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Social inequalities in low birth weight outcomes in Sri Lanka: evidence from the Demographic and Health Survey 2016

Social inequalities in low birth weight outcomes in Sri Lanka: evidence from the Demographic and Health Survey 2016
Social inequalities in low birth weight outcomes in Sri Lanka: evidence from the Demographic and Health Survey 2016

Objective To investigate social inequalities underlying low birthweight (LBW) outcomes in Sri Lanka. Design Cross-sectional study. Setting This study used the Sri Lanka Demographic and Health Survey 2016, the first such survey to cover the entire country since the Civil War ended in 2001. Participants Birthweight data extracted from the child health development records available for 7713 babies born between January 2011 and the date of interview in 2016. Outcome measures The main outcome variable was birth weight, classified as LBW (≤2500 g) and normal. Methods We applied random intercept three-level logistic regression to examine the association between LBW and maternal, socioeconomic and geographic variables. Concentration indices were estimated for different population subgroups. Results The population-level prevalence of LBW was 16.9% but was significantly higher in the estate sector (28.4%) compared with rural (16.6%) and urban (13.6%) areas. Negative concentration indices suggest a relatively higher concentration of LBW in poor households in rural areas and the estate sector. Results from fixed effects logistic regression models confirmed our hypothesis of significantly higher risk of LBW outcomes across poorer households and Indian Tamil communities (AOR 1.70, 95% CI 1.02 to 2.83, p<0.05). Results from random intercept models confirmed there was substantial unobserved variation in LBW outcomes at the mother level. The effect of maternal biological variables was larger than that of socioeconomic factors. Conclusion LBW rates are significantly higher among babies born in poorer households and Indian Tamil communities. The findings highlight the need for nutrition interventions targeting pregnant women of Indian Tamil ethnicity and those living in economically deprived households.

community child health, nutrition & dietetics, public health, social medicine
2044-6055
1-10
Abeywickrama, Dineshika, Gayathri
8f6a5549-3007-4b97-92ff-2513b0e68789
Padmadas, Sabu
64b6ab89-152b-48a3-838b-e9167964b508
Hinde, Andrew
0691a8ab-dcdb-4694-93b4-40d5e71f672d
Abeywickrama, Dineshika, Gayathri
8f6a5549-3007-4b97-92ff-2513b0e68789
Padmadas, Sabu
64b6ab89-152b-48a3-838b-e9167964b508
Hinde, Andrew
0691a8ab-dcdb-4694-93b4-40d5e71f672d

Abeywickrama, Dineshika, Gayathri, Padmadas, Sabu and Hinde, Andrew (2020) Social inequalities in low birth weight outcomes in Sri Lanka: evidence from the Demographic and Health Survey 2016. BMJ Open, 10 (5), 1-10, [10:e037223]. (doi:10.1136/bmjopen-2020-037223).

Record type: Article

Abstract

Objective To investigate social inequalities underlying low birthweight (LBW) outcomes in Sri Lanka. Design Cross-sectional study. Setting This study used the Sri Lanka Demographic and Health Survey 2016, the first such survey to cover the entire country since the Civil War ended in 2001. Participants Birthweight data extracted from the child health development records available for 7713 babies born between January 2011 and the date of interview in 2016. Outcome measures The main outcome variable was birth weight, classified as LBW (≤2500 g) and normal. Methods We applied random intercept three-level logistic regression to examine the association between LBW and maternal, socioeconomic and geographic variables. Concentration indices were estimated for different population subgroups. Results The population-level prevalence of LBW was 16.9% but was significantly higher in the estate sector (28.4%) compared with rural (16.6%) and urban (13.6%) areas. Negative concentration indices suggest a relatively higher concentration of LBW in poor households in rural areas and the estate sector. Results from fixed effects logistic regression models confirmed our hypothesis of significantly higher risk of LBW outcomes across poorer households and Indian Tamil communities (AOR 1.70, 95% CI 1.02 to 2.83, p<0.05). Results from random intercept models confirmed there was substantial unobserved variation in LBW outcomes at the mother level. The effect of maternal biological variables was larger than that of socioeconomic factors. Conclusion LBW rates are significantly higher among babies born in poorer households and Indian Tamil communities. The findings highlight the need for nutrition interventions targeting pregnant women of Indian Tamil ethnicity and those living in economically deprived households.

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More information

Accepted/In Press date: 16 April 2020
e-pub ahead of print date: 25 May 2020
Published date: 25 May 2020
Additional Information: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: community child health, nutrition & dietetics, public health, social medicine

Identifiers

Local EPrints ID: 439659
URI: http://eprints.soton.ac.uk/id/eprint/439659
ISSN: 2044-6055
PURE UUID: 9b0f5499-c4ef-4219-91c1-fe85f89cf2ad
ORCID for Sabu Padmadas: ORCID iD orcid.org/0000-0002-6538-9374
ORCID for Andrew Hinde: ORCID iD orcid.org/0000-0002-8909-9152

Catalogue record

Date deposited: 29 Apr 2020 16:30
Last modified: 23 Jul 2022 04:53

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Contributors

Author: Dineshika, Gayathri Abeywickrama
Author: Sabu Padmadas ORCID iD
Author: Andrew Hinde ORCID iD

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