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Impact of Maternal Age and Other Biosocial Factors on Newborn Health
at Hospitals in Peshawar, N-W.F.P Pakistan
Sareer Badshah
Director of studies: Professor Paulo G. J. Lisboa
School of Computing and Mathematical Sciences,Liverpool John Moores University, Liverpool
L3 3AF
.
Aim of the study:
To investigate the influence/impact of maternal age and other biosocial factors on the hospital newborn’s health, controlling for a range of other variables.
Objective of the study To assess birth-health, i.e.,
Weight Length Head circumference, and Apgar (heart rate, respiratory efforts, muscle tone, reflex irritability,
and colour). To examine the effect of maternal age and other
biosocial factors on birth health. To generate yardsticks/parameters and establish base
statistics, for further comparisons in future with national and international studies.
To identify adverse factors affecting birth health, which will inform/help
Parents Husbands Doctors health department and Funding agencies.
Pakistan: Demographic indicators
Population 138.1 million (2000) Urban 37.0%
Pop. Growth 2.4%
Life expectancy at birth 59.6 years
Fertility rate (births per women) 4.8
Mortality rate Infant 89.8 (per 1,000 live birth) Under-5 yrs 126.0 (per 1,000 live birth) Maternal 4-7 (per 1,000)
Education Adult literacy rate 45.0% Male/female 58.9%/31.0%
Pakistan Vs NWFP & Fed. Adm.Tri.Area (2003)
Pakistan NWFP FATAArea (sq. km) 796,000
(100%)(9.42%) (3.4%)
Pop. (1998) 138.0 million(100%)
(13.04%) (2.30%)
Annual Pop. Growth 2.6% 2.8%
Literacy (Pak ) 45% 37% 17.42 %
Male 59% 56% 29.5 %
Female 31% 20% 3.0 %
Pop. / Hospital bed 1450 1869 2327
Pop./ Doctor 1490 1510 8189
Water safe 83% 58% 43.4%
Poverty 32.2% 42.6%
Literature review Data from Pakistan:
17 publications 13 in Pakistan (using very simple tools) 04 others (UK & Australia)
Other than Pakistan: 14 publications
India 05 Nigeria 03 Bangladesh 02 Canada 02 Jordan 01 Ethiopia 01*
Tools Cross-tabulation, percentages, and chi-square:
(H. Yadav.(1983)., T. O. Lawoyin., et al. (1992)., N. Nahar et al.(1998)., B. Mondal.(1997). and Sushma Malik.(1997).
T-test
(Sami A. Khoury et al.(2000)., Y. Feleke.(1999)., and S. A. Taha et al.(1984).
Odds ratios:
(Suzanne C. Tough., et al.(2001)., J.C. Grant et al.(1997)., and Kwang-sun Lee et al.(1988).
Logistic Regression model and the use of -2LL: (J. C. Grant et al.(1997).
Regression Analyses: (E. Karim et al.(1997).
Data (May-December, 2003) Retrospective data collection (May-July, 2003)
Revise questionnaire & ethical approval (August 6, 2003)
Prospective data collection (August-
December 2003)
Retrospective data: understanding with the staff coding combination of categories introducing medical terminology, & tools learning/testing
Prospective data collection
Total sample: 1039 (August-December, 2003)
Hospitals in Peshawar:• Hayatabad Postgraduate Medical Complex
• Khyber Postgraduate Teaching Hospital
• Lady Reading P. G. Teaching Hospital, and
• Maternity Hospital Peshawar
Introduction of data Maternal Age(<20) 7.5%
M. weight (<57kg) 24.7%
Entry in emergency 75%
Employed mothers 5.8%
Afghan refugees 11.8%
Nuclear family 25%
Abortions/Misc. 17%
Other risks 6.1%
Congenital abnormality 4%
M. education (illiterate) 70%
Rural & U.Slums 64.8%
Water (fresh) 63.3%
Father age(<25) 5%
Father edu. (illiterate) 38.1%
Income (<5000)69%
Cousin marriages 60.1%
and Diabetes 2.7%
Hypertension 18.3%
Anaemia 38.9%
Mode of del.(other) 33.5%
Birth status (other) 9.2%
Age at marriage (<20) 50.1%
Body Mass Index (<19.1) 3.9%
Gravida (one) 28.5%
Preterm del. (yes) 11.9%
Gap (<=2 years) 65%
Visits (nil) 31.3%
Visits (<=2) 51.6%
Gestation (<37wk) 22.5%
Birth weight (<2.5 kg) 9.9%
length (<45cm) 14.4%
h.Circu (<32cm) 14.9%
Apgar (<7points) 2.8%
Maternal age & Incidence of Low birth weight
010203040506070
Inci
den
ce o
f b
irth
(<2
.5 k
g)
14 18 22 26 30 34 38 42 46
Maternal age
< 2.5 kg
Gestation (<37 weeks)
<37 weeks
0
10
20
30
40
<= 19years
20-24years
25-29years
30-34years
>=35years
<37 weeks
Age group and birth-weight Estimated Marginal Means of B. Weight
Age gr.
>=35 years30-34 years25-29 years20-24 years<= 19 years
Estim
ate
d M
arg
ina
l M
ea
ns
3.3
3.2
3.1
3.0
2.9
2.8
2.7
2.6
2.5
Age group, birth-weight and gestation
Birth weight
Maternal age group
>=35 years30-34 years25-29 years20-24 years<= 19 years
Est
ima
ted
Ma
rgin
al M
ea
ns
(kg
)
3.4
3.2
3.0
2.8
2.6
2.4
2.2
2.0
Gestation
<37 weeks
>=37 weeks
Age group and birth-lengthEstimated Marginal Means of B. Lenght
Age gr.
>=35 years30-34 years25-29 years20-24 years<= 19 years
Estim
ate
d M
arg
ina
l M
ea
ns
49.0
48.8
48.6
48.4
48.2
48.0
47.8
Age group, birth-length and gestation
Birth Lenght
Maternal age group
>=35 years30-34 years25-29 years20-24 years<= 19 years
Estim
ate
d M
arg
ina
l M
ea
ns (
cm
)
50
49
48
47
46
45
Gestation
<37 weeks
>=37 weeks
Head circumference (<32 cm)
0
5
10
15
20
25
30
<= 19years
20-24years
25-29years
30-34years
>=35years
Maternal age
% I
nc
ide
nce
of
sm
all
hes
c
irc
um
fere
nce
Age group, and Head-circumferenceEstimated Marginal Means of B. H. Circumf.
Age gr.
>=35 years30-34 years25-29 years20-24 years<= 19 years
Estim
ate
d M
arg
ina
l M
ea
ns
35.2
35.0
34.8
34.6
34.4
34.2
34.0
33.8
33.6
Age group, birth Head-circum. and gestation
Birth Head Circumference .
Maternal age group
>=35 years30-34 years25-29 years20-24 years<= 19 years
Estim
ate
d M
arg
ina
l M
ea
ns (
cm
)
35.5
35.0
34.5
34.0
33.5
33.0
32.5
Gestation
<37 weeks
>=37 weeks
Incidence of Apgar score % (<7 points)
0
5
10
15
20
25
<= 19years
20-24years
25-29years
30-34years
>=35years
Age group, and ApgarEstimated Marginal Means of B. APGAR
Age gr.
>=35 years30-34 years25-29 years20-24 years<= 19 years
Estim
ate
d M
arg
ina
l M
ea
ns
9.2
9.0
8.8
8.6
8.4
8.2
8.0
7.8
Age group, Head circumference and gestation
Birth Head Circumference .
Maternal age group
>=35 years30-34 years25-29 years20-24 years<= 19 years
Estim
ate
d M
arg
ina
l M
ea
ns (
cm
)
35.5
35.0
34.5
34.0
33.5
33.0
32.5
Gestation
<37 weeks
>=37 weeks
Comparison of low birth-weight and head-circumference
Incidence of Low birth weight
R2 = 0.9955
0
5
10
15
20
25
30
35
0 1 2 3 4 5 6
Maternal age group
% o
f low
birt
h we
ight
(<2.5
kg)
Incidence of Head circumference
R2 = 1
0
5
10
15
20
25
30
0 1 2 3 4 5 6
Maternal age group
% o
f low
small
hea
ds (<
32 cm
)
Maternal age, Apgar & Birth status(still birth etc)
02468
101214161820
% o
f in
cid
en
ce
<=19 20-24 25-29 30-34 >=35
Maternal age group
Less than 7 Birth status (not live)
Low birth-weight (Area-status)
Incidence of low birth-weight (Area-wise)
0
10
20
30
40
0 2 4 6
Maternal age group
Inc
ide
nc
e o
f lo
w-
bir
th (
%)
SettledArea
Agency(FATA)
Age group, birth weight and Apgar
Estimated Marginal Means of B. Weight
Age gr.
>=35 years30-34 years25-29 years20-24 years<= 19 years
Estim
ate
d M
arg
ina
l M
ea
ns
3.4
3.2
3.0
2.8
2.6
2.4
2.2
2.0
1.8
1.6
Apgar in groups
Less than 7
>=7 points
Age, birth weight and birth status (live, still birth)
Estimated Marginal Means of B. Weight
Age gr.
>=35 years30-34 years25-29 years20-24 years<= 19 years
Estim
ate
d M
arg
ina
l M
ea
ns
3.4
3.2
3.0
2.8
2.6
2.4
2.2
2.0
1.8
2.24Fetal Outcome
Live birth
other
Linear Regression results
F a the r A ge
M . E d uca tion
M . H e ig h t
N a tion a li ty
M . W e ig h t
M . R e g es tra tion
d iab e tes
g rav ida
g e sta tion
W eig h t
P re te rm D e l.
F . A ge
g e sta tion
L e ng th
P re te rm D e l.
H ype r te ns ion
g e sta tion
H . C ircu m fe re n ce
o th er r isk fac to rs
F . E d u ca tion
A na em ia
P re te rm D e l.
m ar r ia ge d ura tion
g e sta tion
A pg ar
No
Incidence of Health parametersBirth Weight, Length, H.Cir., & Apgar
All Three Two One Non
1 GESTATION
Age M.reg Body mass index
Marriage duration
2 Weight Entry Area status Area
3 M. EducationAge at
marriage ConsanguinityFamily status
4Nationality Height
Abortion / miscarriages
Distance from
hospital
5 Preterm del. ProfessionDistance from
hospitalGravida
6 Anaemia Water Gap Diabetes
7 Fetal outcome
Father age, education Gravida
Gender
8 Congenital abnormality
Income Visits
9 Parity
10 Ab./Misca.before
Collaboration with Dr. Jose (Uni. De Cantabria Spain)
Thank you
?