Impact of Maternal Age and Other Biosocial Factors on Newborn Health

at Hospitals in Peshawar, N-W.F.P Pakistan

Sareer Badshah

Director of studies: Professor Paulo G. J. Lisboa

School of Computing and Mathematical Sciences,Liverpool John Moores University, Liverpool

L3 3AF

.

Aim of the study:

To investigate the influence/impact of maternal age and other biosocial factors on the hospital newborn’s health, controlling for a range of other variables.

Objective of the study To assess birth-health, i.e.,

Weight Length Head circumference, and Apgar (heart rate, respiratory efforts, muscle tone, reflex irritability,

and colour). To examine the effect of maternal age and other

biosocial factors on birth health. To generate yardsticks/parameters and establish base

statistics, for further comparisons in future with national and international studies.

To identify adverse factors affecting birth health, which will inform/help

Parents Husbands Doctors health department and Funding agencies.

Pakistan: Demographic indicators

Population 138.1 million (2000) Urban 37.0%

Pop. Growth 2.4%

Life expectancy at birth 59.6 years

Fertility rate (births per women) 4.8

Mortality rate Infant 89.8 (per 1,000 live birth) Under-5 yrs 126.0 (per 1,000 live birth) Maternal 4-7 (per 1,000)

Education Adult literacy rate 45.0% Male/female 58.9%/31.0%

Pakistan Vs NWFP & Fed. Adm.Tri.Area (2003)

Pakistan NWFP FATAArea (sq. km) 796,000

(100%)(9.42%) (3.4%)

Pop. (1998) 138.0 million(100%)

(13.04%) (2.30%)

Annual Pop. Growth 2.6% 2.8%

Literacy (Pak ) 45% 37% 17.42 %

Male 59% 56% 29.5 %

Female 31% 20% 3.0 %

Pop. / Hospital bed 1450 1869 2327

Pop./ Doctor 1490 1510 8189

Water safe 83% 58% 43.4%

Poverty 32.2% 42.6%

Literature review Data from Pakistan:

17 publications 13 in Pakistan (using very simple tools) 04 others (UK & Australia)

Other than Pakistan: 14 publications

India 05 Nigeria 03 Bangladesh 02 Canada 02 Jordan 01 Ethiopia 01*

Tools Cross-tabulation, percentages, and chi-square: 

(H. Yadav.(1983)., T. O. Lawoyin., et al. (1992)., N. Nahar et al.(1998)., B. Mondal.(1997). and Sushma Malik.(1997).

  T-test

(Sami A. Khoury et al.(2000)., Y. Feleke.(1999)., and S. A. Taha et al.(1984).

  Odds ratios: 

(Suzanne C. Tough., et al.(2001)., J.C. Grant et al.(1997)., and Kwang-sun Lee et al.(1988). 

Logistic Regression model and the use of -2LL:  (J. C. Grant et al.(1997). 

Regression Analyses:  (E. Karim et al.(1997).

Data (May-December, 2003) Retrospective data collection (May-July, 2003)

Revise questionnaire & ethical approval (August 6, 2003)

Prospective data collection (August-

December 2003)

Retrospective data: understanding with the staff coding combination of categories introducing medical terminology, & tools learning/testing

Prospective data collection

Total sample: 1039 (August-December, 2003)

Hospitals in Peshawar:• Hayatabad Postgraduate Medical Complex

• Khyber Postgraduate Teaching Hospital

• Lady Reading P. G. Teaching Hospital, and

• Maternity Hospital Peshawar

Introduction of data Maternal Age(<20) 7.5%

M. weight (<57kg) 24.7%

Entry in emergency 75%

Employed mothers 5.8%

Afghan refugees 11.8%

Nuclear family 25%

Abortions/Misc. 17%

Other risks 6.1%

Congenital abnormality 4%

M. education (illiterate) 70%

Rural & U.Slums 64.8%

Water (fresh) 63.3%

Father age(<25) 5%

Father edu. (illiterate) 38.1%

Income (<5000)69%

Cousin marriages 60.1%

and Diabetes 2.7%

Hypertension 18.3%

Anaemia 38.9%

Mode of del.(other) 33.5%

Birth status (other) 9.2%

Age at marriage (<20) 50.1%

Body Mass Index (<19.1) 3.9%

Gravida (one) 28.5%

Preterm del. (yes) 11.9%

Gap (<=2 years) 65%

Visits (nil) 31.3%

Visits (<=2) 51.6%

Gestation (<37wk) 22.5%

Birth weight (<2.5 kg) 9.9%

length (<45cm) 14.4%

h.Circu (<32cm) 14.9%

Apgar (<7points) 2.8%

Maternal age & Incidence of Low birth weight

010203040506070

Inci

den

ce o

f b

irth

(<2

.5 k

g)

14 18 22 26 30 34 38 42 46

Maternal age

< 2.5 kg

Gestation (<37 weeks)

<37 weeks

0

10

20

30

40

<= 19years

20-24years

25-29years

30-34years

>=35years

<37 weeks

Age group and birth-weight Estimated Marginal Means of B. Weight

Age gr.

>=35 years30-34 years25-29 years20-24 years<= 19 years

Estim

ate

d M

arg

ina

l M

ea

ns

3.3

3.2

3.1

3.0

2.9

2.8

2.7

2.6

2.5

Age group, birth-weight and gestation

Birth weight

Maternal age group

>=35 years30-34 years25-29 years20-24 years<= 19 years

Est

ima

ted

Ma

rgin

al M

ea

ns

(kg

)

3.4

3.2

3.0

2.8

2.6

2.4

2.2

2.0

Gestation

<37 weeks

>=37 weeks

Age group and birth-lengthEstimated Marginal Means of B. Lenght

Age gr.

>=35 years30-34 years25-29 years20-24 years<= 19 years

Estim

ate

d M

arg

ina

l M

ea

ns

49.0

48.8

48.6

48.4

48.2

48.0

47.8

Age group, birth-length and gestation

Birth Lenght

Maternal age group

>=35 years30-34 years25-29 years20-24 years<= 19 years

Estim

ate

d M

arg

ina

l M

ea

ns (

cm

)

50

49

48

47

46

45

Gestation

<37 weeks

>=37 weeks

Head circumference (<32 cm)

0

5

10

15

20

25

30

<= 19years

20-24years

25-29years

30-34years

>=35years

Maternal age

% I

nc

ide

nce

of

sm

all

hes

c

irc

um

fere

nce

Age group, and Head-circumferenceEstimated Marginal Means of B. H. Circumf.

Age gr.

>=35 years30-34 years25-29 years20-24 years<= 19 years

Estim

ate

d M

arg

ina

l M

ea

ns

35.2

35.0

34.8

34.6

34.4

34.2

34.0

33.8

33.6

Age group, birth Head-circum. and gestation

Birth Head Circumference .

Maternal age group

>=35 years30-34 years25-29 years20-24 years<= 19 years

Estim

ate

d M

arg

ina

l M

ea

ns (

cm

)

35.5

35.0

34.5

34.0

33.5

33.0

32.5

Gestation

<37 weeks

>=37 weeks

Incidence of Apgar score % (<7 points)

0

5

10

15

20

25

<= 19years

20-24years

25-29years

30-34years

>=35years

Age group, and ApgarEstimated Marginal Means of B. APGAR

Age gr.

>=35 years30-34 years25-29 years20-24 years<= 19 years

Estim

ate

d M

arg

ina

l M

ea

ns

9.2

9.0

8.8

8.6

8.4

8.2

8.0

7.8

Age group, Head circumference and gestation

Birth Head Circumference .

Maternal age group

>=35 years30-34 years25-29 years20-24 years<= 19 years

Estim

ate

d M

arg

ina

l M

ea

ns (

cm

)

35.5

35.0

34.5

34.0

33.5

33.0

32.5

Gestation

<37 weeks

>=37 weeks

Comparison of low birth-weight and head-circumference

Incidence of Low birth weight

R2 = 0.9955

0

5

10

15

20

25

30

35

0 1 2 3 4 5 6

Maternal age group

% o

f low

birt

h we

ight

(<2.5

kg)

Incidence of Head circumference

R2 = 1

0

5

10

15

20

25

30

0 1 2 3 4 5 6

Maternal age group

% o

f low

small

hea

ds (<

32 cm

)

Maternal age, Apgar & Birth status(still birth etc)

02468

101214161820

% o

f in

cid

en

ce

<=19 20-24 25-29 30-34 >=35

Maternal age group

Less than 7 Birth status (not live)

Low birth-weight (Area-status)

Incidence of low birth-weight (Area-wise)

0

10

20

30

40

0 2 4 6

Maternal age group

Inc

ide

nc

e o

f lo

w-

bir

th (

%)

SettledArea

Agency(FATA)

Age group, birth weight and Apgar

Estimated Marginal Means of B. Weight

Age gr.

>=35 years30-34 years25-29 years20-24 years<= 19 years

Estim

ate

d M

arg

ina

l M

ea

ns

3.4

3.2

3.0

2.8

2.6

2.4

2.2

2.0

1.8

1.6

Apgar in groups

Less than 7

>=7 points

Age, birth weight and birth status (live, still birth)

Estimated Marginal Means of B. Weight

Age gr.

>=35 years30-34 years25-29 years20-24 years<= 19 years

Estim

ate

d M

arg

ina

l M

ea

ns

3.4

3.2

3.0

2.8

2.6

2.4

2.2

2.0

1.8

2.24Fetal Outcome

Live birth

other

Linear Regression results

F a the r A ge

M . E d uca tion

M . H e ig h t

N a tion a li ty

M . W e ig h t

M . R e g es tra tion

d iab e tes

g rav ida

g e sta tion

W eig h t

P re te rm D e l.

F . A ge

g e sta tion

L e ng th

P re te rm D e l.

H ype r te ns ion

g e sta tion

H . C ircu m fe re n ce

o th er r isk fac to rs

F . E d u ca tion

A na em ia

P re te rm D e l.

m ar r ia ge d ura tion

g e sta tion

A pg ar

No

Incidence of Health parametersBirth Weight, Length, H.Cir., & Apgar

All Three Two One Non

1 GESTATION

Age M.reg Body mass index

Marriage duration

2 Weight Entry Area status Area

3 M. EducationAge at

marriage ConsanguinityFamily status

4Nationality Height

Abortion / miscarriages

Distance from

hospital

5 Preterm del. ProfessionDistance from

hospitalGravida

6 Anaemia Water Gap Diabetes

7 Fetal outcome

Father age, education Gravida

Gender

8 Congenital abnormality

Income Visits

9 Parity

10 Ab./Misca.before

Collaboration with Dr. Jose (Uni. De Cantabria Spain)

Thank you

?