Maternal and Child Health Unit, Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria.
Matern Child Health J. 2010 Nov;14(6):978-86. doi: 10.1007/s10995-009-0528-4.
Adverse birth outcomes remain significant contributors to perinatal mortality as well as developmental disabilities worldwide but limited evidence exists in sub-Saharan Africa based on a conceptual framework incorporating neighborhood context. This study therefore set out to determine the prevalence and risk factors for preterm births and low birthweight in an urban setting from this region. A cross-sectional study of all live births from May 2005 to December 2007 in an inner-city maternity hospital in Lagos, Nigeria. Factors predictive of preterm births and low birthweight were determined by unconditional multivariable logistic regression within a conceptual framework for adverse birth outcomes. Population attributable risk (PAR%) for each factor was also determined. Of the 4,314 newborns enrolled, 859 (19.9%) were preterm and 440 (10.2%) were low birthweight. One-third of mothers received no antenatal care while about 6% had HIV and another 6% had a history of hypertensive disorders. About 43% of the low birthweight infants were born full term. Maternal predictors of preterm delivery and/or low birthweight were marital status, occupation, residential accommodation with shared sanitation facilities, lack of antenatal care, absence of previous cesarean section, hypertensive disorders and antepartum hemorrhage. Gender and intrauterine growth restriction (IUGR) were also predictive of low birthweight. Premature rupture of membranes (PAR = 33.91%) and antepartum hemorrhage (PAR = 33.54%) were the leading contributors to preterm birth in contrast to IUGR (PAR = 82.28%) and premature rupture of membranes (PAR = 32.31%) for low birthweight. [corrected] The burden of preterm and low birthweight deliveries in this setting is associated with modifiable individual and neighborhood-level risk factors that warrant community-oriented public health interventions.
不良出生结局仍然是围产期死亡和全球发育障碍的重要原因，但基于纳入邻里环境概念框架的证据，在撒哈拉以南非洲地区十分有限。因此，本研究旨在确定该地区城市环境中早产和低出生体重的发生率和危险因素。这是一项在尼日利亚拉各斯市一家市立妇产医院于 2005 年 5 月至 2007 年 12 月期间进行的所有活产儿的横断面研究。采用不良出生结局概念框架内的非条件多变量逻辑回归来确定早产和低出生体重的预测因素。还确定了每个因素的人群归因风险（PAR%）。在纳入的 4314 名新生儿中，859 名（19.9%）早产，440 名（10.2%）低出生体重。三分之一的母亲没有接受产前护理，约 6%的母亲感染了艾滋病毒，另有 6%的母亲有高血压病史。大约 43%的低出生体重婴儿是足月出生的。早产和/或低出生体重的产妇预测因素是婚姻状况、职业、与他人共用卫生设施的住所、缺乏产前护理、没有先前的剖宫产、高血压疾病和产前出血。性别和宫内生长受限（IUGR）也与低出生体重相关。胎膜早破（PAR = 33.91%）和产前出血（PAR = 33.54%）是早产的主要原因，而 IUGR（PAR = 82.28%）和胎膜早破（PAR = 32.31%）是低出生体重的主要原因。[校正] 这种情况下早产和低出生体重分娩的负担与可改变的个体和邻里水平的危险因素有关，需要以社区为导向的公共卫生干预。
