Relationship between environmental factors and adverse birth outcomes in a rural high altitude community in East Africa

Abstract

Abstract: Background Evidence emerging are suggesting associations between environmental exposures and adverse pregnancy outcomes.
Subject and methods: This was a prospective cohort study, carried out in year 2019, over a period of 12 months in Gitwe village,
Rwanda. Mother-infant pairs were recruited consecutively, on firstcome-first-serve basis from Gitwe district hospital. Newborns were classified based on their weight and gestational age, soon after birth. Healthy, singleton newborns, weighing ≥1.5kg were included in the study (n = 529).Very small, sick babies, and multiple gestation pregnancies were excluded from the study. Data on socio-demographics, environmental exposures and birth outcomes were obtained in the postnatal ward before discharge. Logistic regression models and Chi test were used to examine the relationships between environment exposures as independent variables and birth outcomes as dependent variables. The results were presented in p-values, Odds ratio and 95% confidence interval.
Results: Rates of antenatal exposures to charcoal fuel, unsafe water and potentially harmful social habits in the study were 96.2%, 67.1% and 12.5%, respectively. Overall, the prevalence of adverse birth outcomes [SGA, LBW, Preterm (according to WHO classification) and cesarean section births were 21.4%, 10.6%, 4.9% and 38.8%, respectively], was unusually high in this study. Exposures to unsafe water and charcoal fuel were the strongest environmental factors determining gestational age at birth. Unsafe water was strongly linked to pregnancies complicated with preterm, LBW and cesarean section births. Use of charcoal fuel for cooking and house heating was particularly associated with post-term (rather than preterm) and SGA births. Antenatal ingestion of or exposure to local herbs/alcohol/tobacco, which may have contained some unknown insulinogenic or sex selection compounds, led to increased risk of preterm, male, LGA and cesarean section births in the study.
Conclusion and Recommendations The environmental factors that led to an unusually high prevalence of adverse birth outcomes in the study, could be modified by maternal counseling, rehabilitation and public education, upgrading access road to the health facilities, and improving WASH situation in the rural areas