RFP-3: The Gambia
Low Birth Weight: A Prospective Study of Burden, Risk Factors and Neonatal Mortality
The University of The Gambia was awarded RFP-3 in 2004 to conduct a prospective study to estimate burden, risk factors and neonatal mortality due to low birth weight in The Gambia. The study was conducted in collaboration with the other institutions: Nutrition Programme, Medical Research Council (MRC) Laboratories, Department of State for Health and Social Welfare and National Nutrition Agency of The Gambia.
The objectives of the study were to determine the prevalence of low birth weight (LBW) and its relative contributions to prematurity and Small for Gestational Stage (SGA), and in addition to determine the role of nutritional status, malaria, obstetric and medical conditions. The study would also evaluate the contribution of LBW to neonatal morbidity and mortality and explore the effects of socioeconomic norms and practices that include utilization and quality of health services on both LBW and neonatal mortality.
The study suggested two strategies to address the issue. A prospective cohort accompanied by a case-control study. The prospective cohort study was designed to define the burden of low birth weight and assess risk factors, and the case-control study to explore the relationship between low birth weight and neonatal mortality. A social science research methodology using in-depth interviews and focus group discussions was employed to explore socio-cultural beliefs, attitudes and practices that may contribute to the risk of low birth weight. A questionnaire was completed for each pregnant woman attending study institutions for delivery. This included information on age, reproductive history, current pregnancy history, social and economic variables and maternal-weight at each visit, iron-folate supplementation, anti-malarial, antenatal complications, highest recorded blood pressure and drugs history. Blood and urine samples were collected from the women before and after delivery; a blood sample was collected from the umbilical cord and placenta for laboratory analyses. The placenta was weighed and placental biopsy specimens were taken from the maternal surface.
By the end of 2007, a total of 981 cases and 981 controls were recruited which were 33 cases short of target and control cases. It was anticipated that 20% of the cases would be lost in the follow up after a month. In reality, it was found that many women returned to their villages or neighboring country, Senegal, after delivery and this resulted in a 48.3% loss from the original recruited cases. However, as the proposed sample size of the project was not achieved and some critical components were not implemented due to various problems, the OCHRC Board asked the researchers to submit a new proposal that would enable the researchers to achieve the original objective of the study. In latter part of 2007 the Board approved the revised proposal. The Gambia project resumes its activities and it is anticipated that the project will complete the analysis and submit the final report by mid 2009.
