Pregnancy Risk, Neonatal Factors, and Health Care Services on Low Birth Weight Mortality
Abstract
Low birth weight (LBW) infants are highly vulnerable to death during the first 28 days of life. However, evidence from primary care settings that simultaneously examines pregnancy related, neonatal, and health service factors remains limited. This retrospective case control study used secondary records for LBW infants born between 2018 through 2022 at six public health centers in X city, Indonesia. The analytical sample comprised 86 infants, including 43 neonatal deaths (cases) and 43 controls who survived beyond 28 days. Data were extracted from Perinatal Verbal Autopsy forms, delivery registers, and medical records. Bivariate associations were assessed using Pearson’s chi-square test or Fisher‘s exact tests, and crude odds ratios (cORs). Six non-separated predictors were subsequently entered into a multivariable binary logistic regression model. Maternal anemia (hemoglobin <11 g/dL) occurred in 29/43 cases (67.4%) and 9/43 controls (20.9%) and was associated with neonatal death in bivariate analysis (cOR 7.83; 95% CI 2.96-20.70; p<0.001). Respiratory compromise showed complete separation: all 43 infants with abnormal respiratory status were cases (Fisher p<0.001), so a conventional OR could not be estimated. Delivery facility type, breastfeeding, neonatal follow-up, and referral status also contained zero cells. The six predictor model was significant overall (p=0.002); maternal anemia remained the only independently significant predictor (aOR 8.94; 95% CI 2.95-27.09; p<0.001). The complete separation observed for several neonatal and service variables suggests strong distributional differences between cases and controls; however, these findings should be interpreted cautiously because of potential severity related referral bias, reverse causality, and survivor bias. Maternal anemia was the most consistent independent factor associated with neonatal death among LBW infants. Strengthening antenatal screening and treatment for maternal anemia, improving immediate respiratory assessment, enhancing referral documentation, and ensuring linkage between maternal and infant health records may contribute to better prevention and surveillance efforts.
Keywords: Low Birth Weight, Neonatal Mortality, Case-Control Study, Maternal Anemia.
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DOI: http://dx.doi.org/10.30829/contagion.v8i3.31168
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