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Malaria Infection, Poor Nutrition and Indoor Air Pollution Mediate Socioeconomic Differences in Adverse Pregnancy Outcomes in Cape Coast, Ghana

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  • Adeladza K Amegah
  • Obed K Damptey
  • Gideon A Sarpong
  • Emmanuel Duah
  • David J Vervoorn
  • Jouni J K Jaakkola

Abstract

Background: The epidemiological evidence linking socioeconomic deprivation with adverse pregnancy outcomes has been conflicting mainly due to poor measurement of socioeconomic status (SES). Studies have also failed to evaluate the plausible pathways through which socioeconomic disadvantage impacts on pregnancy outcomes. We investigated the importance of maternal SES as determinant of birth weight and gestational duration in an urban area and evaluated main causal pathways for the influence of SES. Methods: A population-based cross-sectional study was conducted among 559 mothers accessing postnatal services at the four main health facilities in Cape Coast, Ghana in 2011. Information on socioeconomic characteristics of the mothers was collected in a structured questionnaire. Results: In multivariate linear regression adjusting for maternal age, parity and gender of newborn, low SES resulted in 292 g (95% CI: 440–145) reduction in birth weight. Important SES-related determinants were neighborhood poverty (221 g; 95% CI: 355–87), low education (187 g; 95% CI: 355–20), studentship during pregnancy (291 g; 95% CI: 506–76) and low income (147 g; 95% CI: 277–17). In causal pathway analysis, malaria infection (6–20%), poor nutrition (2–51%) and indoor air pollution (10–62%) mediated substantial proportions of the observed effects of socioeconomic deprivation on birth weight. Generalized linear models adjusting for confounders indicated a 218% (RR: 3.18; 95% CI: 1.41–7.21) risk increase of LBW and 83% (RR: 1.83; 95% CI: 1.31–2.56) of PTB among low income mothers. Low and middle SES was associated with 357% (RR: 4.57; 95% CI: 1.67–12.49) and 278% (RR: 3.78; 95% CI: 1.39–10.27) increased risk of LBW respectively. Malaria infection, poor nutrition and indoor air pollution respectively mediated 10–21%, 16–44% and 31–52% of the observed effects of socioeconomic disadvantage on LBW risk. Conclusion: We provide evidence of the effects of socioeconomic deprivation, substantially mediated by malaria infection, poor nutrition and indoor air pollution, on pregnancy outcomes in a developing country setting.

Suggested Citation

  • Adeladza K Amegah & Obed K Damptey & Gideon A Sarpong & Emmanuel Duah & David J Vervoorn & Jouni J K Jaakkola, 2013. "Malaria Infection, Poor Nutrition and Indoor Air Pollution Mediate Socioeconomic Differences in Adverse Pregnancy Outcomes in Cape Coast, Ghana," PLOS ONE, Public Library of Science, vol. 8(7), pages 1-8, July.
    • Handle: RePEc:plo:pone00:0069181
    DOI: 10.1371/journal.pone.0069181
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    References listed on IDEAS

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    1. Van De Mheen, H. & Stronks, K. & Van Den Bos, J. & Mackenbach, J. P., 1997. "The contribution of childhood environment to the explanation of socio-economic inequalities in health in adult life: A retrospective study," Social Science & Medicine, Elsevier, vol. 44(1), pages 13-24, January.
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    1. Hanna Demelash Desyibelew & Abel Fekadu Dadi, 2019. "Burden and determinants of malnutrition among pregnant women in Africa: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-19, September.

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