Growth Patterns and Factors Associated With Loss to Follow-up at Two Weeks Post-discharge Among Low Birth Infants at Knh

Abstract

Background: Low birth weight (LBW) infants are frequently discharged from hospital growth retarded and show reduced growth postdischarge. Neonatal growth failure has been linked to increased mortality, higher rehospitalization rates and neurological abnormalities. Neonatal follow-up clinics are an important avenue for identifying growth failure among LBW infants post discharge from the newborn unit. Despite this recognized benefit they often have high attrition rates. Mothers of LBW infants often experience exacerbation of parenting strains as they transition home. The growth trends, rates of loss to follow-up (LTFU) among LBW newborns at their initial neonatal outpatient clinic (NOPC) visit and maternal experiences as they transition home with their LBW infants have not been studied at Kenyatta National Hospital (KNH). Broad objectives: To determine growth patterns of LBW infants, factors associated with LTFU and to describe the maternal experiences as they transition with their LBW infants to post discharge care two weeks after being discharged from the newborn unit (NBU). Methodology: A mixed-methods approach was used. A longitudinal approach was used in the quantitative component to assess growth patterns and risk factors for LTFU. This involved taking anthropometric measurements and using a standardized questionnaire to collect data on infant, mother and environmental characteristics. Two weeks following discharge, the anthropometric measures were retaken at the NOPC. In-depth interviews (IDIs) were conducted with 21 mothers during their NOPC visit following NBU discharge to learn more about the difficulties they encountered when taking care of their infants at home. Mothers who skipped the initial clinic were called to find out the factors that caused them to skip the appointment. Data analysis: Analysis of quantitative data was performed using R version 4.3.0. Means, standard deviations, medians and interquartile ranges were used to summarize continuous variables. Categorical variables were summarized using frequencies. Odds ratios (ORs) were used to assess associations, which were considered statistically significant at P<0.05. Qualitative data was analyzed using Mistral. Results: A total of 136 LBW infants were enrolled into the study and 21 IDIs were conducted. Majority (63.24%, 86/136) returned to the NOPC 2-week postdischarge. Only 19.5% of the LBW infants who returned for the two-week visit had a weight gain of >15g/kg/day two weeks post discharge from the NBU (P<0.01). Factors that were statistically significantly positively associated with a weight gain of >15g/kg/day were: mother having secondary level education (OR 2.02, 95% CI 1.96-2.1), absence of maternal illness after delivery (OR 0.42, 95% CI 0.31- 0.64), breastfeeding at initiation of feeds (OR 1.74, 95% CI 1.51-1.96), breastfeeding as the mode of feeding at the two week review (OR 2.10, 95% CI 2.08- 2.12), spouse assisting in infant care (OR 3.2, 95% CI 3.17-3.23) and absence of infant illness after discharge (OR 1.45, 95% CI 1.41-1.51). Mothers who were employed had lower odds of LTFU OR 0.32 (95% CI 0.14-0.80). Longer distance from the nearest health facility and to KNH were associated with higher odds of LTFU (OR 1.09, 95% CI 1.0-1.2 and OR 1.02, 95% CI 1.0-1.04, respectively). The commonest reason (25.93%) given for failure to attend the first NOPC was lack of funds to pay the consultation fee. Other reasons given were; the mother thought the baby was well, long distance to KNH, they went for follow-up at a nearby clinic, the mother did not have anyone to accompany her to the clinic and some mothers did not see the need of attending the clinic. The themes that emerged from the qualitative analysis were; mothers felt they were adequately prepared by the nurses to take care of their LBW infants at home. Mothers experienced challenges such as financial constraints, infant illness after discharge and lack of

social support. A facilitator of clinic attendance was short distance to KNH. Vaccination schedule for their LBW infants was not clearly understood by the mothers. Conclusion: Majority of the LBW infants had poor weight gain two weeks postdischarge from the NBU. Short distance from KNH and mother being employed were associated with lower odds of LTFU. Mothers challenges were financial constraints, poor social support, infant illness after discharge and poor understanding of the vaccination schedule. Inclusion of growth monitoring charts in the NBU file to enable close monitoring of weight gain, consider subsidizing the consultation fee for the NOPC and give patients who live far away from KNH alternative hospitals with a NOPC where they can receive follow-upservices.