Table 3.
Prevalence and risk factors of neonatal mortality among women enrolled in SHINE trial (2012–17)a
| Neonatal death31.4/1000 LBW (95% CI 26.9, 36.5)(152/4843) |
|||
|---|---|---|---|
| Unadj RR (95% CI) | Adj RR (95% CI) | Adj RR (95% CI) | |
| n = 4461 | n = 2982 | n = 2982 | |
| LBW model | SGA model | ||
| Maternal factors | |||
| Age | |||
| <20 years | 1.53 (1.03, 2.25) | 1.42 (0.72, 2.80) | 1.65 (0.86, 3.18) |
| 20–35, years | 1.00 | 1.00 | 1.00 |
| >35, years | 1.84 (1.17, 2.88) | 1.10 (0.48, 2.52) | 1.29 (0.57, 2.91) |
| Married | 0.98 (0.44, 2.21) | – | – |
| Education, years | 0.91 (0.84, 0.99) | 0.98 (0.84, 1.13) | 0.97 (0.84, 1.11) |
| Height | 0.99 (0.98, 1.01) | 1.00 (0.97, 1.03) | 0.99 (0.97, 1.01) |
| MUAC, cm | |||
| <23 (thin) | 0.95 (0.61, 1.48) | 0.87 (0.35, 2.14) | 0.95 (0.38, 2.32) |
| 23 <27 (normal) | 1.00 | 1.00 | 1.00 |
| 27 <31(overweight) | 0.72 (0.51, 1.00) | 0.91 (0.40, 2.06) | 0.70 (0.32, 1.55) |
| ≥31 (obese) | 0.88 (0.52, 1.48) | 2.29 (0.94, 5.58) | 2.40 (0.99, 5.80) |
| HIV-infected | 1.21 (0.80, 1.84) | 0.67 (0.29, 1.56) | 0.77 (0.33, 1.76) |
| Anaemic | 1.72 (1.17, 2.53) | 1.98 (1.02, 3.90) | 1.65 (0.85, 3.20) |
| Hypertensive | 0.66 (0.17, 2.59) | – | – |
| Maternal capabilitiesb | |||
| Depression | 0.56 (0.23, 1.35) | – | |
| Low PHS | 0.70 (0.50, 1.00) | 0.73 (0.41, 1.32) | 0.72 (0.41, 1.28) |
| Low DMA | 0.87 (0.62, 1.23) | – | |
| Low MSE | 0.97 (0.68, 1.36) | – | |
| Low GNA | 1.08 (0.76, 1.52) | – | |
| Low PSS | 0.85 (0.61, 1.18) | – | |
| Low PTS | 1.14 (0.82, 1.58) | – | |
| Household factors | |||
| Wealth scorec | 0.96 (0.87, 1.05) | – | |
| Food insecurityd | 1.18 (0.79, 1.77) | – | |
| No improved latrine | 1.15 (0.80, 1.65) | – | |
| Feces in yard | 0.94 (0.66, 1.34) | – | |
| Improved drinking water | 1.25 (0.87, 1.78) | – | |
| Antenatal/delivery factors | |||
| Booked ANC | 0.40 (0.10, 1.51) | – | |
| Non-institutional delivery | 2.09 (1.32, 3.33) | 1.44 (0.62, 3.36) | 1.55 (0.68, 3.51) |
| Twin/triplet | 4.95 (3.15, 7.77) | 1.59 (0.69, 3.67) | 3.23 (1.44, 7.25) |
| Hungry season deliverye | 1.01 (0.73, 1.39) | 0.86 (0.49, 1.50) | 0.87 (0.50, 1.51) |
| Female infant | 0.70 (0.50, 0.98) | 0.93 (0.53, 1.63) | 1.03 (0.60, 1.78) |
| Infant birthweight, kgf | 0.17 (0.13, 0.21) | – | |
| Preterm birth | 5.99 (3.90, 9.20) | – | |
| Small for gestational age | 1.11 (0.63, 1.94) | – | |
| Term NBW | 1.00 5 | 1.00 | |
| Preterm NBW | 2.15 (1.08, 4.24) | 1.49 (0.55, 4.05) | |
| Term LBW | 3.10 (1.22, 7.91) | 4.69 (1.70, 12.98) | |
| Preterm LBW | 18.31 (11.56, 29.02) | 17.05 (8.57, 33.91) | |
| Term AGA | 1.00e | – | 1.00 |
| Term SGA | 1.70 (0.82, 3.51) | – | 2.02 (0.85, 4.80) |
| Preterm AGA | 6.49 (4.00, 10.53) | – | 5.25 (2.72, 10.13) |
| Preterm SGA | 10.56 (4.27, 26.17) | – | 7.19 (2.08, 24.76) |
| Study arm g | |||
| SOC | 1.00 | 1.00 | 1.00 |
| IYCF | 1.12 (0.66, 1.92) | 0.84 (0.37, 1.91) | 0.89 (0.39, 2.03) |
| WASH | 1.25 (0.75, 2.08) | 0.89 (0.42, 1.90) | 0.94 (0.44, 1.99) |
| WASH+IYCF | 1.24 (0.75, 2.06) | 1.04 (0.50, 2.13) | 1.17 (0.56, 2.42) |
RR, risk ratio; LB, live births; MUAC, mid-upper arm circumference; ANC, antenatal care. SGA, small for gestational age defined as <10th centile weight for gestational age using Intergrowth Fetal Growth Standards; LBW, low birthweight defined as weight <2500 g at birth; NBW, normal birthweight; anaemic: haemoglobin concentration <12 µg/dl; Hypertensive: systolic blood pressure >140 mm Hg and/or diastolic blood pressure >90 mm Hg; preterm birth: <37 weeks’ gestation calculated from last menstrual period. Maternal and household baseline data were collected about 2 weeks after consent was recorded (at roughly 14 weeks’ gestation). This gap created opportunity for loss to follow-up between consent and baseline; thus, for all outcomes, the number of mothers included in the risk factor analysis is less than the denominator used to calculate prevalence. Bold indicates factors associated at P value <0.05.
For further discussion of all maternal capabilities see Matare.1 Low PHS, low perceived health status defined as mother perceives herself to have poor health status; low DMA, low decision-making autonomy defined as mother perceives herself to have little decision-making autonomy; low MSE, low mothering self-efficacy, mother perceives herself not to be efficacious in her mothering skills; low GNA, low gender norm attitudes defined as mother holds inequitable gender norm attitudes; low PSS, low perceived social support defined as mother perceives herself to have little social support; low PTS, low perceived time stress defined as mother perceives herself as unstressed.
Wealth score was an asset index created for SHINE2.
Food insecurity defined as Coping Strategy Index.3
Hungry season is period of relative food scarcity defined as October–March.
Infant birthweight, preterm status and small for gestational age status were entered into univariate analyses. In adjusted analyses, these variables were not entered singly but as part of Term/Preterm/NBW/LBW category.
Study arms of SHINE trial. SOC, Standard of Care; IYCF, Infant and Young Child Feeding; WASH, Water And Sanitation, Hygiene; WASH+IYCF, WASH and IYCF interventions delivery concurrently.
Matare C, Mbuya M, Pelto G, Dickin K, Maluccio J, Stoltzfus R. Assessing maternal capabilities in the SHINE Trial: a heretofore overlooked piece in the causal pathways to child health. Clin Infect Dis 2015;61(Suppl 7):S745–51).
Chasekwa B, Maluccio JA, Ntozini R et al. Measuring wealth in rural communities: lessons from the Sanitation, Hygiene, Infant Nutrition Efficacy (SHINE) trial. PLoS One 2018;13:e0199393.
Maxwell D, Watkins B, Wheeler R, Collins G. The Coping Strategy Index: A tool for rapid measurement of household food security and the impact of food aid programs in humanitarian emergencies. Nairobi: CARE and WFP, 2003.