Association between adequacy of antenatal care and neonatal outcomes in Rwanda: a cross-sectional study design using the Rwanda demographic and health surveys.

BACKGROUND: Maternal and neonatal health services are life-saving interventions for neonatal health outcomes. As Rwanda endeavors to accomplish sustainable development goals, adequate ANC is essential to lessen of neonatal mortality. The utilization of ANC continues to be inadequate and high neonatal mortality rate persevere in Rwanda. Understanding the direct and indirect factors that affect newborn health outcomes is necessary for well-targeted interventions. However, few studies had been conducted in Rwanda to evaluate the importance of ANC in improving neonatal health. This study therefore assessed the association between ANC and neonatal outcomes. METHODS: The Demographic and Health Surveys (DHS) are household surveys that are cross-sectional, nationally representative, and used to collect data on population, health, and nutrition. Data from the 2010,2015 and 2020 Rwanda Demographic and Health Surveys (RDHS) were used. The study involved 17,747 women between the ages of 15 and 49 who had a single live birth and at least one ANC visit in five years prior to each survey. Bivariate and multivariable logistic regression, a survey adjusted for clusters at multiple level, and the estimation of adjusted odds ratios (aOR) and 95% confidence intervals were used to evaluate the relationship between the outcome and independent variables. RESULTS: Out of 17,747 women ;7638(42.91%) of the mothers had adequate ANC visits and low birth weight (LBW) was found among 833(4.63%) neonates. The birth of a LBW baby (aOR:4.64;95%CI:3.19,6.74) was directly related to increased odds of neonatal death. Mothers aged 20-34 years (aOR:0.40; 95%CI:0.20,0.81), a preceding birth interval of 24months or greater (aOR:0.41:95%CI:0.28,0.60), baby being female (aOR:0.72; 95%CI:0.54,0.96), having adequate ANC visits (aOR:0.64;95% CI:0.46,0.89) and the birth order of the newborn being ranked second or third (aOR:0.60; 95%CI:0.38,0.95) were negatively associated with neonatal death. CONCLUSION: Health education programs targeting teen and primigravida mothers should be encouraged. Among the newborn survival interventions, addressing short birth intervals and the effective management of LBW cases should be explored. The findings confirm the fundamental importance of adequate ANC in the neonatal survival.

Association between quality antenatal care and low birth weight in Rwanda: a cross-sectional study design using the Rwanda demographic and health surveys data.

BACKGROUND: Low birth weight (LBW) is an important factor influencing infant morbidity and mortality. Pregnant women should receive a variety of interventions during antenatal care (ANC) that are crucial in improving birth weight. ANC visits alone do not promise that women have received all recommended antenatal services. However, there are limited evidence of the relationship between ANC quality and LBW in Rwanda. Therefore, the purpose of this study was to assess the association between quality ANC and LBW along with the factors influencing LBW and how quality ANC affects LBW in Rwandan pregnant women. METHODS: The Demographic and Health Surveys (DHS) are cross-sectional, nationally representative household surveys that collect population, health, and nutrition. In this Study we used three waves of Rwanda Demographic and Health Surveys 2010,2014-5 and 2019-20. A total of 16,144 women aged 15 to 49 years who had live births in the five years preceding each survey were included in this study. A stratified two-stage sampling methods was used to select the participants. The first stage involves selecting clusters (villages) from a list of all clusters in the country. The second stage involves selecting households within each cluster. A survey adjusted for clusters at multiple level and a bivariate and multivariable logistic regression was used to estimate adjusted odds ratios(aOR) and 95% confidence intervals to assess the association between the outcome and independent variables. RESULTS: The utilization of a high-quality ANC increased slightly over the three survey years and LBW had a slow decline. Out of 5813 women;201(3.45%) had high-quality ANC in the 2010 survey, and out of 5813 newborns,180(3.10%) were LBW. Out of 5404 women;492(9.11%) had high-quality ANC in 2015, and out of 5404 newborns,151(2.79% were LBW). Out of 5203 women,776(14.92%) had high-quality ANC in the 2020 survey year, and out of the 5206 newborns,139(2.67%) were LBW. In multivariable analysis, at a borderline limit high quality ANC was negatively associated with LBW(aOR:0.67;95%CI:0.43,1.05) compared to low-quality ANC. Higher birth orders of the newborn were negatively associated with LBW (aOR:0.63;95%CI:0.49,0.82 and aOR:0.44;95%CI:0.32,0.61 for 2nd -3rd and 4th and above respectively) compared to 1st orders newborn. Newborns from rich households were less likely to experience LBW than those from poor households (aOR:0.71;95%CI:0.55,0.91). Female newborns were associated with an increase of LBW (aOR:1.43;95% CI:1.18,1.73) than male newborns. CONCLUSION: The findings confirm the fundamental importance of a high-quality ANC on LBW. The findings could be utilized to develop monitoring strategies and assess pregnancy health assistance programs with a focus on LBW reduction.

Consumption of sugar sweetened beverages, artificially sweetened beverages and fruit juices and risk of type 2 diabetes, hypertension, cardiovascular disease, and mortality: A meta-analysis.

Introduction: Sugar-sweetened beverage (SSB) intake is associated with an increased risk of cardiometabolic diseases. However, evidence regarding associations of artificially sweetened beverages (ASBs) and fruit juices with cardiometabolic diseases is mixed. In this study, we aimed to investigate the association between the SSB, ASB and fruit juice consumption with the incidence of cardiometabolic conditions and mortality. Methods: Relevant prospective studies were identified by searching PubMed, Web of Science, Embase, and Cochrane Library until December 2022 without language restrictions. The pooled relative risk (RR) and 95% confidence intervals (CIs) were estimated for the association of SSBs, ASBs, and fruit juices with the risk of type 2 diabetes (T2D), cardiovascular disease (CVD), and mortality by using random-effect models. Results: A total of 72 articles were included in this meta-analysis study. Significantly positive associations were observed between the consumption of individual beverages and T2D risk (RR: 1.27; 95% CI: 1.17, 1.38 for SSBs; RR: 1.32; 95% CI: 1.11, 1.56 for ASBs; and RR:0.98; 95% CI: 0.93, 1.03 for fruit juices). Moreover, our findings showed that intakes of SSBs and ASBs were significantly associated with risk of hypertension, stroke, and all-cause mortality (RR ranging from 1.08 to 1.54; all p < 0.05). A dose-response meta-analysis showed monotonic associations between SSB intake and hypertension, T2D, coronary heart disease (CHD), stroke and mortality, and the linear association was only significant between ASB consumption and hypertension risk. Higher SSB and ASB consumptions were associated with a greater risk of developing cardiometabolic diseases and mortality. Fruit juice intake was associated with a higher risk of T2D. Conclusion: Therefore, our findings suggest that neither ASBs nor fruit juices could be considered as healthier beverages alternative to SSBs for achieving improved health.Systematic Review Registration: [PROSPERO], identifier [No. CRD42022307003].