Psychological stress predictors of low birth weight among post natal mothers in Kilifi county, Kenya

Abstract

Worldwide, low birth weight (LBW, <2500gms) remains pervasive despite focused antenatal care interventions. Children with LBW have increased risk for death and multiple morbidities whose consequences track through life span. They require advanced medical care to manage effectively yet, these are often meagre in the high burden regions. Maternal psychosocial stress and determinants are insidious and subtle risk factor for LBW but is not routinely screened for during antenatal visits, indicating missed opportunities in the care continuum. By 2019, the global prevalence of was approximately 20 million comprising 14.6% of live births. Of these 95% were born in the developing countries with 13.7% being in Africa, 13.4% in East Africa and 11.5% in Kenya. Coastal region in Kenya is leading with a prevalence of 12.7%. Understanding the occurrence and predictors of maternal psychosocial stress could enable early identification and referral for definitive care to improve health outcomes. The current study aimed to investigate the antenatal psychological stress predictors of LBW among postnatal mothers in Kilifi County, Kenya. Specifically, the study determined prevalence of LBW infants among mothers who had psychological stress during antenatal period; socio-demographic characteristics of mothers with LBW infants; the association between antenatal psychological stress and LBW infants. Througha cross-sectional design, data was obtained from 387 postnatal mothers at Rabai and Mariakani Sub-County Hospitals. Eligible participants were identified through simple random sampling from the postnatal clinic. Structured questionnaires were used alongside perceived stress scale (PSS) and Edinburgh depression scale (EDS). The PSS has 10 items, each scored between 0-4. Iindividual scores range from 0 to 40 with higher scores indicating higher perceived stress; EDS has 10 items each scored between 0-3, with summated scores of 10 or more indicating possible depression. Data was analysed descriptively with chi-square test of association employed to establish the association between categorical variables. Statistically significant variables were modelled using logistics regression with crude and adjusted odds ratios estimated. The mean age was 25.9 years (±5.1); 30(7.8%) had no formal education, 160(41.3%) had primary level education, 125(32.3%) had secondary level education and 72(18.6%) had tertiary education. Majority (86.8%, n=336) were married;50.4% (n=195) were unemployed, 59.4%(n=230) were multiparous and 47.8%(n=185) had attended at least four antenatal care visit. The overall prevalence of low birth weight was 25.1% with 54.3%(n=19) of the births being from mother with psychosocial stress. Mothers with tertiary level of education (OR 0.32; 95% CI=0.12,0.89, p=0.028) and those who were formally employed(OR 0.35; 95% CI=0.14,0.86, p=0.022) had lower odds of delivering infants with low birth weight. Maternal age-group25-34 years was a significant predictor of low birth weight(95%CI=1.05, 3.46, p=0.035).Frequency of ANC visit did not reach statistical significance, although the odds of giving birth to LBW child was lower among mothers who attended at least 4 ANC visits (OR=0.58, 95% CI=0.21, 1.61). Bivariate analyses were performed to determine the association between prenatal psychological stress and LBW. Women with moderate (OR=2.30, 95%CI=1.41, 3.78, p=0.001) or high stress levels (OR=9.94, 95%CI=1.74,56.64, p=0.01) and those with depression (AOR=1.87, 95%CI=1.15-3.04)) had higher odds of giving birth to LBW infants. The burden of LBW associated with stress, and depression were considerable in this population. Findings from this study highlight the need for routine early screening for antenatal psychosocial stress and depression during routine visits as well as providing program postnatal monitoring interventions to aimed to reduce the risk of LBW.