Is home birth a marker for severe malnutrition in early infancy in urban communities of low-income countries?

This matched case-control study set out to determine the association between place of delivery and severe undernutrition in early infancy in a low-income country. All infants (aged 0-3 months) with severe undernutrition attending four well-child clinics for routine immunization in inner-city Lagos, Nigeria were matched for age and sex with well-nourished peers. The main outcome measures were the adjusted-matched-odds ratios from conditional logistic regression analysis of undernutrition based on z-scores below -3 for weight-for-age, height/length-for-age and body-mass-index-for-age using current World Health Organization's Multicentre Growth Reference (WHO-MGR). From an eligible population of 7075 mother-infant pairs, 918 severely undernourished infants were enlisted as cases matched with 1836 controls. While there was no statistically significant difference between infants born outside hospitals as a group compared to those born in hospitals, infants delivered at residential homes compared to public hospitals had two-to-three fold odds of being severely underweight (p=0.002), severely stunted (p < 0.001) and severely wasted (p=0.008) after controlling for potential confounders. Infants delivered in private hospitals were also significantly associated with severe stunting (p=0.032). This study demonstrates that delivery in homes and private hospitals are potential markers for severe undernutrition in early infancy in this urban population and merits closer attention in any early nutritional intervention in comparable settings of low-income countries.