Regional trends in birth weight in low- and middle-income countries 2013-2018

Irene Marete, Osayame Ekhaguere, Carla M Bann, Sherri L Bucher, Paul Nyongesa, Archana B Patel, Patricia L Hibberd, Sarah Saleem, Robert L Goldenberg, Shivaprasad S Goudar, Richard J Derman, Ana L Garces, Nancy F Krebs, Elwyn Chomba, Waldemar A Carlo, Adrien Lokangaka, Melissa Bauserman, Marion Koso-Thomas, Janet L Moore, Elizabeth M McClure, Fabian Esamai, Irene Marete, Osayame Ekhaguere, Carla M Bann, Sherri L Bucher, Paul Nyongesa, Archana B Patel, Patricia L Hibberd, Sarah Saleem, Robert L Goldenberg, Shivaprasad S Goudar, Richard J Derman, Ana L Garces, Nancy F Krebs, Elwyn Chomba, Waldemar A Carlo, Adrien Lokangaka, Melissa Bauserman, Marion Koso-Thomas, Janet L Moore, Elizabeth M McClure, Fabian Esamai

Abstract

Background: Birth weight (BW) is a strong predictor of neonatal outcomes. The purpose of this study was to compare BWs between global regions (south Asia, sub-Saharan Africa, Central America) prospectively and to determine if trends exist in BW over time using the population-based maternal and newborn registry (MNHR) of the Global Network for Women'sand Children's Health Research (Global Network).

Methods: The MNHR is a prospective observational population-based registryof six research sites participating in the Global Network (2013-2018), within five low- and middle-income countries (Kenya, Zambia, India, Pakistan, and Guatemala) in threeglobal regions (sub-Saharan Af rica, south Asia, Central America). The birth weights were obtained for all infants born during the study period. This was done either by abstracting from the infants' health facility records or from direct measurement by the registry staff for infants born at home. After controlling for demographic characteristics, mixed-effect regression models were utilized to examine regional differences in birth weights over time.

Results: The overall BW meanswere higher for the African sites (Zambia and Kenya), 3186 g (SD 463 g) in 2013 and 3149 g (SD 449 g) in 2018, ascompared to Asian sites (Belagavi and Nagpur, India and Pakistan), 2717 g (SD450 g) in 2013 and 2713 g (SD 452 g) in 2018. The Central American site (Guatemala) had a mean BW intermediate between the African and south Asian sites, 2928 g (SD 452) in 2013, and 2874 g (SD 448) in 2018. The low birth weight (LBW) incidence was highest in the south Asian sites (India and Pakistan) and lowest in the African sites (Kenya and Zambia). The size of regional differences varied somewhat over time with slight decreases in the gap in birth weights between the African and Asian sites and slight increases in the gap between the African and Central American sites.

Conclusions: Overall, BWmeans by global region did not change significantly over the 5-year study period. From 2013 to 2018, infants enrolled at the African sites demonstrated the highest BW means overall across the entire study period, particularly as compared to Asian sites. The incidence of LBW was highest in the Asian sites (India and Pakistan) compared to the African and Central American sites. Trial registration The study is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT01073475.

Keywords: Birth weight; Global network; Low birth weight; Neonatal mortality; Newborns.

Conflict of interest statement

The authors have no competing interest.

Figures

Fig. 1
Fig. 1
Sample selection
Fig. 2
Fig. 2
Regional differences in birth weight (g) in 2013 and 2018. Adjusted means obtained from models with the following variables: year, region, year × region interaction, maternal age, parity, year × parity interaction, education, maternal weight, maternal height, infant sex, and time between birth and weight measurement
Fig. 3
Fig. 3
Distribution of birth weight categories by region

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