title: How do low-birthweight neonates fare 2 years after discharge from a low-technology neonatal care unit in a rural district hospital in Burundi?
abstract: As neonatal care is being scaled up in economically poor settings, there is a need to know more on post-hospital discharge and longer-term outcomes. Of particular interest are mortality, prevalence of developmental impairments and malnutrition, all known to be worse in low-birthweight neonates (LBW, <2500 g). Getting a better handle on these parameters might justify and guide support interventions. Two years after hospital discharge, we thus assessed: mortality, developmental impairments and nutritional status of LBW children.
  
  
  
  Household survey of LBW neonates discharged from a neonatal special care unit in Rural Burundi between January and December 2012.
  
  
  
  Of 146 LBW neonates, 23% could not be traced and 4% had died. Of the remaining 107 children (median age = 27 months), at least one developmental impairment was found in 27%, with 8% having at least five impairments. Main impairments included delays in motor development (17%) and in learning and speech (12%). Compared to LBW children (n = 100), very-low-birthweight (VLBW, <1500 g, n = 7) children had a significantly higher risk of impairments (intellectual - P = 0.001), needing constant supervision and creating a household burden (P = 0.009). Of all children (n-107), 18% were acutely malnourished, with a 3½ times higher risk in VLBWs (P = 0.02).
  
  
  
  Reassuringly, most children were thriving 2 years after discharge. However, malnutrition was prevalent and one in three manifested developmental impairments (particularly VLBWs) echoing the need for support programmes. A considerable proportion of children could not be traced, and this emphasises the need for follow-up systems post-discharge.
authors.affiliation: Médecins Sans Frontières, Brussels Operational Centre - Operational Research Unit (LuxOR), Luxembourg City, Luxembourg.
authors.forename: W
authors.initials: W
authors.lastname: van den Boogaard
authors.affiliation: Médecins Sans Frontières, Brussels Operational Centre, Brussels, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Zuniga
authors.affiliation: Médecins Sans Frontières, Brussels Operational Centre - Operational Research Unit (LuxOR), Luxembourg City, Luxembourg.
authors.forename: M
authors.initials: M
authors.lastname: Manzi
authors.affiliation: Médecins Sans Frontières, Brussels Operational Centre - Operational Research Unit (LuxOR), Luxembourg City, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Van den Bergh
authors.affiliation: Médecins Sans Frontières, Brussels Operational Centre, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Lefevre
authors.affiliation: Médecins Sans Frontières, Bujumbura, Burundi.
authors.forename: K
authors.initials: K
authors.lastname: Nanan-N'zeth
authors.affiliation: Médecins Sans Frontières, Bujumbura, Burundi.
authors.forename: B
authors.initials: B
authors.lastname: Duchenne
authors.affiliation: Médecins Sans Frontières, Brussels Operational Centre, Brussels, Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Etienne
authors.affiliation: Ministry of Health, Bujumbura, Burundi.
authors.forename: N
authors.initials: N
authors.lastname: Juma
authors.affiliation: Ministry of Health, Bujumbura, Burundi.
authors.forename: B
authors.initials: B
authors.lastname: Ndelema
authors.affiliation: Médecins Sans Frontières, Brussels Operational Centre - Operational Research Unit (LuxOR), Luxembourg City, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
authors.affiliation: Médecins Sans Frontières, Brussels Operational Centre - Operational Research Unit (LuxOR), Luxembourg City, Luxembourg.
authors.forename: A
authors.initials: A
authors.lastname: Reid
mesh_terms: D002063:Burundi / Q000453:epidemiology; D002662:Child Health Services; D005260:Female; D005500:Follow-Up Studies; D006767:Hospitals, District; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000453:epidemiology*; D065886:Neurodevelopmental Disorders / Q000453:epidemiology*; D009752:Nutritional Status; D010351:Patient Discharge; D015995:Prevalence; D019035:Rural Health Services; D012424:Rural Population
keywords: Afrique subsaharienne; desnutrición; developmental impairments; déficiences développementales; investigación de operaciones; low-birthweight neonates; malnutrition; neonatos con bajo peso al nacer; nouveau-nés de faible poids de naissance; operational research; recherche opérationnelle; retraso en el desarrollo; sub-Saharan Africa; África sub-Sahariana