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

Abstract

BackgroundAs 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.MethodsCross-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.ResultsOf 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.ConclusionsHigh 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.Electronic supplementary materialThe online version of this article doi: (10.1186/s12887-017-0946-1) contains supplementary material, which is available to authorized users.

High Burden of Undernutrition among At-Risk Children in Neonatal Follow-Up Clinic in Rwanda

“…As expected, there was higher burden of stunting, underweight, and wasting (58.8%, 47.5%, 25.8%, respectively) among children enrolled in the PDC aged 6-59 months between 2014 and 2017, compared to the national prevalence of undernutrition among children under five years of age in rural Rwanda (stunting: 40.6%, underweight: 10.0% and wasting: 2.3%) [8]. Two earlier studies in Rwanda and Burundi showed elevated rates of stunting, underweight and wasting among preterm and LBW infants, however stunting in our sample was lower (58.8% in PDC versus 79.0% in Rwanda without PDC at ages 12-36 months and 81.0% in Burundi at age 2 years) and prevalence of wasting was higher (25.8% PDC versus 9.0% and 18.0%, respectively) [9,22]. It is important to note that both of these studies had a large number of children that could not be located for assessment (23-46%) or died (4-6%) indicating potential Table 1: Associations between selected demographic and clinical characteristics of Pediatric Development Clinic (PDC) participants and their families with malnutrition outcomes;…”

“…In Rwanda, childhood malnutrition is a significant problem-with 41% of children under five years stunted, 10% underweight and 2% wasted in rural areas [8]. While the burden of malnutrition in children with increased biologic or social vulnerability has not been fully documented in Rwanda, 78% of premature and/or LBW children discharged from a rural hospital neonatal unit were stunted and 9% wasted at ages 1-3 years [9].…”

Optimalisasi Pertumbuhan Bayi Prematur dan Pasca Prematur di Indonesia; Mengacu pada Pedoman Nutrisi Bayi Prematur di RSCM

“…Akibat komorbiditas ini dan kondisi dasar bayi prematur, klinisi cenderung menunda pemberian susu sehingga terjadi EUGR. 14,15 Perubahan pedoman nutrisi untuk bayi prematur tahun 2018…”

Optimalisasi Pertumbuhan Bayi Prematur dan Pasca Prematur di Indonesia; Mengacu pada Pedoman Nutrisi Bayi Prematur di RSCM

“…Akibat komorbiditas ini dan kondisi dasar bayi prematur, klinisi cenderung menunda pemberian susu sehingga terjadi EUGR. 14,15…”