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Background Low birth weight (LBW) is defined as a birth weight less than 2500 g. It is an important predictor of early neonatal mortality, morbidity, and long-term health outcomes. The aim of this study was to identify risk factors for low birth weight in Marrakech Morocco. Methods A retrospective based case-control study was conducted from July 2018 to July 2019. 462 mother infant pairs (231 low birth weight babies as cases and 231 normal birth weights as controls) were included in the study. Data were collected through face to face interview using a structured and pretested questionnaire. The collected data were managed with Statistical Package for Social Science (SPSS) version 20. Bivariate and multivariate binary logistic regression were used to identify factors associated with low birth weight at p-value < 0.05 with their respective odds ratios and 95% confidence interval. Results The univariate analysis revealed the effect of the following determinants on the LBW: rural residence, father’s age, father’s professional activity, consanguinity, family type, mother’s low educational level, and mother’s intense physical activity. After the multivariate analysis, the risk factors identified were: rural residence (P = 0.017), father’s professional activity (temporarily working) (P = 0.000), absence of the consanguinity link (P = 0.016), and mother’s intense physical activity (P = 0.014). Conclusion Results show father’s professional activity (temporarily working), rural residence, absence of the consanguinity link and mother’s intense physical activity are independent predictors of low birth weight. The current findings add substantially to the growing literature on the influence of parent’s socio-demographic and cultural factors on LBW in resource-constrained settings and provide empirical data for public health interventions to reduce low birth weight.
A retrospective case-control study was conducted from July 2018 to July 2019, at the maternity hospital of Ibn Zohr Hospital, Mother and Child Hospital CHU Mohammed VI; and at three health centers with a delivery module: Loudaya; Massera and Syba in Marrakech. These maternities recorded a very high number of deliveries. According to the statistics provided by the Health Delegation of the Marrakech-Safi Region, the total number of live newborns in 2017, at the CHU, was 14932 (Health Delegation of the Marrakech-Safi Region, 2017). Ibn Zohr Hospital and CHU Mohammed VI ensure 83% of deliveries in this region. The health services offered by these two establishments include prenatal consultations and postnatal monitoring of newborns. The region of Marrakech-Safi covers an area of 41,404 km2 or 6% of the national territory and has 4520569 inhabitants (General Population and Housing Census, 2018). The density of 109 inhabitants per km2. The region includes 215 municipalities-divided into 18 urban and 197 rural. The capital of the region is the province of Marrakech. Newborns who were born in the two public hospitals and three health centers during the study period (12 months) were included in this study. Live newborns delivered at term without known risk factors (i.e. intrauterine growth restriction) of low birth weight were included in the study. Mothers with premature delivery (before 37 completed weeks of gestation) and mothers with medical status that would affect birth weight (i.e. hypertensive disorders of pregnancy, diabetes mellitus), were excluded from the study. Mothers who gave birth to neonates weighing less than 2500 grams were cases and neonates’ ≥2500 grams were controls. The outcome/dependent variable was low birth weight. The exposure/independent variables were socio-economic and cultural variables (maternal and paternal age, education, occupation, residence, marital status, relationship, using tobacco, alcoholic, social and medical coverage and maternal physical activity (High physical activity: housework tasks or work outside). The Sample size was calculated using the STATCALC program of EPI6, for unmatched case control with 95% confidence and 80% power to detect a minimum odds ratio of 2.0 assuming that the least prevalent factor will be present in minimum 10% of the controls as reported by Anand13 in his study. The final calculated sample size was 231 cases and 231 controls. Both cases and controls were recruited on an ongoing basis until the required sample size was fulfilled. The hospitals and the health centers where the study takes out were selected purposely. Cases (birth weight less than 2500 grams) were included in the study and two consecutive mothers in the controls (birth weight ≥2500 grams) were interviewed. Data for the study were extracted from birth registers containing information about maternal and newborn characteristics using a structured database. Data were collected using a pre-tested and structured questionnaire through a face-to-face interview. The questionnaire includes information about: Socio-economic and cultural characteristics of mothers, Socio-economic and cultural characteristics of father’s, and characteristics of birth. The questionnaire was validated and pre-tested on 5% of the sample size in Mother and Child Hospital CHU Mohammed VI. The data was collected during two day at each hospital and one day at each health centers. Supervisors checked the completeness of the data. The statistical package for social sciences (SPSS) version 20.0-computer software was used for statistical analysis. Frequency distributions and cross tabulation between cases and controls were completed. Univariable and multivariable logistic regression analyses were computed in order to understand the effect of independent variables on the outcome variable. The variables with p-value ≤0.2 in the univariate analysis were introduced into multivariable logistic regression analysis. Backward stepwise logistic regression method was used the Hosmer-Lemeshow test was used to assess goodness-of-fit. We considered p-value < 0.05 as level of significance. Official authorizations were obtained from the Regional Delegation of the Ministry of Health in Marrakech and from the Directorate of the Hospitals to access the maternity services and conduct this study. Informed verbal consent was obtained from study participants after being made informed of the objectives of the study. Confidentiality was guaranteed by keeping the anonymity of the respondents.
