GET THE APP

Epidemiology of Low Birth Weight in the Town of Sidi Bel Abbes (W
Journal of Nutrition & Food Sciences

Journal of Nutrition & Food Sciences
Open Access

ISSN: 2155-9600

Research Article - (2014) Volume 4, Issue 3

Epidemiology of Low Birth Weight in the Town of Sidi Bel Abbes (West of Algeria): A Case-Control Study

Ghani AEA, Mai H and Demmouche A*
Department of Biology, Faculty of Natural Sciences and life-Djillali University Sidi Bel Abbes-Liabes BP 89, Faubourg Larbi Ben M’hidi 22000, Sidi Bel Abbes, Algeria, E-mail: demmoucheabbassia@yahoo.fr
*Corresponding Author: Demmouche A, Department of Biology, Faculty of Natural Sciences and life-Djillali University Sidi Bel Abbes-Liabes, Algeria

Abstract

Introduction: The Low birth weight is defined as a live birth weighting less than 2500 g and it is considered to be a major determinant of the child survival, his health and development. Objective: This study examined the frequency and risk factors that influence birth weight <2.5 kg (LBW) in the region of Sidi bel Abbes (west of Algeria). Materials and methods: A descriptive prospective case-control study was done during the period of June 2012 to January 2013. Total samples were 1828 pregnant women and their newborns in neonatology department of Hospital Obstetrics and Gynecology in Sidi bel Abbes west Algeria. Results: At the end of this work, it appears a prevalence of 1828 new born, including maximum newborn babies 92.97% had birth weight 2.5 Kg or more and 128 newborns with low birth weight <2.5 Kg, or a rate of 7.02%. It was found that mean weight of newborn babies was 3386.95 ± 560.70 (g). This study confirms the close association between low birth weight newborn and prematurity, primiparity, short interpregnancy interval, multiple pregnancy, previous history of low birth weight, delayed of first antenatal visit, low pre-pregnancy BMI, gestational weight gain less than the recommendations, primary educated mothers, other complications and diseases which contributed to high prevalence of LBW included hypertension and gestational diabetes. Conclusion: It is essential to do a searching for pregnancies with higher risk of LWB like those who are primiparous or have short birth intervals, and it is also important to have better and more attentive prenatal care in order to reduce the incidence of LBW.

Introduction

Low birth-weight is a weight at birth less than 2,500 grams irrespective of gestational age [1]. The raison why 2.500 g has been chosen as a cut-off is based on the observations and research which found that if an infant is born weighing less than 2.500 g, he is more likely to die than heavier babies [2].

Every year it is estimated that 18 million LBW babies are born globally making up nearly 16% of all live births [3]. More than 95% of the low birth weight babies are born in developing countries. The estimated level of LBW in developing countries 16.5% is two-fold higher than the level observed in developed countries 7% [4]. In Europe the prevalence of LBW is of one in every seventeen infants, however in some regions of Asia the prevalence is of one in every two infants [5].

Birth weight determines the future mental and physical development of the newborn [6] and it can be caused by one of two reasons either by intrauterine growth retardation (IUGR) or by preterm birth or even in some cases by both. There is a change of the cause of the LWB according to the countries of its occurrence. For example, in developing countries it is caused by IUGR, however in the United States it is more frequently caused by preterm birth [7]. Children who survive LBW have a higher incidence of diseases, retardation in cognitive development and undernourishment.

LBW is also associated with predisposition for some future health issues like for example cardiac diseases or diabetes [8,9]. However, VLBW is more associated with the death of the infants at a rate that is 40 more higher than those with NBW [10]. In fact, even LBW infants are 25 to 30 times more at risks of death than NBW [11].

A variety of factors influence fetal growth, but they can be grouped into several general categories. The causes of LBW can be found in some biological determinants of the fetus and also of the mother, the medical care during the prenatal period, or the social and economic environment of the parents [12-14].

In order to reduce the rate of infant death, it is important to have reliable information on LBW rates, especially in developing countries. Therefore, the main objectives of this study were to determine the prevalence of LBW and to explore the effects of various maternal risk factors associated with low birth weighting in Sidi Bel Abbes, Algeria.

Materials and Methods

This prospective case-control study was conducted in neonatology department of Hospital Obstetrics and Gynecology in Sidi bel Abbes city, west Algeria during the period of June 2012 to January 2013, and the neonates were successively enrolled in the study and divided into two groups according to the birth weights recorded in the health records.

All LBW neonates were classified as the case group while those whose birth weight exceeded 2,500 g served as the control group, the infants were weighed on an electronic metric scale in the delivery room immediately after birth. We interviewed the mother and used the information from the maternal health record. We were interested in the gestational and pre-gestational morbidities, the characteristics of the prenatal care, and the socioeconomic and demographic information about the mother. Due to the fact of incomplete files we were unable to process further because of data shortage, which made it our only exclusion criteria in processing this study.

Statistical analysis was performed by the software STAT-VIEW (1998), Logistic regression analyses were conducted to determine the effect of risk factors on the birth weight. Factors with a p-value < 0.05 were taken as statistically significant.

Results

A total of 1828 deliveries were reported during the study period. Maximum newborn babies 92.97% had birth weight 2.5 Kg or more and 128 newborns with low birth weight <2.5 Kg, rate of 7.02%. Mean birth weight of the infants was 3386.95 ± 560.70 (g), the LBW infants seen in the period were distributed as follows: ELBW (4.8%), VLBW (11.53%) and MLBW (83.65) in the LBW group (Figure 1).

nutrition-food-sciences-low-weight

Figure 1: Frequency distribution for the low weight of the newborn.

Compared to babies with normal Apgar score>7, infants with low Apgar Scores <7 were found born with low birth weights (p<0,001). There is statistical significant (P=0.0012) between the biparietal diameter (BPD) and the weight of newborn in both groups (<2500 and ≥2500 g), our data showed that newborn’s gender was significantly associated with LBW delivery (p=<0.0001), and that 72.22% of newborn loss were due to low birth weight < 2500 g (p<0.0001) (Table 1).

Variable Average % P value Significant p value (compared   groups)
BPD (mm) <2500 93.25  ±  7.67 6 0.0012         
  ≥2500 93.25  ±  28.27 93.9    
Apgar Score  (fifth minute) 0-3 2585.29  ±  1019.84 1.88 <0.0001 S  
4-6 3118.42  ±  778.02 2.15 <0.0001 P:  (0-3) & (4 - 6) 
7-10 3413.07  ±  524.96 95.96 0.001  
newborn’s gender Male 3439.63  ±  560.32 50.74 <0.0001  
Female 3337.41  ±  549.06 49.25    
State of New born Alive 3405.45  ±  529.89 98.02 <0.0001  
Dead 2490.28  ±  1085.84 1.97    
Gender of twin Male 2600.00  ±  693.93 41.17 0.762         
Female 2530.00  ±  631.70 58.82    

Table 1: Distribution of birth weight according to Newborn characteristics.

The premature babies represent 53.12% of LBW against 46.87% of BW superior or equal 37 weeks of amenorrhea, (p<0.001). 5.31% were singleton while 58.06% were multiple birth, this difference is statistically significant (p<0.0001), (Table 2). Most women whose infants were studied were in the age group 20-34 years (75.3%) and the mean age was (29.56 ± 6.01), no association was found between LBW and mother’s age.

Variable Birth Weight P value Significant p value
(comparison groups)
Child Birth interval (years) <2500 2.575  ±  2.375   0.0375  
≥ 2500 3.144  ±  2.361      
Gestational Age(WA) <2500 34.781  ±  4.660   <0.0001  
≥ 2500 38.876  ±  2.610   <0.0001  
fundal height(cm) <2500 29.616  ±  3.977   <0.0001  
≥ 2500 31.903  ±  3.086      
Parity Primiparous 3307.615  ±  51.887 44.26% <0.0001 S P: Primiparous &       pauciparous
pauciparous 3447.728  ±  53.629 54.25% 0.013
Multiparous 3577.778  ±  02.924 1.48% 0.2301
    Pathology Anemia 3395.735  ±  76.220 54.24 0.074
AHT 3307.692  ±  08.864 36.76 0.1734 NS P: AHT& Diabetes  
Diabetes 3688.571  ±  57.880 9 0.008   S
Number of Fetus Unique 3405.143  ±  43.654 98.29 <0.001
  Multiple 2487.09  ±  620.614 1.7    
pre-pregnancy BMI >16.5 3179.684 ± 467.668 1.18 0.3705  
16.5-18.5 3297.368  ±  43.228 8.27 0.1113  
18.5-25 3381.426  ±  46.659 62.5 0.0474 P: (>16.5) &  (30-  35)
25-30 3436.657  ±  31.906 22.45 0.0154  S  
30-35 3521.605  ±  04.201 5.05 0.106  
35-40 3200.000  ±  03.563 0.49    
Weight gains kg <10 Kg 3357.59  ±  573.01 82.75 <0.001 S P: ( <10 Kg) &
(10-14 Kg)
10-14 Kg 3553.48  ±  517.61 13.48 0.0251
>14 Kg 3514.70  ±  507.63 4.26 0.6207
Weight gain Less than recommended 3351.522  ±  67.868 70.94 0.0011 S   P: Less than    Recommended
& Recommended
Recommended 3472.330  ±  43.426 20.64 0.0051
More than recommended 3502.381   ±  8.131 8.41 0.6181
LBW antecedent Yes 3297.802 ±542.623 18.99 0.0013  
No 3509.794 ± 568.880 81.00    
month prenatal care <2500 3.556 ± 1.509   0.0333  
≥ 2500 2.389  ± .525      
mother's educational status Illiterate 3475.556 ± 554.948 3.73 0.129  
Primary 3296.583 ± 596.77 16.25 0.028  S P: Primary  &    Middle
Middle 3394.309 ± 564.811 43.24 0.216  
Secondary 3428.215 ± 516.413 22.2 0.512  
University 3391.566 ± 554.062 14.56    
socioeconomic status Low 3295.031 ± 585.792 18.64 0.012 S  
Average 3409.230 ± 553.792 70.72 0.7785 P: Low &    Average
High 3396.721 ± 564.022 10.62 0.0504 NS  

S: significant
NS: not significant
P-value < 0.05 was taken as statistically significant.

Table 2: Distribution of birth weight according to maternal characteristics, pregnancy and maternal history.

Mode of delivery was compared between the two groups. Delivery by way of caesarean section was seen in 18.53% and 81.46% be born through vaginal birth, no statistically significant difference was found.

Table 2 shows the results of testing the association of 13 maternal factors found to influence LBW in the present study. LBW has bivariate associations with mother’s educational status (primary p=0.028) health problems during pregnancy (hypertension p=0.008) , month prenatal care began (delay in the first prenatal visit p=0.0333), gestational age (p<0.0001), a reduced childbirth interval (p=0.0375), parity (primiparous women p <0.0001), small fundal height (p<0.0001), gestational weight gain (less than IOM guidelines p=0.0003), history of previous LBW (p=0.0013), number of fetus (multiple p<0.001), socioeconomic status (Low p=0.012), pre-pregnancy BMI (p=0.0154) and weight gains < 10 kg (p<0.001).

Discussion

This study examined and analysed the prevalence and risk factors associated with LBW in a case- control study of birth cohort in Sidi Bel Abbes city. The incidence of LBW found in this study 7.02% which is closed to 7% published in 2004 by the World Health Organization (WHO) for Algeria [4]. It is quite similar to the rate found in Tunisia with 7% but lower than Egypt with 12% and Morocco with 11%. Making Algeria and Tunisia rate closer to those found in developed countries such as France and Spain with 6% [4]. In our study, the rate of female sex was predominant among LBW infants. Studies dealing with the etiology of LBW have shown us that; female sex is an important risk factor and this is attributed to the predisposition of the female sex to the other risk factors [15,16]. As expected, low birth weight deliveries were higher in babies whose gestation ages were below the norm of 37 full weeks. The preterm birth with low birth weight in our study is predominant 56.25% which is consistent with that of other studies [10,17-21]. In literature [22], two-thirds of infants born weighing less than 2500 g are preterm. Our study also showed a relationship between LBW and infant mortality where 72.22% of deceased new-borns had a weight less than 2500 g and the impact of LBW on neonatal mortality was found in many researches [23-25].

Neonatal and infant mortality can be reduced by the intervention of the obstetricians and it is important to note that the prognostic outcomes of preterm birth are in general way worse than the prognostic outcomes of infants born at term [26]. Some factors known as “risk factors” that are associated with LBW, if they are present in an individual women can increase the risk of having a LBW infants.

As with regards to maternal factors, we found no significant relationship between maternal age and LBW (R=0.05). Proportion of primigravida was high among cases as compared to group control 52.34%. The difference revealed was statistically significant. This finding was similar to previous studies which revealed that primiparity is significantly associated with LBW [27,28]. It is considered that BMI is a good marker for the tissue nutrient reserves [29]. And we found that the mother with a low BMI had more risk of having a LBW [30].

During our study, we have discovered that a low pre-pregnancy BMI was significantly associated with LBW that was consistent with the results of other studies [31,32]. It is also believed that women with a reduced weight gain in their pregnancy have more risks of giving birth to LBW infants [33-35]. We found that an average weight gain of 10 kg during pregnancy period had some protective effects against the occurrence of this finding is in agreement with Bakewell et al. [36].

7.72% of mothers who gained weight lower than the weight recommended by (IOM, 1990) are significantly associated with LBW same results have been reported by [34-36] whereas a study found by [37] did not find any relation between the recommended weight gain and LBW.

In this study, Anemia was not a significant factor (p>0.05) but contribution of Anemia leading to LBW babies is controversial [38,39]. We established that the main pathology during pregnancy is practically associated with LBW. In our study, 11.88% of mothers suffering arterial hypertension had LBW newborn (p=0.0008), which was in agreement with findings from other studies [40-43].

Short birth intervals were found to increase LBW rate, similar studies done by [21,44]. This kind of results indicates that it is very important to have a little longer birth spacing in order to reduce LBW.

Multiple pregnancies have a significant association with birth weight similar studies done by Khatun et al. [45]. It is largely known that multiple birth infants have more risk of being LBW [46].

Birth weight is thought to be a reflection of socio-economic status and the quality of medical care received before birth. A lot of studies have shown the beneficial effects of prenatal cares [42]. In our study the incidence of LBW in mother who had done a first trimester visit is lower than those who didn’t, this is similar to what was observed by Anand. Some risk factors were not associated with LBW in our study like the mode of delivery, the maternal age or the number of prenatal care. This kind of results can be caused by the nature of each mother included in our study.

A small number of women who never had prenatal care followed traditional way of care and advice from experienced fellows. Maternal age and prenatal care among the categories of the selected variables could not be compared because the full term neonates who had low birth weights were fewer (3.67%-3.84% respectively).

Various factors are clearly and consistently linked to low birth weight. And there are a lot of opportunities that exist even before pregnancy begins that can reduce the prevalence of LBW, but most of the times they are overlooked.

Conclusion

It is not easy to single out one particular factor that cause LBW, because there are many different factors interacting together affecting the weight of the infant and causing the happing of LWB. So, this is why it is very important to look for pregnancy that has more risk of giving birth to LBW infant, and this is the role of the physicians who should be more vigilant and attentive in checking those different factors, such as health problems during pregnancy, antenatal care , reduce gestational age, a reduced childbirth interval, primiparous women, small fundal height, gestational weight gain less than IOM guidelines, history of previous LBW, multiple pregnancy and low pre-pregnancy BMI.

We can also reduce LBW even before pregnancy occurs, for example by instructing the mother and giving her some health and nutrition education and nutrition also by increasing the use of health services before and during pregnancy. We highly recommend that mothers who are at risk be provided with adequate prenatal care and facilities.

References

  1. World Health Organization (1992) Low birth weight: a tabulation of available information, WHO/MCH/92.2. Geneva: World Health Organization.
  2. Kramer MS (1987) Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ 65: 663-737.
  3. Badshah S, Mason L, McKelvie K, Payne R, Lisboa PJ (2008) Risk factors for low birthweight in the public-hospitals at Peshawar, NWFP-Pakistan. BMC Public Health 8: 197.
  4. WHO, UNICEF (2004) Low birth weight, country, regional and global estimates.WHO Dept of Reproductive Health Research. New York 1-31.
  5. Delaram M (2010) The incidence and related factors of low birth weight. Iran J Nurs 23: 29-36.
  6. Alexander GR, Wingate MS, Mor J, Boulet S (2007) Birth outcomes of Asian-Indian-Americans. Int J Gynaecol Obstet 97: 215-220.
  7. Stoll BJ, Adams-Chapman I (2007) The high-risk infant. In: Behrman RE, Kliegman RM, Jenson HB, Stanton BF. Nelson Textbook of Pediatrics (18thedn).
  8. Barker DJ, Forsén T, Uutela A, Osmond C, Eriksson JG (2001) Size at birth and resilience to effects of poor living conditions in adult life: longitudinal study. BMJ 323: 1273-1276.
  9. Eriksson JG, Forsén T, Tuomilehto J, Winter PD, Osmond C, et al. (1999) Catch-up growth in childhood and death from coronary heart disease: longitudinal study. BMJ 318: 427-431.
  10. Levene MI, Vries LD (2006) Epidemiology and perinatal services. In: Martin RJ, Fanaroff AA, Walsh MC, 8th ed. Fanaroff and Martin Neonatal–Perinatal Medicine. Disease of the fetus and infant. Philadelphia: Elsevier.
  11. Podja J, Kelley L (2000) Administrative Committee on Coordination /Sub – Committee on Nutrition. The UN Systems Forum for Nutrition.
  12. Fuller KE (2000) Low birth-weight infants: the continuing ethnic disparity and the interaction of biology and environment. Ethn Dis 10: 432-445.
  13. Savitz DA, Kaufman JS, Dole N, Siega-Riz AM, Thorp JM Jr, et al. (2004) Poverty, education, race, and pregnancy outcome. Ethn Dis 14: 322-329.
  14. Valero De Bernabé J, Soriano T, Albaladejo R, Juarranz M, Calle ME, et al. (2004) Risk factors for low birth weight: a review. Eur J Obstet Gynecol Reprod Biol 116: 3-15.
  15. Wen SW, Goldenberg RL, Cutter GR, Hoffman HJ, Cliver SP (1990) Intrauterine growth retardation and preterm delivery: prenatal risk factors in an indigent population. Am J Obstet Gynecol 162: 213-218.
  16. Steketee RW, Wirima JJ, Hightower AW, Slutsker L, Heymann DL, et al. (1996) The effect of malaria and malaria prevention in pregnancy on offspring birthweight, prematurity, and intrauterine growth retardation in rural Malawi. Am J Trop Med Hyg 55: 33-41.
  17. Bellamy C, UNICEF (2000) The State of the World’s Children, Progress since the World Summit for Children: A statistical review. New York: United Nations Children’s Fund
  18. Roudbari M, Yaghmaei M, Soheili M (2007) Prevalence and risk factors of low-birth-weight infants in Zahedan, Islamic Republic of Iran. East Mediterr Health J 13: 838-845.
  19. Nobile CG, Raffaele G, Altomare C, Pavia M (2007) Influence of maternal and social factors as predictors of low birth weight in Italy. BMC Public Health 7: 192.
  20. Gebremariam A (2005) Factors predisposing to low birth weight in Jimma Hospital south western Ethiopia. East Afr Med J 82: 554-558.
  21. Scholl TO, Johnson WG (2000) Folic acid: influence on the outcome of pregnancy. Am J Clin Nutr 71: 1295S-303S.
  22. Fahrija S, Dubravka B, Amela S, Evlijana H, Selma M, et al. (1996) Association of Low Birth Weight Infants and Maternal Sociodemographic Status in Tuzla Canton during 1992–1995 War Period in Bosnia and Herzegovina, International Journal of Pediatrics.
  23. Bobossi S, Mbongo Z, Diemer F, Nadji-A, Siopathis R (2000) les nouveau-nés de faible poids de naissance a l’unité de néonatologies du complexe pédiatrique de Bangui (r.c.a) : devenir immédiat et pronostic, médecine d'afrique noire 47: 191-195.
  24. Keita MM, Samake M, Dao A (1992) Les nouveau-nés de petit poids de naissance à Bamako: Devenir immédiat. Publ Méd Afr 11-16.
  25. Kramer MS, Demissie K, Yang H, Platt RW, Sauve R, et al. (2000) The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. JAMA 284: 843-849.
  26. Deshmukh JS, Motghare DD, Zodpey SP, Wadhva SK (1998) Low birth weight and associated maternal factors in an urban area. Indian Pediatr 35: 33-36.
  27. Amin N, Abel R, Sampathkumar V (1993) Maternal risk factors associated with low birth weight. Indian J Pediatr 60: 269-274.
  28. Schieve LA, Cogswell ME, Scanlon KS, Perry G, Ferre C, et al. (2000) Prepregnancy body mass index and pregnancy weight gain: associations with preterm delivery. The NMIHS Collaborative Study Group. Obstet Gynecol 96: 194-200.
  29. Neggers Y, Goldenberg RL (2003) Some thoughts on body mass index, micronutrient intakes and pregnancy outcome. J Nutr 133: 1737S-1740S.
  30. Rode L, Hegaard HK, Kjaergaard H, Møller LF, Tabor A, et al. (2007) Association between maternal weight gain and birth weight. Obstet Gynecol 109: 1309-1315.
  31. Ehrenberg HM, Dierker L, Milluzzi C, Mercer BM (2003) Low maternal weight, failure to thrive in pregnancy, and adverse pregnancy outcomes. Am J Obstet Gynecol 189: 1726-1730.
  32. Siega-Riz AM, Viswanathan M, Moos MK, Deierlein A, Mumford S, et al. (2009) A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol 201: 339. e331-314.
  33. Bakewell JM, Stockbauer JW, Schramm WF (1997) Factors associated with repetition of low birthweight: Missouri longitudinal study. Paediatr Perinat Epidemiol 11 Suppl 1: 119-129.
  34. Ngassa PC, Feuzeu L, Wamba MT, Kouam L, Fomulu N, et al. (2005) Factors influencing birth weights in Cameroon. Clin Mother Child Health 2: 369-373.
  35. Chang M, Chun H, Kuei-Feng C (2010) The effects of pre-pregnancy body mass index and gestational weight gain on neonatal birth weight in Taiwan. International Journal of Nursing and Midwifery 2: 28-34.
  36. Chen Z, Du J, Shao L, Zheng L, Wu M, et al. (2010) Prepregnancy body mass index, gestational weight gain, and pregnancy outcomes in China. Int J Gynaecol Obstet 109: 41-44.
  37. Bianco AT, Smilen SW, Davis Y, Lopez S, Lapinski R, et al. (1998) Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol 91: 97-102.
  38. Philip JS (2000) Maternal hemoglobin concentration and birth weight. Am J Clin Nutr 71: 1285-1287.
  39. Anand K, Garg BS (2000) A Study of Factors Affecting LEW. Indian Journal of Community Medicine; 25: 4-6.
  40. Fang J, Madhavan S, Alderman MH (1999) The influence of maternal hypertension on low birth weight: differences among ethnic populations. Ethn Dis 9: 369-376.
  41. Odell CD1, Kotelchuck M, Chetty VK, Fowler J, Stubblefield PG, et al. (2006) Maternal hypertension as a risk factor for low birth weight infants: comparison of Haitian and African-American women. Matern Child Health J 10: 39-46.
  42. Rahman LA, Hairi NN, Salleh N (2008) Association between pregnancy induced hypertension and low birth weight; a population based case-control study. Asia Pac J Public Health 20: 152-158.
  43. Wolf M, Shah A, Jimenez-Kimble R, Sauk J, Ecker JL, et al. (2004) Differential risk of hypertensive disorders of pregnancy among Hispanic women. J Am Soc Nephrol 15: 1330-1338.
  44. Eshraghian MR, Abolghasemi J, Ghafari J, Rajai S (2008) The effects of risk factor of pregnancy period on infant’s weight. J Qazvin Univ Med Sci 11: 60-65.
  45. Khatun S, Rahman M (2008) Socio-economic determinants of low birth weight in Bangladesh: a multivariate approach. Bangladesh Med Res Counc Bull 34: 81-86.
  46. Joseph KS, Kramer MS, Marcoux S, Ohlsson A, Wen SW, et al. (1998) Determinants of preterm birth rates in Canada from 1981 through 1983 and from 1992 through 1994. N Engl J Med 339: 1434-1439.
Citation: Ghani AEA, Mai H, Demmouche A (2014) Epidemiology of Low Birth Weight in the Town of Sidi Bel Abbes (West of Algeria): A Case-Control Study. J Nutr Food Sci 4:278.

Copyright: © 2014 Ghani AEA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Top