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Problems of Low Birth Weight: A community based monitoring surveillance system in
West Bengal.
By
Pandey CS, R. Anuradha, Jana Laboni
Child In Need Institute
February 2004
Thrust Areas• Safe motherhood.
• Child survival, growth & development.
• Nutrition for vulnerable groups.
• Reproductive and sexual health of young people
• Prevention of RTI/STI/HIV/AIDS
About CINI
Area & Population• CINI reaches out to more
than 700,000 rural and urban poor population in 4 districts of West Bengal.
• 5,000 street children in
Kolkata
• 5,000 sex workers in four
rural red light areas.
• Many other population
groups through its
collaborative work with
government agencies and
NGOs in other states of
India.
LCA Implementing Units
Institute based activities
Out Patient Department
Thursday Clinic
Reproductive Health Clinic
Adolescent Health Clinic
Nutrition Rehabilitation Center
Lactation Management Unit
Emergency Ward
~ Major National Priorities ~
• Reduce Maternal Mortality Ratio.
• Reduce Infant and Child Mortality rates.
• Reduce Proportion of Low Birth Weight babies.
• Reduce Severe and Moderate Malnutrition in U5 children.
• Reduce Unmet Need for contraception.
• Reduce Anaemia prevalence among women and adolescent girls.
• Complete Primary Immunization of all children aged 11-23 months.
• Reduce spread of HIV infection.
Source: NPP 2000, NHP 2001, 10th 5YP, NACO 2002
Lifecycle Approach
to bring about ‘Sustainable Health & Nutrition
Development for Women & Children’
LCA: A Package of interventions organised to
Pregnancy
Early childhoo
d
Adolescence
address risks and opportunities during critical stages of lifecycle, starting with pregnancy and moving through birth, infancy, early childhood and adolescence.
Early registrationEarly registration Ensure adequate Ensure adequate
weight gainweight gain Ensure TT , IFA, 3 Ensure TT , IFA, 3
or more ANC or more ANC Attended deliveryAttended delivery
Adequate nutritionAdequate nutrition Reduce anaemia among Reduce anaemia among
girlsgirls Awareness regarding Awareness regarding
pubertal changespubertal changes Develop life skillsDevelop life skills
Birth weight above 2500 gmBirth weight above 2500 gm Proper feeding as well as Proper feeding as well as
weaningweaning Early stimulationEarly stimulation Timely immunizationTimely immunization Prevent frequent illnessPrevent frequent illness Reduce incidence of deathReduce incidence of death
Translating Medico-Social Factors Into Doables
Low birth weight
Maternal Anthropometric measures
Gestational Weight Gain
Pre-pregnancy BMI
· Energy expenditure (rest and workload)
•Diet during pregnancy
· Inter-pregnancy Interval
· Anaemia
· Previous Pregnancy history
· Mental stress
· Maternal Chronic diseases (Heart, TB, respiratory illness)
· Maternal problem during 3rd trimester (eclampsia, antepartum haemorrhage)
· Substance abuse (tobacco, alcohol)
Maternal Infection (malaria, diarrhoea, RTI/ STI/HIV/AIDS)
Contextual Factors
Familial Factors
Individual Factors
Access to health services
Strategies
1. Case Management
2. Behaviour change and communication
3. Linkage, convergence and partnership
Existing Scenario: Global & Developing countries
UN Regions and Sub Regions
% of LBW incidence
Oft cited estimate
Mean Birth Weight (Kg.)
Africa 15 - 22 2.9 – 3.1 Asia 18- Eastern 5.8- South - 28.3 South – Eastern 10.3 2.9 – 3.1
o Bangladesh 23 - 60 50o India 10-56 33 2.6
o Nepal 14-23 2.7o Srilanka 18-25 2.8o Pakistan 18-34 25- Western 8.3
All developing 16.4
Estimated incidence of LBW and mean birth weight
Indian Scenario: LBW prevalence in selected state of India
33
42.5
28
76.5
28.9
7.912.4 16.4
35.1
95.1
55.4
22.1 14.8 21.9 19.4 18.9 17.3 17 16.910.8
16.515.3
0
10
20
30
40
50
60
70
80
90
100
pe
rce
nta
ge
Percentage of livebirths w eighed at birth
Percentage of LBW
Pregnancies3819
Abortions117
Deliveries2714
Live Born2645 (97.5%)
Stillborn69 (25/1000)
Still Alive2563
Died 0-7 days
46 (17.4/1000)
Died 29 days – 1 yr
17 (6.4/1000)
Case Management Activities from October 2001 to September 2003
Died 8-28 days
19 (7.2/1000)
Low Birth Weight
554 (20.9%)
Normal Birth Weight
1966 (74.3%)
Normal curve distribution of birth weight
Mean = 2.7 kgSD = 455 gramsN= 2510
1 2 3 4
Mean = 2.72 kgs, SD=464 grams N=1726
1 2 3 4
Mean = 2.66 kgs, SD=430 grams N=784
October 2001 – September 2002 October 2002 – September 2003
Correlates of Low Birth Weight
Maternal Anthropometric measures
17.336.1
82.763.9
020406080
100120
> = 40 kgs(N=416)
< 40 kgs(N=144)
Normal birthweight (>= 2500grams)
Low birth weight<2500 grams)
39.221.7
60.878.3
0
20
40
60
80
100
120
< 140 cm.(N=51)
> = 140 cm.(2410)
Normal birthweight (>= 2500grams)
Low birth weight<2500 grams)
Maternal weight in 1st Trimester Maternal height
2 = 21.9 , df =1, p < 0.0001 2 = 8.9 , df =1, p = 0.002
Maternal Age
2 = 20.8 , df =3, p = 0.0001
18.3
81.7
18.820.528.4
81.279.571.6
0
20
40
60
80
100
Under 19(N=679)
20 - 24(N=1315 )
25 - 30(N=426)
31 - 44(N=71)
Age of pregnant women in years
Pe
rcn
en
tag
e (
%)
Low birth weight Normal birth weight
Pregnancy characteristics
2 = 33.6, df =1, p< 0.0001
Gravida and birth weight
2 = 3.9, df =1, p=0.04
72.4 78.2
27.6 21.8
0
20
40
60
80
100
Yes (N=217) No (N=2282)
Complication in previous pregnancy
Perc
enta
ge (%
)
Low birthweight <2500grams)
Normal birthweight (>=2500 grams)
Complication in previous pregnancy
72.1 81.9
27.9 18.1
0
20
40
60
80
100
Primi Gravida(N=1068)
Multi Gravida(N=1423)
Gravida
Perc
enta
ge (%
)
Low birth weight<2500 grams)
Normal birthweight (>= 2500grams)
Consequences
of
Low Birth Weight
Changes in Nutritional status of LBW children at first 3, 6 and 12 months
of life
Cohort of 700 children born before Oct’ 2002
9.128.9
54
18.240.4 37.5
13.731.4 40.9
90.971.1
46
81.859.6 62.5
86.368.6 59.1
020406080
100
No
rma
l
Gra
de
IG
rad
eII
- IV
No
rma
l
Gra
de
IG
rad
eII
- IV
No
rma
l
Gra
de
IG
rad
eII
- IV
3 months 6 months 12 months
Nutritional status
Pe
rce
nta
ge
(%
)
Low birth weight Normal birth weight
Infant deaths in LBW babies
2 = 17.7, df =2, p= 0.0001
65.784.2
17.6
34.315.8
82.4
0
20
40
60
80
100
0-7 days (N=35) 8-28 days(N=19)
9 days – 1 year(N=17)
Infant death
Perc
en
tag
e (
%)
Low birth weight Normal birth weight
Database Management
AND
Field MIS
Database
Village Census
Household Census Referral Slip
Information Sheet
(one time only)
Cohort Register (health worker
wise)
Follow up List for Supervisor
Monthly Report
Supervisor’s Visit
Supervisor’s Report
Monthly
One time
Annually
Annual Report
MIS Information Flow
At A Glance Report
Sponsor Report
Vital Events
Mother & Child Protection Card
Limitations
• Field based routine monitoring data
• Validation of birth weight
• Differences in birth weight - home & institution
Thank you!