|Survival of low birthweight neonates in Uganda: analysis of progress between 1995 and 2011|
||Malachi Ochieng Arunda, Anette Agardh, and Benedict Oppong Asamoah
||BMC Pregnancy and Childbirth , 18:189; DOI: 10.1186/s12884-018-1831-0
||Background: Although low birthweight (LBW) babies represent only 15.5% of global births, it is the leading
underlying cause of deaths among newborns in countries where neonatal mortality rates are high. In Uganda, like
many other sub-Saharan African countries, the progress of reducing neonatal mortality has been slow and the
contribution of low birthweight to neonatal deaths over time is unclear. The aim of this study is to investigate the
association between low birthweight and neonatal mortality and to determine the trends of neonatal deaths
attributable to low birthweight in Uganda between 1995 and 2011.
Methods: Cross-sectional survey datasets from Uganda Demographic and Health Surveys between 1995 and 2011
were analyzed using binary logistic regression with 95% confidence interval (CI) and Kaplan-Meier survival analysis
to examine associations and trends of neonatal mortalities with respect to LBW. A total of 5973 singleton last-born
live births with measured birthweights were included in the study.
Results: The odds of mortality among low birthweight neonates relative to normal birthweight babies were; in
1995, 6.2 (95% CI 2.3 -17.0), in 2000–2001, 5.3 (95% CI 1.7 -16.1), in 2006, 4.3 (95% CI 1.3 - 14.2) and in 2011, 3.8
(95% CI 1.3 - 11.2). The proportion of neonatal deaths attributable to LBW in the entire population declined by
more than half, from 33.6% in 1995 to 15.3% in 2011. Neonatal mortality among LBW newborns also declined from
83.8% to 73.7% during the same period.
Conclusion: Low birthweight contributes to a substantial proportion of neonatal deaths in Uganda. Although
significant progress has been made to reduce newborn deaths, about three-quarters of all LBW neonates died in
the neonatal period by 2011. This implies that the health system has been inadequate in its efforts to save LBW
babies. A holistic strategy of community level interventions such as improved nutrition for pregnant mothers,
prevention of teenage pregnancies, use of mosquito nets during pregnancy, antenatal care for all, adequate skilled
care during birth to prevent birth asphyxia among LBW babies, and enhanced quality of postnatal care among
others could effectively reduce the mortality numbers.
Keywords: Low birthweight, Attributable neonatal mortality, Logistic regression, Kaplan-Meier survival analysis,