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. 2017 Nov 15;17(1):191.
doi: 10.1186/s12887-017-0946-1.

Health, nutrition, and development of children born preterm and low birth weight in rural Rwanda: a cross-sectional study

Catherine M Kirk  1 , Jean Claude Uwamungu  2 , Kim Wilson  3   4 , Bethany L Hedt-Gauthier  2   4 , Neo Tapela  2   4   5 , Peter Niyigena  2 , Christian Rusangwa  2 , Merab Nyishime  2 , Evrard Nahimana  2 , Fulgence Nkikabahizi  6 , Christine Mutaganzwa  2 , Eric Ngabireyimana  6 , Francis Mutabazi  6 , Hema Magge  2   3   5
Affiliations

Health, nutrition, and development of children born preterm and low birth weight in rural Rwanda: a cross-sectional study

Catherine M Kirk et al. BMC Pediatr. .

Abstract

Background: As care for preterm and low birth weight (LBW) infants improves in resource-limited settings, more infants are surviving the neonatal period. Preterm and (LBW) infants are at high-risk of nutritional and medical comorbidities, yet little is known about their developmental outcomes in low-income countries. This study evaluated the health, nutritional, and developmental status of preterm/LBW children at ages 1-3 years in Rwanda.

Methods: Cross-sectional study of preterm/LBW infants discharged between October 2011 and October 2013 from a hospital neonatal unit in rural Rwanda. Gestational age and birth weight were gathered from hospital records to classify small for gestational age (SGA) at birth and prematurity. Children were located in the community for household assessments in November-December 2014. Caregivers reported demographics, health status, and child development using locally-adapted Ages and Stages Questionnaires (ASQ-3). Anthropometrics were measured. Bivariate associations with continuous ASQ-3 scores were conducted using Wilcoxon Rank Sum and Kruskal Wallis tests.

Results: Of 158 eligible preterm/LBW children discharged from the neonatal unit, 86 (54.4%) were alive and located for follow-up. Median birth weight was 1650 grams, median gestational age was 33 weeks, and 50.5% were SGA at birth. At the time of household interviews, median age was 22.5 months, 46.5% of children had feeding difficulties and 39.5% reported signs of anemia. 78.3% of children were stunted and 8.8% wasted. 67.4% had abnormal developmental screening. Feeding difficulties (p = 0.008), anemia symptoms (p = 0.040), microcephaly (p = 0.004), stunting (p = 0.034), SGA (p = 0.023), very LBW (p = 0.043), lower caregiver education (p = 0.001), and more children in the household (p = 0.016) were associated with lower ASQ-3 scores.

Conclusions: High levels of health, growth, and developmental abnormalities were seen in preterm/LBW children at age 1-3 years. As we achieve necessary gains in newborn survival in resource-limited settings, follow-up and early intervention services are critical for ensuring high-risk children reach their developmental potential.

Keywords: Early childhood development; Low birth weight; Nutrition; Prematurity; Sub-Saharan Africa.

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Conflict of interest statement

Ethics approval and consent to participate

All aspects of this study, including hospital chart review and community-based data collection, were approved by the Rwanda National Ethics Committee (No.161/RNEC/2014), the Boston Children’s Hospital Institutional Review Board (IRB-P00011420), and the Rwandan Ministry of Health (No.20/4267/PHIS/ME&R/2014). All caregivers provided written informed consent for themselves and their child.

Consent for publication

Not applicable.

Competing interests

Authors CMK, JCU, BHG, PN, CR, MN, EvN, CM, and HM were employees or affiliates of Partners In Health/Inshuti Mu Buzima at the time of study but did not receive additional financial benefits as a result of participation in this study. Partners In Health/Inshuti Mu Buzima provided funding support for data collection in this study.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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