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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
As in studies conducted elsewhere [8-11], we found an association between sex and birth weight, with boys significantly heavier than girls. Similarly, it has been found in animals (e.g., calves) that males are heavier and are carried slightly longer in the uterus [12,13]; this effect is probably due to sex hormones.
Chest circumference was the best predictor of birth weight, with the highest prediction, correlation, sensitivity, and specificity. This is similar to the findings of studies conducted in Saudi Arabia  and Egypt , and the same association has been observed in calves . Our study suggests that a cutoff point between 29 and 30 cm maximizes sensitivity and predictive value.
We recommend the use of chest circumference as a surrogate measure of birth weight for several reasons. It is a good predictor of birth weight. The measurements are not affected by sex, and only one standard reference is needed for both sexes. In contrast to the middle upper arm, the chest is relatively hard, so that the demarcation for measurement is easy to identify; thus repeatability is expected to be higher.
We suggest producing an inelastic tape marked with chest measurements in centimetres and the corresponding predicted birth weights in kilograms, divided into coloured zones that can be easily recognized by illiterate midwivesred below 29 cm, yellow between 29 and 30 cm, and green above 30 cm (see Figure. 3. Suggested measuring tape for estimating birth weight (actual size) learn, and apply. It took only one hour for the students to understand it.). The midwives will be advised to refer any newborn whose chest circumference falls within the red zone for professional medical attention if possible, and those in the yellow zone should receive special care and close follow-up.
Such a tape can be made cheaply in quantity and will be easy to carry and use. The dean of the midwifery school and officials at the state Ministry of Health have agreed to include the proposed tape in the bag of equipment given to the midwives on graduation.
As this study was hospital-based in a community where most deliveries take place in the home, it could not assess the effectiveness of the method at the community level in identifying low birth weight and leading to appropriate referrals. This is to be the subject of further study.
The authors thank the Ford Foundation for funding this research.
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