Baseline characteristics of the children
Of the 923 children registered in the follow up clinic from January 2017 to February 2018; 506 met our inclusion criteria (Fig. 1). We enrolled 251 children and the mean age was 29.7 months (SD ± 4.5) and 51.4% were male. Children with birth weight ≤ 1500 gm were 104 (41.6%) and those > 1500 were 146 (58.4%). The median duration of hospital stay post- delivery was 12 days (IQR: 7–18).
The summary of the baseline characteristics for the study participants are summarized in Table 1 below. The ratio of male to female was 0.9:1. Most of the participants were delivered by spontaneous vertex delivery 177 (70.5%) and majority were singletons 179 (71.3%).
Table 1
Baseline characteristics for the participants
Variable
|
Frequency
|
Percentage %
|
Sex of the child
|
|
|
Male
|
129
|
51.4
|
Female
|
122
|
48.6
|
Age of the child
|
|
|
22–30 months
|
141
|
56.2
|
31–38 months
|
110
|
43.8
|
Mode of delivery
|
|
|
Caesarean section
|
74
|
29.5
|
Vaginal delivery
|
177
|
70.5
|
Type of delivery
|
|
|
Multiple
|
72
|
28.7
|
Singleton
|
179
|
71.3
|
Birth weight
|
|
|
≤1500 gm
|
104
|
41.6
|
>1500 gm
|
146
|
58.4
|
Child EBF
|
|
|
Yes
|
165
|
65.7
|
No
|
86
|
34.3
|
Duration of hospital stay
|
|
|
1–7 days
|
134
|
53.4
|
8–14 days
|
98
|
39.0
|
15–28 days
|
19
|
7.6
|
EBF: Exclusive Breastfeeding for first 6 months of life
Maternal/caretaker Characteristics
Among the maternal characteristics summarized in Table 2, the anthropometric measurements for 236 mothers were included for analysis because 15 participants were accompanied by other caretakers (10 fathers, 2 grandparents and one aunt).
Table 2
Baseline characteristics for the mothers
Variable
|
Frequency
|
Percentage %
|
Age
|
|
|
≤25 years
|
50
|
19.9
|
26–30 years
|
103
|
41.1
|
> 30 years
|
98
|
39.04
|
Estimated Distance from home to hospital
|
|
|
< 5 Km
|
28
|
11.1
|
5–15 km
|
212
|
84.5
|
≥ 15 Km
|
11
|
4.4
|
Education level
|
|
|
Primary below/none
|
51
|
20.3
|
Secondary/tertiary level
|
200
|
79.7
|
Marital status
|
|
|
Married / co-habiting
|
199
|
79.3
|
Single / divorced/ separated
|
52
|
20.7
|
Employment status
|
|
|
Employed
|
164
|
65.3
|
Not employed
|
87
|
34.7
|
Have social support
|
|
|
Yes
|
224
|
89.6
|
No
|
26
|
10.4
|
Number of children
|
|
|
1–2 children
|
111
|
44.9
|
3–4 children
|
87
|
35.2
|
>5 children
|
49
|
19.9
|
Mother’s BMI
|
|
|
< 18.5 (Underweight)
|
1
|
0.4
|
18.5 - ≤ 25 (Normal Range)
|
106
|
42.2
|
25.0- <30 (Overweight)
|
78
|
31.1
|
≥ 30 (Obese)
|
66
|
26.3
|
Growth And Nutrition Status Of The Children
The summary of growth status for the participants using anthropometric measurements by sex and age are shown in Fig. 2 and Table 3. Of the participants, 101 (40.2%) had caught up on the normal anthropometric measurements z scores > -2 SD of the reference population for their age and sex.
The prevalence for wasting (weight for height z-score <-2SD) was 8 (3.2%), underweight (weight for age z-score <-2 SD) 36 (14.4%) and the prevalence of stunting (height for age z-score <-2) was 106 (42.2%). There were more boys stunted, 64 out of 106 participants compared to girls (p = 0.001). There was no statistically significant difference based on sex for the children who were wasted or underweight. For 246 (98.8%) participants, MUAC was normal (≥ 12.5 cm) and for 216 (86.8%) the head circumference was within normal range for age.
The scatter plot graphs show individual growth parameters (weight and height/length) for the children and their corresponding age and sex based on the 2006 WHO multicenter reference growth population: A – Weight for Height/Length, B – Weight for Age, C – Height/Length for Age.
The z-scores for the weight for age, weight for height, height for age, and head circumference for the participants are summarized in Table 3.
Table 3
Summary of Participants’ anthropometric measurements
|
|
<-3SD
|
>=-3SD to<-2SD
|
>=-2SDto < 2SD
|
>=2SDto < 3SD
|
>=3SD
|
Total
|
Weight
For Age
|
Male n%
Female n%
Total
|
0 (0.0)
1 (0.8)
1 (0.4)
|
18(14.8)
12 (9.3)
30 (12)
|
104 (85.3)
116 (89.9)
220 (87.7)
|
-
-
-
|
-
-
-
|
122
129
251
|
Weight
For
Height
|
Male n%
Female n%
Total
|
2 (1.7)
1 (0.8)
3 (1.2)
|
2 (1.7)
3 (2.3)
5 (2.0)
|
112 (92.6)
124 (96.1)
236 (94.4)
|
4 (3.3)
1 (0.8)
5 (2.0)
|
1 (0.8)
0 (0.0)
1 (0.4)
|
121
129
250
|
Height
For Age
|
Male n%
Female n%
Total
|
26 ()21.3
15 (11.6))
41 (16.3)
|
39 (32.0)
26 (20.2)
65(25.9)
|
56 (45.9)
88 (68.2)
144 (57.4)
|
1 (0.8)
0 (0.0)
1 (0.4)
|
-
-
|
122
129
251
|
Head
Circumference
|
Male n%
Female n%
Total
|
2 (1.7)1 (0.8)
3 (1.2)
|
2 (1.7)
3 (2.3)
5 (2.0)
|
112 (92.6)
124 (96.1)
236 (94.4)
|
4 (3.3)
1 (0.8)
5 (2.0)
|
1 (0.8)
0 (0.0)
1 (0.4)
|
121
129
250
|
Factors Associated With Nutritional Status Of The Children
After bivariate and multivariate analysis to establish the association between child and maternal characteristics with the nutrition status are summarized in Tables 4 & 5 for underweight and stunting respectively.
Birth weight ≤ 1500 gm and hospital stay of more than 14 days were found to have an association with underweight (AOR 2.36 95% CI 1.13,4.95, p = 0.043) and (AOR 5.77, 95% CI1.88,17.67, p = 0.002) respectively as shown in Table 4.
Table 4
Bivariate and multivariate analysis of Child factors associated with underweight
Variables
|
Growth status the preterm children
|
COR 95% Cl
|
P value
|
AOR 95% CI *
|
P value
|
Underweight (W/A Z-score <-2)
(n = 35) (f, %)
|
Not Underweight W/A Z-score ≥-2) (n = 216) (f, %)
|
|
|
Sex of the child
|
|
|
|
|
|
|
Male
|
17(48.6)
|
112(51.9)
|
0.87 (0.43, 1.79)
|
0.719
|
|
|
Female
|
18(51.4)
|
104(48.2)
|
|
|
|
|
Age of the child
|
|
|
|
|
|
|
22–30 months
|
17(48.6)
|
124(57.4)
|
1
|
|
|
|
31–38 months
|
18(51.4)
|
92(42.6)
|
1.42 (0.70, 2.92)
|
0.330
|
|
|
Mode of delivery b
|
|
|
|
|
|
|
Caesarean section
|
10(28.6)
|
64(29.6)
|
0.95 (0.43, 2.09)
|
0.899
|
0.81(0.36, 1.89)
|
0.639
|
Vaginal delivery
|
25(71.4)
|
152(70.4)
|
|
|
|
|
Type of delivery a
|
|
|
|
|
|
|
Multiple
|
8(22.9)
|
64(29.6)
|
0.70 (0.30, 1.63)
|
0.413
|
0.71(0.29, 1.72)
|
0.450
|
Singleton
|
27(77.1)
|
152(70.4)
|
|
|
|
|
Birth weight b
|
|
|
|
|
|
|
≤1500 grams
|
21(60.0)
|
83(38.6)
|
2.38 (1.14, 4.95)
|
0.020
|
2.36 (1.13, 4.95)
|
0.023
|
>1500 grams
|
14(40.0)
|
132(61.4)
|
|
|
|
|
Child EBF b
|
|
|
|
|
|
|
Yes
|
11(31.4)
|
75(34.7)
|
1
|
1
|
|
|
No
|
24(68.6)
|
141(65.3)
|
0.86(0.4, 1.85)
|
0.703
|
0.83(0.35, 1.95)
|
0.669
|
Duration of hospital stay b
|
|
|
|
|
|
|
1–7 days
|
12(34.3)
|
122(56.5)
|
1
|
1
|
1
|
|
8–14 days
|
16(45.7)
|
82(38)
|
1.98 (0.89, 4.41)
|
0.093
|
1.84(0.81, 4.15)
|
0.140
|
15–28 days
|
7(20)
|
12(5.6)
|
5.93 (1.96, 17.90)
|
0.002
|
5.77(1.88, 17.67)
|
0.002
|
Completed one year in care b
|
|
|
|
|
|
|
Yes
|
19(54.3)
|
119(55.1)
|
1.03(0.50, 2.12)
|
0.929
|
0.95 (0.45, 0.36)
|
0.886
|
No
|
16(45.7)
|
97(44.9)
|
1
|
1
|
|
|
Reference group: Not Underweight. EBF: Exclusive Breastfeeding, COR: Crude Odds Ratio, CI: Confidence interval. a Adjusted for Number of children, Previous preterm deliveries. b Adjusted for Number of children, Previous preterm deliveries, Multiple births |
The factors associated with stunting were male sex (AOR 2.33, 95% CI 1.42 to 4.04, p = 0.001), maternal age less than ≤ 25 years when compared to 26–30 years (AOR 2.16, 95% CI1.02, 4.54, p = 0.043) and maternal height less than 150 cm (AOR 4.87, 95% CI1.70, 13.93, p = 0.003), Table 5.
Table 5
Association between Child and Maternal characteristics with Stunting
Variables
|
Growth status the preterm children
|
COR 95% CI
|
P value
|
AOR 95% CI
|
P value
|
Stunted (H/A Z-score <-2)
(n = 35) (f, %)
|
Not Stunted H/A Z-score ≥-2)
(n = 216) (f, %)
|
|
|
Sex of the child
|
|
|
|
|
|
|
Male
|
64(61)
|
58(39.7)
|
2.36 (1.42,3.95)
|
0.001
|
2.39(1.42,4.04)
|
0.001
|
Female
|
41(39)
|
88(60.3)
|
1
|
|
|
|
Age
|
|
|
|
|
|
|
≤ 25 years
|
30(28.6)
|
20(13.7)
|
2.27(1.13,4.52)
|
0.020
|
2.16(1.02,4.54)
|
0.043
|
26–30 years
|
41(39)
|
62(42.5)
|
1
|
|
|
|
> 30 years
|
34(32.4)
|
64(43.8)
|
0.80(0.45,1.43)
|
0.454
|
|
|
Marital status
|
|
|
|
|
|
|
Married / co-habiting
|
77(73.3)
|
122(83.6)
|
1
|
|
|
|
Single / divorced/ separated
|
28(26.7)
|
24(16.4)
|
1.84(1.00,3.42)
|
0.050
|
1.79(0.93,3.45)
|
0.079
|
BMI for caretaker
|
|
|
|
|
|
|
< 18.5
|
0(0)
|
1(0.7)
|
-
|
-
|
|
|
18.5 to < 25
|
50(50)
|
50(37)
|
1
|
|
|
|
25 to < 30
|
30(30)
|
43(31.9)
|
0.70(0.38,1.28)
|
0.247
|
0.72(0.38,1.34)
|
0.300
|
≥ 30
|
20(20)
|
41(30.4)
|
0.49(0.25,0.94)
|
0.034
|
0.64(0.34,1.29)
|
0.210
|
Maternal Height*
|
|
|
|
|
|
|
Less than 150
|
18 (18.0)
|
4(4.4)
|
5.00(1.79,13.99)
|
0.002
|
4.87(1.7,13.93)
|
0.003
|
150–154.9
|
22(22.0)
|
28(20.7)
|
1.31(0.64,2.69)
|
0.462
|
1.2(0.58,2.51)
|
0.622
|
155–159.9
|
30(30.0)
|
50(37.0)
|
1
|
|
1
|
|
160–164.9
|
23(23.0)
|
36(26.7)
|
1.06(0.53,2.13)
|
0.859
|
1.17(0.57,2.39)
|
0.662
|
more = 165
|
7(7.0)
|
15(11.1)
|
0.78(0.28,2.12)
|
0.624
|
0.87(0.31,2.45)
|
0.787
|