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A low-cost tool for traditional birth attendants to identify low-birth-weight infants

M. M. A. Magzoub, T. E. Ali, and A. B. Ali



One of the most important strategies in health development is inter-sectoral collaboration. This study is an example of collaboration between a medical doctor and an animal-production scientist to develop an easy, low-cost, rapid method for the assessment of birth weight. In developing countries where neonatal and infant mortality are high, birth weight could be a useful measure for identifying high-rise; neonates who need special attention. However, weighing a newborn is often not possible because more than three-fourths of deliveries take place at home. Most are attended by village midwives or traditional birth attendants who do not have weighing scales. Our study in the Wad Medani teaching hospital showed that chest circumference is the best predictor of birth weight (R2 82%, corresponding to a correlation coefficient of .91). A tape was developed with chest circumference measurements corresponding to predicted birth weights. The tape is coloured so that it can be used by illiterate midwives. Both the midwives and their instructors in the midwifery school found this method easy to learn and use.


Health is defined by the World Health Organization as complete physical, social and psychological wellbeing, not merely the absence of disease. Ensuring that people attain this wider level of health cannot be left to the health sector alone. All sectors should work together in a multidisciplinary approach for better quality of life. Inter-sectoral action must be emphasized; it must be viewed as an important, if not decisive, factor of successful development. The present study is an example of inter-sectoral collaboration between a health professional (a medical doctor) and an agriculturist (an animal-production scientist) in developing a rapid and cheap method for the anthropometric assessment of newborns which should be of help in addressing the priority problem of low birth weight.

There is a pressing need for an easy and rapid method to identify low birth weight, defined as birth weight below 2.5 kg. The prevalence of low birth weight varies widely, ranging from 4% in Scandinavia to around 50% in parts of India and Bangladesh [1]. It has a marked association with mortality that extends into the postneonatal and childhood periods; it has been found to be associated with 56%, 85%, and 87% of neonatal mortality in North Acrot and Hyderabad, India, and Santa Maria Cauque, Guatemala, respectively [1]. It may also be associated with high morbidity; it is known that the immune response of low-birth-weight babies is severely impaired, making them more prone to diarrhoea and respiratory infections, which are important causes of mortality [1]. Identification of low birth weight helps to identify high-risk newborns who need special care. In addition to helping to reduce neonatal, infant, and child mortality, birth weight could be a sensitive indicator for the evaluation of antenatal care and maternal nutrition programmes.

Unfortunately, in developing countries weighing a newborn is often not possible because deliveries often take place at home where scales are unobtainable. Also, deliveries are generally attended by village midwives or traditional birth attendants— women who typically are old and illiterate but who are accepted by their communities—most of whom are unable to use scales. There is therefore a need to develop methods that will be accessible and easy for them to use.

A special training programme for traditional birth attendants in Sudan was begun in Omdurman in 1924, originally for six months. By the early 1950s the training had been extended to two years to include antenatal and child care. The graduates may include some women who are not basically traditional birth attendants, who are given a new title, village midwife, and are considered personnel of the Ministry of Health. Most of Central State and Khartoum are well covered by village midwives, but other parts of Sudan still lag behind. Recently the Ministry of Health reintroduced the six-month training programme to cover these areas.

The training concentrates on practical manual procedures, sterilization of equipment, and when and how to refer complicated deliveries. It follows an interesting and practical methodology that depends mainly on the use of the senses: for example, repeating knowledge to fix it in the memory through hearing, identifying sterilization solutions and equipment by their colours and shapes through sight, becoming familiar with equipment by touch, recognizing various substances by their salty or sweet tastes, and so on. On completion of the course, the graduate is given a bag containing all the necessary equipment, including different coloured metallic coins for referral as aids to the memory—for instance, a red coin for bleeding and white one for normal delivery.

Animal-science literature is rich with studies undertaking to relate the external body measurements of farm animals to body size, weight, dystocia type, and conformation [2-5]. Such measurements are directly related to the productivity of both beef and dairy cattle. These and many other researchers have concluded unanimously that chest circumference ("heart girth") is an excellent predictor of body weight and size. A variety of "weighing tapes"—i.e., measuring tapes for estimating the weight of animals—have been developed, with chest-circumference measurements corresponding to predicted body weights (see Figure. 1. Tape of estimating the weight of cattle and pigs (65% of actual length)), based on the regression of weight on chest circumference with a large set of data. The tapes are quite easy to use and give fairly accurate predictions. They are particularly useful under field conditions where a heavy and cumbersome scale is not practical, and are also of great value when animals need to be grouped according to body weight for sales, research, and management purposes.

The present study examines the possibility of developing a surrogate measure of birth weight of reasonable accuracy on the same principal which could easily be made available for use by illiterate village midwives and traditional birth attendants, with a view to incorporating it into the curriculum of the midwifery school in Wad Medani.

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