Prevalence and determinants of low-birth-weight deliveries at four district hospitals in Kigali, Rwanda: a cross-sectional study

BACKGROUND: Low birth weight (LBW) is a significant public health concern, particularly in developing countries, because it is associated with increased neonatal and infant morbidity and mortality. In Rwanda, LBW remains a critical issue affecting the overall health and development of children. Understanding the factors contributing to LBW is essential for designing effective interventions to reduce its prevalence and improve maternal and child health outcomes. We aimed to determine the prevalence and determinants of LBW among neonates delivered at four district hospitals in the City of Kigali Province, Rwanda. METHODS: A hospital-based retrospective cross-sectional study was conducted among neonates delivered at three public and one private district hospital located in the City of Kigali from November 2023 to February 2024. All available neonatal medical records that met the inclusion criteria were reviewed using retrospective chart review approach. Data analysis was performed via STATA version 17 to conduct descriptive, bivariate, and multivariate logistic regression to determine the adjusted odds ratios (AORs) with 95% confidence intervals (CIs) and corresponding P-values for the determinants of LBW. RESULTS: The prevalence of LBW was 8.2% (95% CI: 7.6-8.8; n = 453/5520). Significant determinants included HIV-positive status (AOR = 2.07, 95% CI [1.01-4.22], p = 0.046), indicating more than twice the odds of delivering an LBW infant compared to HIV-negative mothers; female neonates (AOR = 1.52, 95% CI [1.21-1.89], p < 0.001); preeclampsia/eclampsia (AOR = 4.46, 95% CI [2.32-8.58], p < 0.001); and hospitalization during pregnancy (AOR = 4.34, 95% CI [2.20-8.56], p < 0.001). Preterm birth (< 38 weeks gestation) was the strongest determinant (AOR = 16.85, 95% CI [13.19-21.52], p < 0.001). CONCLUSION: The prevalence of LBW among neonates in Kigali was 8.2%. Maternal HIV-positive status, female child sex, preeclampsia/eclampsia, and prior admission during current pregnancy were key determinants of LBW. Strengthening antenatal care and targeted maternal health programs, especially for teenage mothers, HIV-positive pregnant women, and women with hypertensive disorders of pregnancy, can help address these factors and reduce LBW rates in Rwanda.