LBW has been associated with an increased risk of respiratory and diarrhoeal disease [9]–[11], impaired growth and mental development, and poor outcomes in young adulthood [12]–[15]. A round-the-clock hospital-based clinical surveillance system has been operating in the area since 1997 and has been described in detail elsewhere [33]. In brief, all children attending the paediatric department are seen by project health personnel who administer a detailed standardized clinical and demographic questionnaire that documents signs and symptoms including birth weight. No, Is the Subject Area "Hospitals" applicable to this article? The months a baby spends in the womb, along with the first 12 months after birth, are arguably the most important time of all.1 Similarly, a growing percentage of LBW and VLBW babies in Shelby County and throughout Tennessee are surviving their first year of life. In addition, the study assessed the burden of mortality associated with LBW as well as the relationship between weight at birth and costs of routine health care for the household. It was estimated that out of 1000 babies born in Manhiça, 120 are LBW, and of these, 10 are VLBW. Including deaths, the percentage of outpatient attendance was 92.44% for non-LBW weigh babies and 84.6% for LBW babies [Chi2(17) = 19.78; p = 0.285]. Preterm/low birth weight infant hospital stays have an average cost of $15,000 and an average length of 12 days, versus $600 and 1.9 days for full-term, normal birth weight babies. However, the aim of the estimated regression between household costs and weight at birth was not to assess the existence of a relationship but rather to measure, through univariate analysis, the magnitude of such a relationship. Skewness of cost distribution is a well known issue and both probabilistic sensitivity analysis and logarithmic transformation were used to resolve it [46]. Very low birth weight (VLBW) babies, defined as weighing 1.5 kg or less at birth, have a high risk of death and disease during the first year of life [4]. Information on health provider costs was collected by interviewing clinical staff to illustrate routine health care and resources required to provide necessary health care for LBW babies at the MDH and MCH. From 2005 to 2007, there were 40,193 live births per year in the county; of these 2,712 (6.7%) were low birth weight. You'll hear this term if your baby weighs less than 2.5kg when they’re born. 8oz. Any measure of mortality or morbidity burden caused by LBW should include the long term disability associated with this health status at birth. Eighty percent of pregnant women in this area have institutional delivery (Nhacolo A, personal communication). Considering 3,322 live births, the overall DALYs due to LBW in the study area were 2,746.06. Medicaid is the largest payer for maternity care in the United States. Including deaths, this percentage was 23.5% for non-LBW weigh babies and 37.6% for LBW babies [Chi2(3) = 11.93; p = 0.008]. Direct and indirect household costs for routine health care were 24.12 US$ (CI 95% 21.51; 26.26). The study was carried out in Manhiça, Maputo Province, a semi-rural area in Southern Mozambique. The indirect costs calculated were income or welfare losses incurred by caretakers because of their children's need for care. 2500 g – 4200 g is considered as the normal weight for a newborn baby, for a full term delivery. �����Q�cJ��z9�>7I�fyR�_��i���j�z_L Yes This study aimed at estimating the costs of health care of LBW babies for the health system and the household during the first year of life in a rural area of Southern Mozambique. Household costs were not calculated directly from the study sample. Applied to the target population of 1000 newborns considered in the analysis, it was estimated that 8 out of 10 VLBW and 17 out of 110 LBW would die during the first year of life. How much does premature birth cost society? Source: https://wonder.cdc.gov. The cases were studied to find out the incidence and relation of maternal age, parity, gestational age, sex, etiological factors, mode of deliveries with Low Birth Weight (LBW) babies. One of the known causes of this condition is premature birth. For instance, the use of point of care diagnostic tests at the ANC, followed by adequate treatment, against frequent causes of LBW, is likely to have an impact decreasing this burden. Household cost distribution for routine health care appeared positively skewed, with one high value of 156.86 US$ (which included the cost of referral to the tertiary hospital), while the majority of the estimated costs were concentrated around similar lower values. Years of Life with Disability (YLDs), for the first weeks of life, were included in DALYs calculation, applying a duration disability of 2 to 21 days (uniform distribution) and a disability weight of 0.256 for treated low birth weight sequelae. The reason behind this choice is related to the difficulties of estimating the economic value of lost lives [54]. PLoS ONE 6(12): The inclusion of these costs in the estimate undertaken in this study was conditioned on significant positive difference in the number of visits or admissions among LBW compared to non-LBW babies during the first year of life [36]. Here’s how the numbers add up: $16.9 billion in medical and health care costs for the baby; $1.9 billion in … Costs incurred by the households were collected through exit surveys. https://doi.org/10.1371/journal.pone.0028744.t003. The calculation of costs associated with hospital admissions and outpatient attendances was based on estimates of unit costs at Level I and II health facilities produced by the Ministry of Health [34]. An average baby weighs around 8 pounds (3.6 kgs). No, Is the Subject Area "Infants" applicable to this article? The cost of a routine visit at the MDH was estimated as the monetary value of the proportion of health workers' time spent in this activity. Mean birth weight was 2.26 kg, and 69% were females. Forty six caretakers of babies born with LBW were identified and interviewed at the time of hospital discharge or at outpatient attendance for an acute illness episode. December 13, 2018. Although taking into account differences in health system organizations and LBW prevalence, extrapolation of these findings to other Sub-Saharan African countries might be possible for the similar resources available for the treatment and care of LBW babies. On the other hand, welfare losses borne by caretakers without a formal and remunerated occupation (housewives) were conservatively estimated by multiplying the amount of time spent away from their main activity because of child's illness times the average national minimum statutory monthly wage in force in Mozambique at the time of the study (37 US$) [40]. An increase in birth weight of 100 grams would lead to a 53% decrease in these costs. A Demographic Surveillance System (DSS) is run by the Centro de Investigaçâo em Saúde de Manhiça (CISM) and covers Manhiça town and surrounding villages, the Manhiça study area, with a total population under surveillance of over 80.000 inhabitants, which constitutes about 60% of the population of the Manhiça District. Information on birthweight was registered for 990 of them (98.6%), and of these 117 were LBW babies (12%) [36]. Fifty five caretakers of LBW babies were interviewed after hospital delivery, and another 32 at attendance to the routine weighing visit (Table 3). H�lW�rۺ}�W���W$E�j:��$N;+�s'�DA�PЊ��oz��k���].H�v2��X@K`�{�zq��d���d2���O�N�4��Q>O,vg������o��ƂeQ��g_�Ż���|O�������7�n�����x��������O�[�?��i����t��:���?+�g�Q2��eZ����c��}�����Ӵ�˲�N=_ K�Y�L^.v�����t����2ϓQ��{���e�,�O=�����׼�N����_dYϣK܃�tgy:=]�ݫ__D8�O�s�Ӣw;ٺt���l~��ꗛ�����HN��F_ݾ�n9��ɢ��~�}�$�t^�K�ֻՇ�H��ʸ-��T��c�ݾ~|:g���h�e*��Q��$[�|�&��u��hVW�V��N6N��A�k^�3�k�R�U[;%��I�� Costs associated with LBW excess morbidity were calculated on the incremental number of hospital admissions in LBW babies compared to non-LBW weight babies. Costs associated with LBW excess morbidity were calculated on the incremental number of hospital admissions in LBW babies compared to non-LBW weight babies. Households also bore a significant economic burden, being the incremental LBW costs per child for LBW care more than 16 times higher than the cost, estimated in the same area, of an episode of malaria in a child [50]. A child weighing less than 1,200 grams (about 2 pounds, 10 ounces) at birth or a child weighing between 1,200 and 2,000 grams (about 4 pounds, 6 ounces) at birth … After hospital delivery, mothers of babies with weight at birth ≤2 kg are trained on kangaroo mother care (KMC) techniques [38]. This imbalance may be explained by the significant association between female gender and LBW observed among newborns in the area, and by the existence of a trend towards increased neonatal mortality among male LBW babies compared to female LBW babies [51]. DALYs due to excess mortality were calculated based on the evidence that LBW is a statistically significant risk factor for infant death in the area and it is, thus, responsible for incremental mortality compared to non-LBW weight [36]. https://doi.org/10.1371/journal.pone.0028744.t004. At these visits their health status is evaluated. You'll hear this term if your baby weighs less than 2.5kg (5.5lb) when she's born. United Health Foundation. Let us try to understand this phenomenon better. There are recent data suggesting that low birth weight (LBW) and preterm birth may be risk factors for hip osteoarthritis. Unit costs were obtained from previous estimates and data provided by the administration department of the MDH [34]. About one in 15 babies who are born in Australia have a low birth weight (AIHW 2020). 1 Babies born weighing less than 2,500 grams or 5 lbs. Citation: Sicuri E, Bardají A, Sigauque B, Maixenchs M, Nhacolo A, Nhalungo D, et al. The number of required visits at the health facility (N) was estimated according to previous estimates of daily weight gain in LBW babies [39], using the following formula:Costs associated with outpatient visits and hospital admissions during the first year of life were estimated as the sample average cost of a hospital admission or of an outpatient attendance. Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain, Most commercial activities are concentrated along the main road from Maputo to Beira. Prenatal interventions that result in a normal birth (over 2500 grams or 5.5 pounds) saves $59,700 in medical expenses in the infant's first year. Infants born with LBW have added health risks which require close management, often in a neonatal intensive care unit (NICU). A baby whose birth weight is less than 2.5 kilograms is considered to have low birth weight. The extraordinary cost of managing the medical, educational, and social needs of extremely low-birth-weight newborns, as well as term newborns with perinatal asphyxia, often are not discussed with parents early in the infant's care. Yes here. Health system costs for routine health care of LBW babies were calculated as the sum of costs of incremental hospital admission days after delivery and weighing visits. Geographical and demographic characteristics of the area have been described elsewhere [32]. In 2007, the Institute of Medicine reported that the cost associated with premature birth in the United States was $26.2 billion each year. Discover a faster, simpler path to publishing in a high-quality journal. Direct and indirect household costs for routine health care were 24.12 US$ (CI 95% 21.51; 26.26). Ǹ C��k+���l��ua�3���tǘ�;}�A��K��N������Ab��� F#]k`�i G9�6�bo`��)��F�WF[{ae���;��>4ፖm;qd��)a�*�c��)��P�O�,zF�e-�-�����e���t�b������:LY���a�۪~�dT��^�{ vm��^9��ɔǐ��?pB���� %$��6��rG6:�n�R6��zV� Q����t����G�� ��j�2��R���wn[I�K���˜ȣ䕭&$���jd�@�P�א?0 ��R���\�IE���7�l��Z3`���F4��w Experiences during this time can have life-long effects on intellectual, emotional, and social functioning. Yes Copyright: © 2011 Sicuri et al. There are two main towns in the district, Manhiça and Xinavane, but most of the population lives in small dispersed villages. All LBW babies receive iron supplementation and multivitamins for 3 months [37]. Low birth weight is one of the prominent ‘new baby concern’ for most parents. Incremental costs to the households due to hospital admission during the first year of life were 8.50 US$ (CI 95% 6.33, 10.72) of which 75% were indirect costs (Figure 2). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The average number of days admitted to the MDH and the average number of routine weighing visits were 3.44 and 2.13, respectively. While some long term LBW costs estimates have been undertaken in high-income countries [55], these are extremely scarce in low-income countries [56]. To examine the cost-effectiveness of prophylactic probiotics on necrotizing enterocolitis (NEC) prevention in very low birth weight (VLBW) infants. Manhiça Health Research Centre (CISM), Manhiça, Mozambique, Affiliations The study was approved by the National Mozambican Ethics Review Committee and the Hospital Clinic of Barcelona Ethics Review Committee. Direct and indirect household costs for hospital admissions were 8.50 US$ (CI 95% 6.33; 10.72). broad scope, and wide readership – a perfect fit for your research every time. "Percentage of infants with low birth weight in the United States as of 2018, by state*." For premature and/or low birth weight babies (less than 37 weeks gestation and/or less than 2500 grams), the average cost was $55,393, of which $54,149 was paid by the health plan. Cost analysis studies too reflected changes of cost in (inverse) relation to birth weight and this includes a local study by Cheah et al. Even though the economic evaluation of interventions to reduce this burden is essential to guide health policies, data on costs associated with LBW are scarce. Lifelong Cost. No, Is the Subject Area "Neonates" applicable to this article? For a tiny baby born at 24 weeks, this may mean gaining about five grams (0.20 ounce) per day at first. For instance, non-LBW term newborns with an eutocic delivery are admitted less than 24 hours (cost of 1 bed/day from Table 2 = US$ 17.28) and, on average, 0.7 times during the first year of life for an average 6 nights (US$17.28*6). We are very grateful to the babies and their caretakers who participated in the study. Yes According to international guidelines, the follow up of LBW babies requires weekly visits to the health facility for weight control until they reach 2.5 kg. While the majority of babies in the U.S. arrive on or around their due dates and at a normal weight (on average 7.5 pounds), about 1 in 10 infants are born prematurely and about 8 percent have a low birth weight. During the study 1004 babies were born alive at the MDH and were followed up for one year through the clinical and demographic surveillance systems in place in the area. There were 172 patients with LBW babies out of 1517 patient. Analyzed the data: ES. The distribution of household cost was positively skewed with a median value of 4.06 US$, and minimum and maximum values of 0.19 and 156.86 US$, respectively (Figure 1). It was estimated that, on average, it takes 7 minutes per baby for a nurse to provide training on KMC techniques. �7��0��!��p�! Preterm/low birth weight infant stays averaged $15100, with a mean length of stay of 12.9 days versus $600 and 1.9 days for uncomplicated newborns. The independent variables were a constant term and weight at birth, measured in grams. Funding: Elisa Sicuri is supported by a grant from the MiP Consortium, which is funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Tropical Medicine, and by a CIBERESP (Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica) fellowship. We observed a gender imbalance, being 69% of LBW babies females and 31% males. Including the 9 twin babies, there were total 181 babies with LBW. Why some babies have low weight at the time of birth is explained below. Hampson G(1), Roberts SLE(2), Lucas A(3), Parkin D(4). To our knowledge, this is the first economic evaluation of the costs associated with LBW in rural areas of low-income countries, and shows that LBW carries a significant economic burden both for the health system as well as for the families. The Centro de Investigaçao em Saude de Manhica (CISM) receives major core funding from the Spanish Agency for International Cooperation (AECI). Therefore, the average costs associated with each non-LBW baby is US$ 121 (17.28+17.28*6). Adjacent to the CISM is the Manhiça District Hospital (MDH), a 110 bed health facility, which provides preventive and curative services. No, Is the Subject Area "Body weight" applicable to this article? Through the comparison between DALYs due to the death of VLBW babies estimated in this study (257.44) and DALYs from all neonatal mortality in the area (836.68), it can be estimated that VLBW contributes to more than one third of the burden of neonatal mortality in the area. Most of these deaths occur during the neonatal period when the risk of death is six times higher than in high-income countries [6]–[8]. LBW, defined by the World Health Organization (WHO) as weight at birth of less than 2.5 kg irrespective of gestational age, has adverse consequences on infant survival and physical and cognitive development [2], [3]. The extraordinary cost of managing the medical, educational, and social needs of extremely low-birth-weight newborns, as well as term newborns with perinatal asphyxia, often are not discussed with parents early in the infant's … Information on household costs for LBW babies was collected between July and November 2007 at the MDH through exit survey. LOW BIRTH WEIGHT BABY 1. Logarithmic transformation of costs was carried out because of distribution skewness [46]. DALYs were calculated with reference to a global life expectancy (both sexes) for the year 2007 of 68 years [47], age-weighted using the standard age weighting function [48], and discounted at 3%. https://doi.org/10.1371/journal.pone.0028744.g001. We thank the staff of the Manhiça District Hospital, especially those at the maternity clinic and at the administration department, and the staff of the Manhiça Health Research Center (CISM).