2. 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

3. 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 About CINI 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.

4. LCA Implementing Units

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

6. ~ 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, 10 th 5YP, NACO 2002

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

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

9. Translating Medico-Social Factors Into Doables Low birth weight Maternal Anthropometric measures Gestational Weight Gain Pre-pregnancy BMI · 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 3 rd trimester (eclampsia, antepartum haemorrhage) · Substance abuse (tobacco, alcohol) Maternal Infection (malaria, diarrhoea, RTI/ STI/HIV/AIDS) Contextual Factors Familial Factors Individual Factors Access to health services

10. Strategies 1.Case Management 2.Behaviour change and communication 3.Linkage, convergence and partnership

11. Existing Scenario: Global & Developing countries

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

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

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

15. Correlates of Low Birth Weight

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

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

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

19. Consequences of Low Birth Weight

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

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

22. Database Management AND Field MIS

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

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

25. Thank you!