Background: Classification of infants into low birth weight (LBW, o2500 g) or very low birth weight (VLBW, o2000 g) categories is a crucial step in targeting interventions to high-risk infants. Objective: To compare the validity of chest circumference and foot length as surrogate anthropometric measures for the identification of LBW and VLBW infants. Subjects and setting: Newborn infants (n ¼ 1640) born between March and June 2004 in 30 Village Development Committees of Sarlahi district, Nepal. Design: Chest circumference, foot length and weight (SECA 727, precise to 2 g) of newborns were measured within 72 h after birth. The sensitivity, specificity and predictive values for a range of cutoff points of the anthropometric measures were estimated using the digital scale measurements as the gold standard. Results: Among LBW infants (469/1640, 28.6%), chest circumference measures o30.3 cm were 91% sensitive and 83% specific. Similar levels of sensitivity for foot length were achieved only with considerable loss of specificity (o45%). Foot length measurements o6.9 cm were 88% sensitive and 86% specific for the identification of VLBW infants. Conclusion: Chest circumference was superior to foot length in classification of infants into birth weight categories. For the identification of VLBW infants, foot length performed well, and may be preferable to chest circumference, as the former measure does not require removal of infant swaddling clothes. In the absence of more precise direct measures of birth weight, chest circumference is recommended over foot length for the identification of LBW infants.
Efforts to formalize the role of traditional birth attendants (TBAs) in maternal and neonatal health programs have had limited success. TBAs’ continued attendance at home deliveries suggests potential to influence maternal and neonatal outcomes. The objective of this qualitative study was to identify and understand the knowledge, attitudes, and practices of TBAs in rural Nepal. Twenty one trained and untrained TBAs participated in focus groups and in-depth interviews about antenatal care, delivery practices, maternal complications, and newborn care. Antenatal care included advice about nutrition and tetanus toxic (TT) immunization but did not include planning ahead for transport in cases of complications. Clean delivery practices were observed by most TBAs though hand washing practices differed by training status. There was no standard practice to identify maternal complications such as excessive bleeding, prolonged labour, or retained placenta, and most referred outside in the event of such complications. Newborn care practices included breastfeeding with supplemental feeds, thermal care after bathing and mustard seed oil massage. TBAs reported high job satisfaction and desire to improve their skills. Despite uncertainty regarding the role of TBAs to manage maternal complications, TBAs may be strategically placed to make potential contributions to newborn survival.
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