Low birthweight increased the risk of neonatal death twenty-folds in Northern Uganda: a community-based cohort study.

BackgroundLow birthweight (LBW) is the leading cause of neonatal mortality and hospitalization worldwide. This study specifically aimed to: 1) determine the frequency of a) neonatal deaths and 2) assess their association with LBW in Northern Uganda. MethodsA cohort study, nested in the Survival Pluss cluster randomized trial (NCT02605369), was conducted from January 2018 to February 2019 in Lira district, Northern Uganda. Out of 1877 pregnant women, 1556 live-born infants had their birthweight measured and were followed up to 28 days after birth. Generalized estimation equation regression models of the Poisson family with a log link were used to calculate the risk ratios between LBW and death. ResultsThe risk of neonatal death was: 21/1,556 or 13.5 (95% CI: 8.8 - 20.6) per 1,000 live births. The respective sex and cluster adjusted proportion of neonatal death per 1000 live births among LBW, normal weight and not-weighed infants were 103 (95% CI: 47.2 - 212), 5.4 (95% CI: 2.1 - 13.9) and 167 (95% CI: 91.1-285). Compared to normal birthweight, LBW and not-weighed infants were each associated with a 20- and 30-folds increased risk of neonatal death. ConclusionIn this community-based cohort study in Northern Uganda, neonatal mortality was 13.5/1000 live births. In the LBW and not-weighed groups, the risk of a neonatal death were more than twenty-times that of non-LBW infants. Efforts to reduce the number of LBW infants and/or prevent adverse outcomes in this patient group urgently are needed. In addition, all babies with should have birthweight recorded to facilitate early risk identification and management.