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Problems of Low Birth Weight: A community based monitoring surveillance system in West Bengal.

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. About CINI. Thrust Areas Safe motherhood. Child survival, growth & development. Nutrition for vulnerable groups.

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Problems of Low Birth Weight: A community based monitoring surveillance system in West Bengal.

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  1. 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

  2. About CINI • 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 • 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.

  3. LCA Implementing Units

  4. Institute based activities • Out Patient Department • Thursday Clinic • Reproductive Health Clinic • Adolescent Health Clinic • Nutrition Rehabilitation Center • Lactation Management Unit • Emergency Ward

  5. ~ 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

  6. Lifecycle Approach to bring about ‘Sustainable Health & Nutrition Development for Women & Children’

  7. LCA: A Package of interventions organised to address risks and opportunities during critical stages of lifecycle, starting with pregnancy and moving through birth, infancy, early childhood and adolescence. Pregnancy • Early registration • Ensure adequate weight gain • Ensure TT , IFA, 3 or more ANC • Attended delivery Adolescence Early childhood • Adequate nutrition • Reduce anaemia among girls • Awareness regarding pubertal changes • Develop life skills • Birth weight above 2500 gm • Proper feeding as well as weaning • Early stimulation • Timely immunization • Prevent frequent illness • Reduce incidence of death

  8. Translating Medico-Social Factors Into Doables • ·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 Maternal Anthropometric measures Gestational Weight Gain Familial Factors Low birth weight Pre-pregnancy BMI Individual Factors Access to health services

  9. Strategies • Case Management • Behaviour change and communication • Linkage, convergence and partnership

  10. Existing Scenario: Global & Developing countries

  11. Indian Scenario: LBW prevalence in selected state of India

  12. Case Management Activities from October 2001 to September 2003 Low Birth Weight 554 (20.9%) Normal Birth Weight 1966 (74.3%) Abortions 117 Live Born 2645 (97.5%) Still Alive 2563 Pregnancies 3819 Stillborn 69 (25/1000) Deliveries 2714 Died 0-7 days 46(17.4/1000) Died 8-28 days 19 (7.2/1000) Died 29 days – 1 yr 17 (6.4/1000)

  13. October 2001 – September 2002 Mean = 2.66 kgs, SD=430 grams N=784 Normal curve distribution of birth weight October 2002 – September 2003 Mean = 2.7 kg SD = 455 grams N= 2510 Mean = 2.72 kgs, SD=464 grams N=1726

  14. Correlates of Low Birth Weight

  15. Maternal weight in 1st Trimester Maternal height Maternal Anthropometric measures 2 = 21.9 , df =1, p < 0.0001 2 = 8.9 , df =1, p = 0.002

  16. Maternal Age 2 = 20.8 , df =3, p = 0.0001

  17. Complication in previous pregnancy 2 = 3.9, df =1, p=0.04 Pregnancy characteristics Gravida and birth weight 2 = 33.6, df =1, p< 0.0001

  18. Consequences of Low Birth Weight

  19. Changes in Nutritional status of LBW children at first 3, 6 and 12 months of life Cohort of 700 children born before Oct’ 2002

  20. Infant deaths in LBW babies 2 = 17.7, df =2, p= 0.0001

  21. Database Management AND Field MIS

  22. MIS Information Flow Mother & Child Protection Card Cohort Register (health worker wise) Information Sheet (one time only) Village Census Supervisor’s Visit Household Census Referral Slip Database Follow up List for Supervisor Vital Events Sponsor Report One time Monthly Report Monthly At A Glance Report Annually Supervisor’s Report Annual Report

  23. Limitations • Field based routine monitoring data • Validation of birth weight • Differences in birth weight - home & institution

  24. Thank you!

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