Abstract

Low birth weight (LBW) is a major public health problem, due to its magnitude and its strong association with infant morbidity and mortality. To identify socioeconomic and demographic factors of pregnant women that could be related to low birth weight babies in eight general hospitals in the District of Abidjan. This is a prospective descriptive study of a cohort of 1600 women who gave their consent, which focused on the analysis of obstetric records and the taking of in situ measurements of certain characteristics of parturients and their newborns having been admitted to the maternity wards of 8 general hospitals in the district of Abidjan (general hospitals of Abobo, Anyama, Bingerville, Koumassi, Marcory, Treichville, Port-Bout and Yopougon). The majority of the women interviewed (57%) were between 20 and 30 years old. A total of 38.6% of the women surveyed were in their first pregnancy and 71.22% were cohabiting with their spouses. On average, each pregnant woman lived in a household of four (4) people whose daily budget for food varied between 2000 and 3000 FCFA (FCFA: Franc of the French Colonies of Africa, currency used by several groups of countries in Africa and the Pacific zone). More than half of women working during pregnancy (54.7%) continued their gainful activities after the eighth month of pregnancy. The practice of a particular activity such as housework increases the risk of giving birth to a low birth weight baby (P=0.045*). Examination of the impact of the socioeconomic and demographic characteristics of pregnant women on the birth weight of the baby showed that only the practice of activities, in particular household activities, during pregnancy represents a risk factor for FPN.

1. Introduction

In Côte d'Ivoire, neonatal mortality is a major concern because it persists at a high level despite the strategies and interventions implemented to combat this scourge. Although not very recent, the year 2005 represented a dark period marked by the death of 84 newborns for every 1000 births considered. This figure was considered alarming and among the highest in the world ¹. Since 2003, Côte d'Ivoire was a candidate for achieving the fourth millennium goal which aimed to reduce infant mortality by two thirds (2/3) by 2015, through a significant reduction in neonatal mortality ². Unfortunately, during the evaluation of the Millennium Development Goals (MDGs), at the end of 2015, it appeared that Côte d'Ivoire had not yet achieved its objectives in terms of reducing neonatal mortality. Nevertheless, enormous progress illustrated by the reduction from 93 newborn deaths per 1000 births considered to 38 deaths per 1000 births declared from the year 1990 to 2019 ³ In order to reduce the neonatal mortality, its leading causes should be identified. Thus, many publications have been made to alert public opinion to the risk factors of neonatal mortality. The main causes of neonatal deaths vary from one region to another depending on the level of development of the region, the weight of the newborn at birth, the duration of the pregnancy, the state of health of the mother and the fetus during pregnancy ⁴. In developing countries, low newborn weight (LBW) is a major contributor to infant mortality. Low birth weight is a health problem that is the cause of several very severe and sometimes irremediable disabilities ⁵. The low birth weight of neonates is defined as a birth weight strictly lower than 2500g whatever the term of the pregnancy ⁶. African countries are making enormous efforts in favor of the fight against LBW. Côte d'Ivoire has recently developed the action plan "every newborn Ivory Coast 2018-2020 action plan", so that every newborn is born healthy and lives healthy. This action plan is essentially focused on improving the quality of services and strengthening reception capacities in maternal and newborn health services ³. Despite these efforts, low newborn weight (LBW) still remains a reality in even the most developed Ivorian cities such as Abidjan. For example, it is reported that at the Centre Universitaire and Hospitalier (CHU) of Bouaké, 60.2% of newborn babies who died had low birth weight ⁷. Also the latest survey on the situation of women and children, mentions the existence of infants with low birth weight on the national territory ⁸. Consequently, Côte d'Ivoire has not yet reached the 5% low birth weight rate set by the Sustainable Development Goals. Consequently, maternal and neonatal health professionals wonder about the existence of other factors apart from those related to the quality of health personnel and the capacity of reception of maternal and neonatal health services. It seems that there are indeed other socio-demographic factors of the pregnant mother which contribute to the occurrence of low birth weight (LBW). This study aims to examine the influence of the socio-demographic characteristics of parturients received in consultations in eight general hospitals of the District of Abidjan on the occurrence of LBW.

2. Material and Methods

This is a prospective descriptive cohort study which focused on the analysis of obstetric records and the taking of measurements of certain characteristics of parturients who were admitted to the maternity ward of 8 general high-traffic hospitals in the district of Abidjan. The files selected were those of women who attended these hospitals from February to December 2016. The analysis of the files is based on the reliability of the collection of all the information constituting the obstetric file in these services. Also, these women were subjected to a questionnaire to determine the characteristics of their family environment.

This study concerns pregnant women seen in the general hospitals of the study site. The newborns of these women are also received just after delivery for birth weight gain in these health centers.

The parturient should be registered and monitored in one of the general hospitals of the District of Abidjan (Côte d'Ivoire) which are: hôpital général d’Abobo; hôpital général d’Anyama; hôpital général de Bingerville; hôpital général de Koumassi; hôpital général de Marcory; hôpital général de Treichville; hôpital général de Port-Bout et hôpital général de Yopougon. The pregnant woman should be in the third trimester of pregnancy and agree to give birth in one of the general hospitals mentioned above.

Could not be part of our sample, any bulimic woman in the third trimester of pregnancy.

The choice of hospitals was non-probabilistic. It was based on the existence of a general hospital in each Commune of the District of Abidjan. On the other hand, the selection of the medical file of the pregnant women was random.

Based on the medical file of each parturient, prenatal information related to the socio-demographic characteristics of the pregnant woman was collected. The data collected provides information on place of residence, age, ethnicity, level of study, activity, type of housing, religion, marital status, number of children, number of people living in the household and the source of food supply. After delivery, information related to the birth weight of the baby was also collected.

3. Résults

At the end of the survey carried out in eight (08) general hospitals of the District of Abidjan, the files of 1,600 pregnant women were selected. The distribution of these women according to their age shows that 57% of these women were between 20 and 30 years old. With regard to professional occupation and level of education, 52% of women had a paid job and 35% of them were illiterate. Also, 71.22% of the total number of women questioned were cohabiting with their spouse (Table 1).

Certain external factors related to the lifestyle and environment of the pregnant woman were examined. Those who were concerned by the study are the size of the family, the type of housing, the work stoppage in the 8th month of gestation, the life as a couple of the pregnant woman, the number of biological children of the woman enclosure and source of food supply. Statistical processing showed that 38.6% of the women questioned were in their first pregnancy. More than half of women working during pregnancy (54.7%) continued their gainful activities after the eighth month of pregnancy. Compared to the total number of women who took part at the study, 81.1% of women lived with their spouses during the study period, 86.5% lived in a rented house. Observation of the results revealed that 44.8% of all women are represented by pregnant women who live in a household of more than 4 people (Table 2).

All pregnant women who took part at the study are classified according to their nationality. According to a decreasing gradient of representativeness, these pregnant women were Ivorians (77.83%), Burkinabes (8.37%), Malians (7.14%), Guineans (1.97%), Nigeriens (1.48%), Nigerian (1.23%), Beninese (0.74%), Senegalese (0.74%) and Ghanaians (0.49%) (Figure 1).

The ivorian pregnant women concerned by this study are classified according to their ethnic groups. The main ethnic groups identified were Baoulé (26.51%), Malinké (20.88%), Sénoufo (11.65%), Bété (7.63%) and others (33.33%) (Figure 2).

The following Figure shows the ivorian pregnant women distribution according to the religion. The analysis of this figure indicated that most of women surveyed were Christians (53%) or Muslims (44.8%) (Figure 3).

4. Socio-demographic Characteristics of the Spouse

The distribution of the pregnant women according to the sociodemographic parameters of the partner was analysed. Out of 100 women questioned, about 29 women were unaware of the level of education of their spouses (29.3%). At least 84% of women had a spouse who worked in the private sector. Also, 45.9% of women's spouses had a daily budget for family food which fluctuated between 2,000 and 3,000 FCFA. The majority of these women lived alone with the spouse without any presence of a co-wife in the marital home (94.3 %) (Table 3).

5. Correlation between Socio-demographic Characteristics of the Pregnant Woman and the Birth Weight of the Baby

The influence of socio-demographic factors on the birth weight of the baby was revealed that only the practice of a particular activity has an Significant effect on the birth weight of the baby with a significance level of 0.045. Indeed, housewives are more likely to give birth to a LBW baby (19.5%); against 16.80% for those who are gainfully employed and 9.9% among female students. On the other hand, all the other socio-demographic characteristics mentioned in this study had no influence on the birth weight of the baby (Table 4).

6. Discussion

The socio-demographic characteristics of the pregnant woman were examined in order to detect their possible influence in the occurrence of LBW in the baby just after delivery. One of the characteristics of pregnant women that has been studied is the age of parturients. Analysis of the results related to the age of the parturients indicated that more than half of the women who participated in the study were aged between 20 and 30 years. This result does not differ from those Legesse et al. ⁹, who demonstrated that the average age of pregnant women received in Prenatal Consultation at the Chu de Cocody-Abidjan (Côte d'Ivoire) is 29.7 years. The ideal time for motherhood is between 20 and 34 years old. After the age of 35, women are at increased risk of complications during pregnancy, such as spontaneous abortion, high blood pressure, hemorrhages and fetal death ¹⁰. Conversely, the young age of the adolescent girl, her biological, affective and social immaturity aggravate the difficulties observed during her pregnancy and maternity. The risk appears all the higher when the mother is very young, with a greater frequency of arterial hypertension, toxemia, anemia, difficulties in childbirth, prematurity, fetal hypotrophy and deformities ¹¹. Therefore, the majority of women seen in consultation in the eight general hospitals of the district of Abidjan do not seem to be too young or too old for pregnancy.

Regarding the profession of pregnant women, more than half are gainfully employed. Sometimes they are active until the 9th month of pregnancy despite the fatigue caused by the weight of pregnancy. According to ¹², approximately 47% of pregnant women involved in a study in Ethiopia engage in vigorous activity during pregnancy. The practice of physical and vigorous activity by parturients in the ninth month of pregnancy would be explained by the decline in household purchasing power ¹³. Faced with financial difficulties, ninth-month parturients engage in income-generating activities to support financially their spouses. Indeed, the fall in world cocoa prices has contributed to the increase in the national poverty rate ¹³ due to the fact that Côte d'Ivoire is the world's leading producer. The spouse's occupation is a very important factor in the socio-demographic background of pregnant women and can contribute to the assessment of risk factors for LBW. The results of this study indicated that 84.5% of spouses worked in the informal sector as drivers, carpenters, mechanics, tailors and electricians. These jobs in the informal sector generate irregular and most often low incomes. Then the financial instability which reigns in the households would explain the daily budgets of 2000 to 3000 FCFA for the food of the members of the household whose size is on average 4 people. This budget constitutes very low purchasing power for a healthy and balanced diet for the parturient. The low rate of parturient civil servants who participated in this study (02%) is due to the long queues in the reception rooms of general hospitals. Consequently, female civil servants are more attracted to clinics where they are quickly received by health professionals. The level of education of women is low, which would partly explain the high rate of women who devote themselves to small trades. The low weight of the baby at birth is always the consequence of an exposure factor which may be linked to the environment and the socio-demographic characteristics of the pregnant woman ¹⁴. In this study, the examination of the correlation between the socio-demographic characteristics of the pregnant woman and the birth weight revealed that the practice of household activities during pregnancy negatively influences the weight of the baby at birth and represents a risk factor for FPN. In addition, the study by Yenan et al. proved that domestic fatigue is a risk factor for LBW ¹⁵. From the eighth month of pregnancy, the parturient needs rest. Thus the physical efforts provided by the parturient increase her energy needs and create a competition for nutrients between the mother and the fetus. This competition reduces the availability of the nutrients necessary for the good growth of the fetus.

7. Conclusion

Examination of the impact of the socio-demographic characteristics of pregnant women on the birth weight of the baby has shown that the practice of activities, in particular household activities, during pregnancy represents a risk factor for LBW. Unfortunately, the majority of women received in the eight general hospitals of the District of Abidjan carry out activities until the ninth month of pregnancy in order to financially support their partners.

Acknowledgements

We are very much grateful to each Director of the general hospitals visited. Our thanks are also addressed to reviewers for their insightful comments and suggestions for the improvements of this manuscript

Competing Interests

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

References