Catch-up growth and nutritional status of preterms born at a Ugandan tertiary hospital: An Observational study.

Catch-up growth and nutritional status of preterms born at a Ugandan tertiary hospital: An Observational study. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Catch-up growth and nutritional status of preterms born at a Ugandan tertiary hospital: An Observational study. Flaviah Namiiro, Anthony Batte, Joseph Rujumba, Nicolette Nabukeera, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-126512/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Advances in neonatal care have led to the increasing survival of preterm/low birth weight infants worldwide. However, there is limited data on growth outcomes following preterm births especially in low and middle income countries. We assessed the catch-up growth, nutritional status and associated factors of Ugandan children who were born preterm/ low birth weight at Mulago National Referral Hospital. Methods: We enrolled children aged 22-38 months who had been born as preterm with low birth weight and their mothers. Participants were identified and recruited from the follow up clinic for preterm babies discharged from the neonatal unit of Mulago Hospital. Anthropometric measurements for mothers and children were taken. The children’s weight for height z-scores, height for age z-scores, weight for age z-scores, head circumference and mid upper arm circumference (MUAC) were taken and the mothers’ body mass index were generated based on the World Health Organization standards. Results: Of the 251 children and mother pairs recruited, 129 children (51.4%) were male, the mean age was 29.7 months (SD±4.5) and the mean maternal age was 29.9 (SD±5.3). 101(40.1%) of the children enrolled had attained catch up growth on the normal anthropometric measurements for their age. Among the participants, the prevalence of wasting, underweight and stunting was: 8 (3.2%), 36 (14.4%) and 106 (42.2%) respectively. Factors associated with stunting were male sex (AOR 2.36, 95% CI 1.42 to 3.95); p=0.001 ), maternal age ≤ 25years: AOR 2.27 (95%CI 1.13, 4.52); p= 0.020 , and maternal height <150cm: AOR 5.57(95%CI 1.90, 16.94); P= 0.002. Associations with underweight in the children were; birth weight ≤1500 gms: AOR 2.38(95%CI 1.14, 4.95); p= 0.020 and post-natal hospitalization of more than 14 days: AOR 5.93(95%CI 1.96, 17.90); p= 0.002 . For 246 (98.8%) participants, MUAC was normal (≥ 12.5 cm) and for 216 (86.8%) the head circumference was within normal range for age. Conclusion : Of the children born preterm/LBW 40.1% of the participants had attained the expected catch up growth at 2 to 3 years of age, 42.2% were observed to be stunted while 14.4% were underweight both higher than the national levels. Targeted interventions are specifically needed for children born with very low birth weight, those requiring long postnatal hospitalization, males and those born to short or young mothers. Nutrition & Dietetics Catch up growth Prematurity Low birth weight Stunting Wasting Underweight Figures Figure 1 Figure 1 Background Prematurity is on the rise globally, contributing about 15 million births annually [ 1 ]. More than 60% of preterm with low birth weight (LBW) babies are born in Asia and Sub Saharan Africa [ 2 ]. Prematurity causes an estimated one million neonatal deaths worldwide and it is a significant contributor to morbidities among survivors extending to adulthood [ 3 , 4 ]. Uganda is ranked 13th of the 184 countries in the world with the highest number of babies born prematurely; with approximately 14% of babies born preterm [ 1 , 5 ]. Although mortality has been high among preterm/LBW infants, advances in neonatal care have led to better survival of preterm and low birth weight infants worldwide [ 2 , 6 ]. Therefore, children born preterm should be followed up with long term growth monitoring with the aim of achieving catch-up growth as early as possible to combat health consequences like undernutrition later in life [ 7 , 8 ]. Growth status is defined by normal anthropometric measurements for age and sex with weight and height z scores > -2 SDs of the reference population [ 9 , 10 ]. At two years of age, children born preterm are expected to have caught up on the normal growth curve with their appropriate to gestation age (AGA) counterparts [ 11 – 13 ]. However, some studies have reported that at this age some children are still stunted and underweight, and this growth restriction persists into adulthood [ 14 – 17 ]. Survivors are at risk of long-term consequences and require follow up beyond the neonatal period [ 18 , 19 ]. It is therefore important that early childhood follow up identifies children poorly progressing in growth to ensure that appropriate interventions are instituted at the earliest opportunity [ 15 , 20 , 21 ]. Compared to high income countries, in low and middle income countries (LMICs) there is limited literature on post- hospital discharge growth status of preterm children [ 7 , 8 ]. We therefore sought to evaluate the catch up growth, nutritional status and associated factors for children aged at 22–38 months born preterm/low birth weight in a low resource setting. Methods This was a cross sectional survey which assessed the anthropometric measurements of children aged 22–38 months born preterm/low birth weight (LBW). The study was conducted at the preterm/LBW follow up clinic of Mulago National Referral Hospital, Kampala, Uganda. This clinic attends to any baby born with weight ≤ 2500gms and majority of these are usually pre-term babies. This is a follow up clinic for babies discharged from Mulago hospital neonatal unit. A total of 251 child and caretaker pairs of eligible children were recruited from November 2019 to February 2020. Eligible children were children aged 22–38 months, and weighed ≤ 2000 grams at birth and attended the preterm/LBW follow up clinic at Mulago Hospital. For inclusion in the study, hospital outpatient records were evaluated for children who were aged 22-38months at the time of enrolment (were attending and registered in the follow up clinic between January 2017 to February 2018 and had a birth weight of ≤ 2000 grams). A list of the eligible children was made and every second mother was given a telephone call by the research team and was requested to bring back the child to the clinic for participation in the study. However, using this systematic sampling of every second child, we were only able to reach 108 out of the 506 eligible participants. We therefore consecutively called up every caretaker. A large proportion of telephone calls to the caretakers were not picked after three attempts. There were also some incomplete or wrong telephone numbers and some numbers were not validated or were out of service. A few caretakers/mothers were not able to come back to the clinic despite responding to our call. Study Measurements Mother/caretaker-infant pairs came to the clinic on the appointed days. Research assistants who were nurses obtained both infant and maternal demographics (age, sex, birth weight and socioeconomic characteristics). Other data collected included: mode and type of delivery, estimated distance from hospital, duration in hospital, duration of exclusive breastfeeding and duration in the follow up clinic. Anthropometric measurements were taken for each child including: weight, height/length, head circumference and mid-upper arm circumference. Mother’s weight, height and body mass index (BMI) were also measured. The weights were taken using a digital portable SECA® weighing scale. Weight was taken while child was wearing light clothing and bare feet. The values were recorded to one decimal point. Height was measured to the nearest 0.1 cm precision using a stadiometer. All measurements were taken once by a trained research assistant. Analysis And Data Management The WHO Anthropometrics software was used to convert height, weight and age measurements to height-for-age z-scores (HAZ), weight-height z-scores (WHZ) and weight-for-age z-scores (WAZ) which were used to classify stunting, wasting and underweight respectively. Child was considered to have caught up or attained normal growth if their z-scores were above − 2SD of the reference population and to have undernutrition when their z-scores below − 2SD. To establish the association of infant and maternal factors with nutritional status for wasting, underweight and stunting, stepwise logistic regression analysis was performed. Factors that were found significant at bivariate analysis were further fitted in model 1 and 2 at multivariate analysis. We used multivariable logistic regression analysis to estimate adjusted odds ratios (AORs) along with their 95% confidence intervals (CIs) for the associations between each infant and maternal characteristic with child anthropometric outcomes (below − 2 SD) as the reference category. For all statistical tests a p < 0.05 was considered statistically significant. Data were analyzed using STATA version 15 statistical software (StataCorp. 2017 College Station, TX: StataCorp LLC). The severity of stunting, underweight and wasting by prevalence ranges among children were assessed using the WHO classification for assessing severity of malnutrition by prevalence ranges among children under-5 years of age[ 10 ]. Results Baseline characteristics of the children Of the 923 children registered in the follow up clinic from January 2017 to February 2018; 506 met our inclusion criteria (Fig. 1 ). We enrolled 251 children and the mean age was 29.7 months (SD ± 4.5) and 51.4% were male. Children with birth weight ≤ 1500 gm were 104 (41.6%) and those > 1500 were 146 (58.4%). The median duration of hospital stay post- delivery was 12 days (IQR: 7–18). The summary of the baseline characteristics for the study participants are summarized in Table 1 below. The ratio of male to female was 0.9:1. Most of the participants were delivered by spontaneous vertex delivery 177 (70.5%) and majority were singletons 179 (71.3%). Table 1 Baseline characteristics for the participants Variable Frequency Percentage % Sex of the child Male 129 51.4 Female 122 48.6 Age of the child 22–30 months 141 56.2 31–38 months 110 43.8 Mode of delivery Caesarean section 74 29.5 Vaginal delivery 177 70.5 Type of delivery Multiple 72 28.7 Singleton 179 71.3 Birth weight ≤1500 gm 104 41.6 >1500 gm 146 58.4 Child EBF Yes 165 65.7 No 86 34.3 Duration of hospital stay 1–7 days 134 53.4 8–14 days 98 39.0 15–28 days 19 7.6 EBF: Exclusive Breastfeeding for first 6 months of life Maternal/caretaker Characteristics Among the maternal characteristics summarized in Table 2 , the anthropometric measurements for 236 mothers were included for analysis because 15 participants were accompanied by other caretakers (10 fathers, 2 grandparents and one aunt). Table 2 Baseline characteristics for the mothers Variable Frequency Percentage % Age ≤25 years 50 19.9 26–30 years 103 41.1 > 30 years 98 39.04 Estimated Distance from home to hospital < 5 Km 28 11.1 5–15 km 212 84.5 ≥ 15 Km 11 4.4 Education level Primary below/none 51 20.3 Secondary/tertiary level 200 79.7 Marital status Married / co-habiting 199 79.3 Single / divorced/ separated 52 20.7 Employment status Employed 164 65.3 Not employed 87 34.7 Have social support Yes 224 89.6 No 26 10.4 Number of children 1–2 children 111 44.9 3–4 children 87 35.2 >5 children 49 19.9 Mother’s BMI < 18.5 (Underweight) 1 0.4 18.5 - ≤ 25 (Normal Range) 106 42.2 25.0- <30 (Overweight) 78 31.1 ≥ 30 (Obese) 66 26.3 BMI Body Mass Index Growth And Nutrition Status Of The Children The summary of growth status for the participants using anthropometric measurements by sex and age are shown in Fig. 2 and Table 3 . Of the participants, 101 (40.2%) had caught up on the normal anthropometric measurements z scores > -2 SD of the reference population for their age and sex. The prevalence for wasting (weight for height z-score <-2SD) was 8 (3.2%), underweight (weight for age z-score <-2 SD) 36 (14.4%) and the prevalence of stunting (height for age z-score <-2) was 106 (42.2%). There were more boys stunted, 64 out of 106 participants compared to girls ( p = 0.001 ). There was no statistically significant difference based on sex for the children who were wasted or underweight. For 246 (98.8%) participants, MUAC was normal (≥ 12.5 cm) and for 216 (86.8%) the head circumference was within normal range for age. The scatter plot graphs show individual growth parameters (weight and height/length) for the children and their corresponding age and sex based on the 2006 WHO multicenter reference growth population: A – Weight for Height/Length, B – Weight for Age, C – Height/Length for Age. The z-scores for the weight for age, weight for height, height for age, and head circumference for the participants are summarized in Table 3 . Table 3 Summary of Participants’ anthropometric measurements =-3SD to=-2SDto =2SDto =3SD Total Weight For Age Male n% Female n% Total 0 (0.0) 1 (0.8) 1 (0.4) 18(14.8) 12 (9.3) 30 (12) 104 (85.3) 116 (89.9) 220 (87.7) - - - - - - 122 129 251 Weight For Height Male n% Female n% Total 2 (1.7) 1 (0.8) 3 (1.2) 2 (1.7) 3 (2.3) 5 (2.0) 112 (92.6) 124 (96.1) 236 (94.4) 4 (3.3) 1 (0.8) 5 (2.0) 1 (0.8) 0 (0.0) 1 (0.4) 121 129 250 Height For Age Male n% Female n% Total 26 ()21.3 15 (11.6 ) ) 41 (16.3) 39 (32.0) 26 (20.2) 65(25.9) 56 (45.9) 88 (68.2) 144 (57.4) 1 (0.8) 0 (0.0) 1 (0.4) - - 122 129 251 Head Circumference Male n% Female n% Total 2 (1.7)1 (0.8) 3 (1.2) 2 (1.7) 3 (2.3) 5 (2.0) 112 (92.6) 124 (96.1) 236 (94.4) 4 (3.3) 1 (0.8) 5 (2.0) 1 (0.8) 0 (0.0) 1 (0.4) 121 129 250 Factors Associated With Nutritional Status Of The Children After bivariate and multivariate analysis to establish the association between child and maternal characteristics with the nutrition status are summarized in Tables 4 & 5 for underweight and stunting respectively. Birth weight ≤ 1500 gm and hospital stay of more than 14 days were found to have an association with underweight (AOR 2.36 95% CI 1.13,4.95, p = 0.043) and (AOR 5.77, 95% CI1.88,17.67, p = 0.002) respectively as shown in Table 4 . Table 4 Bivariate and multivariate analysis of Child factors associated with underweight Variables Growth status the preterm children COR 95% Cl P value AOR 95% CI * P value Underweight (W/A Z-score <-2) (n = 35) (f, %) Not Underweight W/A Z-score ≥-2) (n = 216) (f, %) Sex of the child Male 17(48.6) 112(51.9) 0.87 (0.43, 1.79) 0.719 Female 18(51.4) 104(48.2) Age of the child 22–30 months 17(48.6) 124(57.4) 1 31–38 months 18(51.4) 92(42.6) 1.42 (0.70, 2.92) 0.330 Mode of delivery b Caesarean section 10(28.6) 64(29.6) 0.95 (0.43, 2.09) 0.899 0.81(0.36, 1.89) 0.639 Vaginal delivery 25(71.4) 152(70.4) Type of delivery a Multiple 8(22.9) 64(29.6) 0.70 (0.30, 1.63) 0.413 0.71(0.29, 1.72) 0.450 Singleton 27(77.1) 152(70.4) Birth weight b ≤1500 grams 21(60.0) 83(38.6) 2.38 (1.14, 4.95) 0.020 2.36 (1.13, 4.95) 0.023 >1500 grams 14(40.0) 132(61.4) Child EBF b Yes 11(31.4) 75(34.7) 1 1 No 24(68.6) 141(65.3) 0.86(0.4, 1.85) 0.703 0.83(0.35, 1.95) 0.669 Duration of hospital stay b 1–7 days 12(34.3) 122(56.5) 1 1 1 8–14 days 16(45.7) 82(38) 1.98 (0.89, 4.41) 0.093 1.84(0.81, 4.15) 0.140 15–28 days 7(20) 12(5.6) 5.93 (1.96, 17.90) 0.002 5.77(1.88, 17.67) 0.002 Completed one year in care b Yes 19(54.3) 119(55.1) 1.03(0.50, 2.12) 0.929 0.95 (0.45, 0.36) 0.886 No 16(45.7) 97(44.9) 1 1 Reference group: Not Underweight. EBF: Exclusive Breastfeeding, COR: Crude Odds Ratio, CI: Confidence interval. a Adjusted for Number of children, Previous preterm deliveries. b Adjusted for Number of children, Previous preterm deliveries, Multiple births The factors associated with stunting were male sex (AOR 2.33, 95% CI 1.42 to 4.04, p = 0.001), maternal age less than ≤ 25 years when compared to 26–30 years (AOR 2.16, 95% CI1.02, 4.54, p = 0.043) and maternal height less than 150 cm (AOR 4.87, 95% CI1.70, 13.93, p = 0.003), Table 5 . Table 5 Association between Child and Maternal characteristics with Stunting Variables Growth status the preterm children COR 95% CI P value AOR 95% CI P value Stunted (H/A Z-score <-2) (n = 35) (f, %) Not Stunted H/A Z-score ≥-2) (n = 216) (f, %) Sex of the child Male 64(61) 58(39.7) 2.36 (1.42,3.95) 0.001 2.39(1.42,4.04) 0.001 Female 41(39) 88(60.3) 1 Age ≤ 25 years 30(28.6) 20(13.7) 2.27(1.13,4.52) 0.020 2.16(1.02,4.54) 0.043 26–30 years 41(39) 62(42.5) 1 > 30 years 34(32.4) 64(43.8) 0.80(0.45,1.43) 0.454 Marital status Married / co-habiting 77(73.3) 122(83.6) 1 Single / divorced/ separated 28(26.7) 24(16.4) 1.84(1.00,3.42) 0.050 1.79(0.93,3.45) 0.079 BMI for caretaker < 18.5 0(0) 1(0.7) - - 18.5 to < 25 50(50) 50(37) 1 25 to < 30 30(30) 43(31.9) 0.70(0.38,1.28) 0.247 0.72(0.38,1.34) 0.300 ≥ 30 20(20) 41(30.4) 0.49(0.25,0.94) 0.034 0.64(0.34,1.29) 0.210 Maternal Height* Less than 150 18 (18.0) 4(4.4) 5.00(1.79,13.99) 0.002 4.87(1.7,13.93) 0.003 150–154.9 22(22.0) 28(20.7) 1.31(0.64,2.69) 0.462 1.2(0.58,2.51) 0.622 155–159.9 30(30.0) 50(37.0) 1 1 160–164.9 23(23.0) 36(26.7) 1.06(0.53,2.13) 0.859 1.17(0.57,2.39) 0.662 more = 165 7(7.0) 15(11.1) 0.78(0.28,2.12) 0.624 0.87(0.31,2.45) 0.787 Discussion We sought to establish the catch up growth, nutritional status and associated factors for children born with preterm/LBW at Mulago Hospital, Kampala. From our study, 101 (40.1%) of the participants had caught up on normal growth for their age while the rest of the children had undernutrition. The prevalence of stunting was 42.2% and underweight 14.4% which are markers of chronic malnutrition; but relatively low levels of wasting 3.2%, a marker of acute malnutrition. Stunting was associated with male sex, maternal age ≤ 25 years and maternal height less than 150 cm. Childhood underweight was associated with birth weight ≤ 1500 grams and longer hospital stay of > 14 days following delivery. The head circumference for 216 (86.8% %) was within normal range and MUAC for 246 (98.8%) was ≥ 12.5 cm within normal range for age. Less than half of our participants demonstrated catch up growth a prevalence lower than what was observed in other studies [ 13 , 14 ]. Mukhopadhyay et al in India showed no catch up growth beyond 2 years among extreme low birth weight infants [ 13 ]. A cross sectional study from 51 nations showed no catch-up growth from 2 to 5 years [ 17 ]. This showed a steep decline in children’s height for age z-scores from birth to the first two years of life with no deterioration thereafter. The anthropometric parameters at two years can therefore fairly predict the growth outcomes later in life[ 17 ]. We enrolled children who were born preterm/LBW; these are a high risk for undernutrition[ 22 ] and this may explain the high prevalence of stunting demonstrated by our results. The prevalence of stunting in the children under-5 years based on a Uganda national survey was 29% [ 23 ]. The same survey showed that stunting increased with age, peaking at 37 percent among children 18–35 months [ 24 ] in the general population. In our study, stunting was associated with male sex, lower maternal age and lower maternal height. In our study, the boys 61% were more likely to be stunted compared to the girls 39%. This is similar to other studies [ 25 ], although further studies are needed to evaluate the mechanism in which sex may contribute to stunting. Similar to previous studies [ 26 , 27 ], our study demonstrated that young mothers had higher chances of having stunted children compared to older mothers. It is thought that older mothers are usually more knowledgeable in aspects of baby care compared to young and teenage mothers [ 26 ] hence the better outcome of their children. The maternal height could most probably be attributed to genetic and environmental factors. Studies have demonstrated mothers with short stature or those born with low birth weight were more likely to give birth to children with the same features [ 17 , 25 ]. Even though factors such as maternal education wealth quintile, maternal BMI have been described to be associated with stunting[ 24 , 25 , 28 ], our study did not find these to be associated with stunting. Underweight was observed among 14.4% of our participants a prevalence slightly higher than the Uganda prevalence of 11% according to UDHS 2016, [ 23 ]. Underweight was associated with low birth weight and long hospital stay. In general, children who are born with low birth weight are at high risk of being underweight in their childhood which occasionally persists in adulthood [ 29 ]. It is possible that difficulties encountered in feeding low birth weight infants majority of whom are preterm babies, contributes to their poor growth in early childhood [ 30 , 31 ] .The finding that long hospital stay influences the ability of the baby to add weight and reach appropriate z-scores could be a marker of difficulties in feeding or generally ill-health which may hinder adequate feeding and growth. Only 3.2% of our study participants were wasted as compared to the 4% in the general population[ 24 ]. Wasting is an indicator of acute illness and we did not identify many children in whom recent acute illness was reported and this probably led to low prevalence. Our findings have several implications on growth monitoring of children born preterm which should not be limited to the neonatal period but extend to childhood and beyond. Child growth and nutritional status may be strongly linked to fetal life suggesting a need for interventional focus on nutrition during pregnancy and early childhood. To end all forms of malnutrition by 2030: Sustainable Development Goal 2 [ 32 ], a life-course approach of nutritional interventions are needed targeting at risk populations. These will in turn lead to child survival, educational achievements and overall well- being later in life. Secondly, collection and analysis of long-term data in former preterm and LBW children linked to nutritional strategies and growth parameters are still strongly recommended in our setting. Although pre-pregnancy and natal nutritional status was not assessed in our study, they have been linked to growth failures in early childhood in other studies [ 33 ]. It is equally important to mind the mother’s nutritional status from pre-conception throughout pregnancy [ 17 , 34 ]. The strength of this study is we enrolled children who weighed less than 2000 grams at birth majority of whom will also be preterm. The predominant mode of feeding in our study population was exclusive breastfeeding with no modification for all the participants. The limitations included the cross sectional data does not reflect changes in growth of individual children overtime. Details of dietary intake and complimentary feeding practices were not collected in our study to minimize long term recall bias. Nevertheless, the results clearly indicate a need for rigorous growth monitoring for children born preterm/LBW beyond the neonatal period. Conclusion Of the children born preterm/LBW 40.1% of the participants had attained the expected catch up growth at 2 to 3 years of age, 42.2% were observed to be stunted and 14.4% were underweight both higher than the national levels. Targeted interventions are specifically needed for children born with very low birth weight, those requiring long postnatal hospitalization, males and those born to short or young mothers. Abbreviations AGA Appropriate for gestation age CUG Catch up growth LBW Low birth weight Declarations Ethics approval and consent to participate The protocol was approved by Makerere University and Mulago Hospital Research and Ethics Committees (Ref 2019-117) and the Uganda National Council of Science & Technology. The caretakers gave informed consent to participate in the study. All methods were performed in accordance with the relevant guidelines and regulations involving human research. Informed consent was verbally obtained from participant caregivers after needed information was explained. Participation was voluntary and caregivers signed or thumb printed a statement of an informed consent before being interviewed. Consent for publication: All Authors approved manuscript for publication Availability of data and materials: The data supporting the conclusions of this article are included within the manuscript. Competing interests: The authors have no conflicts of interest to declare. Funding : Support was from the Forgaty International Center of National Institutes of Health, U.S Department of State’s Office of Global AIDS Coordinator and Health Diplomacy (S/GAC), and President’s Emergency Plan for AIDS Relief (PEPFAR) under Award Number 1R25TW011213. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Author Contributions : FN, JR, AB, NNB & VK participated in concept development. SK & IM reviewed the proposal. RS did the statistics and FN supervised the data collection and wrote initial manuscript. All authors contributed to revision of the final manuscript and approved it for submission. Acknowledgements : We thank the Management of Mulago Hospital, Staff at the Preterm Clinic, Research Assistants: F Fawling, C. Akello & F Nakirijja, the participants and their parents. My Mentors: Dr E Mupere, Dr A.Yasser, Dr D. Kyazze & Mrs Maria Musisi. References Hannah Blencowe., Simon Cousens., Doris Chou., Mikkel Oestergaard., Lale Say., Ann-Beth Moller., Mary Kinney., Joy Lawn.: Born Too Soon: The global epidemiology of 15 million preterm births . Reproductive Health 2013, 10 ((Suppl 1): S2). Howson C.P., Kinney V. M., Lawn E. J.: Born Too Soo: The Global Action Report on Preterm Birth . In: World Health Orgainization, Geneva Edited by March of Dimes P, Save the Children, WHO; 2012. Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C, Group GR: Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data . BMC Pregnancy Childbirth 2010, 10 Suppl 1 (Suppl 1):S1-S1. Liu L, Johnson H., Cousens, S., Perin, J., Scott, S., et al, : Global, regional and national causes of child mortality in 2000-2013, with projections to inform post-2015 priorities: an updated systematic analysis. . The Lancet 2015, 385 (9966):430-440. Unicef, World Health Organization. A decade of tracking progress for maternal, newborn, and child survival: 2015 Report. Countdown to 2015. . In . : Unicef, World Health Organization.; 2015. Pinto F, Fernades, E., Virella, D., Abrantes, A., Neto, T.M.,: Born Preterm: A Public Health Issue. Pertguese Journal of Public Health 2019, 10 . Vohr B.R.: Neonatal Follow up programs in the new Millenium. Neo-reviews 2001, 2 (e):241-248. Ho LY: Follow up care and Outcome Evaluation of High-Risk Preterm infants: A life-Course commitment. Editorial 2018. Nutrition Landscape Information System (NLIS) country profile indicators: interpretation guide. In . : World Health Organisation; 2010. WHO: World Health Organization Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age.l 2006 . Acta Paediatr Suppl 2006, 450 (14):76-85. Raaijmakers A, Allegaert K: Catch-Up Growth in Former Preterm Neonates: No Time to Waste . Nutrients 2016, 8 (12):817. A .M. Euser., C.C. de Wit., M.J.J. Finken., M. Rijken., Wit. JM: Growth of Preterm Born Children Hormone Research 2008, 70 :319-328. Kumar J, Mukhopadhyay K: Longitudinal Growth of Extremely Low Birth Weight Infants at 5 years . The Indian Journal of Pediatrics 2019, 86 (12):1139-1141. Bocca-Tjeertes IF., van Buuren S., Bos AF., Kerstjens JM., ten Vergert EM., SA. R: Growth in preterm and fullterm children aged 0-4 years: integrating median growth and variability into growth charts. Pediatrics 2012, 161 :460-465. Toftlund LH, Halken S, Agertoft L, Zachariassen G: Catch-Up Growth, Rapid Weight Growth, and Continuous Growth from Birth to 6 Years of Age in Very-Preterm-Born Children . Neonatology 2018, 114 (4):285-293. Fink G, Sudfeld, C.R., Danael, G., Ezzati, M., Fawzi, W.W.,: "Scaling-Up Access to Family Planning May Improve Linear Growth and Child Development in Low and Middle Income Countries" . PlosONE 2014, 9 (7: e102391). Leroy JL, Ruel M, Habicht J-P, Frongillo EA: Linear Growth Deficit Continues to Accumulate beyond the First 1000 Days in Low- and Middle-Income Countries: Global Evidence from 51 National Surveys . The Journal of Nutrition 2014, 144 (9):1460-1466. Lex W. Doyle., Peter J. Anderson., Malcom Battin., Jennifer R. Bowen., Brown. N: Long term follow up of high risk children: who,why and how? . BMC Pediatrics 2014, 14 (279). WHO: World Health Organization. Global targets 2025. To improve maternal, infant and young child nutrition . In . ; 2014. Ina S. Santos. AM, Marlos R. Domingues, Aluisio J.D. Barros., Cesar G. Victora., Fernando C. Barros. : Late preterm birth is a risk factor for growth falteringin early childhood: a cohort study. BMC Pediatrics 2009, 9 (17). Victora CG dOM, Hallal PC, Blössner M, Shrimpton R.: Worldwide timing of growth faltering: revisiting implications for interventions. . Pediatrics 2010, 125 :e473-480. Luis Pereira-da-Silva., Daniel Virella., Fusch. C: Nutritional Assessment in Preterm Infants: A Practical Approach in the NICU . In: Nutrients. vol. 11; 2019. Uganda Bureau of Statistics (UBOS) and ICF Internatioanl Inc, Uganda Demographic and Health Survey 2016. Kampala, Uganda: UBOS, and Rockville, Maryland, USA: UBOS and ICF . In . ; 2018. USAID. "Country Profile: Uganda: Nutrition Profile." In . ; 2018. Zhihui Li. RK, Sebastian Vollmer., S. V. Subramanian., : Factors Associated With Child Stunting, Wasting, and Underweight in 35 Low- and Middle-Income Countries . In . , vol. 3. JAMA Network Open; 2020. Wemakor A, Garti H, Azongo T, Garti H, Atosona A: Young maternal age is a risk factor for child undernutrition in Tamale Metropolis, Ghana . BMC research notes 2018, 11 (1):877. Yu SH, Mason J, Crum J, Cappa C, Hotchkiss DR: Differential effects of young maternal age on child growth . Global health action 2016, 9 (1):31171. Ozaltin E HK, Subramanian SV.: Association of maternal stature with offspring mortality, underweight, and stunting in low- to middle-income countries. . JAMA , 303 :1507-1516. Rahman MS, Howlader T, Masud MS, Rahman ML: Association of low-birth weight with malnutrition in children under five years in Bangladesh: do mother’s education, socio-economic status, and birth interval matter? PloS one 2016, 11 (6):e0157814. Dusick AM, Poindexter BB, Ehrenkranz RA, Lemons JA: Growth failure in the preterm infant: can we catch up? In: Seminars in perinatology: 2003 : Elsevier; 2003: 302-310. Ziegler EE, Carlson SJ: Early nutrition of very low birth weight infants . The Journal of Maternal-Fetal & Neonatal Medicine 2009, 22 (3):191-197. Sachs J, Schmidt-Traub, G., Kroll, C., Durand-Declare, D., Teksoz, K.,: SDG Index and Dashboards report 2017. New York: Bertelsmann Stiftung and Sustainable Development Solutions Network (SDSN) . In . ; 2017. Parul Christian SEL, Moira Donahue Angel, Linda S Adair, Shams E Arifeen et al: Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries . International Journal of Epidemiology 2013, 42 :1340-1355. Black RE AL, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J.: Maternal and child undernutrition: global and regional exposures and health consequences. . Lancet 2008, 371 :243-260. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-126512","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":6598809,"identity":"c8a1161e-0c99-451d-9ed0-193e7a93321c","order_by":0,"name":"Flaviah Namiiro","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYBACAwbGhwcYGCQYDNgbQFwLYrQwG0C08BwAcSWI1gJSnACiiNBiLt3McOBnm4W8ueTzqxt+FEgw8Ld3J+DVYjnnMMPB3jYJw52zc8pu9gAdJnHm7Ab8DruRf+AAzxkJxg23c9Ju8AC1GEjkEtKSzHDwzxkJ+w03z6Td/EOslsM8FRKJG26wH7tNlC2WM4BaZCokkjecyWG7LWMgwUPQL+YSyYwP3xjU2W44fvzZzTd/bOT423vxa0ECPAZgkljlIMD+gBTVo2AUjIJRMIIAAFsAS0sny0+GAAAAAElFTkSuQmCC","orcid":"","institution":"Mulago Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Flaviah","middleName":"","lastName":"Namiiro","suffix":""},{"id":6598810,"identity":"4a76662e-4e96-4592-9ac9-35fb9666eef4","order_by":1,"name":"Anthony Batte","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Anthony","middleName":"","lastName":"Batte","suffix":""},{"id":6598811,"identity":"678e26cb-a1f0-4ad7-a1e3-d315a6ddeef9","order_by":2,"name":"Joseph Rujumba","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"","lastName":"Rujumba","suffix":""},{"id":6598812,"identity":"b1401476-cbd1-4c29-82be-975509e79d5c","order_by":3,"name":"Nicolette Nabukeera","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nicolette","middleName":"","lastName":"Nabukeera","suffix":""},{"id":6598813,"identity":"db70aa5b-a7dd-4327-a21d-3dce8068acd9","order_by":4,"name":"Ian Munabi","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ian","middleName":"","lastName":"Munabi","suffix":""},{"id":6598814,"identity":"db03c43f-ad38-445a-b06d-fd66f419a56b","order_by":5,"name":"Violet Kayom","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Violet","middleName":"","lastName":"Kayom","suffix":""},{"id":6598815,"identity":"129d57b6-ebbf-4b82-914e-23ab4fac7701","order_by":6,"name":"Robert Serunjogi","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Robert","middleName":"","lastName":"Serunjogi","suffix":""},{"id":6598816,"identity":"bab97bbb-b60c-4e03-a317-c292d0b27c1e","order_by":7,"name":"Sarah Kiguli","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Kiguli","suffix":""}],"badges":[],"createdAt":"2020-12-11 10:44:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-126512/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-126512/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":4361902,"identity":"3931dd5e-a487-4867-a514-f83143db5f93","added_by":"auto","created_at":"2020-12-18 15:22:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":141942,"visible":true,"origin":"","legend":"Scatter graphs showing the weights and heights of the participants by sex ","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-126512/v1/fbe051fd8b7b3c3671998e6b.png"},{"id":4361901,"identity":"a24d01e0-518f-4a68-9bee-6cd677a77339","added_by":"auto","created_at":"2020-12-18 15:22:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":7728,"visible":true,"origin":"","legend":"Participants Flow diagram","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-126512/v1/6115b85b570c0f9e6f34481f.png"},{"id":13634549,"identity":"b3751882-e384-4843-814f-7991d2592df2","added_by":"auto","created_at":"2021-09-17 08:32:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1632319,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-126512/v1/097503fb-52d0-4589-ab05-954ac8cdfcf4.pdf"}],"financialInterests":"","formattedTitle":"Catch-up growth and nutritional status of preterms born at a Ugandan tertiary hospital: An Observational study.","fulltext":[{"header":"Background","content":"\u003cp\u003ePrematurity is on the rise globally, contributing about 15\u0026nbsp;million births annually [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e]. More than 60% of preterm with low birth weight (LBW) babies are born in Asia and Sub Saharan Africa [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e]. Prematurity causes an estimated one million neonatal deaths worldwide and it is a significant contributor to morbidities among survivors extending to adulthood [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eUganda is ranked 13th of the 184 countries in the world with the highest number of babies born prematurely; with approximately 14% of babies born preterm [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although mortality has been high among preterm/LBW infants, advances in neonatal care have led to better survival of preterm and low birth weight infants worldwide [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, children born preterm should be followed up with long term growth monitoring with the aim of achieving catch-up growth as early as possible to combat health consequences like undernutrition later in life [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. Growth status is defined by normal anthropometric measurements for age and sex with weight and height z scores \u0026gt; -2 SDs of the reference population [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. At two years of age, children born preterm are expected to have caught up on the normal growth curve with their appropriate to gestation age (AGA) counterparts [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, some studies have reported that at this age some children are still stunted and underweight, and this growth restriction persists into adulthood [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. Survivors are at risk of long-term consequences and require follow up beyond the neonatal period [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. It is therefore important that early childhood follow up identifies children poorly progressing in growth to ensure that appropriate interventions are instituted at the earliest opportunity [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eCompared to high income countries, in low and middle income countries (LMICs) there is limited literature on post- hospital discharge growth status of preterm children [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. We therefore sought to evaluate the catch up growth, nutritional status and associated factors for children aged at 22\u0026ndash;38 months born preterm/low birth weight in a low resource setting.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis was a cross sectional survey which assessed the anthropometric measurements of children aged 22\u0026ndash;38 months born preterm/low birth weight (LBW). The study was conducted at the preterm/LBW follow up clinic of Mulago National Referral Hospital, Kampala, Uganda. This clinic attends to any baby born with weight\u0026thinsp;\u0026le;\u0026thinsp;2500gms and majority of these are usually pre-term babies. This is a follow up clinic for babies discharged from Mulago hospital neonatal unit. A total of 251 child and caretaker pairs of eligible children were recruited from November 2019 to February 2020. Eligible children were children aged 22\u0026ndash;38 months, and weighed\u0026thinsp;\u0026le;\u0026thinsp;2000 grams at birth and attended the preterm/LBW follow up clinic at Mulago Hospital. For inclusion in the study, hospital outpatient records were evaluated for children who were aged 22-38months at the time of enrolment (were attending and registered in the follow up clinic between January 2017 to February 2018 and had a birth weight of \u0026le;\u0026thinsp;2000 grams). A list of the eligible children was made and every second mother was given a telephone call by the research team and was requested to bring back the child to the clinic for participation in the study. However, using this systematic sampling of every second child, we were only able to reach 108 out of the 506 eligible participants. We therefore consecutively called up every caretaker. A large proportion of telephone calls to the caretakers were not picked after three attempts. There were also some incomplete or wrong telephone numbers and some numbers were not validated or were out of service. A few caretakers/mothers were not able to come back to the clinic despite responding to our call.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eStudy Measurements\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eMother/caretaker-infant pairs came to the clinic on the appointed days. Research assistants who were nurses obtained both infant and maternal demographics (age, sex, birth weight and socioeconomic characteristics). Other data collected included: mode and type of delivery, estimated distance from hospital, duration in hospital, duration of exclusive breastfeeding and duration in the follow up clinic. Anthropometric measurements were taken for each child including: weight, height/length, head circumference and mid-upper arm circumference. Mother\u0026rsquo;s weight, height and body mass index (BMI) were also measured. The weights were taken using a digital portable SECA\u0026reg; weighing scale. Weight was taken while child was wearing light clothing and bare feet. The values were recorded to one decimal point. Height was measured to the nearest 0.1\u0026nbsp;cm precision using a stadiometer. All measurements were taken once by a trained research assistant.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAnalysis And Data Management\u003c/strong\u003e\u003c/p\u003e \u003cp\u003eThe WHO Anthropometrics software was used to convert height, weight and age measurements to height-for-age z-scores (HAZ), weight-height z-scores (WHZ) and weight-for-age z-scores (WAZ) which were used to classify stunting, wasting and underweight respectively. Child was considered to have caught up or attained normal growth if their z-scores were above \u0026minus;\u0026thinsp;2SD of the reference population and to have undernutrition when their z-scores below \u0026minus;\u0026thinsp;2SD. To establish the association of infant and maternal factors with nutritional status for wasting, underweight and stunting, stepwise logistic regression analysis was performed. Factors that were found significant at bivariate analysis were further fitted in model 1 and 2\u0026nbsp;at multivariate analysis. We used multivariable logistic regression analysis to estimate adjusted odds ratios (AORs) along with their 95% confidence intervals (CIs) for the associations between each infant and maternal characteristic with child anthropometric outcomes (below \u0026minus;\u0026thinsp;2 SD) as the reference category. For all statistical tests a p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003eData were analyzed using STATA version 15 statistical software (StataCorp. 2017 College Station, TX: StataCorp LLC). The severity of stunting, underweight and wasting by prevalence ranges among children were assessed using the WHO classification for assessing severity of malnutrition by prevalence ranges among children under-5\u0026nbsp;years of age[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e "},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003eBaseline characteristics of the children\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 923 children registered in the follow up clinic from January 2017 to February 2018; 506 met our inclusion criteria (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). We enrolled 251 children and the mean age was 29.7 months (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5) and 51.4% were male. Children with birth weight\u0026thinsp;\u0026le;\u0026thinsp;1500\u0026nbsp;gm were 104 (41.6%) and those\u0026thinsp;\u0026gt;\u0026thinsp;1500 were 146 (58.4%). The median duration of hospital stay post- delivery was 12 days (IQR: 7\u0026ndash;18).\u003c/p\u003e\n\u003cp\u003eThe summary of the baseline characteristics for the study participants are summarized in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e below. The ratio of male to female was 0.9:1. Most of the participants were delivered by spontaneous vertex delivery 177 (70.5%) and majority were singletons 179 (71.3%).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eBaseline characteristics for the participants\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage %\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex of the child\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e129\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e51.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e122\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e48.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge of the child\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22\u0026ndash;30 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e141\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e56.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31\u0026ndash;38 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMode of delivery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCaesarean section\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVaginal delivery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e177\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e70.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eType of delivery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMultiple\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingleton\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e179\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e71.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBirth weight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026le;1500\u0026nbsp;gm\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e104\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;1500\u0026nbsp;gm\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e146\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e58.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChild EBF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e165\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e65.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDuration of hospital stay\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;7 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e134\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e53.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u0026ndash;14 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u0026ndash;28 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003eEBF: Exclusive Breastfeeding for first 6 months of life\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\u003cp\u003e\u003cstrong\u003eMaternal/caretaker Characteristics\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eAmong the maternal characteristics summarized in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, the anthropometric measurements for 236 mothers were included for analysis because 15 participants were accompanied by other caretakers (10 fathers, 2 grandparents and one aunt).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eBaseline characteristics for the mothers\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage %\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026le;25\u0026nbsp;years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26\u0026ndash;30\u0026nbsp;years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e103\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt; 30\u0026nbsp;years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39.04\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEstimated Distance from home to hospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;5\u0026nbsp;Km\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u0026ndash;15\u0026nbsp;km\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e212\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e84.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;15\u0026nbsp;Km\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEducation level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrimary below/none\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecondary/tertiary level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e200\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e79.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarital status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarried / co-habiting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e199\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e79.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle / divorced/ separated\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEmployment status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEmployed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e164\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e65.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot employed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHave social support\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e224\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e89.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNumber of children\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;2 children\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e111\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e44.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u0026ndash;4 children\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;5 children\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMother\u0026rsquo;s BMI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;18.5 (Underweight)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.5 - \u0026le; 25 (Normal Range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e106\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25.0- \u0026lt;30 (Overweight)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e78\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e31.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;30 (Obese)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBMI Body Mass Index\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\u003cp\u003e\u003cstrong\u003eGrowth And Nutrition Status Of The Children\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe summary of growth status for the participants using anthropometric measurements by sex and age are shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. Of the participants, 101 (40.2%) had caught up on the normal anthropometric measurements z scores \u0026gt; -2 SD of the reference population for their age and sex.\u003c/p\u003e\n\u003cp\u003eThe prevalence for wasting (weight for height z-score \u0026lt;-2SD) was 8 (3.2%), underweight (weight for age z-score \u0026lt;-2 SD) 36 (14.4%) and the prevalence of stunting (height for age z-score \u0026lt;-2) was 106 (42.2%). There were more boys stunted, 64 out of 106 participants compared to girls (\u003cstrong\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/strong\u003e). There was no statistically significant difference based on sex for the children who were wasted or underweight. For 246 (98.8%) participants, MUAC was normal (\u0026ge;\u0026thinsp;12.5\u0026nbsp;cm) and for 216 (86.8%) the head circumference was within normal range for age.\u003c/p\u003e\n\u003cp\u003eThe scatter plot graphs show individual growth parameters (weight and height/length) for the children and their corresponding age and sex based on the 2006 WHO multicenter reference growth population: A \u0026ndash; Weight for Height/Length, B \u0026ndash; Weight for Age, C \u0026ndash; Height/Length for Age.\u003c/p\u003e\n\u003cp\u003eThe z-scores for the weight for age, weight for height, height for age, and head circumference for the participants are summarized in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSummary of Participants\u0026rsquo; anthropometric measurements\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026lt;-3SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026gt;=-3SD to\u0026lt;-2SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026gt;=-2SDto\u0026thinsp;\u0026lt;\u0026thinsp;2SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026gt;=2SDto\u0026thinsp;\u0026lt;\u0026thinsp;3SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026gt;=3SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eWeight\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFor Age\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale n%\u003c/p\u003e\n\u003cp\u003eFemale n%\u003c/p\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0)\u003c/p\u003e\n\u003cp\u003e1 (0.8)\u003c/p\u003e\n\u003cp\u003e1 (0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18(14.8)\u003c/p\u003e\n\u003cp\u003e12 (9.3)\u003c/p\u003e\n\u003cp\u003e30 (12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e104 (85.3)\u003c/p\u003e\n\u003cp\u003e116 (89.9)\u003c/p\u003e\n\u003cp\u003e220 (87.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e122\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e129\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e251\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eWeight\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFor\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHeight\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale n%\u003c/p\u003e\n\u003cp\u003eFemale n%\u003c/p\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1.7)\u003c/p\u003e\n\u003cp\u003e1 (0.8)\u003c/p\u003e\n\u003cp\u003e3 (1.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1.7)\u003c/p\u003e\n\u003cp\u003e3 (2.3)\u003c/p\u003e\n\u003cp\u003e5 (2.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e112 (92.6)\u003c/p\u003e\n\u003cp\u003e124 (96.1)\u003c/p\u003e\n\u003cp\u003e236 (94.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (3.3)\u003c/p\u003e\n\u003cp\u003e1 (0.8)\u003c/p\u003e\n\u003cp\u003e5 (2.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.8)\u003c/p\u003e\n\u003cp\u003e0 (0.0)\u003c/p\u003e\n\u003cp\u003e1 (0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e121\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e129\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e250\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHeight\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFor Age\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale n%\u003c/p\u003e\n\u003cp\u003eFemale n%\u003c/p\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26 ()21.3\u003c/p\u003e\n\u003cp\u003e15 (11.6\u003cstrong\u003e)\u003c/strong\u003e)\u003c/p\u003e\n\u003cp\u003e41 (16.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39 (32.0)\u003c/p\u003e\n\u003cp\u003e26 (20.2)\u003c/p\u003e\n\u003cp\u003e65(25.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56 (45.9)\u003c/p\u003e\n\u003cp\u003e88 (68.2)\u003c/p\u003e\n\u003cp\u003e144 (57.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.8)\u003c/p\u003e\n\u003cp\u003e0 (0.0)\u003c/p\u003e\n\u003cp\u003e1 (0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e122\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e129\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e251\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHead\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCircumference\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale n%\u003c/p\u003e\n\u003cp\u003eFemale n%\u003c/p\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1.7)1 (0.8)\u003c/p\u003e\n\u003cp\u003e3 (1.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1.7)\u003c/p\u003e\n\u003cp\u003e3 (2.3)\u003c/p\u003e\n\u003cp\u003e5 (2.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e112 (92.6)\u003c/p\u003e\n\u003cp\u003e124 (96.1)\u003c/p\u003e\n\u003cp\u003e236 (94.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (3.3)\u003c/p\u003e\n\u003cp\u003e1 (0.8)\u003c/p\u003e\n\u003cp\u003e5 (2.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.8)\u003c/p\u003e\n\u003cp\u003e0 (0.0)\u003c/p\u003e\n\u003cp\u003e1 (0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e121\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e129\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e250\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\u003cp\u003e\u003cstrong\u003eFactors Associated With Nutritional Status Of The Children\u003c/strong\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAfter bivariate and multivariate analysis to establish the association between child and maternal characteristics with the nutrition status are summarized in\u003c/strong\u003e Tables \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e \u0026amp; \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e \u003cstrong\u003efor underweight and stunting respectively.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBirth weight\u0026thinsp;\u0026le;\u0026thinsp;1500\u0026nbsp;gm and hospital stay of more than 14 days were found to have an association with underweight (AOR 2.36 95% CI 1.13,4.95, p\u0026thinsp;=\u0026thinsp;0.043) and (AOR 5.77, 95% CI1.88,17.67, p\u0026thinsp;=\u0026thinsp;0.002) respectively as shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eBivariate and multivariate analysis of Child factors associated with underweight\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGrowth status the preterm children\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCOR 95% Cl\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAOR 95% CI *\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUnderweight (W/A Z-score \u0026lt;-2)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;35) (f, %)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNot Underweight W/A Z-score \u0026ge;-2) (n\u0026thinsp;=\u0026thinsp;216) (f, %)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex of the child\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17(48.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e112(51.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.87 (0.43, 1.79)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.719\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18(51.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e104(48.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge of the child\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22\u0026ndash;30 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17(48.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e124(57.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31\u0026ndash;38 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18(51.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e92(42.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.42 (0.70, 2.92)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.330\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMode of delivery \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCaesarean section\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10(28.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64(29.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.95 (0.43, 2.09)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.899\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.81(0.36, 1.89)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.639\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVaginal delivery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25(71.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e152(70.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eType of delivery \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMultiple\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(22.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64(29.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.70 (0.30, 1.63)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.413\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.71(0.29, 1.72)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.450\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingleton\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27(77.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e152(70.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBirth weight \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026le;1500 grams\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21(60.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83(38.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.38 (1.14, 4.95)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.36 (1.13, 4.95)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.023\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;1500 grams\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14(40.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e132(61.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChild EBF \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(31.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75(34.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24(68.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e141(65.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.86(0.4, 1.85)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.703\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.83(0.35, 1.95)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.669\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDuration of hospital stay \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;7 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12(34.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e122(56.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u0026ndash;14 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16(45.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e82(38)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.98 (0.89, 4.41)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.093\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.84(0.81, 4.15)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.140\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u0026ndash;28 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7(20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12(5.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e5.93 (1.96, 17.90)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e5.77(1.88, 17.67)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCompleted one year in care \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19(54.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e119(55.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.03(0.50, 2.12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.929\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.95 (0.45, 0.36)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.886\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16(45.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e97(44.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e\u003cem\u003eReference group: Not Underweight. EBF: Exclusive Breastfeeding, COR: Crude Odds Ratio, CI: Confidence interval.\u003c/em\u003e \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e \u003cem\u003eAdjusted for Number of children, Previous preterm deliveries.\u003c/em\u003e \u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e \u003cem\u003eAdjusted for Number of children, Previous preterm deliveries, Multiple births\u003c/em\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe factors associated with stunting were male sex (AOR 2.33, 95% CI 1.42 to 4.04, p\u0026thinsp;=\u0026thinsp;0.001), maternal age less than \u0026le;\u0026thinsp;25\u0026nbsp;years when compared to 26\u0026ndash;30\u0026nbsp;years (AOR 2.16, 95% CI1.02, 4.54, p\u0026thinsp;=\u0026thinsp;0.043) and maternal height less than 150\u0026nbsp;cm (AOR 4.87, 95% CI1.70, 13.93, p\u0026thinsp;=\u0026thinsp;0.003), Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eAssociation between Child and Maternal characteristics with Stunting\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGrowth status the preterm children\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCOR 95% CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAOR 95% CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eStunted (H/A Z-score \u0026lt;-2)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;35) (f, %)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNot Stunted H/A Z-score \u0026ge;-2)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;216) (f, %)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex of the child\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64(61)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58(39.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.36 (1.42,3.95)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.39(1.42,4.04)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41(39)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e88(60.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026le;\u0026thinsp;25\u0026nbsp;years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30(28.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20(13.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.27(1.13,4.52)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.16(1.02,4.54)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.043\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26\u0026ndash;30\u0026nbsp;years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41(39)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62(42.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;30\u0026nbsp;years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34(32.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64(43.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.80(0.45,1.43)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.454\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarital status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarried / co-habiting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e77(73.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e122(83.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle / divorced/ separated\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28(26.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24(16.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1.84(1.00,3.42)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.050\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.79(0.93,3.45)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.079\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBMI for caretaker\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(0.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.5 to \u0026lt;\u0026thinsp;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50(50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50(37)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25 to \u0026lt;\u0026thinsp;30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30(30)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43(31.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.70(0.38,1.28)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.247\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.72(0.38,1.34)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.300\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20(20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41(30.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.49(0.25,0.94)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.64(0.34,1.29)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.210\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMaternal Height*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLess than 150\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 (18.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(4.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e5.00(1.79,13.99)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e4.87(1.7,13.93)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e150\u0026ndash;154.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22(22.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28(20.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.31(0.64,2.69)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.462\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.2(0.58,2.51)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.622\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e155\u0026ndash;159.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30(30.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50(37.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e160\u0026ndash;164.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23(23.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36(26.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.06(0.53,2.13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.859\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.17(0.57,2.39)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.662\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003emore\u0026thinsp;=\u0026thinsp;165\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7(7.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15(11.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.78(0.28,2.12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.624\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.87(0.31,2.45)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.787\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe sought to establish the catch up growth, nutritional status and associated factors for children born with preterm/LBW at Mulago Hospital, Kampala. From our study, 101 (40.1%) of the participants had caught up on normal growth for their age while the rest of the children had undernutrition. The prevalence of stunting was 42.2% and underweight 14.4% which are markers of chronic malnutrition; but relatively low levels of wasting 3.2%, a marker of acute malnutrition. Stunting was associated with male sex, maternal age\u0026thinsp;\u0026le;\u0026thinsp;25\u0026nbsp;years and maternal height less than 150\u0026nbsp;cm. Childhood underweight was associated with birth weight\u0026thinsp;\u0026le;\u0026thinsp;1500 grams and longer hospital stay of \u0026gt;\u0026thinsp;14\u0026nbsp;days following delivery. The head circumference for 216 (86.8% %) was within normal range and MUAC for 246 (98.8%) was \u0026ge;\u0026thinsp;12.5\u0026nbsp;cm within normal range for age.\u003c/p\u003e\n\u003cp\u003eLess than half of our participants demonstrated catch up growth a prevalence lower than what was observed in other studies [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]. Mukhopadhyay et al in India showed no catch up growth beyond 2\u0026nbsp;years among extreme low birth weight infants [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. A cross sectional study from 51 nations showed no catch-up growth from 2 to 5\u0026nbsp;years [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. This showed a steep decline in children\u0026rsquo;s height for age z-scores from birth to the first two years of life with no deterioration thereafter. The anthropometric parameters at two years can therefore fairly predict the growth outcomes later in life[\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eWe enrolled children who were born preterm/LBW; these are a high risk for undernutrition[\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e] and this may explain the high prevalence of stunting demonstrated by our results. The prevalence of stunting in the children under-5\u0026nbsp;years based on a Uganda national survey was 29% [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]. The same survey showed that stunting increased with age, peaking at 37 percent among children 18\u0026ndash;35\u0026nbsp;months [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e] in the general population.\u003c/p\u003e\n\u003cp\u003eIn our study, stunting was associated with male sex, lower maternal age and lower maternal height. In our study, the boys 61% were more likely to be stunted compared to the girls 39%. This is similar to other studies [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e], although further studies are needed to evaluate the mechanism in which sex may contribute to stunting. Similar to previous studies [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e], our study demonstrated that young mothers had higher chances of having stunted children compared to older mothers. It is thought that older mothers are usually more knowledgeable in aspects of baby care compared to young and teenage mothers [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e] hence the better outcome of their children. The maternal height could most probably be attributed to genetic and environmental factors. Studies have demonstrated mothers with short stature or those born with low birth weight were more likely to give birth to children with the same features [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. Even though factors such as maternal education wealth quintile, maternal BMI have been described to be associated with stunting[\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e], our study did not find these to be associated with stunting.\u003c/p\u003e\n\u003cp\u003eUnderweight was observed among 14.4% of our participants a prevalence slightly higher than the Uganda prevalence of 11% according to UDHS 2016, [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]. Underweight was associated with low birth weight and long hospital stay. In general, children who are born with low birth weight are at high risk of being underweight in their childhood which occasionally persists in adulthood [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e]. It is possible that difficulties encountered in feeding low birth weight infants majority of whom are preterm babies, contributes to their poor growth in early childhood [\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e] .The finding that long hospital stay influences the ability of the baby to add weight and reach appropriate z-scores could be a marker of difficulties in feeding or generally ill-health which may hinder adequate feeding and growth. Only 3.2% of our study participants were wasted as compared to the 4% in the general population[\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. Wasting is an indicator of acute illness and we did not identify many children in whom recent acute illness was reported and this probably led to low prevalence.\u003c/p\u003e\n\u003cp\u003eOur findings have several implications on growth monitoring of children born preterm which should not be limited to the neonatal period but extend to childhood and beyond. Child growth and nutritional status may be strongly linked to fetal life suggesting a need for interventional focus on nutrition during pregnancy and early childhood. To end all forms of malnutrition by 2030: Sustainable Development Goal 2 [\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e], a life-course approach of nutritional interventions are needed targeting at risk populations. These will in turn lead to child survival, educational achievements and overall well- being later in life. Secondly, collection and analysis of long-term data in former preterm and LBW children linked to nutritional strategies and growth parameters are still strongly recommended in our setting. Although pre-pregnancy and natal nutritional status was not assessed in our study, they have been linked to growth failures in early childhood in other studies [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e]. It is equally important to mind the mother\u0026rsquo;s nutritional status from pre-conception throughout pregnancy [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThe strength of this study is we enrolled children who weighed less than 2000 grams at birth majority of whom will also be preterm. The predominant mode of feeding in our study population was exclusive breastfeeding with no modification for all the participants. The limitations included the cross sectional data does not reflect changes in growth of individual children overtime. Details of dietary intake and complimentary feeding practices were not collected in our study to minimize long term recall bias. Nevertheless, the results clearly indicate a need for rigorous growth monitoring for children born preterm/LBW beyond the neonatal period.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOf the children born preterm/LBW\u0026nbsp; 40.1% of the participants had attained the expected catch up growth at 2 to 3 years of age, 42.2% were observed to be stunted and 14.4% were underweight both higher than the national levels. Targeted interventions are specifically needed for children born with very low birth weight, those requiring long postnatal hospitalization, males and those born to short or young mothers.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAGA Appropriate for gestation age\u003c/p\u003e\n\u003cp\u003eCUG Catch up growth\u003c/p\u003e\n\u003cp\u003eLBW Low birth weight\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol was approved by Makerere University and Mulago Hospital Research and Ethics Committees (Ref 2019-117) and the Uganda National Council of Science \u0026amp; Technology. The caretakers gave informed consent to participate in the study. All methods were performed in accordance with the relevant guidelines and regulations involving human research. Informed consent was verbally obtained from participant caregivers after needed information was explained. Participation was voluntary and caregivers signed or thumb printed a statement of an informed consent before being interviewed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e All Authors approved manuscript for publication\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The data supporting the conclusions of this article are included within the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors have no conflicts of interest to declare.\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: Support was from the Forgaty International Center of National Institutes of Health, U.S Department of State\u0026rsquo;s Office of Global AIDS Coordinator and Health Diplomacy (S/GAC), and President\u0026rsquo;s Emergency Plan for AIDS Relief (PEPFAR) under Award Number 1R25TW011213. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e: FN, JR, AB, NNB \u0026amp; VK participated in concept development. SK \u0026amp; IM reviewed the proposal. RS did the statistics and FN supervised the data collection and wrote initial manuscript. All authors contributed to revision of the final manuscript and approved it for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: We thank the Management of Mulago Hospital, Staff at the Preterm Clinic, Research Assistants: F Fawling, C. Akello \u0026amp; F Nakirijja, the participants and their parents. My Mentors: Dr E Mupere, Dr A.Yasser, Dr D. Kyazze \u0026amp; Mrs Maria Musisi.\u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHannah Blencowe., Simon Cousens., Doris Chou., Mikkel Oestergaard., Lale Say., Ann-Beth Moller., Mary Kinney., Joy\u0026nbsp;Lawn.: \u003cstrong\u003eBorn Too Soon: The global epidemiology of 15\u0026nbsp;million preterm births\u003c/strong\u003e.\u003cem\u003e Reproductive Health \u003c/em\u003e2013, \u003cstrong\u003e10\u003c/strong\u003e((Suppl 1): S2).\u003c/li\u003e\n\u003cli\u003eHowson C.P., Kinney V. M., Lawn E. J.: \u003cstrong\u003eBorn Too Soo: The Global Action Report on Preterm Birth\u003c/strong\u003e. In: \u003cem\u003eWorld Health Orgainization, Geneva \u003c/em\u003eEdited by March of Dimes P, Save the Children, WHO; 2012.\u003c/li\u003e\n\u003cli\u003eLawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C, Group GR: \u003cstrong\u003eGlobal report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data\u003c/strong\u003e. \u003cem\u003eBMC Pregnancy Childbirth \u003c/em\u003e2010, \u003cstrong\u003e10 Suppl 1\u003c/strong\u003e(Suppl 1):S1-S1.\u003c/li\u003e\n\u003cli\u003eLiu L, Johnson H., Cousens, S., Perin, J., Scott, S., et al, : \u003cstrong\u003eGlobal, regional and national causes of child mortality in 2000-2013, with projections to inform post-2015 priorities: an updated systematic analysis.\u0026nbsp; \u003c/strong\u003e. \u003cem\u003eThe Lancet \u003c/em\u003e2015, \u003cstrong\u003e385\u003c/strong\u003e(9966):430-440.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eUnicef, World Health Organization. A decade of tracking progress for maternal, newborn, and child survival: 2015 Report. Countdown to 2015. \u003c/strong\u003e. In\u003cem\u003e.\u003c/em\u003e: Unicef, World Health Organization.; 2015.\u003c/li\u003e\n\u003cli\u003ePinto F, Fernades, E., Virella, D., Abrantes, A., Neto, T.M.,: \u003cstrong\u003eBorn Preterm: A Public Health Issue.\u003c/strong\u003e \u003cem\u003ePertguese Journal of Public Health \u003c/em\u003e2019, \u003cstrong\u003e10\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eVohr B.R.: \u003cstrong\u003eNeonatal Follow up programs in the new Millenium.\u003c/strong\u003e \u003cem\u003eNeo-reviews \u003c/em\u003e2001, \u003cstrong\u003e2\u003c/strong\u003e(e):241-248.\u003c/li\u003e\n\u003cli\u003eHo LY: \u003cstrong\u003eFollow up care and Outcome Evaluation of High-Risk Preterm infants: A life-Course commitment.\u003c/strong\u003e \u003cem\u003eEditorial \u003c/em\u003e2018.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eNutrition Landscape Information System (NLIS) country profile indicators: interpretation guide.\u003c/strong\u003e In\u003cem\u003e.\u003c/em\u003e: World Health Organisation; 2010.\u003c/li\u003e\n\u003cli\u003eWHO:\u003cstrong\u003e World Health Organization Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age.l 2006\u003c/strong\u003e.\u003cem\u003e Acta Paediatr Suppl \u003c/em\u003e2006, \u003cstrong\u003e450\u003c/strong\u003e(14):76-85.\u003c/li\u003e\n\u003cli\u003eRaaijmakers A, Allegaert K: \u003cstrong\u003eCatch-Up Growth in Former Preterm Neonates: No Time to Waste\u003c/strong\u003e. \u003cem\u003eNutrients \u003c/em\u003e2016, \u003cstrong\u003e8\u003c/strong\u003e(12):817.\u003c/li\u003e\n\u003cli\u003eA .M. Euser., C.C. de Wit., M.J.J. Finken., M. Rijken., Wit. JM:\u003cstrong\u003e Growth of Preterm Born Children \u003c/strong\u003e\u003cem\u003eHormone Research \u003c/em\u003e2008, \u003cstrong\u003e70\u003c/strong\u003e:319-328.\u003c/li\u003e\n\u003cli\u003eKumar J, Mukhopadhyay K: \u003cstrong\u003eLongitudinal Growth of Extremely Low Birth Weight Infants at 5 years\u003c/strong\u003e. \u003cem\u003eThe Indian Journal of Pediatrics \u003c/em\u003e2019, \u003cstrong\u003e86\u003c/strong\u003e(12):1139-1141.\u003c/li\u003e\n\u003cli\u003eBocca-Tjeertes IF., van Buuren S., Bos AF., Kerstjens JM., ten Vergert EM., SA. R:\u003cstrong\u003e Growth in preterm and fullterm children aged 0-4 years: integrating median growth and variability into growth charts.\u003c/strong\u003e\u003cem\u003e Pediatrics \u003c/em\u003e2012, \u003cstrong\u003e161\u003c/strong\u003e:460-465.\u003c/li\u003e\n\u003cli\u003eToftlund LH, Halken S, Agertoft L, Zachariassen G: \u003cstrong\u003eCatch-Up Growth, Rapid Weight Growth, and Continuous Growth from Birth to 6 Years of Age in Very-Preterm-Born Children\u003c/strong\u003e. \u003cem\u003eNeonatology \u003c/em\u003e2018, \u003cstrong\u003e114\u003c/strong\u003e(4):285-293.\u003c/li\u003e\n\u003cli\u003eFink G, Sudfeld, C.R., Danael, G., Ezzati, M., Fawzi, W.W.,: \u003cstrong\u003e\"Scaling-Up Access to Family Planning May Improve Linear Growth and Child Development in Low and Middle Income Countries\"\u003c/strong\u003e. \u003cem\u003ePlosONE \u003c/em\u003e2014, \u003cstrong\u003e9\u003c/strong\u003e(7: e102391).\u003c/li\u003e\n\u003cli\u003eLeroy JL, Ruel M, Habicht J-P, Frongillo EA: \u003cstrong\u003eLinear Growth Deficit Continues to Accumulate beyond the First 1000 Days in Low- and Middle-Income Countries: Global Evidence from 51 National Surveys\u003c/strong\u003e. \u003cem\u003eThe Journal of Nutrition \u003c/em\u003e2014, \u003cstrong\u003e144\u003c/strong\u003e(9):1460-1466.\u003c/li\u003e\n\u003cli\u003eLex W. Doyle., Peter J. Anderson., Malcom Battin., Jennifer R. Bowen., Brown. N:\u003cstrong\u003e Long term follow up of high risk children: who,why and how? \u003c/strong\u003e. \u003cem\u003eBMC Pediatrics \u003c/em\u003e2014, \u003cstrong\u003e14\u003c/strong\u003e(279).\u003c/li\u003e\n\u003cli\u003eWHO: \u003cstrong\u003eWorld Health Organization. Global targets 2025. To improve maternal, infant and young child nutrition\u003c/strong\u003e. In\u003cem\u003e.\u003c/em\u003e; 2014.\u003c/li\u003e\n\u003cli\u003eIna S. Santos. AM, Marlos R. Domingues, Aluisio J.D. Barros., Cesar G. Victora., Fernando C. Barros. : \u003cstrong\u003eLate preterm birth is a risk factor for growth falteringin early childhood: a cohort study.\u003c/strong\u003e \u003cem\u003eBMC Pediatrics \u003c/em\u003e2009, \u003cstrong\u003e9\u003c/strong\u003e(17).\u003c/li\u003e\n\u003cli\u003eVictora CG dOM, Hallal PC, Bl\u0026ouml;ssner M, Shrimpton R.:\u003cstrong\u003e Worldwide timing of growth faltering: revisiting implications for interventions. \u003c/strong\u003e. \u003cem\u003ePediatrics \u003c/em\u003e2010, \u003cstrong\u003e125\u003c/strong\u003e:e473-480.\u003c/li\u003e\n\u003cli\u003eLuis Pereira-da-Silva., Daniel Virella., Fusch. C: \u003cstrong\u003eNutritional Assessment in Preterm Infants: A Practical Approach in the NICU\u003c/strong\u003e. In: \u003cem\u003eNutrients.\u003c/em\u003e vol. 11; 2019.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eUganda Bureau of Statistics (UBOS) and ICF Internatioanl Inc, Uganda Demographic and Health Survey 2016. Kampala, Uganda: UBOS, and Rockville, Maryland, USA: UBOS and ICF\u003c/strong\u003e. In\u003cem\u003e.\u003c/em\u003e; 2018.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eUSAID. \"Country Profile: Uganda: Nutrition Profile.\" \u003c/strong\u003eIn\u003cem\u003e.\u003c/em\u003e; 2018.\u003c/li\u003e\n\u003cli\u003eZhihui Li. RK, Sebastian Vollmer., S. V. Subramanian., : \u003cstrong\u003eFactors Associated With Child Stunting, Wasting, and Underweight in 35 Low- and Middle-Income Countries\u003c/strong\u003e. In\u003cem\u003e.\u003c/em\u003e, vol. 3. JAMA Network Open; 2020.\u003c/li\u003e\n\u003cli\u003eWemakor A, Garti H, Azongo T, Garti H, Atosona A: \u003cstrong\u003eYoung maternal age is a risk factor for child undernutrition in Tamale Metropolis, Ghana\u003c/strong\u003e. \u003cem\u003eBMC research notes \u003c/em\u003e2018, \u003cstrong\u003e11\u003c/strong\u003e(1):877.\u003c/li\u003e\n\u003cli\u003eYu SH, Mason J, Crum J, Cappa C, Hotchkiss DR: \u003cstrong\u003eDifferential effects of young maternal age on child growth\u003c/strong\u003e. \u003cem\u003eGlobal health action \u003c/em\u003e2016, \u003cstrong\u003e9\u003c/strong\u003e(1):31171.\u003c/li\u003e\n\u003cli\u003eOzaltin E HK, Subramanian SV.:\u003cstrong\u003e Association of maternal stature with offspring mortality, underweight, and stunting in low- to middle-income countries. \u003c/strong\u003e. \u003cem\u003eJAMA\u003c/em\u003e, \u003cstrong\u003e303\u003c/strong\u003e:1507-1516.\u003c/li\u003e\n\u003cli\u003eRahman MS, Howlader T, Masud MS, Rahman ML: \u003cstrong\u003eAssociation of low-birth weight with malnutrition in children under five years in Bangladesh: do mother\u0026rsquo;s education, socio-economic status, and birth interval matter?\u003c/strong\u003e \u003cem\u003ePloS one \u003c/em\u003e2016, \u003cstrong\u003e11\u003c/strong\u003e(6):e0157814.\u003c/li\u003e\n\u003cli\u003eDusick AM, Poindexter BB, Ehrenkranz RA, Lemons JA: \u003cstrong\u003eGrowth failure in the preterm infant: can we catch up?\u003c/strong\u003e In: \u003cem\u003eSeminars in perinatology: 2003\u003c/em\u003e: Elsevier; 2003: 302-310.\u003c/li\u003e\n\u003cli\u003eZiegler EE, Carlson SJ: \u003cstrong\u003eEarly nutrition of very low birth weight infants\u003c/strong\u003e. \u003cem\u003eThe Journal of Maternal-Fetal \u0026amp; Neonatal Medicine \u003c/em\u003e2009, \u003cstrong\u003e22\u003c/strong\u003e(3):191-197.\u003c/li\u003e\n\u003cli\u003eSachs J, Schmidt-Traub, G., Kroll, C., Durand-Declare, D., Teksoz, K.,: \u003cstrong\u003eSDG \u003cem\u003eIndex and Dashboards report 2017. New York: Bertelsmann Stiftung and Sustainable Development Solutions Network (SDSN)\u003c/em\u003e\u003c/strong\u003e. In\u003cem\u003e.\u003c/em\u003e; 2017.\u003c/li\u003e\n\u003cli\u003eParul Christian SEL, Moira Donahue Angel, Linda S Adair,\u0026nbsp; Shams E Arifeen et al: \u003cstrong\u003eRisk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries\u003c/strong\u003e. \u003cem\u003eInternational Journal of Epidemiology \u003c/em\u003e2013, \u003cstrong\u003e42\u003c/strong\u003e:1340-1355.\u003c/li\u003e\n\u003cli\u003eBlack RE AL, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J.:\u003cstrong\u003e Maternal and child undernutrition: global and regional exposures and health consequences. \u003c/strong\u003e. \u003cem\u003eLancet \u003c/em\u003e2008, \u003cstrong\u003e371\u003c/strong\u003e:243-260.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Catch up growth, Prematurity, Low birth weight, Stunting, Wasting, Underweight","lastPublishedDoi":"10.21203/rs.3.rs-126512/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-126512/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction \u003c/strong\u003eAdvances in neonatal care have led to the increasing survival of preterm/low birth weight infants worldwide. However, there is limited data on growth outcomes following preterm births especially in low and middle income countries. We assessed the catch-up growth, nutritional status and associated factors of Ugandan children who were born preterm/ low birth weight at Mulago National Referral Hospital.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe enrolled children aged 22-38 months who had been born as preterm with low birth weight and their mothers. Participants were identified and recruited from the follow up clinic for preterm babies discharged from the neonatal unit of Mulago Hospital. Anthropometric measurements for mothers and children were taken. The children’s weight for height z-scores, height for age z-scores, weight for age z-scores, head circumference and mid upper arm circumference (MUAC) were taken and the mothers’ body mass index were generated based on the World Health Organization standards. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOf the 251 children and mother pairs recruited, 129 children (51.4%) were male, the mean age was 29.7 months (SD±4.5) and the mean maternal age was 29.9 (SD±5.3). 101(40.1%) of the children enrolled had attained catch up growth on the normal anthropometric measurements for their age. Among the participants, the prevalence of wasting, underweight and stunting was: 8 (3.2%), 36 (14.4%) and 106 (42.2%) respectively. Factors associated with stunting were male sex (AOR 2.36, 95% CI 1.42 to 3.95); \u003cstrong\u003ep=0.001\u003c/strong\u003e), maternal age ≤ 25years: AOR 2.27 (95%CI 1.13, 4.52); p= \u003cstrong\u003e0.020\u003c/strong\u003e, and maternal height \u0026lt;150cm: AOR 5.57(95%CI 1.90, 16.94); P=\u003cstrong\u003e0.002.\u003c/strong\u003e\u0026nbsp;Associations with underweight in the children were; birth weight ≤1500 gms: AOR 2.38(95%CI 1.14, 4.95); p=\u003cstrong\u003e0.020\u003c/strong\u003e and post-natal hospitalization of more than 14 days: AOR 5.93(95%CI 1.96, 17.90); p=\u003cstrong\u003e0.002\u003c/strong\u003e.\u0026nbsp;For 246 (98.8%) participants, MUAC was normal (≥ 12.5 cm) and for 216 (86.8%) the head circumference was within normal range for age.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Of the children born preterm/LBW 40.1% of the participants had attained the expected catch up growth at 2 to 3 years of age, 42.2% were observed to be stunted while 14.4% were underweight both higher than the national levels. Targeted interventions are specifically needed for children born with very low birth weight, those requiring long postnatal hospitalization, males and those born to short or young mothers.\u003c/p\u003e","manuscriptTitle":"Catch-up growth and nutritional status of preterms born at a Ugandan tertiary hospital: An Observational study.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-12-18 15:22:52","doi":"10.21203/rs.3.rs-126512/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bd0fddc8-b2fa-4b03-b74e-dc91e6d68a8e","owner":[],"postedDate":"December 18th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":1529995,"name":"Nutrition \u0026 Dietetics"}],"tags":[],"updatedAt":"2021-03-08T12:14:15+00:00","versionOfRecord":[],"versionCreatedAt":"2020-12-18 15:22:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-126512","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-126512","identity":"rs-126512","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}