Socio-demographic characteristics of the study
A total of 292 mothers with their respective newborns (73 cases and 219 controls) were included in the study, with response rate of 97.9%. The mean ± SD of maternal age among cases and controls was 25.1 ± 4.94 and 24.8 ± 4.96 years, respectively. The majority 74% of mothers in both cases and controls were in the age group of 21-35 years, followed by 19.2% and 18.3% of maternal age <20 years in the cases and controls, respectively. More than 90% of the participants in both cases and controls were married. Moreover, 89.0% and 87.2%of mothers among cases and controls were living in urban setting, respectively, While 24.7%and 18.7%among cases and controls had not attended formal education, respectively. Almost half of mothers in both cases 56.2%and controls 48.9%were house wife. (Table 1)
Table 1Socio-demographic characteristics of the participants among cases and controls in public health facilities dire-dawa city eastern Ethiopia 2020
Variables
|
Categories
|
Frequency of Cases (Yes)
N (%)
|
Frequency of Control(No)
N (%)
|
Age of the mother
|
≤20
|
14(19.2)
|
40(18.3)
|
21-35
|
54(74.0)
|
162(74.0)
|
>35
|
5(6.8)
|
17(7.8)
|
Marital status
|
Currently Married
|
67(91.8)
|
198(90.4)
|
Currently not married
|
6(8.2)
|
21(9.6)
|
Residence Area
|
Urban
|
65(89.0)
|
191(87.2)
|
Rural
|
8(11.0)
|
28(12.80
|
Religion
|
Muslim
|
48(65.8)
|
155(70.8)
|
Christian
|
25(34.2)
|
64(29.2)
|
Ethnicity
|
Somali
|
10(13.7)
|
85(38.8)
|
Oromo
|
51(69.9)
|
104(47.5)
|
Amhara
|
8(11.0)
|
18(8.2)
|
Others
|
4(5.5)
|
12(5.5)
|
Maternal educational status
|
Informal education
|
18(24.7)
|
41(18.7)
|
Formal education
|
55(75.3)
|
178(81.3)
|
Husband educational status
|
Informal education
|
15(20.5)
|
37(16.9)
|
Formal education
|
58(79.5)
|
182(83.1)
|
Maternal occupation status
|
House wife
|
41(56.2)
|
107(48.9)
|
Employee
|
21(28.8)
|
71(32.4)
|
Merchant
|
6(8.2)
|
27(12.3)
|
Others
|
5(6.8)
|
14(6.4)
|
Husband occupation status
|
Employee
|
34(46.6)
|
102(46.6)
|
Farmer
|
11(15.1)
|
26(11.9)
|
Merchant
|
20(27.4)
|
77(35.2)
|
Others
|
8(11.0)
|
14(6.4)
|
Sex of newborn
|
Male
|
39(53.4)
|
132(60.3)
|
Female
|
34(46.6)
|
87(39.7)
|
Maternal obstetric, medical, nutritional and behavioral characteristics of the study
The majority of mothers 63.0% among cases and 69.9% of controls were Multigravida. Regarding the parity, 38% of both cases and control groups were Primipara mothers. The history of still birth among cases and controls were 16.4% and 11.4%, respectively. Maternal nutritional counseling during ANC visit was 60.3% among cases and 81.7% controls. Whereas, as the mothers among cases 41.1% and 63.0% controls had consumption extra meal during pregnancy. Less than half of mothers among cases 42.5% and 22.4% controls had not taken iron supplementation during pregnancy. The mothers among cases 16.4% and 11.0% controls were reported history of hypertension during current pregnant. (Table 2)
Table 2frequency distribution of maternal obstetric, medical and behavioral characteristics among cases and controls in public health facilities dire-dawa city eastern Ethiopia 2020
Variables
|
categories
|
Frequency of Cases(Yes)
N (%)
|
Frequency of Control (No)
N (%)
|
Gravidity
|
Primi-gravidity
|
27(37.0)
|
66(30.1)
|
Multi-gravidity
|
46(63.0)
|
153(69.9)
|
Parity
|
Primipara
|
28(38.4)
|
83(37.9)
|
Multipara
|
45(61.6)
|
136(62.1)
|
Birth interval
|
<3 years
|
15(33.3)
|
38(28.1)
|
>=3 years
|
30(66.7)
|
97(71.9)
|
History of stillbirth
|
Yes
|
12(16.4)
|
25(11.4)
|
No
|
61(83.6)
|
194(88.6)
|
History abortion
|
Yes
|
14(19.2)
|
32(14.6)
|
No
|
59(80.8)
|
187(85.4)
|
History of contraceptive methods
|
Yes
|
64(87.7)
|
180(82.2)
|
No
|
9(12.3)
|
39(17.8)
|
ANC visit
|
Yes
|
61(83.6)
|
201(91.8)
|
No
|
12(16.4)
|
18(8.2)
|
Times of visit
|
< 3 visit
|
15(24.6)
|
62(30.8)
|
>=3 visit
|
46(75.4)
|
139(69.2)
|
Nutritional counseling
|
Yes
|
44(60.3)
|
179(81.7)
|
No
|
29(39.7)
|
40(18.3)
|
Additional meal
|
Yes
|
30(41.1)
|
138(63.0)
|
No
|
43(58.9)
|
81(37.0)
|
Iron supplementation
|
Yes
|
42(57.5)
|
170(77.6)
|
No
|
31(42.5)
|
49(22.4)
|
History of hypertension
|
Yes
|
12(16.4)
|
24(11.0)
|
No
|
61(83.6)
|
195(89.0)
|
History of infection (syphilis)
|
Yes
|
21(28.8)
|
49(22.4)
|
No
|
52(71.2)
|
170(77.6)
|
Substance abuse
|
Yes
|
24(32.9)
|
62(28.3)
|
No
|
49(67.1)
|
157(71.7)
|
Anthropometric and laboratory investigation characteristics of the study
The maternal weight less than 50 kg were 12.3% and 7.3%among the cases and controls respectively. Likewise the maternal height less than 150cm were 15.1% and 9.1% among cases and controls respectively. Maternal MUAC among cases 52.1% and 20.1% controls had MUAC <23cm. Maternal Anemia status based on low hemoglobin concentration (< 110 g/L) among cases and controls 32.9% and 14.6%respectively. (Table 3)
Table 3 frequency distribution of maternal anthropometrics measurement and laboratory investigation among cases and controls in public health facilities dire-dawa city eastern Ethiopia 2020
Variables
|
Categories
|
Frequency of
Cases(Yes)
N (%)
|
Frequency of Control (No)
N (%)
|
Weight of mothers
|
<50kg
|
9(12.3)
|
16(7.3)
|
>=50kg
|
64(87.7)
|
203(92.7)
|
Height of mothers
|
<150cm
|
11(15.1)
|
20(9.1)
|
>=150cm
|
62(84.9)
|
199(90.9)
|
MUAC of mothers
|
<23cm
|
38(52.1)
|
44(20.1)
|
>=23cm
|
35(47.9)
|
175(79.9)
|
Hemoglobin level
|
≥ 110 g/dL
|
49(67.1)
|
187(85.4)
|
<110 g/dL
|
24(32.9)
|
32(14.6)
|
Bivariate logistic regression
In Bivariate analysis performed to identify candidate variables for multivariate analysis. Variables having P.value <0.25 were entered to multivariate logistic regression for further analysis
Socio-demographic characteristics with LBW
Without adjusting potential confounders our study showed that socio-demographic factors such as maternal age, marital status, residence area, maternal educational status, maternal occupation, sex of newborn were not statically significant with low birth weight (Table 4).
Table 4 Bivariate logistic regression analysis of socio-demographic characteristics with LBW in public health facilities dire-dawa city eastern Ethiopia 2020
Variables
|
categories
|
Birth weight
|
COR(95% CI)
|
P.value
|
Frequency of Cases
N (%)
|
Frequency of Control
N (%)
|
Age of the mother
|
<=20
|
14(19.2)
|
42(19.0)
|
1.47(0.47--4.60)
|
0.512
|
21-35
|
54(74.0)
|
157(71.0)
|
1
|
|
>35
|
5(6.8)
|
22(10.0)
|
0.65(0.21--2.04)
|
0.460
|
Marital status
|
Currently Married
|
67(91.8)
|
200(90.5)
|
1
|
|
Currently not married
|
6(8.2)
|
21(9.5)
|
1.17(0.45--3.03)
|
0.742
|
Residence Area
|
Urban
|
65(89.0)
|
192(86.9)
|
1
|
|
Rural
|
8(11.0)
|
29(13.1)
|
0.82(0.36--1.87)
|
0.629
|
Maternal educational status
|
Informal education
|
18(24.7)
|
41(18.6)
|
1.43(.76--2.70)
|
0.260
|
Formal education
|
55(75.3)
|
180(81.4)
|
1
|
|
Maternal occupation status
|
House wife
|
41(56.2)
|
109(49.3)
|
1
|
|
Employee
|
21(28.8)
|
71(32.1)
|
0.79(0.43--1.44)
|
0.436
|
Merchant
|
6(8.2)
|
27(12.2)
|
0.59(0.23--1.54)
|
0.280
|
Others
|
5(6.8)
|
14(6.3)
|
0.95(0.32--2.80)
|
0.925
|
Sex of newborn
|
Male
|
39(53.4)
|
133(60.2)
|
1
|
|
Female
|
34(46.6)
|
88(39.8)
|
1.32(0.77--2.25)
|
0.310
|
Maternal obstetric, medical, nutritional and behavioral characteristics with LBW
Without any adjustments antenatal visit, nutritional counseling, additional meals, iron supplementation, history of hypertension during current pregnancy were significant associated with LBW. On other hand gravidity, parity, birth interval, history of still birth, history of abortion, history of contraceptive methods, history of infection, using any substance abuse during current pregnancy were not significant associated with LBW (Table 5).
Table 5 Bivariate logistic regression analysis of maternal obstetric Ethiopia 2020, medical and behavioral characteristics with LBW in public health facilities dire-dawa city eastern
Variables
|
categories
|
Frequency of Cases
N (%)
|
Frequency of Control
N (%)
|
COR(95% CI)
|
P. value
|
Gravidity
|
Primi-gravidity
|
27(37.0)
|
66(29.9)
|
1.38(0.79--2.40)
|
0.258
|
Multi-gravidity
|
46(63.0)
|
155(70.1)
|
1
|
|
Parity
|
Primipara
|
28(38.4)
|
83(37.6)
|
1.04(0.60--1.78)
|
0.903
|
Multipara
|
45(61.6)
|
138(62.4)
|
1
|
|
Birth interval
|
<3 years
|
15(33.3)
|
38(27.7)
|
1.30(0.63--2.69)
|
0.474
|
>=3 years
|
30(66.7)
|
99(72.3)
|
1
|
|
History of stillbirth
|
Yes
|
12(16.4)
|
25(11.3)
|
1.54(0.73-3.25)
|
0.255
|
No
|
61(83.6)
|
196(88.7)
|
1
|
|
History abortion
|
Yes
|
14(19.2)
|
32(14.5)
|
1.40(0.70--2.80)
|
0.340
|
No
|
59(80.8)
|
189(85.5)
|
1
|
|
History of contra-captive
|
Yes
|
64(87.7)
|
181(81.9)
|
0.64(0.29--1.38)
|
0.254
|
No
|
9(12.3)
|
40(18.1)
|
1
|
|
ANC visit
|
Yes
|
61(83.6)
|
202(91.4)
|
1
|
|
No
|
12(16.4)
|
19(8.6)
|
2.09(0.96--4.55)
|
0.063
|
Times of visit
|
< 3 visit
|
15(24.6)
|
63(31.2)
|
0.72(0.37--1.38)
|
0.324
|
>=3 visit
|
46(75.4)
|
139(68.8)
|
1
|
|
Nutritional counseling
|
Yes
|
44(60.3)
|
181(81.9)
|
1
|
|
No
|
29(39.7)
|
40(18.1)
|
2.98(1.67--5.33)
|
0.0001
|
Additional meal
|
Yes
|
30(41.1)
|
140(63.3)
|
1
|
|
No
|
43(58.9)
|
81(36.7)
|
2.48(1.44--4.25)
|
0.001
|
Iron supplementation
|
Yes
|
42(57.5)
|
172(77.8)
|
1
|
|
No
|
31(42.5)
|
49(22.2)
|
2.74(1.56--4.80)
|
0.0001
|
History of hypertension
|
Yes
|
12(16.4)
|
24(10.9)
|
1.62(0.76--3.42)
|
0.211
|
No
|
61(83.6)
|
197(89.1)
|
1
|
|
History of infection
|
Yes
|
21(28.8)
|
50(22.6)
|
1.38(0.76--2.51)
|
0.289
|
No
|
52(71.2)
|
171(77.4)
|
1
|
|
Substance abuse
|
Yes
|
24(32.9)
|
62(28.1)
|
1.26(0.71--2.22)
|
0.433
|
No
|
49(67.1)
|
159(71.9)
|
1
|
|
Anthropometric and laboratory investigation characteristics with LBW
Without controlling possible confounders, mothers weight <50kg, mothers height <150cm, mothers nutritional status MUAC <23cm and mothers hemoglobin level <110g/dl were significantly associated with LBW (Table 6).
Table 6 Bivariate logistic regression analysis of maternal anthropometrics measurement and laboratory with LBW in public health facilities dire-dawa city eastern Ethiopia 2020
Variables
|
categories
|
Frequency of Cases
N (%)
|
Frequency of Control
N (%)
|
COR(95% CI)
|
P. value
|
Weight of mothers
|
<50kg
|
9(12.3)
|
16(7.2)
|
1.80(0.76--4.27)
|
0.181
|
>=50kg
|
64(87.7)
|
205(92.8)
|
1
|
|
Height of mothers
|
<150cm
|
11(15.1)
|
20(9.0)
|
1.78(0.81--3.92)
|
0.151
|
>=150cm
|
62(84.9)
|
201(91.0)
|
1
|
|
MUAC of mothers
|
<23cm
|
38(52.1)
|
44(19.9)
|
4.37(2.48--7.69)
|
0.0001
|
>=23cm
|
35(47.9)
|
177(80.1)
|
1
|
|
Hemoglobin level
|
Normal (≥ 110 g/dL)
|
49(67.1)
|
189(85.5)
|
1
|
|
Anemic (<110 g/dL)
|
24(32.9)
|
32(14.5)
|
2.89(1.56--5.35)
|
0.001
|
Determinants of low birth weight
In multivariate binary logistic regression analysis indicated that maternal who did not received nutritional counseling during current pregnancy [AOR=3.13; (95% CI, 1.59--6.16)], similarly maternal who did not take additional meals during current pregnancy [AOR=2.37 ;( 95% CI, 1.26--4.44)], Likewise maternal lack of iron supplementation during current [AOR=2.21 ;( 95% CI 1.14--4.29)], Maternal under nutrition [AOR=4.83;(95% CI 2.49--9.38)], and maternal anemic [AOR=3.51 ;( 95% CI 1.64--7.53)] were significantly associated with LBW (Table 7)
Table 7 Multivariate logistic regression analysis with determinants of low birth weight for newborns delivered public health facilities in dire-dawa city eastern Ethiopia 2020
Variables
|
categories
|
Frequency of Cases
N (%)
|
Frequency of Controls
N (%)
|
COR(95% CI)
|
AOR(95% CI)
|
ANC visit
|
Yes
|
61(83.6)
|
201(91.8)
|
1
|
1
|
No
|
12(16.4)
|
18(8.2)
|
2.20(1.00--4.81)
|
2.26(0.85--6.02)
|
Nutritional counseling
|
Yes
|
44(60.3)
|
179(81.7)
|
1
|
1
|
No
|
29(39.7)
|
40(18.3)
|
2.95(1.65--5.27)
|
3.13(1.59--6.16)*
|
Additional meal
|
Yes
|
30(41.1)
|
138(63.0)
|
1
|
1
|
No
|
43(58.9)
|
81(37.0)
|
2.44(1.42--4.20)
|
2.37(1.26--4.44)*
|
Iron supplementation
|
Yes
|
42(57.5)
|
170(77.6)
|
1
|
1
|
No
|
31(42.5)
|
49(22.4)
|
2.71(1.55--4.75)
|
2.21(1.14--4.29)*
|
History of hypertension
|
Yes
|
12(16.4)
|
24(11.0)
|
1.60(0.76--3.39)
|
1.58(0.65--3.88)
|
No
|
61(83.6)
|
195(89.0)
|
1
|
1
|
Weight of mothers
|
<50kg
|
9(12.3)
|
16(7.3)
|
1.78(0.75--4.23)
|
1.30(0.46--3.54)
|
>=50kg
|
64(87.7)
|
203(92.7)
|
1
|
1
|
Height of mothers
|
<150cm
|
11(15.1)
|
20(9.1)
|
1.77(0.80--3.89)
|
0.89(0.35--2.25)
|
>=150cm
|
62(84.9)
|
199(90.9)
|
1
|
1
|
MUAC of mothers
|
<23cm
|
38(52.1)
|
44(20.1)
|
4.32(2.45--7.60)
|
4.83(2.49--9.38)*
|
>=23cm
|
35(47.9)
|
175(79.9)
|
1
|
1
|
Hemoglobin level
|
Normal (≥ 110 g/dL)
|
49(67.1)
|
187(85.4)
|
1
|
1
|
Anemic (<110 g/dL)
|
24(32.9)
|
32(14.6)
|
2.86(1.55--5.30)
|
3.51(1.64--7.53)*
|
OR=odds ratio
AOR=adjusted odds ratio
CI=confidence interval
*=p-value less than 0.05