Factors determining hemoglobin levels in vaginally delivered term newborns at public hospitals in Lusaka, Zambia

Background Limited data is available regarding the prevalence of neonatal anemia and its associated risk factors in areas with constrained resources. Subject and methods In a cross-sectional study, data pertaining to socio-demographic and clinical characteristics of 489 mother-singleton, term newborn pairs were consecutively collected from the admission wards of six public hospitals in Lusaka. The information was then analyzed to determine the prevalence of newborn anemia and its associated risk factors. Newborn and maternal anemia were defined as hemoglobin levels below 15g/dl and 11g/dl, respectively. The relationship between the variables was explored using Chi-square tests and a binary logistic regression model. The findings were reported in terms of p-values, odds ratios, and 95% confidence intervals. Results The prevalence of anemia and severe anemia in newborns was 72.4% and 2.5% respectively, while in mothers it was 30.5% and 14.7% respectively. Delayed cord clamping was performed in 71.4% of the deliveries, and 86.5% of newborns had their hemoglobin levels estimated between 4-6 hours after birth. Maternal pre-delivery hemoglobin data were obtained from the hospital records of 246 (49.7%) out of the 489 mothers in the study. The majority (63.4%) of maternal hemoglobin levels were determined more than 4 weeks before delivery, and this infrequent hemoglobin assessment was significantly associated with newborn anemia (p<0.001; OR 3.60; 95% CI 1.81, 7.14). Additionally, 11% of the 489 mothers had underlying medical conditions, which were also significantly associated with newborn anemia (p=0.019; OR=2.96; [95%CI 1.20, 7.32]). The top three maternal medical conditions were HIV (35.2%), hypertension (25.9%), and Hepatitis B virus infection (13%). Maternal age was significantly associated with newborn anemia, with teenage pregnancy posing the highest risk (93.8%; p<0.001; OR 5.68; [95%CI 1.94, 16.60]). Furthermore, primiparous (p<0.001; OR 5.46 [95% CI 2.02, 14.93]), para 2 (p=0.014; OR=2.11 [95% CI 1.16, 3.83]), and multiparous (p=0.009; OR=4.77; [95% CI 1.48, 15.35]) mothers were more likely to produce anemic newborns compared to other parity. Newborns born before 40 weeks gestation were 3.11 times (95% CI 1.75, 5.52) more likely to have anemia, p<0.001, compared to full-term babies. Normal birthweight babies were less likely to become anemic compared to low birthweight babies (p=0.003; OR=0.31 [95% CI 0.14, 0.68]). Conclusion Enhanced antenatal care for pregnant mothers in resource-limited settings is essential, with particular focus on maternal hemoglobin, nutrition, and medical conditions. Attention should also be given to teenage pregnancy, primiparous and multiparous mothers, as well as preterm and low birthweight babies, to prevent newborn anemia and consequently reduce infant morbidity and mortality.