Doddamani
R.1, Jyothi S.D.2, Pujar T.V.3
1Dr.
Raghavendra Doddamani, Assistant Professor, Department of Pediatrics, JJMMC,
Davangere, 2Dr. Jyothi S.D., Assistant Professor, Department of
Pediatrics, Belgaum Institute of Medical Sciences, Belgaum,3Dr.
TejaswiVittalPujar, Associate Professor, Department of Obstetrics and
Gynecology, SSIMSRC, Davangere, Karnataka, India
Corresponding Author:Jyothi
S.D.,Assistant Professor, Department of Pediatrics, Belgaum Institute of
Medical Sciences, Belgaum. E-mail id:rags_md@yahoo.co.in,
drjyothipgbelgaum@gmail.com
Abstract
Introduction:
Low birth weight is seen most commonly in developing countries. In India
majority of births are conducted at home by the Traditional Birth Attendants
(TBA) or relatives, where the estimation of birth weight is not done because of
lack of weighing machines. Therefore, an early identification and prompt
referral of LBW newborns is vital in preventing neonatal deaths.Objective: To determine the magnitude
of low birth weight babies and to correlate birth weight and other
anthropometric measurements.Methodology:
This is a cross sectional study done at Christian fellowship
hospital,Oddanchatram, Dindigal, Tamilnadu from 1st Dec 2011 to 31st
Nov 2012. 500 newborns were examined within 24 hours of their birth in this
hospital during this period. Antenatal history and anthropometric measurements
were recorded. Results: The male newborn
(57.2%) were more than of female (42.8%). The magnitude of the low birth weight
was 262 (52.4%). It was observed that correlation coefficients of all the
parameters are positive and are statistically significant (p < 0.001).
Maximum and minimum positive correlation was observed in case of thigh
circumference (r = 0.776) and Foot length (r = 0.460) respectively.
Keywords:Anthropometric
measurements, Correlation, Low birth weight, Thigh circumference
Author Corrected: 27th July 2018 Accepted for Publication: 31st July 2018
Introduction
World
Health Organization defines Low Birth Weight (LBW) as baby weight at birth less
than 2,500 grams. Globally, LBW is a considerable public health problem which
is associated with consequences that have effects for both short-and long term.
On estimation, 15-20% of all births worldwide are low birth weight,
representing more than 20 million births a year. With great variation in the prevalence of LBW
across the countries, it is seen more in developing than developed countries;
especially in the most vulnerable populations. Regional estimates of low birth
weight include 28% in south Asia, 13% in sub-Saharan Africa and 9% in Latin America
[1, 2].
In
2011, Indian Statistical Institute reported nearly 20% of new born have LBW in
India[3]. Low birthweight is associated with foetal and neonatal mortality and
morbidity, inhibited growth and cognitive development, and chronic diseases
later in life. In India, infant mortality rate remains unbearably high at 34
per 1000 live births. [4].
Recording
of birth weight is universal in developed countries and in regions where
deliveries are conducted in hospitals. But in developing countries like India
majority of births are conducted at home by the Traditional Birth Attendants
(TBA) or relatives, where the estimation of birth weight is not done because of
lack of weighing machines. Therefore, an early identification and prompt
referral of LBW newborns is vital in preventing neonatal deaths. Due to limited
resources, it is not possible to provide expensive weighing scales to the
community members and families. Therefore, it is essential to find out an
alternative method for the estimation of birth weight. Hence, this study is
done with the objective to find out the relationship between birth weight and
different anthropometric measurements from which low birth weight babies could
be identified reliably and managed accordingly.
Objectives
1. To
determine the magnitude of low birth weight babies.
2. To
correlate birth weight and other anthropometric measurements.
Methodology
Study design:
Cross sectional study
Study place:
Christian fellowship hospital,Oddanchatram, Dindigal, Tamilnadu.
Study duration:
1st Dec 2011 to 31st Nov 2012.
Study population:
Live newborns of term gestation in Christian fellowship hospital,Oddanchatram,
Dindigal, Tamilnadu.
Sample size:
500 (convenient sampling method)
Inclusion criteria:
All live newborns of term gestation
Exclusion criteria
· Preterm
babies
· Asphyxiated/sick
newborns under intensive care in the first 24 hours of birth.
Data collection: Relevant antenatal history
was obtained with interview of mother within 24 hours of child birth and
through review of obstetric case sheets. Gestational age assessment was done by
New Ballard Score as described by Ballard J.L. et al. [5]
Anthropometric
measurements
The anthropometricmeasurements were recorded in the newborn in awarm
environment.
· Birth
weight of naked baby was measured with the spring scale to the nearest 25 g.
· Head
circumference (HC) was measured with a non-stretchable measuring tape placed
over the occiput at the back and just above the supra-orbital ridges in front.
The maximum occipito-frontal circumference was recorded to the nearest 0.1 cm.
· Chest
circumference (CC) was measured to the nearest 0.1 cm at the level of nipple /
fourthcostosternal joint.
· Mid
upper arm circumference (MUAC) was measured at the mid-point between the tip of
acromion and the olecranon process in the left upper arm with the
non-stretchable measuring tape to the nearest 0.1 cm.
· Thigh
circumference (TC) was measured in supine position to the nearest 0.1 cm at the
level of the lowest gluteal furrow of left thigh, the tape being placed
perpendicular to the long axis of the left lower limb
· Calf
circumference (Ca C) was measured at the most prominent point in semi-flexed
position of the leg with the measuring tape to the nearest 0.1 cm.
· Foot
length (FL): A 15 cms long sliding gauge with divisions upto 0.05 cm was
prepared. Heel was stabilised against the fixed vertical end of the gauge and
sliding end was adjusted against the tip of big toe after straightening the
foot and foot length measurement was recorded to the nearest 0.1 cm.
· Crown-heel
length (CHL) was recorded to the nearest of 0.1 cm on an infantometer with the
baby being supine, knees fully extended and soles of feet held firmly against
the foot board and head touching fixed board.
Statistical analysis- The
data was entered into Microsoft excel sheet and analysed using SPSS Version 10
software. The data will be represented in the form of descriptive statistics
like frequency, percentages, mean, standard deviation. Correlation Coefficient
(r) of individual anthropometric measurements with respect to birth weight was
calculated and the The statistical significance was evaluated at 95% confidence
level (p < 0.05). Regression equations were drawn to predict birth weight
based on other anthropometric measurements.
Results
The
male new borns (57.2%) were more than of female (42.8%). The magnitude of the
low birth weight was 262 (52.4%). The details of the low birth weight with
respect to sex are described in table 1.
Table-1:
Distribution of low birth weight babies according to sex.
Male |
Female |
Total |
||||
LBW |
Frequency |
Percent |
Frequency |
Percent |
Frequency |
Percent |
Present (n = 262, 52.4%) |
||||||
<2 |
6 |
2.10 |
10 |
4.70 |
16 |
3.2 |
2.01-2.5 |
142 |
49.70 |
104 |
48.60 |
246 |
49.2 |
Absent (n = 238, 47.4%) |
||||||
2.51
– 3 |
138 |
48.30 |
99 |
46.30 |
237 |
47.4 |
3.01
- 3.5 |
0 |
00 |
1 |
0.50 |
1 |
0.2 |
Total |
286 |
100 |
214 |
100 |
500 |
100.0 |
The mean, standard deviation and correlation of the
anthropometric measurements are described in table 2 and table 3.
Table-2: Anthropometric
measurements of the study subjects
Sl.No. |
Anthropometric
measurements |
Mean |
Std.
Deviation |
1 |
Weight (kg) |
2.58 |
0.676 |
2 |
Crown Heel length (cm) |
46.45 |
3.460 |
3 |
Head circumference (cm) |
32.74 |
1.724 |
4 |
Mid upper arm circumference (cm) |
9.53 |
1.106 |
5 |
Thigh circumference (cm) |
14.44 |
2.482 |
6 |
Chest circumference (cm) |
30.56 |
1.839 |
7 |
Foot length
(cm) |
7.45 |
0.658 |
8 |
Calf circumference (cm) |
9.77 |
1.020 |
Table-3: Correlation
matrix between anthropometric parameters
Correlation
co-efficient |
Wt |
CHL |
HC |
MUAC |
TC |
CC |
FL |
Ca C |
Wt |
1 |
.492* |
.609* |
.635* |
.776* |
.581* |
.460* |
.646* |
CHL |
|
1 |
.573* |
.484* |
.508* |
.593* |
.430* |
.548* |
HC |
|
|
1 |
.628* |
.485* |
.849* |
.526* |
.644* |
MUAC |
|
|
|
1 |
.577* |
.671* |
.614* |
.790* |
TC |
|
|
|
|
1 |
.571* |
.347* |
.662* |
CC |
|
|
|
|
|
1 |
.553* |
.659* |
FL |
|
|
|
|
|
|
1 |
.580* |
Ca C |
|
|
|
|
|
|
.* |
1 |
*significant
From
table 3, it was observed that correlation coefficients of all the parameters
are positive and are statistically significant (p < 0.001). Maximum and
minimum positive correlation was observed in case of thigh circumference (r =
0.776) and Foot length (r = 0.460) respectively.
Chart-1:
Scatter plots between birth weight and other anthropometric measurements
Scatter
plots are drawn between birth weight and other anthropometric measurements.
(Chart 1). The cut off values and regression equation are described in table 4.
Table-4:
Regression equations for anthropometric measurements
Anthropometric
measurements |
Regression equation |
Cut off |
CHL |
BW (in kg) = -4.1427 + 0.1371 x
CHL |
48.45 |
HC |
BW (in kg) = -6.4285 + 0.264 x HC |
33.82 |
MUAC |
BW (in kg) = -2.7467 + 0.5254 x
MUAC |
9.99 |
TC |
BW (in kg) = -1.6672 + 0.2693 x
TC |
15.47 |
CC |
BW
(in kg) = -6.3497 + 0.2809 x CC |
31.50 |
FL |
BW (in kg) = -2.6910 + 2.5 x FL |
7.67 |
Ca C |
BW
(in kg) = -3.0309 + 0.5397 x CC |
10.25 |
Discussion
The
early identification of low birth weight babies is an important pre-requisite
of any initiative to reduce mortality. In many developing countries including
India, widespread accurate measurement of birth weight was not practicable,
thus easily measurable substitutes for birth weight were therefore needed. In
the present study, an attempt has been made to find such substitute for birth
weight and to establish a cut-off value for the detection of birth weight of
< 2.5 kg.
The
present study was conducted on 500 newborns(286 male and 214 female). Mean
birth weight of the study subjects was 2.58 + 0.676 kg. This is similar
to other studies done by Diamond I et al., (2.798, 2.634 and 2.850 in New Delhi
(A), New Delhi (B) and Chandigarh) and Huque F et al. in Bangladesh (2.679)
[6,7] but not in line with other studies done in Brazil (3.101), Egypt (3.5)
and Nepal (3.029) [8,9,10].
At
the cut-off value of < 2.5 kg, the prevalence of LBW was 52.4% (n=262) in
the present study; which was a little higher when compared to other studies
done in Bangladesh (15.18%) and South India (38.2%) [11,12] but it was
comparable to the study done by Kaur M et al., (48.7%) [13].
Comparison
of anthropometric parameters of our study with other studies:
Thigh circumference:
In the present study, among all the anthropometric measurements, high correlation
was found with birth weight and thigh circumference (r – 0.776). Similar high correlation with thigh
circumference was found in other studies done by JN Sharma et al., (r – 0.9201)
[14], Ahmed M ( r- 0.789 in males and r – 0.804 in females) [15], Ramji S et
al., (0.918) [16] and Oo WM (0.82)[17]
Calf
circumference: The correlation between birth
weight and calf circumference was found to be 0.646, next to thigh
circumference. But in other studies done
by Neela J et al., (0.83) [18], Samal GC et al., (0.78)[19], Das JC et al., (0.946)[20]
, correlation value was found to be high than the present study.
Mid
Upper arm circumference: MUAC correlated with
birth weight with the value of 0.635 in the present study. The values of
correlation were found to be high in other studies done by Sharma JN et al.,
(0.8912) [14], Ramji S et al (0.8292) [16], Ahmed FU et al (0.7920) [21]. Bhargava
SK et al (0.8110) [22], Das JC et al (0.9560) [20].
Head
circumference: In the present study, the
correlation between birth weight and head circumference was found to be 0.609.
Other studies reported correlation values of 0.71 [23], 0.7257[14], 0.7264
[22], 0.68 [18], 0.6200 [24].
Chest
circumference: 0.581 was the correlation value
found between birth weight and chest circumference. This value is in line with
a study done by Neeluri R (0.6090 [23] but lower compared to other studies
where the correlation value is around 0.8 [14, 18, 22].
Crown-Heel
length: The correlation between CHL and
birthweight in the present study was 0.492. Similar correlation value was found
in the study done by Neeluri R (0.549) and Samal GC [0.57] but not in line with
other studies - 0.8081 [14], 0.8023 [22].
Foot length:Among
all the anthropometric measurements, the correlation value was found to be low
between birth weight and foot length (r – 0.460). This is in contrast to the
results found in other studies done by Amar M T et al., (r – 0.715[25] and
Gowri S et al.(0.94) [26]
Recommendation- We
recommend use of a simple 'Tri-colored tape' for anthropometric measurements to
facilitate early detection of LBW newborns especially for home deliveries in
rural communities so as to provide timely management. The device should be
flat, flexible, non-stretchable and suitably coloured in red, yellow and green,
so that these can be used and understood easily by the illiterate Traditional
Birth Attendants (TBA).
Conclusion
It can be concluded that all the
anthropometric measurements correlate significantly with birth weight. In the
present study, the highest correlation was found between birth weight and thigh
circumference, followed by Calf circumference, MUAC, Head circumference, Chest
circumference, Crown-Heel length and Foot length. Thus, anthropometric
parameters can be considered as a useful tool to identify low birth-weight.
The results of this study suggest that thigh
circumference is a simple and cheap method for detecting and screening low
birth weight babies by using a non-stretchable measuring tape. Thigh
circumference is measured at the most prominent position of the thigh. This can
help relatives and grass root level workers to predict LBW babies in rural or
hard to reach areas and aid in better care of the high-risk child. Addition to
it, these measurements are simple, easy, cost – effective to be introduced in
the current health care system.
What is already
known?
The prevalence of Low birth weights
babies is high in developing countries like India and appropriate alternative
are needed in rural and hard to reach areas to predict birth weight for early
management of the babies.
Contributions
· Dr
Raghavendra Doddamani helped in data collection and analysis.
· Jyothi
SD wrote first draft of the manuscript.
· TejaswiVittalPujar
made final correction of manuscript before submission.
· All
authors approved submission of the manuscript and own responsibility of the
manuscript.
· None
of the authors have any conflict of interest.
Ethical
approval: obtained
Funding:
Nil
Conflict
of interest: None initiated
Permission
from IRB: Yes
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