrospective study design was used to analyze 4262 delivery records for singleton pregnancies from January 2013 to December 2014 seen at the Hohoe municipal hospital, Volta region in Ghana. The data on birth weight and related factors were derived from the delivery book. Data was analyzed using STATA. Multinomial logistic regression was used to assess the association between maternal factors such as parity, age and intermittent preventive treatment of malaria, sex of infant and abnormal birth weight. Association between stillbirth and related factors was assessed using logistic regression.
  
  
  RESULTS
  prevalence of low birth weight (<2.5kg) was 9.69% and macrosomia (≥4.0kg) was 3.03%. There was an increased risk of a first born being of low birth weight than second or third born (RR; 2.04, CI; 1.59-2.64, p<0.0001). There were also an increased risks of mothers <20 years giving birth to low-birthweight infants (RR; 1.46, CI; 1.11-1.93, p=0.007) compared to mothers who were within the age ranges of 20-30 years and also among those who took only one (RR; 1.57, CI; 1.02-2.39, p=0.039) or no intermittent preventive treatment for malaria during pregnancy (RR; 1.57, CI; 1.24-1.98, p=<0.0001) compared to those who took three doses. Risk of macrosomic birth was particularly high among 5th born (RR; 2.66, CI; 1.43-4.95, p=0.002) compared to first or second born. Stillbirth rate was 27/1000 births. Thirty-two percent of the stillbirths (n=38) had low birth weight whereas 6.8% (n=8) were macrosomic. There was a greater than fivefold (AOR; 5.6, CI; 3.6-8.7) and greater than twofold (AOR; 2.4, CI; 1.1-5.3, p=0.025) increase in odds for stillbirth among low birth weight and macrosomic infants respectively.
  
  
  CONCLUSIONS
  macrosomia and low birth weight co-existed among infants in Hohoe municipality, both of which are associated with adverse pregnancy outcome such as stillbirth. Given the apparent association between maternal age <20 years and increased risk, health promotion strategies aimed at preventing pregnancies among teenagers could be implemented to aid the reduction of stillbirth rates.
authors.affiliation: Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Hohoe campus, Ho, Ghana; Institute of Public Health, Medical Faculty, University of Heidelberg, Germany.
authors.forename: Faith
authors.initials: F
authors.lastname: Agbozo
authors.affiliation: Institute of Public Health, Medical Faculty, University of Heidelberg, Germany; Department of Community Nutrition, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana. Electronic address: abubakari.abdulai1@uds.edu.gh.
authors.forename: Abdulai
authors.initials: A
authors.lastname: Abubakari
authors.affiliation: Department of Epidemiology and Biostatistics, University of Health and Allied Sciences, Ghana.
authors.forename: Joyce
authors.initials: J
authors.lastname: Der
authors.affiliation: Institute of Public Health, Medical Faculty, University of Heidelberg, Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Jahn
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology*; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007230:Infant, Low Birth Weight; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*
keywords: Live birth; Low birth weight; Macrosomia; Maternal; Newborn; Stillbirth