Low birthweight increased the risk of neonatal death twenty-folds in Northern Uganda: a community-based cohort study

Abstract

Abstract Background Low birthweight (LBW) is the leading cause of neonatal mortality and hospitalization worldwide. This study specifically aimed to: 1) determine the frequency of a) neonatal deaths and 2) assess their association with LBW in Northern Uganda. Methods A cohort study, nested in the Survival Pluss cluster randomized trial ( NCT02605369 ), was conducted from January 2018 to February 2019 in Lira district, Northern Uganda. Out of 1877 pregnant women, 1556 live-born infants had their birthweight measured and were followed up to 28 days after birth. Generalized estimation equation regression models of the Poisson family with a log link were used to calculate the risk ratios between LBW and death. Results The risk of neonatal death was: 21/1,556 or 13.5 (95% CI: 8.8 – 20.6) per 1,000 live births. The respective sex and cluster adjusted proportion of neonatal death per 1000 live births among LBW, normal weight and not-weighed infants were 103 (95% CI: 47.2 – 212), 5.4 (95% CI: 2.1 – 13.9) and 167 (95% CI: 91.1-285). Compared to normal birthweight, LBW and not-weighed infants were each associated with a 20- and 30-folds increased risk of neonatal death. Conclusion In this community-based cohort study in Northern Uganda, neonatal mortality was 13.5/1000 live births. In the LBW and not-weighed groups, the risk of a neonatal death were more than twenty-times that of non-LBW infants. Efforts to reduce the number of LBW infants and/or prevent adverse outcomes in this patient group urgently are needed. In addition, all babies with should have birthweight recorded to facilitate early risk identification and management.