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BRIEF RESEARCH ARTICLE
Year : 2013  |  Volume : 57  |  Issue : 1  |  Page : 20-23  

Factors associated with low birth weight among newborns in an urban slum community in Bhopal


1 Former Civil Surgeon and Senior Pediatrician, District Hospital, Bhopal, Madhya Pradesh, India
2 Senior Obstetrician & Gynaecologist, District Hospital, Bhopal, Madhya Pradesh, India
3 Principal Medical College, Sagar, Bhopal, Madhya Pradesh, India
4 Professor of Pediatrics, Gandhi Medical College, Bhopal, Madhya Pradesh, India

Date of Web Publication4-May-2013

Correspondence Address:
A K Choudhary
Quarter No. 94/13-F, Tulsi Nagar, Bhopal - 462 003, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.111362

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   Abstract 

A community based cohort study on birth weight of newborns was conducted among pregnant women of an urban slum in Bhupal, India. The study was carried out to assess the magnitude of low birth weight (LBW) and factors contributing it in an urban slum community. Socio-demographic and maternal characteristics were examined applying statistical techniques to find out the variables associated with the LBW. An additional schedule was used to collect information from mothers about their socio-demographic background, dietary intake and the rest during the pregnancy. Weight of newborns of mothers registered in the study and delivering at the district hospital was recorded. Mean birth weight of newborns of 290 registered mothers was 2.57 ± 0.36 g. One hundred and five newborns (36.2%) had a birth weight lesser than 2500 g. Among different variables studied, statistically significant association was found in case of occupation, daily calorie intake and duration of day-time rest taken by pregnant women.

Keywords: Determinants of low birth weight, Low birth weight, Urban slum


How to cite this article:
Choudhary A K, Choudhary A, Tiwari S C, Dwivedi R. Factors associated with low birth weight among newborns in an urban slum community in Bhopal. Indian J Public Health 2013;57:20-3

How to cite this URL:
Choudhary A K, Choudhary A, Tiwari S C, Dwivedi R. Factors associated with low birth weight among newborns in an urban slum community in Bhopal. Indian J Public Health [serial online] 2013 [cited 2019 Dec 5];57:20-3. Available from: http://www.ijph.in/text.asp?2013/57/1/20/111362

Low birth weight (LBW) is a major public health problem in developing countries including India. The epidemiological observations depicted that infants weighing lesser than 2500 g are approximately 20 times more likely to die than heavier babies, closely associated with the fetal and neonatal mortality and morbidity. [1] It also leads to inhibited growth and cognitive development [1] and also associated with chronic diseases later in life. [2] Majority of the community based studies on birth weight are in a rural community and studies from urban areas are limited. Urban population in India is expected to go up to one-third of the total population by the end of the current decade. Mothers in rural areas enjoy benefits of public health services provided by Government-created network of delivery systems. However, in urban areas such a network of services has not yet been developed or underdeveloped as a result of which mothers are deprived of preventive and promotion services. Hence, there is a need to carry out studies in urban population to find the magnitude of the LBW and the associated factors so that appropriate strategies can be designed to tackle the problem. The present study was carried out to assess the magnitude of LBW and factors contributing it in an urban slum community.

This community based cohort study was conducted in Banganga, which is the largest urban slum of Bhopal - situated near Jai-Prakash Government Hospital. The area of study was specifically chosen adjacent to the district hospital hence that effective, controlled, and free services could be provided to the beneficiaries. The area is served by an auxiliary nurse midwife (ANM) from urban family welfare center and Anganwadi worker (AWW) of urban integrated child development services (ICDS) program. Study population comprised of women in 3 rd trimester of pregnancy belonged to Banaganga urban slum area. Inclusion criteria for the study population were pregnancy with completed 6 th months, agreed to follow the intervention protocol during 3 rd trimester and supposed to be delivered at J. P. Hospital (newborn birth weight would be recorded within 24 h). Pregnant women with complications such as high-blood pressure, diabetes, Urinary Tract Infection (UTI), and hemoglobin level lower than 8 g% were excluded from the study because these complications per-se would have contributed to LBW; therefore, would have acted as the confounding factors and would have affected the effect of interventions. In our study, only 15 such cases were excluded. The women were provided with following specific interventions:

  1. All pregnant women were given dietary advice and nutritional supplements.
  2. All women were given iron and folic acid tablets.
  3. All women took 1½-2 h post-lunch day-time rest in left lateral recumbent position.
  4. Women having toxemia of pregnancy were treated intensively.
Considering the prevalence of LBW as 23.7% in Madhya Pradesh, [3] allowable error 20% and 95% confidence limit, sample size was calculated as 316. For the purpose of this study pregnant women were identified with the help of AWW in the study area. A pre-designed schedule was used to record background information and height and weight were recorded using standard equipment and procedures by the local ANM. A complete obstetrical check-up was conducted by one of the authors. Dietary intake of women was assessed by a nutritionist for 7 days using daily diet recall method at the start of the 3 rd trimester. Twenty-four hours activity pattern was also recorded by the ANM to assess the amount of mother's physical activity and the day-time rest. Weight of the mother at the start of 3 rd trimester was taken as the initial weight and thereafter, every month weight gain was observed. Hemoglobin level 11 g% was taken as the cut-off point for anemia as per WHO criteria. The nursing staff of the labor room was specially trained to record birth weight of the newborns using the digital weighing scale. Variables for the study were maternal factors (maternal height and weight, age of mother, parity, hemoglobin % level, calorie intake and the day-time rest) and social factors (type of family, religion, caste, literacy, and occupation of mother). Out of the total registered 320 cases, 290 women who followed all the inclusion criteria of the study were considered for data analysis and results were expressed by Chi-square test.

Among the newborns delivered to the mothers included in the study, 105 (36.2%) were LBW, i.e., below 2500 galthough 185 (63.8%) had a normal birth weight. The overall mean birth weight of newborns was 2.57 kg ± 0.36 kg.

Among female newborns, 55 (37.7%) were LBW as compared to 34.7% males. However, the difference was not found to be significant statistically.

Distribution of LBW and normal birth weight newborns showed that height, weight, age, parity, education, religion, caste, and type of family she belonged to and hemoglobin level did not have any statistically significant association [Table 1]. However, occupation of mother, her daily calorie intake, and duration of day-time rest showed statistically significant differences [Table 2].
Table 1: Distribution of birth weight of the newborns according to socio-demographic characteristics of the mothers (n = 290)

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Table 2: Distribution of birth weight of the newborns according to maternal variables (n = 290)

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Closer examination of the data showed that as many as 91.7% newborns of women consuming between 1800 calories and 2000 calories were LBW. The proportion of LBW newborns came down with an increase in calorie consumption of mother. Among mothers consuming more than 2400 calories per day only 6.3% newborns were LBW.

Type of work carried out and rest taken by mother were also found to be important variables associated with birth weight of newborns. According to occupation of women they were divided into three broad categories - housewives only, women who were engaged as home help, and those who were engaged as a laborer at some work site, the latter two categories also had to look after their household chores. Nearly, three-fourth (71.4%) of mothers engaged as laborer gave birth to LBW babies as compared to the other two categories. The difference was significant statistically. Duration of day-time rest taken by mothers showed that among the LBW newborns three-fourths (76.5%) belonged to mothers who took less than 1 h day-time rest as compared to only 7.1% newborns whose mothers took the rest for 90 min or more.

According to UNICEF estimate, almost every third newborn (30%) in India is LBW. [1] The National Family Health Survey (NFHS)-3 reported that 23.7% of all children had a LBW in Madhya Pradesh. [3] The proportion of LBW newborns in this study was observed as 36.2%, which is almost twice the proportion than reported by NFHS-3. A high incidence of LBW in the present study could be due to the fact that the study subjects belonged to a slum area where socio-economic status of the population was low. Indian studies report wide variation in the reported incidence of LBW. This could be due to a variety of factors, e.g., difference in socio-economic conditions and dietary patterns of women covered in the studies, study design (community based or hospital based), errors in recording weight of newborn (machine/human error) seasonal variation (linked to food availability to women during the pregnancy), etc.

A number of variables have been found to be associated with the LBW of newborns. Kramer [4] in his meta-analysis of LBW has analyzed the determinants of LBW. Parity [5],[6] educational status [7],[8] and age of mother, [9] etc. have been found to be associated with LBW. Nutritional status of mothers has been demonstrated to be an important determinant of birth weight by Kramer [4] and Mavalankar [6] although Kiran and Garg [8] reported that women engaged as laborer were at higher risk of giving birth to LBW babies. However, Biswas et al.[ l0] observed that with a very few exceptions, none of the variables (age, height, religion, type of family, literacy, and antenatal check-up), were found to be significantly associated with birth weight of newborns. In the present study also none of the variables studied except daily calorie intake of mother, occupation and the day-time rest taken, all of which are inter-related, were found to be significantly associated with LBW. Daily calorie consumption of lesser than 2000 kcal, day-time rest of less than 1 h and work as laborer were found to be high-risk factors.

It is known that the maximum weight gain of fetus occurs during the last 3 months of pregnancy [11],[12] If pregnant women can be provided additional diet and micronutrient supplement during the last trimester of pregnancy the incidence of LBW can be reduced significantly. It is recommended that ICDS program, which now covers almost every village and urban slum in the country, should be suitably strengthened and AWW and ANM oriented and trained to ensure that every pregnant woman receives additional food and micronutrients and advice on rest. This would go a long way toward achieving Millennium Development Goal (MDG) of reduction of child mortality.


   Acknowledgment Top


The authors acknowledge financial support received from the Directorate of Health Services, Madhya Pradesh. Support received from AWW and ANM who helped in conducting the study and Mr. C.P. Gupta Systems Analyst Department of Housing & Environment who helped in the statistical analysis of data are gratefully acknowledged. We pay our sincere homage to departed soul of Late Prof. Dr. I. C. Tiwari, who sowed the seed to carry out this work in the interest of mother and child who get little care in the community. This is the last work guided and edited by him.

 
   References Top

1.UNICEF. Low Birth Weight: Country, Regional and Global Estimates. New York: UNICEF; 2004. p. 1-9.  Back to cited text no. 1
    
2.Barker DJ. Faetal and Infant Origins of Diseases. London: BMJ Books; 1992.  Back to cited text no. 2
    
3.International Institute for Population Sciences (IIPS) and Macro International 2007. National Family Health Survey (NFHS-3), 2005-06: India.   Back to cited text no. 3
    
4.Kramer MS. Determinants of low birth weight: Methodological assessment and meta-analysis. Bull World Health Organ 1987;65:663-737.  Back to cited text no. 4
    
5.Amin N, Abel R, Sampathkumar V. Maternal risk factors associated with low birth weight. Indian J Pediatr 1993;60: 269-74.  Back to cited text no. 5
    
6.Mavalankar DV, Gray RH, Trivedi CR. Risk factors for preterm and term low birthweight in Ahmedabad, India. Int J Epidemiol 1992;21:263-72.  Back to cited text no. 6
    
7.Bhargava SK, Bhargava V, Kumari S, Madhavan S, Ghosh S. Birth weight, gestational age and maternal factors in low birth weight babies. Indian Pediatr 1973;10:161-6.  Back to cited text no. 7
    
8.Kiran A, Garg BS. A study of factors affecting low birth weight. Indian J Community Med 2000;25:57-62.  Back to cited text no. 8
    
9.Jha SK, Mishra CP, Hussain MA. Determinants of low birth weight: Findings from a community based study in a rural area of Varanasi. Indian J Community Health 2009;21:18-022.  Back to cited text no. 9
    
10.Biswas R, Dasgupta A, Sinha RN, Chaudhuri RN. An epidemiological study of low birth weight newborns in the district of Puruliya, West Bengal. Indian J Public Health 2008;52:65-71.  Back to cited text no. 10
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11.Nelson's Text Book of Paediatrics. 16 th ed. New Delhi: Harcourt (India) Pvt. Ltd.; 2000. p. 27.  Back to cited text no. 11
    
12.The morphological and functional development of fetus. In: Williams Text Book of Obstetrics. 7 th ed. Englewood Cliffs, NJ: Prentice/Hall Interventional Inc.; 1985. p. 142-3.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2]


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