 |
       |
|
|
ORIGINAL/RESEARCH ARTICLES
LOW BIRTH WEIGHT BABIES - A Pilot Study
RB GURAV*, S KARTIKEYAN**, MR JAPE***
An analysis of 1,432 live births that occurred in the year 2000, in a health care facility in Thane (Maharashtra), revealed that the sex ratio at birth was 117 males per hundred females. Low birth weight babies comprised 35.68% and this percentage was higher for female newborns. The sex-wise difference in low birth weight was statistically significant. The percentage of low birth weight was found to be positively correlated with multi-gravidity and with increasing maternal age.
INTRODUCTIONThe World Health Organization has defined the term “Low birth weight” as birth weight less than 2500 grams.1,4 As per this definition, babies with a birth weight of £ 2,500 grams are classified as “Low birth weight”, irrespective of the duration of the gestational period. Newborns with a birth weight (for gestational age) of less than the 10th percentile, are categorized as “small for date” (SFD).4 Some paediatricians use two standard deviations below the mean weight for gestational age as a cut-off point for defining LBW.3 Thus, the term LBW includes pre-term babies (those born before 37 weeks of gestation), as well as full term babies who are small for date due to intra-uterine growth retardation.1-4 Full term SFD babies comprise the majority of new born in India.
In the developed countries, the proportion of LBW among newborns is low and approximately two-thirds of LBW are pre-term babies. In the developing countries, the proportion of LBW is high and in a majority of cases, this is attributable to IUGR.2 Out of an estimated 22 million low birth weight babies born worldwide annually, India accounts for about 7-10 million.
Infants with a birth weight of = 2,500 grams constitute about 33% of all live births in India. More than half of these newborns are born after full term of gestation.2 The average birth weight of an Indian baby, born at full term is about 2,800 grams, while in affluent countries, it is = 3,000 grams.4 Usually, a birth weight of 2,000 grams is used as a cut-off point for providing special neonatal care.
Low birth weight is one of the most serious challenges in maternal and child health in both developed and developing countries. It is the single most important factor that determines the changes of child survival.2 Nearly 50% of neonatal deaths occur among LBW babies. The survivors among them are at a high risk of developing malnutrition, recurrent infections and neuro-developmental handicaps.
The purpose of this pilot study was to find out the magnitude of this problem and to study the determinants of Low Birth Weight from the available data in a health care facility.
MATERIAL AND METHODS
This pilot study was conducted in the year 2000 in a health care facility in Thane (Maharashtra). A proforma was used to record age and gravidity of the mother, birth weight and sex of the newborn and the outcome of pregnancies, from the available records of the health care facility.
The data were tabulated, statistically analyzed and presented.
RESULT AND DISCUSSION
In all, 1,432 live births (including 10 twin births) occurred during January to December, 2000. Among these live born babies, 774 were males and 658 females. Thus, the sex ratio at birth was 117 males per 100 females. The sex ratio at birth is one of the stable parameters of a population and it should lie in a narrow range of 100-108 males per 100 females. This skewed sex ratio is difficult to explain. 1,127 were full term normal deliveries, 13 were premature deliveries (pre-term) and 282 babies were delivered by lower segment caesarean section (LSCS).
The low birth weight babies (as per WHO definition1) constituted 35.68% of the 1,432 live births. According to the National Neonatal Database (1995),7 LBW babies constituted 32% of the total births in India. Out of the total LBW babies, 67.2%
TABLE 1
Sex-wise distribution
Parameter Male
babies
(n=774)
Female
babies
(n=658)
Z
value
P
valueNumber of babies
0.05
with birth weight
= 2,500 grams
(LBW)
251
(32.43)
260
(39.51)
2.79
<
Number of babies
with birth weight
> 2,500 grams
523
(67.57)398
(60.49)
Mean birth
0.01
weight (Kg.)
2.93 2.50 4.8 < Standard
deviation (Kg.)
1.7 1.8
TABLE 2
Agewise distribution
Parameter Maternal age (in years)
_______________________________value No. of mothers (n=1,422) No. of live births (n=1432) No. of babies with birth = 2500 grams (LBW) weight No. of babies with birth weight >2,500 grams.
TABLE 3
Gravity of the mother
Parameter Gravidity
_______________________
1 2
value
valueNo. of mothers
(n=1422)
-
No. of live
births (n=1432)
No. of babies
<0.001
with birth weight
= 2,500 grams
(LBW)
20.88%
No. of babies
with birth weight
> 2,500 grams.
79.12%
55.19%
social medicine. Second edition. Jaypee Brothers Medical Publishers (Pvt.) Ltd., New Delhi. 1995: 582.2. Park K. Park’s text book of preventive and social medicine. 16th edition. Banarsidas Bhanot, Jabalpur. 2000:
3. Behrman RE, Kliegman RM, Nelson WE, Vaughan VC.(Editors): Nelson text book of pediatrics. 14th edition. WB Saunders Company, Philadelphia (USA) 1992: 442.
4. Ghai OP. Essential pediatrics. 8th reprint. Interprints, New Delhi. 1989: 49-50.
5. Gupte SA. A short text book of pediatrics. 8th edition. Jaypee Brothers Medical Publishers (Pvt.) Ltd., New Delhi.
1998: 496.
6. Paul VK, Deorari AK, Meharban Singh. Management of low birth weight babies. Chapter in Parthsarathy et al edited:
IAP Text Book of Paediatrics”. Jaypee Brothers Medical Publishers (Pvt.) Ltd., New Delhi. 2000: 61.
7. National Neonatology Forum: National neonatal-perinatal database (1995), quoted in: Bulletin NNF. 1997; 11: 35-6.
8. International Institute for Population Sciences: Evaluation and adjustment of age-sex structure. MPS-07(2). International
Institute for Population Sciences, Mumbai. 1996: 14.
Manual therapy (spinal mobilisation) is more effective and less costly than physiotherapy or care
by a general practitioner for treating neck pain. Korthals-de Bos and colleagues conducted an
economic evaluation comparing the cost effectiveness of three different treatments for patients
with neck pain. After 26 weeks, patients having manual therapy had higher recovery rates than
those having physiotherapy or being cared for by a general practitioner, but these rates were
similar after 52 weeks. Total costs in the manual therapy group were around a third of the costs
in the other two groups
.
BMJ, 2003; 326 : 911.
