464 - Prevalence and risk factors of vulnerable newborn phenotypes in rural Amhara, North West Ethiopia

Poster Number: 464
Publication Number: 464.130

Estifanos Baye, Brigham and Women's Hospital, Boston, MA, United States; Firehiwot Workneh Abate, Addis Continental Institute of Public Health, Addis Ababa, Adis Abeba, Ethiopia; Michelle Eglovitch, Virginia Commonwealth University, Richmond, VA, United States; Mulatu Melese Derebe, Amhara public health institute, Bahir Dar, Amara, Ethiopia; Ingrid E. Olson, Brigham and Women's Hospital, Boston, MA, United States; Fisseha Shiferie, Addis Continental Institute of Public Health, Addis Ababa, Adis Abeba, Ethiopia; Sitota Tsegaye, Addis continental institute of public health, Addis Ababa, Adis Abeba, Ethiopia; Kalkidan Yibeltal, Addis Continental Institute of Public Health, Addis Ababa, Adis Abeba, Ethiopia; Workagegnhu Tarekegn, Addis Continental Institute of Public Health, Addis Ababa, Adis Abeba, Ethiopia; Grace J. Chan, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Parul Christian, Johns Hopkins University, Baltimore, MD, United States; Sheila Isanaka, Harvard School of Public Health, Boston, MA, United States; YUNHEE KANG, Johns Hopkins School of Public Health, BALTIMORE, MD, United States; Luke C. Mullany, Johns Hopkins University, Baltimore, MD, United States; Rose L. Molina, Harvard Medical School, Boston, MA, United States; Amare Worku Tadesse, London School of Hygiene and Tropical Medicine, London, England, United Kingdom; Blair J. Wylie, Beth Israel Deaconess Medical Center, Brookline, MA, United States; Alemayehu Worku, Addis Ababa University, Addis Ababa, Adis Abeba, Ethiopia; Yemane Berhane, Addis Continental Institute of Public Health, Addis Ababa, Adis Abeba, Ethiopia; Anne C. Lee, Brigham and Women's Hospital, Department of Pediatric Newborn Medicine; Harvard Medical School, Boston, MA, United States

Background: Low birthweight (LBW) ( < 2500 g) is often used as an indicator of newborn vulnerability. However, this classification does not distinguish preterm birth versus small for gestational age (SGA) newborns and excludes those preterm or SGA with a birthweight of >=2500 g (not LBW (NLBW)), who also carry increased risk. In low-income countries, the quality of data on SGA/preterm prevalence is low due to unavailability of high-quality birth weight and gestational age measurement, and there is limited data on the simultaneous occurrence of these conditions.

Objective: To determine the prevalence & risk factors related to vulnerable newborn phenotypes in a population-based cohort in rural Ethiopia.

Design/Methods: A prospective pregnancy-birth cohort was followed in 12 rural health centers in Amhara region from August 3, 2020 to June 28, 2021. Gestational age was determined by early ultrasound performed at < 24 weeks’ gestation, and birthweight measured by high quality digital weight scales (precision 5g). Preterm birth was defined as a live birth before 37 completed weeks’ gestation. SGA was defined as a birthweight < 10th percentile using the Intergrowth 21st standard, appropriate size for gestational age (AGA) between 10 - 90th percentiles, and large for gestational age (LGA) >90th percentile. Newborns were excluded who were visited after 72 hours or had missing/improbable birthweight or gestational age data. Live births were classified using 10 discrete combinations (“vulnerable newborn phenotypes”) of LBW, preterm, and SGA status.

Results: Five hundred fifty-six singleton consecutive live births were included. Overall, 7.7% were born preterm, 37.1% SGA, and 16.4% LBW (Figure 1).  Among live births, the predominant birth phenotype was Term-AGA-NLBW (55%), followed by Term-SGA-NLBW (25%). Prevalences of Term-SGA-LBW, Preterm-AGA-LBW and Preterm-LGA-LBW were 11.2%, 3.6% and 0.2%, respectively (Figure 2). Among LBW infants, 75.8% were SGA, 30.7% preterm, and 7.6% preterm-SGA. Compared to women with no education, those who completed secondary education and above had a 70% lower risk of having a preterm infant (Adjusted odds ratio [AOR]=0.3, 95% confidence interval [CI]: 0.1 – 0.8). The odds of delivering a LBW infant among women with mid-upper arm circumference (MUAC) < 23cm were two times higher than those with MUAC >=23cm (AOR=1.8, 95% CI: 1.1 – 2.9). Conclusion(s): A high prevalence of LBW and SGA was observed in this rural Ethiopian setting. Implementation and scale-up of effective interventions are needed to prevent these vulnerable birth outcomes, thereby reducing associated neonatal mortality and morbidity.
Curriculum Vitae - Estifanos Baye.pdf
Figure 2. Prevalence of vulnerable newborn phenotypes in rural Amhara, EthiopiaSGA, small for gestational age; AGA, appropriate for gestational age; LGA, large for gestational age; LBW, low birthweight; NLBW, not low birthweight