Hindawi

International Journal of Pediatrics

Volume 2019, Article ID 4628301, 7 pages
https://doi.org/10.1155/2019/4628301

Research Article
Low Birth Weight and Its Associated Factors
among Newborns Delivered at Wolaita Sodo University
Teaching and Referral Hospital, Southern Ethiopia, 2018

Eyasu Alem Lake and Robera Olana Fite

Department of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia

Correspondence should be addressed to Eyasu Alem Lake; [email protected]

Received 20 February 2019; Accepted 10 July 2019; Published 22 July 2019

Academic Editor: Alessandro Mussa

Copyright © 2019 Eyasu Alem Lake and Robera Olana Fite. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

Background. Birth weight has a vital role in determining newborns survival in vulnerable conditions. Low birth weight is associated
with fetal and neonatal morbidity and mortality, impairment of growth and development and also chronic disease later in life.
This study was aimed to assess the magnitude of low birth weight and its determinants in Wolaita Sodo University teaching and
referral hospital, southern Ethiopia. Methods. Institution based cross-sectional study was conducted from November to December
2018. Systematic random sampling technique was used to select study participants. Data was collected by interviewing mothers
through structured questionnaire and reviewing neonates' medical records using a checklist. Multivariable binary logistic regression
analyses were employed to identify factors associated with neonatal jaundice. Results. The proportion of low birth weight in
the study area was found to be 15.8% (95% CI 11.7-19.9). Being primiparity [AOR=5.798; 95% (1.572-21.377)], anemia during
pregnancy [AOR=3.808; 95% (1.513-9.586)], pregnancy induced hypertension [AOR= 6.955; 95% (2.386- 20.275)], intake herbal
medication during pregnancy [AOR=35.762; 95% (4.571-279.764)], drinking alcohol during pregnancy [AOR=8.111; 95% (2.359-27.
895)] were predictors of low birth weight. Conclusion. The proportion of low birth weight among newborns delivered at Wolaita
Sodo University teaching and referral hospital was comparable with the global prevalence of low birth weight. Parity, anemia,
alcohol, herbal medication, and pregnancy-induced hypertension were significantly associated with low birth weight.

1. Introduction Low birth weight (LBW) is still an important public

health problem worldwide. Prevalence of Low birth weight
Low birth weight has a vital role in determining of newborns across the globe accounts for 15.5%, which means that each
survival in a vulnerable condition. It tells fetal exposure year from 130 million annual births, 20 million is low birth
to risk factors such as maternal unfavorable socioeconomic weight [7]. Although there is variation in the number of low
conditions, smoking habit, malnutrition, and diseases as well birth weight babies across regions, low and middle-income
as lack of attention to prenatal care and delivery [1–3]. It also countries took a high figure particularly in most vulnerable
has a crucial role in estimating whether the newborn is at risk populations [8]. The incidence of low birth weight in sub-
of death and disease during their neonatal period [4]. Saharan countries estimates to be 13% to 15% [9]. According
According to the world health organization (WHO) to Studies, in Ethiopia, there is a difference in the prevalence
definition, babies with a birth weight of less than 2500g of low birth weight between geographical areas with a range
regardless of their gestational age are considered as low birth from 8.4% to 28.3% [9–12].
weight newborn [5]. Being low birth weight is associated with Studies tested that various Socio-demographic, obstetrics
fetal and neonatal morbidity and mortality, impairment of and fetal factors are predictors of low birth weight. An
growth and development and also chronic disease later in life institutional study in the northwest part of Ethiopia revealed
[6]. being a preterm, absence of antenatal care, and malarial attack
2 International Journal of Pediatrics

during pregnancy, anemia during pregnancy and lack of iron except those delivered in other health institution or home but
supplementation were the independent predisposing risk of admitted into the hospital.
low birth weight [13].
Though Wolaita Sodo University teaching and referral 2.5. Data Collection Tool, Procedure and Quality Control. The
hospital is the only public referral hospital in the zone study data were collected through interviewing of a mother using a
on magnitude of low birth weight and its predictors were not structured questionnaire, measurement of birth weight and
available, studies in other parts of Ethiopia cannot represent review of medical records. The questionnaire was adapted
a current study area due to a difference in socio-cultural, from previous similar literature [13–15]. It had three parts; the
lifestyle and health-seeking behavior across the country. first part was sociodemographic characteristics, the second
Therefore, this study was aimed to assess the magnitude of part was obstetric and maternal characteristics, and the third
low birth weight and its determinants irrespective gestational part embraces neonatal related factors. Birth weight of naked
age and types of pregnancy in Wolaita Sodo teaching and newborn was measured within an hour of delivery before
referral hospital. Furthermore, the study will have input for significant postnatal weight loss has occurred using balanced
program managers and policymakers in program designing, infant scale.
implementing and evaluating regarding neonatal mortality Data were collected by three BSc nurses who had expe-
and also on improving childhood health care. rience of data collection and one-day training was given.
The overall supervision was carried out by the principal
investigators. A pre-test was conducted on 10% of the similar
2. Methods and Materials study population and appropriate modifications were made.
2.1. Study Design, Setting and Period. A hospital-based cross-
sectional study was conducted in Wolaita Sodo University 2.6. Data Processing and Analysis. The collected data were
Teaching and Referral Hospital from December 1 to Novem- checked manually for completeness and entered into Epi-
ber 30. The hospital is found in Sodo town which is an data version 3.1 and then exported to SPSS version 20.
administrative capital for the Wolaita zonal administration Univariate analysis was done using frequency and percentage.
in South Ethiopia. The town is located at 380 km south In bivariate analysis, candidate variables were recognized for
from Addis Ababa. WSUTRH is the only public teaching multiple binary logistic regressions at a p-value of < 0.05.
and referral hospital in Wolaita Zone which provides a broad In multivariable logistic regression, odds ratios and 95% CI
range of medical services to both in and outpatients of all age were computed and variables with p-value less than 0.05 were
groups in its catchment area for about two million people. considered as significant.
Based on a medical director report for 2017/18, around 3830
deliveries were attended in Wolaita Sdod university teaching 2.7. Operational Definition. Birth weight: the first weight of
and referral hospital in a single year. the newborn which is measured before discharge
Low birth weight: neonate born with a birth weight of
2.2. Sampling Size and Sampling Procedure. The sample ≤2499g [5].
size was determined by using single population proportion Alcohol use: a mother who took any unit of alcohol during
formula with the assumption of 14.9% prevalence of low birth the current pregnancy such as locally prepared alcoholic
weight in North West Ethiopia [13], 95% confidence level and drinks (Tela, Teje, Areka), beer, wine or any alcoholic-liquors
4% margin of error. The sample size was calculated to be beverages
304. Systematic random sampling with every other interval Cigarette smoking: smoking history of cigarette during the
(K=2) was used to select study participants after review of a current pregnancy period even for once
one-year delivery registration record to estimate the number Herbal medicine: herbs, herbal materials, herbal prepa-
of deliveries during the data collection time. If the selected rations and finished herbal products that contain as active
mother-newborn pair does not meet the inclusion criteria or ingredients parts of plants, or other plant materials, or
did not agree the next mother-newborn pair was taken. The combinations (36)
first mother was selected by using the lottery method in the Use of herbal/tradition medication: a mother who took any
hospital. unit of herbal medicine during the current pregnancy
Anemia during pregnancy: a mother whose hemoglobin
(Hb) level is <11g/dl during the current pregnancy (37).
2.3. Source and Study Population. The source populations Pregnancy-induced hypertension (PIH): A mother with
were all neonates with their index mother who were delivered high blood pressure (≥140/90mmHg) after 28 weeks of
at Wolaita Sodo University teaching and referral hospital and gestation of the current pregnancy and with or without
the study populations were all neonates their index mother proteinuria. Pregnancy-induced hypertension includes gesta-
who were delivered at Wolaita Sodo University teaching and tional hypertension, pre-eclampsia, and eclampsia (38).
referral hospital during the data collection time.
2.8. Ethical Consideration. Ethical clearance was obtained
2.4. Inclusion and Exclusion Criteria. All newborns delivered from Wolaita Sodo University College of health science and
at Wolaita Sodo University teaching and referral hospital medicine department of neonatal and pediatric nursing.
were eligible irrespective of their gestational age and parity An official letter of permission was written by the medical
International Journal of Pediatrics 3

director of Wolaita Sodo University teaching and referral 3.4. Bivariate Analyses of Independent Variables with Low
hospital. Mother of the participant neonate was informed Birth Weight. In binary logistic regression analyses, 11 vari-
about the purpose of study, anticipated benefit, full rights ables showed significant association with low birth weight
to refuse part or all of the study and as this study does a p-value of <0.05 with 95% CI. Primiparity 2.381(1.022-
not affect their future life. Written consent was obtained 5.549), antenatal follow up 3.708(1.518-9.055), maternal Co-
from her and confidentiality was assured during the data morbidity during the current pregnancy, such as malaria
collection process. Other responsible authorities were also 2.634(1.368-5.069), hypertension7.029 (3.235-15.273), and
informed to get their support and cooperation for the anemia2.508 (1.342-4.688).
study. Correspondingly, iron intake during current pregnancy
2.821(1.501-0.5.3), Premature rupture of membrane
3. Result 7.029(3.235-15.273), history of abortion 2.105(1-4.43),
and alcohol intake 14.091 (5.55-35.776) were significantly
3.1. Socio-Demographic Characteristics. In this study, a total associated with low birth weight at COR (95%). Moreover,
of 304 mother-newborn pairs were included making100% female newborns 0.363(0.186-0.709) and prematurity
response rate. The mean (±SD range) age of mothers was 3.092(1.628-5.872) had been associated with low birth weight
25±5years ranging from 12 to 35 years and about three-fourth (Table 2).
of the mothers’ age range was between 20 and 34 years.
About 261 (85.9%) and 189 (62.2%) mothers were Wolaita in 3.5. Factors Associated with Low Birth Weight. Multivariable
ethnicity and Protestant in religion, respectively. About 56.3% binary logistic regression analysis was done by taking vari-
of mothers were urban inhabitants. Of the total interviewed ables showing significant association on bivariate analysis at
mothers, 175(66%) were housewives by occupation. The a p-value of ≤0.05 to adjust the possible confounding vari-
majority (46%) of mothers’ educational status was secondary ables. Based on this, parity, anemia, hypertension, traditional
and above (Table 1). medication, and alcohol were predictors of low birth weight
at AOR (95%CI).
3.2. Obstetric and Neonatal Related Factors. Maternal parity The finding of this study showed that the odds of
ranges from 1 to 7 with primiparity accounts for a larger low birth weight among primiparity mothers were five
proportion of 72.69% (221) compared to multiparity. 268 times more likely compared with those multipara moth-
(88.2 %) pregnancies were a singleton and the rest 36 (11.8 ers [AOR=5.798;95% (1.572- 21.377)]. Similarly, maternal
%) multiple. Regarding antenatal care (ANC), 280 (92.1 co-morbidities during pregnancy, i.e., anemia and hyper-
%) respondents had ANC follow-up at least once during tension, had shown significant association with low birth
pregnancy of whom, and 143 (47%) mothers had ANC visit of weight. Low birth weight among anemic mothers was
four and above. Iron was taken by 213 (70.1%) mothers during three times more likely compared with non-anemic moth-
the current pregnancy. ers [AOR=3.808; 95 % (1.513- 9.586)]. Mothers who had
Forty-seven (15.5%) mothers had a history of abortion. a history of hypertension during current pregnancy were
Malaria by 70 (23%), pregnancy-induced hypertension by six times higher risk of getting low birth weight newborn
33 (10.9%), diabetes by 13 (4.3%), premature rupture of compared to those no history of hypertension during current
the membrane by 15 (4.9%) and anemia by108 (35.5%) pregnancy[AOR=6.955;95%(2.386-20.275)].
were documented as complications during the current preg- Furthermore, intake of traditional or herbal medication
nancy. Twelve (3.9%) mothers took traditional or herbal and alcohol during pregnancy has a significant associa-
medication during this pregnancy. Alcohol and cigarette tion with low birth weight. Mothers who took traditional
smoking were practiced by 23 (7.6%) and 24 (7.9%) mothers, medication during pregnancy were thirty-five times more
respectively. likely to get low birth weight baby than mothers who did
With regard to the mode of delivery, spontaneous vaginal not take traditional medication [AOR=35.762; 95 %( 4.571-
delivery accounted for 156 (51.3%) mode of deliveries whereas 279.764)]. Newborn from a mother who drinks alcohol
instrumental and cesarean section were figured by 13 (4.3%) current pregnancy was eight times more likely be low birth
and 113 (44.4%) mothers, respectively. The duration of labor weight compared to a mother who did not drink alcohol
ranges from 1 to 34 hours, of which 110 (36.6%) mothers had during current pregnancy [AOR=8.111;95%(2.359-27. 895)]
experienced prolonged labor. One hundred fifty-four (50.7%) (Table 3).
neonates were male in sex and the number of term and
preterm newborns is 227 (74.7%) and 77 (24.3%), respectively. 4. Discussion
3.3. The Proportion of Low Birth Weight. Of the total 304 World Health Organization (WHO) defines low birth weight
study participants, 48 was low birth weight (LBW) which as a birth weight of an infant 2499 gram or less irrespective
makes the proportion of LBW in Wolaita Sodo Univer- of gestational age (5). The prevalence and risk factors of low
sity teaching and referral hospital found to be 15.8%. The birth vary across ethnicity, geography and economic status
mean (±SD) birth weight of the newborns was 2971± of countries. The study was aimed to assess the proportion
0.783gm ranging from 1600gm to 4800gm. Twenty-six and associated factors of low birth weight in order to reveal
(8.55%) low birth weight babies gestational age was 37 and the burden of the problem and the possible local contributing
above. factors. It was supposed that this study provided important
4 International Journal of Pediatrics

Table 1: The socio-demographic characteristic distribution of mothers with their neonate at Wolaita Sodo University teaching and referral
hospital, 2018.

Variable Category Frequency Percentage (%)

<20 45 14.8
Mothers age 20-34 235 77.3
>35 24 7.9
Wolaita 261 85.9
Tigray 6 2
Ethnicity Amhara 20 6.6
Oromo 7 2.3
Others 10 3.3
Protestant 189 62.2
Orthodox 78 25.7
Religion
Muslim 32 10.5
Other 5 1.6
Single 8 2.6
Marital status Married 293 96.4
Divorced 3 1.0
Urban 171 56.3
Residence
Rural 133 43.7
Unable to read and write 44 14.5
Able to read and write 34 11.2
Educational status
Primary school 156 51.3
Secondary and above 140 46
Housewife 181 59.5
Farmer 6 2.0
Occupation
Governmental employee 106 34.9
Others 11 3.6
Enjera 215 70.7
Cereals 39 12.8
Mother dietary habit Meat 13 4.3
Starchy 32 10.5
Fruit 5 1.6

information and created an overall image on the magnitude had not received any antenatal care (ANC) and those 77.3%
and associated factors of low birth weight at Wolaita Sodo (188) mothers had ANC visit one up to two times only,
University teaching and referral hospital. whereas in this study, 92.1% (280) of mothers had received
The finding of this study revealed that the proportion of ANC at least once during pregnancy of whom 47% of
low birth weight in the study area was found to be 15.8% (95% mothers had an ANC visit of four and above. World Health
CI 11.7-19.9). This finding was consistent with previous studies Organization (WHO) recommends antenatal care models
done in southern Ethiopia (17.88%), northwest Ethiopia with a minimum of four contacts by health professionals for
(14.9%), Tigray region (14.6%), and Gondar town (17.4%) better perinatal outcome [23].
[13, 15–17]. However, this finding was higher than previous Multivariate analyses of this study showed that the odds of
studies done low birth weight among primiparity mothers were 5.8 times
Axum (9.9%), Maichew (6.3%) and Jimma (11.01%) more likely compared to multipara mothers. This study was
[10, 18], Nigeria (6.3%), United States and Canada [19–21]. in line with the study conducted in Nigeria and India [24, 25].
The possible reason for this difference might be a variation However, this finding was not in agreement with a study
in study time or mother's nutritional status and also the conducted in Tamilnadu which shows the prevalence of low
health professional's commitment to antenatal care service birth weight was higher among multipara mothers [26].
provision especially on dietary counseling during pregnancy. Hypertensive mothers were at high risk of getting a low
On the other hand, this finding was lower than a finding birth weight baby. The study showed that mothers who had
in Debre Markose referral hospital Ethiopia (26.3%) [22]. This a history of hypertension during current pregnancy were
might be associated with antenatal care during pregnancy. A 6.9 times higher risk of getting low birth weight newborn
study in Debre Markose revealed that 11.9% (29) of mothers compared to those mothers with no history of hypertension
International Journal of Pediatrics 5

Table 2: The association between low birth weight and independent variables among newborns delivered at Wolaita Sodo University teaching
and referral hospital, Sothern Ethiopia, 2018.

birth weight
Variable Category COR P-value
Low No low
Primi 41 182 2.381(1.022-5.549) 0.044
Parity
Multi 7 74 1 1
Yes 12 35 2.105(1-4.43) 0.05
History abortion
No 36 221 1 1
Yes 39 241 1 1
ANC visit
No 9 15 3.708(1.518-9.055) 0.004
Yes 24 189 1 1
Iron intake during pregnancy
No 24 67 2.821(1.501-0.5.3) 0.001
Yes 19 51 2.634(1.368-5.069) 0.004
Malaria during pregnancy
no 29 205 1 1
Yes 16 17 7.029(3.235-15.273) <0.001
HTN
No 32 239 1 1
YES 7 8 5.293(1.821-15.381) 0.002
PROM
No 41 248 1 1
Yes 26 82 2.508(1.342-4.688) 0.004
Anemia
No 22 174 1 1
Yes 8 4 12.6(3.625-43.791) <0.001
Herbal medication
No 40 252 1 1
Yes 15 8 14.091(5.55-35.776) <0.001
Alcohol use during pregnancy
No 33 248 1 1
Male 34 120 1 1
Sex of neonate
Female 14 136 0.363(0.186-0.709) 0.003
Preterm 22 55 3.092(1.628-5.872) 0.001
Gestation(in weeks)
Term 26 201 1 1
ANC=antenatal care; HTN=hypertension; PROM=premature rupture of membrane

during the current pregnancy. This finding was supported by mothers who drink alcohol heavily during pregnancy might
studies done in northwest Ethiopia and Nigeria [24, 27]. This harm her fetus since alcohol can pass from the mother’s blood
could be due to the fact that hypertension during pregnancy into the fetus blood through the placenta and can damage the
is associated with under or poor perfusion of blood through growth of the babies’ cells, especially the brain and spinal cord
placental and placenta is a vital organ which supplies blood cells. This further leads to low birth weight due to intrauterine
and other essential nutrients to the fetus from its mother for growth retardation or restriction.
normal growth and development [28, 29]. Moreover, this study showed that anemia was one risk
This study also assesses whether traditional (herbal) factor of low birth weight. Low birth weight among anemic
medications have an effect on birth weight of newborn since mothers was 3.8 times more likely compared with non-
there is a cultural issue in the study area in which many more anemic mothers. This finding was supported by studies done
traditional malpractices are carried out. This study revealed in northwest Ethiopia and Sudan [13, 32]. This could be
that low birth weight among mothers who took traditional because anemia during pregnancy has an impact on the
or herbal medications during the current pregnancy was 35.7 production of normal red blood cells that leads to low
times more likely compared to mothers who did not take hemoglobin level. Low level of hemoglobin during pregnancy
herbal medication. This might be due to the harmful effects causes impairment on providing essential nutrients to the
of traditional medications. Using the traditional or herbal developing fetus which may compromise the normal growth.
medicine during pregnancy might result in malnutrition, Furthermore, anemia is the complication of many systemic
congenital anomaly, tumor or renal failure that had a direct infections such as malaria, which further leads to intrauterine
effect on intrauterine growth restriction [30]. growth retardation [26, 33]
The finding revealed that the odds of low birth weight
among mothers who had a habit of alcohol drink during 5. Conclusion
the current pregnancy were 8.1 times more likely compared
to those who did not drink alcohol during the current The proportion of low birth weight among newborns deliv-
pregnancy. This finding was consistent with a study done ered at Wolaita Sodo University teaching and referral hospital
Axum, Ethiopia [31]. This might be due to the fact that was comparable with the global prevalence of low birth
6 International Journal of Pediatrics

Table 3: The association between low birth weight and different factors among newborns delivered at Wolaita Sodo University teaching and
referral hospital, Sothern Ethiopia, 2018.

birth weight
Variable Category AOR P-value
Low No low
Primi 41 182 5.798(1.572-21.377) 0.008
Parity
Multi 7 74 1 1
Yes 12 35 1.189(0.399-3.541) 0.755
History abortion
No 36 221 1 1
Yes 39 241 1 1
ANC visit
No 9 15 0.289(0.051-1.632) 0.16
Yes 24 189 1 1
Iron intake during pregnancy
No 24 67 1.032(0.396-2.689) 0.948
Yes 19 51 1.547(0.59-4.053) 0.375
Malaria during pregnancy
no 29 205 1 1
Yes 16 17 6.955(2.386-20.275) <0.001
HTN
No 32 239 1 1
YES 7 8 2.942(0.596-14.517) 0.185
PROM
No 41 248 1 1
Yes 26 82 3.808(1.513-9.586) 0.005
Anemia
No 22 174 1 1
Yes 8 4 35.762(4.571-279.764) 0.001
Herbal medication
No 40 252 1 1
Yes 15 8 8.111(2.359-27. 895) 0.001
Alcohol use during pregnancy
No 33 248 1 1
Male 34 120 1 1
Sex of neonate
Female 14 136 0.574(0.249-1.32) 0.191
Preterm 22 55 1.983(0.787-4.996) 0.147
Gestation(in weeks)
Term 26 201 1 1
ANC=antenatal care; HTN=hypertension; PROM=premature rupture of membrane

weight. Primiparity, anemia during the current pregnancy, participants for their commitment in responding to our
traditional medication intake during pregnancy, pregnancy- questionnaire. Wolaita Sodo University has covered the per
induced hypertension and alcohol drink during pregnancy diem for data collectors.
were predictors of low birth weight. Furthermore, this study
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