RFP-3: Bangladesh

Low Birth Weight and Prematurity in Rural Bangladesh: Levels, Determinants and Consequences for Neonatal Morbidity and Survival

The overall goal of this project was to improve the understanding of the burden of LBW, its consequences, determinants, consequences, and prevention and management in Bangladesh. Specific objectives were to measure the incidence, investigate determinants and to examine the effect of LBW, IUGR and pre-maturity on neonatal morbidity and survival and to assess the factors that modulate these effects.

To measure the incidence of LBW, its determinants and major consequences in rural Bangladesh, investigators nested this study within the three community-based cohort studies namely MINIMat, Projonmho-1 and -2. The three study sites vary in neonatal mortality, healthcare status and intervention types. The selected sites are also likely to vary in terms of rates of LBW. It was expected that assessment from these three different sites would provide a more representative measure of the burden of LBW, its determinants and consequences in rural populations. MINMat was a community-based randomized intervention trial aimed at evaluating the effect of different interventions and combinations of interventions in a cohort of pregnant women, on birth weight. Projahnma-1 was another community-based project evaluating the effect of a package of pregnancy, delivery, and newborn care interventions on newborn care and neonatal mortality. The study has a home-care, clinic-care and comparison arms. Projahnma -2 is similar to Projahnma -1; however, the intervention includes the detection and etiological assessment of neonatal sepsis. 

The study collected data on 3,267 newborns from MINIMat study and 11,139 newborns from Projonmho-1 and -2 studies to estimate the incidence of LBW, pre-maturity and IUGR. To measure the effect of LBW, pre-maturity and IUGR on neonatal mortality data was collected from 3,267 MINIMat and 3,925 from Projonmho-1 and -2 against the targeted 4,000 newborns. In addition it assessed maternal weight and height during pregnancy with weight measured again at first month postpartum. By conducting advanced secondary analysis on the three studies from the large pooled sample it was possible to use modeling techniques and investigate the effects of LBW, pre-maturity, IUGR and their further sub-classifications on neonatal mortality accounting for other immediate and underlying factors. It also allowed investigation of the interactions between the various determinants. The advanced secondary analysis on the pooled data from the three studies is in progress.  

The study was not completed within the original time frame and was twice awarded a no cost extension. In first the instance, the data collection could not be completed as three primary projects failed to achieve the required sample size and on the second occasion there were problems in linking various databases. However by the end of 2007 the project proponents informed OCHRC that they had finished most of their analysis and were planning to submit the final technical report by early 2009.