Abstract:
Background: Preterm birth continues to be a major public health problem contributing to 75% of the neonatal
mortality worldwide. Low birth weight (LBW) is an important but imperfect surrogate for prematurity when accurate
assessment of gestational age is not possible. While there is overlap between preterm birth and LBW newborns, those
that are both premature and LBW are at the highest risk of adverse neonatal outcomes. Understanding the epide‑
miology of preterm birth and LBW is important for prevention and improved care for at risk newborns, but in many
countries, data are sparse and incomplete.
Methods: We conducted data analyses using the Global Network’s (GN) population-based registry of pregnant
women and their babies in rural communities in six low- and middle-income countries (Democratic Republic of
Congo, Kenya, Zambia, Guatemala, India and Pakistan). We analyzed data from January 2014 to December 2018.
Trained study staf enrolled all pregnant women in the study catchment area as early as possible during pregnancy
and conducted follow-up visits shortly after delivery and at 42 days after delivery. We analyzed the rates of preterm
birth, LBW and the combination of preterm birth and LBW and studied risk factors associated with these outcomes
across the GN sites.
Results: A total of 272,192 live births were included in the analysis. The overall preterm birth rate was 12.6% (ranging
from 8.6% in Belagavi, India to 21.8% in the Pakistani site). The overall LBW rate was 13.6% (ranging from 2.7% in the
Kenyan site to 21.4% in the Pakistani site). The overall rate of both preterm birth and LBW was 5.5% (ranging from 1.2%
in the Kenyan site to 11.0% in the Pakistani site). Risk factors associated with preterm birth, LBW and the combination
were similar across sites and included nulliparity [RR −1.27 (95% CI 1.21–1.33)], maternal age under 20 [RR 1.41 (95%
CI 1.32–1.49)] years, severe antenatal hemorrhage [RR 5.18 95% CI 4.44–6.04)], hypertensive disorders [RR 2.74 (95% CI
−1.21–1.33], and 1–3 antenatal visits versus four or more [RR 1.68 (95% CI 1.55–1.83)].
Conclusions: Preterm birth, LBW and their combination continue to be common public health problems at some of
the GN sites, particularly among young, nulliparous women who have received limited antenatal care services.