Estimating Low Birthweight Prevalence and Stillbirth Rate Among HIV Pregnant Women: A Secondary, Health Facility-Based Cross-Sectional Study in Manica Province, Mozambique

Abstract

Background: Despite remarkable progress on increasing access to antiretroviral therapy (ART), HIV infection in pregnant women is still a global concern, leading to poor maternal and child health outcomes. Estimating low birthweight prevalence and stillbirth rate among HIV-infected mothers, and understanding contextual factors associated with these pregnancy outcomes, is critical to improve child survival. This study aims to close the gap on district-level estimates of low birth weight prevalence and stillbirth rate in central Mozambique. Methods: We conducted a cross-sectional exploratory analysis by combining secondary registry and health facility survey data from 36 health facilities and 2,254 HIV-infected mothers in Manica province, Mozambique. We performed a binomial test and logistic regression models with robust standard errors to estimate the corrected prevalence of low birth weight, small for gestational age and stillbirth rate, and associated risk factors. Crude and adjusted odds ratios were provided for assessed risk factors. Results: Overall, the corrected prevalence of low birth weight, small for gestational age and stillbirth rate were 13.2% (95% CI: 11.8%, 14.7%), 9.3% (95% CI:8.10%, 10.54%), and 17.0 per 1,000 births (95% CI: 12.5, 23.6), respectively. Substantial within-province variation existed, with low birth weight ranging from 8.9% in Chimoio to 24.2% in Sussundenga districts. Gestational age below thirty-seven weeks (OR: 1.65; 95% CI: 1.29, 2.10) and failure to initiate antiretroviral therapy during pregnancy (OR: 3.52, 95% CI: 1.26, 9.82) were significantly associated with increased risk of low birth weight and stillbirth, respectively. Conclusion: Low birth weight and stillbirths continue to be concerning issues in the study setting. Therefore, efforts to improve the quality of care, particularly in antenatal care services and maternity wards, are suggested to further reduce low birthweight prevalence and stillbirth rate in Manica Province.