Incidence and Risk Factors for Low Birthweight and Preterm Birth in Post-Conflict Northern Uganda: A Community-Based Cohort Study

Background: Annually, an estimated 20 million (13%) low-birthweight (LBW) and 15 million (11.1%) preterm infants are born worldwide. A paucity of data and reliance on hospital-based studies from low-income countries make it difficult to quantify the true burden of LBW and PB, the leading cause of neonatal and under-five mortality. We aimed to determine the incidence and risk factors for LBW and preterm birth in Lira district of Northern Uganda. Methods: This was a community-based cohort study, nested within a cluster-randomized trial, designed to study the effect of a combined intervention on facility-based births. In total, 1877 pregnant women were recruited into the trial and followed from 28 weeks of gestation until birth. Infants of 1556 of these women had their birthweight recorded and 1279 infants were assessed for preterm birth using a maturity rating, the New Ballard Scoring system. Low birthweight was defined as birthweight <2.5kg and preterm birth was defined as birth before 37 completed weeks of gestation. The risk factors for low birthweight and preterm birth were analysed using a multivariable generalized estimation equation for the Poisson family. Results: The incidence of LBW was 121/1556 or 7.3% (95% Confidence interval (CI): 5.4-9.6%). The incidence of preterm births was 53/1279 or 5.0% (95% CI: 3.2-7.7%). Risk factors for LBW were maternal age >= 35 years (adjusted Risk Ratio or aRR: 1.9, 95% CI: 1.1-3.4), history of a small newborn (aRR: 2.1, 95% CI: 1.2-3.7), and maternal malaria in pregnancy (aRR: 1.7, 95% CI: 1.01-2.9). Intermittent preventive treatment (IPT) for malaria, on the other hand, was associated with a reduced risk of LBW (aRR: 0.6, 95% CI: 0.4-0.8). Risk factors for preterm birth were maternal HIV infection (aRR: 2.8, 95% CI: 1.1-7.3), while maternal education for >= 7 years was associated with a reduced risk of preterm birth (aRR: 0.2, 95% CI: 0.1-0.98) in post-conflict northern Uganda. Conclusions: About 7.3% LBW and 5.0% PB infants were born in the community of post-conflict northern Uganda. Maternal malaria in pregnancy, history of small newborn and age >= 35 years increased the likelihood of LBW while IPT reduced it. Maternal HIV infection was associated with an increased risk of PB compared to HIV negative status. Maternal formal education of >= 7 years was associated with a reduced risk of PB compared to those with 0-6 years. Interventions to prevent LBW and PBs should include girl child education, and promote antenatal screening, prevention and treatment of malaria and HIV infections.