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!