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ORIGINAL ARTICLE
Year : 2011  |  Volume : 5  |  Issue : 2  |  Page : 48-52

Prevalence and determinants of "low birth weight" among institutional deliveries


1 Department of Obstetrics and Gynecology, Rohilkhand Medical College Bareilly, UP, India
2 Department of Pediatrics, Rohilkhand Medical College Bareilly, UP, India
3 Department of Community Medicine, Rohilkhand Medical College Bareilly, UP, India
4 Sri Guru Ram Rai Institute of Health and Medical Sciences, Dehradun, Uttarakhand, India

Date of Web Publication17-Feb-2012

Correspondence Address:
V K Agrawal
Department of Community Medicine, Rohilkhand Medical College and Hospital, Bareilly - 243 006, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-3131.92950

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   Abstract 

Background: Birth weight is an important determinant of child survival and development. It is also a subject of clinical and epidemiological investigations. This study was planned to find out the epidemiological factors associated with low birth weight (LBW) among institutional deliveries so that suitable recommendation can be made to prevent LBW.
Objectives: The present study was therefore undertaken to find out some maternal factors that may have their association, if any with LBW.
Materials and Methods:
This cross-sectional study was carried out at tertiary care hospital among 350 mothers delivering live born neonate in study place. All babies were weighed within 24 hours after the birth. The babies were weighed on beam type weighing machine up to 20 g accuracy. LBW was defined as a birth weight of <2500 gram. All mothers were examined and interviewed within 24 hours after delivery and findings were recorded. The analysis was done using Epi Info package.
Results : In this study, 40.0% mothers delivered LBW babies. Findings indicate that gestational age less than 37 weeks (76.5%), maternal age less than 20 years (58.5%), irregular antenatal checkup (70.5%), mother's height less than 150 cm (68.5%), mother's weight less than 50 kg (76.1%), hemoglobin less than 10 gm/dl (60.5%), severe physical work (78%), and tobacco chewing (58.5%) are significant determinants of LBW.
Conclusion: Our study indicates that gestational age, maternal age, regular antenatal checkup, mother's height, mother's weight, anemia, physical work, and tobacco chewing are significant determinants of LBW. Prevalence of LBW can be reduced by increasing the gestational age, regular antenatal checkup, balanced diet during antenatal period, adequate rest during antenatal period, and avoiding the tobacco chewing.

Keywords: Determinants, low birth weight, maternal factors


How to cite this article:
Agarwal K, Agarwal A, Agrawal V K, Agrawal P, Chaudhary V. Prevalence and determinants of "low birth weight" among institutional deliveries. Ann Nigerian Med 2011;5:48-52

How to cite this URL:
Agarwal K, Agarwal A, Agrawal V K, Agrawal P, Chaudhary V. Prevalence and determinants of "low birth weight" among institutional deliveries. Ann Nigerian Med [serial online] 2011 [cited 2019 May 20];5:48-52. Available from: http://www.anmjournal.com/text.asp?2011/5/2/48/92950


   Introduction Top


Children's health is tomorrow's wealth is one of World Health Organization (WHO)'s slogans of recent years. However, children's health is to a great extent determined by factors that operate in utero, well before they are born. [1] At birth, fetal weight is accepted as the single parameter that is directly related to the health and nutrition of the mother, [1] and on the other hand is an important determinant of the chances of the newborn to survive and experience healthy growth and development. [1] This is because low birth weight (LBW) has been shown to be directly related to both immediate, long-term and very long-term development and well-being. [2] Birth weight is generally used as a yardstick of maturity and is an important determinant of child survival and development, birth weight specific mortality and morbidity, and this is equally true for very large babies. [3] It is also a subject of clinical and epidemiological investigations and a target for public health intervention. [4] WHO has defined LBW as weight at birth of less than 2 500 g. There is significant variation in the incidence of LBW across regions. South Asia has the highest incidence, with 31% of all infants with LBW, while East Asia/Pacific has the lowest, at 7%. Nearly 40% of all LBW babies in the developing world are born in India. [5] LBW renders individuals vulnerable to infectious disease morbidity and mortality during both infancy and childhood. Some of the interventions suggested to reduce LBW include delaying child bearing in adolescents, efforts to improve the nutritional status of women, particularly anemia in pregnancy, access to antenatal care, advice on adequate rest during pregnancy, especially in undernourished women, efforts to stop smoking, and reduce tobacco chewing in areas wherever it is a common practice, improving female education, especially that of mothers. [6] This study was planned to find out the epidemiological factors associated with LBW among institutional deliveries so that suitable recommendation can be made to prevent LBW.


   Materials and Methods Top


This cross-sectional study was carried out at tertiary care hospital in Uttar Pradesh. Target population was the new born of institutional deliveries and study population was babies born in our hospital during the study period. Institutional ethical clearance was obtained. The sample size was calculated with the following assumptions: alpha error = 5%, p (expected proportion) = 0.65. The proportion of normal weight babies was assumed to be 65% based on earlier studies, [1],[2],[3],[4],[5],[6] q = (1 - p)= 0.35, d (expected deviation) = 5% or 0.05, n = {(Z 1-a/2 ) 2 × p × q/d 2}. [7] Thus, a sample size of 350 was calculated. Unit of study were all mothers delivering live born neonate in study place with following exclusion criteria: mothers with multiple pregnancy, mothers whose last menstrual period was not exactly known, neonates with congenital malformations, chromosomal anomalies, and hemolytic disease of newborn. Mothers with antepartum hemorrhage or mothers with caesarean delivery were not excluded from study.

An elaborated schedule was prepared by the investigator before undertaking the study. It was pretested by carrying out pilot study with sample of 30 subjects. These 30 subjects were included in the study subsequently. The investigator at the hospital in postnatal ward conducted the interviews personally. The women were explained about the objectives of the study and an informed consent was obtained. The mothers were recruited into the study during labor. All babies were weighed within 24 hours after the birth. The babies were weighed on beam type weighing machine up to 20 g accuracy. LBW was defined as a birth weight of <2500 g. All mothers were examined and interviewed within 24 hours after delivery and findings were recorded. Those mothers, whose condition did not permit examination, were examined after 48-72 hours. Mother's height was measured up to the accuracy of 0.5 cm by height measuring stand and weight was recorded on spring balance weighing machine up to the accuracy of 0.5 kg. Standardization of equipment was done to minimize error and observers were trained to avoid to avoid interobserver variabilities in recordings. After completing all the interviews, the responses were coded and entered in the computer. Antenatal checkup was graded regular if minimum three checkup was done and one checkup in each trimester. Physical work during pregnancy was graded as described by Pachauri and Marvah in their study "Socioeconomic factors in relation to birth weight": [8] Light: work done by housewife with one or two children or having a home help if she is having a large family, Moderate: work done by housewife with a large family and not having home help or having a home help and also working outside, Hard: work done by housewife with a large family and not having home help and also working outside. Data validation was done after entry was completed. The analysis was done using Epi Info 6 package. Chi-square test was applied for test of significance.


   Result Top


370 live births were recorded in the facility during the study and 350 mothers/babies were studied. Out of the total 350 newborn babies, 156 (44.5%) were females and 194 (55.5%) were males. Out of 350 mothers, 25.5% mothers were below 20, 55.5% mothers in the age group of 20-30, and 19% mothers were more than 30 years of age. Out of the total 350 mothers, the maximum number mothers belonged to middle lower class (43.4%), followed by mothers who were in middle upper (35.3%) and in lower class (13.7%). Percentage of mother who was in upper class was 7.6. Out of 350 newborn, 34.5% belonged to birth order 1, 40.5% to birth order 2, 19.4% to birth order 3, and 5.6% belonged to birth order 4 and above. Results have been depicted in [Table 1], [Table 2], [Table 3] and [Table 4]. In this study, 140 (40.00%) mothers delivered LBW babies. Out of total 350 newborn babies, 156 (44.5%) were females and 194 (55.5%) were males and there was no significant difference between LBW and gender. Proportion of LBW babies was more for Muslim mothers (58.7%) and it was found statistically significant (P value was <0.005). Association between LBW and Muslim caste requires further studies to reach specific conclusions.
Table 1: Distribution of low birth weight according to some maternal variables

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Table 2: Distribution of low birth weight according to antenatal clinic attendance

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Table 3: Distribution of low birth weight according to Mothers anthropometry

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Table 4: Distribution of low birth weight according to other maternal characteristics

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Prevalence of LBW among mothers having gestational age less than 37 weeks at the time of delivery was 76.5% when compared with 31.4% among the mothers whose gestational age at the time of delivery was 37 weeks and above. This association was statistically significant (P < 0.0000). The proportion of LBW new born was maximum among birth order 1 (39.1%) followed by birth order 2 (34.9%) and birth order 3 (26.0%); however, this reduction in risk of LBW with increasing birth order was not statistically significant (P > 0.05). The proportion of LBW was 38.5% among the mothers who had interpregnancy interval less than 2 years when compared with 31.0% among the mothers who had interpregnancy interval more than 2 years. The difference was not statistically significant. Maximum percentage of LBW babies was observed in two extreme of ages, i.e., below 20 where 58.5% gave birth to LBW babies and similarly in mothers of age 30 and above 48.8% gave birth to LBW babies. The difference was statistically significant (P value was <0.0000).

The proportion of LBW was 70.5% among the mothers who had irregular ante natal checkup when compared with 29.5% among the mother who had regular ANC checkups (three or above). The proportion of LBW was 68.5% among the mothers who reported for ante natal checkup during last trimester when compared with 31.5% and 37.5% among the mother reported for ANC checkups during first and second trimester, respectively. The difference was statistically highly significant (P < 0.0000).

Proportion of LBW among mothers having height less than 150 cm was 65.6% when compared with 34.40% among the mothers whose height was 150 cm and above. The difference was statistically highly significant (P < 0.000). Proportion of LBW was 76.1% among mothers having weight less than 50 kg at the time of delivery when compared with 28.1% among the mothers whose weight was 50 kg and above. The difference was statistically highly significant (P < 0.000). Proportion of LBW among mothers having Hb less than 10 gm/dl was 60.5% when compared with 39.5% among the mothers whose Hb was 10 gm/dl or above. The difference was statistically significant (P < 0.0000). Proportion of LBW was maximum among the mothers who were illiterate (65.5%) and the risk of LBW reduces linearly as the education status improved with an overall reduction by 92% among the mothers who were graduate. The association between mother's education and birth weight was statistically significant (P < 0.0000).

Out of 350 mothers, 15.5% mothers gave the history of chewing tobacco during pregnancy. The proportion of LBW babies among such mothers was 58.5% when compared with 30.5% among the mothers who gave no such history. The difference was statistically significant, P <0.0000. Out of the total 350 mothers, 58.5% mothers reported moderate amount of physical work during pregnancy and 25.5% and 16% mothers reported mild and heavy amount of physical work, respectively. The proportion of LBW among these mothers was 22.5%, 30.0.3%, and 78.0%, respectively. This association between physical work of the mother and LBW was statistically significant (P < 0.0000). Proportion of LBW among mothers with history of abortion was (38.5%) when compared with 34% among the mothers who did not give any history of abortion The difference was not statistically significant.


   Discussion Top


The incidence of LBW in present study (40%) similar to UNICEF-ICMR report which has shown 39.3% incidence of LBW in three slums in Madras, Delhi, Calcutta, and rural areas near Chandigarh, Varanasi, and Hyderabad. [9] In present study, maximum percentage of LBW babies was observed in two extreme of ages, i.e., below 20 and in mothers above 30 years of age. Findings of present study were comparable with the findings of Raman et al. [10] and Negi et al., [11] who observed the similar relationship between age of mother and birth weight. It shows probability of LBW increases in two extreme of ages, i.e., below 20 and in mothers above 30 years of age. The proportion of LBW was 61.8% among the mothers who had irregular ante natal checkup when compared with 39.2% among the mother who had regular ANC checkups. Joshi et al. [12] and Idris et al. [13] also published the similar findings in their study where the incidence of LBW was 57% and 61.76% in mothers who did not receive any antenatal care. Association between irregular antenatal checkup and LBW may be due to noncompliance of advice/drugs during antenatal period.

The present study revealed that anemia is a risk factor for LBW which is comparable to the findings of study by Joshi et al., [12] Mavalankar et al., [14] and Sharma et al. [15] Since only postdelivery Hb was taken in this study, it would have been most ideal to follow the pattern of Hb from antenatal period to delivery as that would give a more scientific picture of the possible association between maternal Hb and birth weight. It is recommended that all efforts should be made to increase the Hb level by regular supplementation of iron and also by dietary modification. This study also revealed that low maternal weight are related to LBW. Similar results have been observed by Chhabra et al. [16] in their study, hence it is recommended to improve the nutritional status of a girl child throughout her life cycle as it will improve the nutritional status of women and will reduce the problem of LBW.

As revealed by the present study, the proportion LBW was higher among the mother with narrow birth interval of less than 2 years. If women cannot recover from the effect of last pregnancy and period of breastfeeding, before conceiving again, her nutritional status deteriorates with subsequent pregnancies. Hence, it is recommended to adopt birth spacing methods and widen the interpregnancy interval at least up to 2 years.

The present study showed that the proportion of LBW babies among mothers who chew tobacco was 56.1% when compared with 31.2% among the mothers who did not give such history. Mehta et al. also revealed that LBW proportion was 36.28% among nonuser of tobacco and 64.62% among user of tobacco. [17] It shows use of tobacco during antenatal period is associated with LBW.

In conclusion, findings indicate that gestational age, maternal age, regular antenatal checkup, mother's height, mother's weight, anemia, physical work, tobacco chewing, and history of abortion are significant determinants of LBW. This is consistent with national [18] and international findings indicating that maternal variables and risk behaviors during pregnancy play important roles on LBW. [19] Similarity of results of this study to earlier studies shows ineffectiveness of existing national programs for improving the antenatal care. Poor pregnancy outcome is the result of a multiplicity of factors and cannot be corrected by a narrow pharmaceutical shortcut. It calls for overall improvement in antenatal care and dietary diversification. Prevalence of LBW can be reduced by increasing the gestational age, regular antenatal checkup, balanced diet during antenatal period, adequate rest during antenatal period, and avoiding the tobacco chewing. Limitations of this study were non-inclusion of screening for maternal hypertensive diseases and renal diseases.

 
   References Top

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7.Israel GD. Sampling The Evidence Of Extension Program Impact. Program Evaluation and Organizational Development, IFAS, University of Florida. PEOD-5. October 1992.   Back to cited text no. 7
    
8.Pachauri S, Marvah SM. Socioeconomic factors in relation to birth weight. Indian Pediatr 1970;7:462-8.  Back to cited text no. 8
    
9.UNICEF-ICMR Report. Indian J Pediatr 1987;59:801-18.  Back to cited text no. 9
    
10.Raman TS. Low birth weight babies: Incidence and risk factors. Armed Forces Med J India 1998;54:191-5.  Back to cited text no. 10
    
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13.Idris MZ, Gupta A, Mohan U, Srivastava AK, Das V. Maternal health and LBW among institutional deliveries. Indian J Community Med 2000;25:156-60.  Back to cited text no. 13
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14.Mavalankar DV, Gray RH, Trivedi CR. Risk factors for preterm and term low birth weight in Ahmedabad. Indian J Epidemiol 1992;21:263-72.  Back to cited text no. 14
    
15.Sharma RK, Cooner PS, Sekhon AS, Dhaliwal DS, Singh K. Study of effect of maternal nutrition on incidence of Low birth weight. Indian J Community Med 1999;24:64-8.  Back to cited text no. 15
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16.Chabra P, Sharma AK, Grover UL, Agarwal OP. Prevalence of LBW and its determinants in an urban resettlement area of Delhi. Asia Pac J Public Health 2004;16:95-8.  Back to cited text no. 16
    
17.Mehta A, Shukla S. Tobacco and pregnancy. J Obstet Gynaecol India 1990;40:1556-60.  Back to cited text no. 17
    
18.Ganesh S, Harsha HN, Jayaram S, Kotian MS. Determinants of low birth weight: A case control study in a district hospital in Karnataka. Indian J Pediatr 2010;77:87-8.  Back to cited text no. 18
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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