The total deliveries with normal birthweights and above for the study period were 3,506, singleton of which 24.1% were macrosomic babies. The mean birthweight was 3793.67±1886.1 grams. Figure 1 shows the distribution of birthweights in all children, male and female infants. Table 1 shows the descriptive statistics of the study sample. About 73% of mother included in this study had normal BMI and 50% of infants were male. Seven percent of the deliveries occurred through caesarian section. The mean maternal age was 28.0±7.0, parity was 3.1±2.1, mean maternal weight was 561.1±101.2, mean height was 1563.6±58.6 and mean a number of ANC visit was 4.1±6.0. About 63% mothers had primary education. About 80% of participants were rural dwellers whilst nearly half of the participants were residing in the southern region. As regards community wealth and education conform to their tertiles.
Table 1 also shows the results of the bivariate analysis. At the individual level, the prevalence of macrosomia was highest in male children, children who were products of caesarian births. The mean age of mothers that had macrosomic babies was significantly higher than that of mothers with normal birth weight babies (28.9±7.5 years vs. 27.7±6.9 years). The mean parity of mothers that had macrosomic babies was significantly higher than that of mothers with normal birth weight babies (3.5±2.2 children vs. 2.9±2.0 children). The prevalence of macrosomic was also highest in mothers with no formal education, had a blue collar job, and resided in poorest households. At the community level, the prevalence of macrosomia was highest in infants from urban areas, central region, poor communities and communities with low percentages of women with primary education.
Table 2 shows a correlation between birthweight and a selected subset of variables. The correlation ranged from weak and negative between female community education and birth weight to weak and positive between parity and birth weight. Figure 2 shows the scatter plots of the relationship between birthweight and a selected subset of variables. Apart from the mean percentage of community female with primary education and above and mother’s BMI, parity and mother’s age were positively associated birthweight.
Random effects – Risk factors for Macrosomia
The findings of the multilevel multivariate logistic regression are shown in Table 3. The contextual-level variance indicated that the total variance on the risk of macrosomia can be attributed to the community in which the mothers were living (Model 1). This could be justified by the statistical significance variation in the communities area variance (AV) = 0.351; standard error (SE) = 0.089; p <.0001. The ICC was 0.0965, implying that approximately 10% of the total variation in fetal macrosomia can be attributed to the communities. In Models 2 and 3, the variation remained statistically significant, even after the adjustment for individual- AV = 0.270; SE = 0.088; p0.0010 and community-level factors AV = 0.235; SE = 0.082; p0.0021 respectively. The estimated proportional change in variance (PCV) indicated that about 23% and 33% of the contextual-level variance was explained by the individual and community-level risk factors respectively. The ICC showed that about 8% and 7% of the total variance in the community could not be explained even after adding individual level and community level factors respectively. Furthermore, in Model 4 the variation remained statistically significant even after adjusting for individual- and community-level factors AV = 0.236; SE = 0.086; p0.0032. The PCV showed 44% of the contextual-level variance of complete immunization can be explained by the individual and community-level factors compositional characteristics. However, ICC showed that about 7% of the total variance remained unexplained even after adjusting for individual- and community-level factors. Fixed effects – Risk factors for Macrosomia Table 3 (Model 4) shows adjusted fixed effects of individual and community–level factors on the risk of fetal macrosomia. At the individual level, male infants had increased odds of being macrosomic (adjusted odds ratio aOR: 1.46; 95% confidence interval 95%CI: 1.23–1.72) compared to girls. Infants who were not delivered through cesarean section, had reduced odds of being macrosomic (aOR: 0.52; 95% CI: 0.38–0.71) compared caesarian deliveries. The risk of macrosomia was positively associated with an increase in parity (aOR: 1.09; 95% CI: 1.01–1.7). Furthermore, the odds of being macrosomic was increased in infants who born to mothers with no formal education (aOR: 2.64; 95% CI: 1.85–3.76) and primary education (aOR: 2.06; 95% CI: 1.60–2.66). At community level the odds of being macrosomic was reduced in infants from communities with the middle (aOR: 0.71; 95% CI: 0.56–0.88) and high (aOR: 0.60; 95% CI: 0.46–0.78) percentage of mothers with primary education and above.