Looking at maternal inequalities (socioeconomic class, age and human immunodeficiency virus status) to predict well-being of neonates during infancy ()
1. INTRODUCTION
The infant mortality rate in Nigeria is around 98/1000 [1]. Developing countries have 2.4 times higher rate of infant mortality than developed ones [2]. Infant health is influenced by maternal factors such as maternal socioeconomic class (SEC), age and human immunodeficiency (HIV). These factors have enormous public health implications, such as huge medical bills on governments, individuals or health insurance. For instance, the Joint Center for Political and Economic Studies in 2009 reported that medical expenses that included infancy related illnesses costed billions of dollars [3]. Mothers who belong to low SEC are not only more vulnerable to illhealth with high mortality rate; their infants also suffer from diseases that could lead to death. Suthers [4] in 2008 published that hundreds of thousands of children died in infancy from causes that included low maternal SEC. Mothers of low SEC are much prone to social vices like discrimination, isolation which have negative health implications on their infants. More so, Derose and Baker [5] in 2000 found that mothers who cannot communicate effectively have problems utilizing the healthcare services and are more likely to have health needs of their infants like immunization un-attended to.
Maternal age (MA) under thirty has been linked to infant abuses, maltreatment and lack of immunization [6]. Maternal inexperience might be responsible for poor infant health in mothers under thirty years of age. Infants that are HIV exposed are more likely to lose their HIV parents due to medical and socioeconomic inadequacies especially in developing countries like ours. As suchthese infants are more likely to be nurtured in poverty without adequate nutrition, shelter, safe drinking water, health care services, immunization and proper environmental sanitation [1,7]. These factors in our locality constitute a threat to infant’s survival because of high disease burden and deaths that are associated with them.
Vast literature reviews showed dearth of information on the triple effect of maternal SEC, age and HIV to predict well being of neonates during infancy especially in developing countries. More so, no such study has been done in Nigeria to the best of my knowledge. This manuscript aimed at: 1) To determine the contributory roles of maternal SEC, age and HIV on babies well-being during infancy based on rational data; 2) To provide relevant public health information regarding babies health during infancy in Maiduguri, Borno state, North-Eastern Nigeria.
2. MATERIAL AND METHODS
2.1. Study Area
The study was conducted at the Department of Paediatrics and Obstetrics unit of the University of Maiduguri Teaching Hospital, (UMTH), Borno State, Nigeria. Being the largest health facility in the region, the UMTH serves as a referral hospital for six North-Eastern States of Nigeria and neighboring countries of Chad, Cameroon and Niger Republics.
2.2. Ethical Considerations
The present study protocol was reviewed and ethical clearance authorized by the Medical Research and Ethics Committee of the UMTH. All work was performed according to the international guidelines for human experimentation in clinical research [8]. Informed consent from parents was also obtained after explaining the purpose and the objectives of the study. Parents had unlimited liberty to deny consent or opt out of the study without any consequences.
2.3. Sample Size/Subject Selection
The minimum sample size was determined using statistical formula, which computes four percent crude birth rate for Nigeria at 95% confidence interval and alpha levels of 0.05 [1,7,9]. This sum up to 60; but 50% of this was added to maximize power. Therefore, the study population consisted of 90 mother-neonatal pairs. Participation in this study was voluntary and consenting pregnant women were selected using systematic random sampling method where the first of every four pregnant woman was picked as they presented to the labor ward. Where the first did not fulfill the inclusion criteria, the immediate next pregnant woman that qualified was selected. Pregnant women who had their antenatal care, consented to HIV screening and delivered at the UMTH were eligible to participate in this study. Severely sick pregnant women or those who decline consent for the study were excluded.
Maternal education, occupation, age, HIV status was obtained using a questionnaire from antenatal health records and in some instances from the mothers themselves. Maternal SEC was obtained from educational and occupational attainment of a mother using the Oyedeji’s model [10]. Gestational age (GA) of the neonates was determined from their mother’s last menstrual period or obstetric ultrasound scan reports or the Dubowitz criteria [11]. Birthweight (BW) of the neonates was measured using the basinet weighing scale that has a sensitivity of 50 grams. Neonates weighing greater than 3.99 kg were classified as macrosomia, those weighing 2.5 - 3.99 kg as normal and those less than 2.5 kg were low birth weight [12].
2.4. Statistical Analysis
Data were expressed as frequencies; mean (SD) and 95% confidence intervals (CIs). Correlation coefficient of MA with GA and BW was obtained; Chi-square and analysis of variance (ANOVA) were used to investigate categorical and quantitative variables respectively. A p-value <0.05 was considered significant. Tables were used for demonstrations. Statistical package for social science (SPSS) statistical software version 16, Illinois, Chicago USA was used for all analysis.
3. RESULTS
Of a total of 90 mother-neonatal pairs enrolled in this study, 47 (52.2%) neonates were males and 43 (47.8%) were females, and the male to female ratio is 1.09:1. Most of the neonates were term 66 (73.3%) and of normal BW 75 (83.4%) (Table 1). There was significant association between maternal (SEC, Age, HIV) and the likely hood of the neonates being less healthy during infancy (χ2 = 126.528, p < 0.005) (Table 2).
Table 3 below shows mean BW, GA and MA of the study group. The mean BW and GA were normal. Maternal age had negative correlation coefficient with GA (r = −0.200) and BW of neonates (r = −0.115) and mean comparison for MA, GA and BW was significant (F = 2662.92, p < 0.0001).