BMJ Open · 7 authors, 6 centres
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This cross-sectional study of 362 preterm/low birth weight infants in rural Kenya found high rates of stunting (27.4%) and underweight (17.2%), with 8.6% showing neurodevelopmental delays and 1.9% with cerebral palsy risk. Caregiver concern for development was reported in 22.7% of cases, yet fewer than 2% identified malnutrition. These findings highlight the urgent need for routine monitoring and early intervention programs for these vulnerable infants in low-resource settings.
**Background:** Preterm (PT) birth and low birth weight (LBW) contribute to 25%–50% of neonatal deaths and 12% of under-5 mortality worldwide. Survivors are at risk for neurodevelopmental impairments, but data from community settings in low- and middle-income countries (LMIC) without neonatal intensive care units are extremely limited. In Kenya, 12% of births are PT and 10.5% are LBW. This study aimed to describe growth and neurodevelopmental outcomes of PT/LBW infants up to 18 months adjusted age in rural Migori County, Kenya.
**Methods:** This cross-sectional study was conducted between October 2018 and May 2019 among a subset of mother-infant dyads previously enrolled in the Preterm Birth Initiative Kenya (PTBi-K) cluster randomized controlled trial. Eligible infants were PT (gestational age <37 weeks with birth weight <3000 g) or LBW (<2500 g) delivered at 17 facilities, alive at 28 days, and approaching 6, 12, or 18 months ±2 weeks adjusted age. Caregiver interviews and infant assessments included sociodemographics, medical history, anthropometric measurements (weight, length), and three neurodevelopmental tools: the Ten Questions Questionnaire (TQQ), Malawi Developmental Assessment Tool (MDAT), and Hammersmith Infant Neurological Examination (HINE). WHO child growth standards were used to calculate z-scores for weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ). Neurodevelopmental delay was defined as meeting delay criteria on at least one tool. Univariate logistic regression examined associations with malnutrition and delay.
**Key Results:** Of 761 eligible infants, 362 (47.6%) were included (155 at 6 months, 159 at 12 months, 48 at 18 months). Most infants were female (60.2%), moderate to late PT (56.6% born at 34–<37 weeks), and LBW (64.4% with birth weight 1500–2499 g). Median gestational age was 36.3 weeks (range 22.0–41.7). Growth outcomes: stunting (LAZ <−2) was present in 27.4% (96/351), underweight (WAZ <−2) in 17.2% (59/343), and wasting (WLZ <−2) in 3.3% (11/339). Composite malnutrition (moderate/severe in at least one measure) was found in 34.0% (123/362). Malnutrition increased with age: 28.4% at 6 months, 37.1% at 12 months, 41.7% at 18 months. Males were more likely to be malnourished (OR 2.53, 95% CI 1.62–3.97), as were infants from multiple gestations (OR 1.72, 95% CI 1.08–2.75) and those with birth weight 1500–2499 g (OR 1.73, 95% CI 1.07–2.81). Neurodevelopmental delay on at least one tool was identified in 8.6% (31/362). MDAT pass/fail criteria identified delay in 6.4% (23/362), with gross motor most affected (4.1%). HINE scores <64 (indicative of cerebral palsy risk) were found in 1.9% (7/362). Caregiver concern on TQQ was reported in 22.7% (82/362). Neurodevelopmental delay was more likely in males (OR 3.55, 95% CI 1.62–7.79), underweight infants (OR 4.01, 95% CI 1.80–8.94), stunted infants (OR 2.96, 95% CI 1.39–6.33), and wasted infants (OR 2.76, 95% CI 1.03–7.36). HINE delay was associated with cesarean delivery (OR 9.27, 95% CI 2.01–42.82) and wasting (OR 7.28, 95% CI 1.56–34.03). Common illnesses included malaria (56.7%), diarrheal disease (55.2%), and serious febrile illness (42.3%).
**Clinical Implications:** This study reveals that PT/LBW infants in rural Kenya have higher rates of stunting and underweight than the general local population (26.4% stunting and 8.6% underweight in children under 5 in Migori County), yet fewer than 2% of caregivers identified malnutrition. Neurodevelopmental delays were present in 8.6%, with 1.9% at risk for cerebral palsy. These findings underscore the need for routine growth monitoring, caregiver education on appropriate growth, and early intervention programs for PT/LBW infants in LMIC. The successful use of standardized neurodevelopmental tools (MDAT, HINE) in a community setting demonstrates feasibility for broader implementation. Limitations include lack of term controls, small sample size for very/extremely PT infants, and potential selection bias (only 47.6% of eligible infants participated). Despite this, the study provides critical community-based data to inform policy and intervention planning for vulnerable infants in high-mortality settings.