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Epidemiology
Original research
Prevalence, risk factors and consequences of newborns born small for gestational age: a multisite study in Nepal
  1. Pragya Gautam Paudel1,2,
  2. Avinash K Sunny2,
  3. Rejina Gurung2,
  4. Abhishek Gurung2,
  5. Honey Malla2,
  6. Shyam Sundar Budhathoki2,3,
  7. Prajwal Paudel4,
  8. Navraj KC4,
  9. Ashish KC5
  1. 1Department of Public Health, University of Tennessee Knoxville, Knoxville, Tennessee, USA
  2. 2Research Division, Golden Community, Lalitpur, Nepal
  3. 3Department of Public Health, Imperial College London, London, UK
  4. 4Department of Public Health, Government of Nepal Ministry of Health and Population, Kathmandu, Nepal
  5. 5Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
  1. Correspondence to Dr Ashish KC; aaashis7{at}yahoo.com

Abstract

Objective To identify the prevalence, risk factors and health impacts associated with small for gestational age (SGA) births in Nepal.

Methods A cross-sectional study was conducted in 12 public hospitals in Nepal from 1 July 2017 to 29 August 2018. A total of 60 695 babies delivered in these hospitals during the study period were eligible for inclusion. Clinical information of mothers and newborns was collected by data collectors using a data retrieval form. A semistructured interview was conducted at the time of discharge to gather sociodemographic information from women who provided the consent (n=50 392). Babies weighing less than the 10th percentile for their gestational age were classified as SGA. Demographic, obstetric and neonatal characteristics of study participants were analysed for associations with SGA. The association between SGA and likelihood of babies requiring resuscitation or resulting in stillbirth and neonatal death was also explored.

Results The prevalence of SGA births across the 12 hospitals observed in Nepal was 11.9%. After multiple variable adjustment, several factors were found to be associated with SGA births, including whether mothers were illiterate compared with those completing secondary and higher education (adjusted OR (AOR)=1.73; 95% CI 1.09 to 2.76), use of polluted fuel compared with use of clean fuel for cooking (AOR=1.51; 95% CI 1.16 to 1.97), first antenatal care (ANC) visit occurring during the third trimester compared with first trimester (AOR=1.82; 95% CI 1.27 to 2.61) and multiple deliveries compared with single delivery (AOR=3.07; 95% CI 1.46 to 6.46). SGA was significantly associated with stillbirth (AOR=7.30; 95% CI 6.26 to 8.52) and neonatal mortality (AOR=5.34; 95% CI 4.65 to 6.12).

Conclusions Low literacy status of mothers, use of polluted fuel for cooking, time of first ANC visit and multiple deliveries are associated with SGA births. Interventions encouraging pregnant women to attend ANC visits early can reduce the burden of SGA births.

  • neonatology
  • epidemiology
  • health service
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjpo-2019-000607

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    Footnotes

    • Twitter @ShyamSuBu, @Ashish_K_C

    • Contributors PGP contributed on planning, creating new variables, performing data analysis on deidentified data and drafted the manuscript. AKS and AG performed data curation and data analysis and reviewed the first draft of the manuscript. RG, HM, SSB, PP and NKC reviewed the first draft of the manuscript and provided feedback. AKC conceptualised the study, provided the outline of the manuscript and reviewed the first draft and data analysis. All the authors read and approved the manuscript.

    • Funding This research was funded by the Swedish Research Council, Laerdal Foundation for Acute Medicine and Einhorn Family Foundation.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval The study was approved by the ethical committee at Nepal Health Research Council (reference number 26-2017). A waiver for consent to use data from the hospital records was provided by the ethical committee. Informed consent was provided by 50 392 participants prior to obtaining sociodemographic information. A total of 10 303 women did not provide the consent for interview.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.