Date of Award

1-5-2018

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Ike Okosun

Second Advisor

Dr. Moges Ido

Abstract

INTRODUCTION: Low birth weight (LBW) is a public health problem in developing countries including Malawi. It is an intermediate endpoint of maternal lifestyles and health status, and a powerful predictor of newborn’s survival. Over 30 risk factors have been associated with LBW, but the role of maternal HIV infection as an underlying factor for LBW is not yet well established. Understanding whether or not maternal HIV status is a risk factor for LBW is key in the prevention of LBW and its life time health effects.

AIM: The purpose of this study was to examine the association between maternal HIV status and LBW in Malawi using DHS 2010 data.

METHODS: This study analyzed 7716 mother-child pairs from the 2010 Malawi Demographic and Health Survey (DHS) data using SAS 9.4 program. Student’s t-test and Chi-square test were applied, for continuous and categorical variables respectively, to compare maternal and child characteristics by HIV status and LBW status separately. Bivariate logistic regression was performed and crude odds ratios were determined to ascertain the relative measure of effect of maternal and fetal characteristics on outcome variable (LBW). Then, multivariable logistic regression analyses were performed to examine the association between maternal HIV infection and LBW adjusting for covariates. Statistical assessment of interaction between HIV infection and covariates on LBW was made. A p-value of.05 or 95% confidence intervals were used to determine statistical significance throughout all the analyses performed.

RESULTS: The proportion of LBW infants was 9.45% in total, with 13.60% among HIV positive women and 9.26% among HIV negative women (p 0.0337). A multivariable logistic regression model showed that HIV positive mother was 77% more likely [odds ratio (OR) 1.77, 95% confidence interval (CI) 1.17-2.67] than HIV negative mother to give birth to LBW infant. The odds of LBW also increased among teenage women (OR = 1.86; 95% CI = 1.47, 2.35), women without education (OR = 1.66; 95% CI = 1.13, 2.43), low income (OR = 1.37; 95% CI = 1.05, 1.78), and Chewa ethnicity (OR = 1.92; 95% CI = 1.39, 2.66). However, LBW was not associated with child sex, marital status, or prenatal care. Though not statistically significant, the association between HIV infection and LBW was modified by increase in age, unmarried marital status, and inadequate prenatal care.

DISCUSSION: These findings are consistent with other previous studies that showed that maternal HIV status is a significant risk factor for LBW.

CONCLUSION: The study has substantiated the need to recognize HIV-positive pregnant mothers as high risk obstetric patients who need extra support and care during pregnancy and delivery, and the need to intervene with supplemental nutritional interventions during antenatal clinics and strengthen HIV prevention among women of child bearing age to reduce LBW infants.

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