One in every seven babies is born underweight: Study

As many as 20.5 million children were born with low birth weight (LBW) in 2015 in the world. And, 91 per cent of them were born in low- and middle-income countries with nearly three-quarters in sub-Saharan Africa and southern Asia. If a child weighs less than 2,500 grams at the time of birth, it is characterised as LBW.

These findings were reported in the first-ever global research done on low birth weight from 2000 to 2015 for which 281 million births were analysed and published in The Lancet, a medical journal. This means that one in every seven babies born in the world had low birth weight.

The findings are important because LBW is a cause for more than 80 per cent of neonatal deaths (deaths taking place before a child completes one year).

“LBW newborns also have a higher risk of morbidity, stunting in childhood, and long-term developmental and physical ill health including adult-onset chronic conditions such as cardiovascular disease,” according to the report.

The report added that though the LBW prevalence declined to 14.6 per cent in 2015 from 17.5 per cent in 2000, it could only register an average annual decline of 1.2 per cent. This, experts said, is far below the target of annual average reduction rate of 2.74 percent.

“To meet the global nutrition target, it will be required to double the progress involving both improved measurement and programme investments to address the causes of LBW throughout the lifecycle,” the researchers suggest.

Among the different regions classified by WHO, southern Asia witnesses the highest number of LBW babies.

“Birth weight matters because of its strong association with neonatal health and survival, child growth, and non-communicable disease (NCD) risk in adulthood. Girls, whose height and weight remain low into motherhood, risk giving birth to another generation of nutritionally disadvantaged children,” the Lancet editorial released in the same issue said.

Researchers attribute half of LBW cases in South Asia to foetal growth restriction driven by undernutrition among girls and maternal obesity, non-communicable diseases, anaemia, and exposure to tobacco smoke and indoor air pollution.

Insofar as  high-income countries are concerned, the authors of the report say they will have a predominance of pre-term births among their LBW figures, and these might be driven by maternal obesity, smoking, non-medically-indicated caesarean sections, or older maternal age.

In Africa, pre-term birth is also the main driver, with a mix of adolescent pregnancy, maternal infections, and possibly genetic influences.

Though the data set has been presented for about 148 nations but it could not be given for India.  The data available through country’s National Family Health Survey did not meet the inclusion criteria for the researchers.

“India was labelled as partial data as no HMIS (health management information system)/ admin data met the inclusion criteria; one survey (National Family Health Survey, 2005-2006) was included, however for the latest survey (National Family Health Survey, 2015-16) only data for a single year met inclusion criteria and the partial data were used,” an appendix to the main report notes.”

However, it clarifies that partial data has been used in regional and global estimates only.

How serious is the problem of non-availability of data? 

“There exist a lot of schemes to bring down the LBW babies but no conclusive data. Whatever data is available, it is only through hospitals, where all births don’t take place and also many a time the available data is scant,” said VP Goswami, president of National Neonatology Forum (NNF) of India.

When asked if there are any possible estimates of LBW, he said it could be as high as 30-40 per cent. This will translate into big numbers as 26 million births take place annually in India.

The researchers say lack of data is big setback in bringing down LBW. “As many as 47 countries — a majority (87 per cent) of them are low-income or middle-income countries — that account for 23 per cent of all births worldwide had no data meeting inclusion criteria. This is a classic example of the inverse data law — the least data for the highest burden settings. In addition, when available, these data tend to be of lower quality with more heaping and other challenges, which probably lead to underestimates of LBW,” according to the report.

What are the solutions?

As solutions, the researchers propose a long-term multi-sectoral response to intergenerational nutritional and environmental insults, particularly for girls, in South Asia so as to provide good antenatal (pregnancy) care.

Second, high- and middle-income countries have made rapid progress in the care of LBW babies, reducing both deaths and disability. These survival gaps can and must be closed in low-income countries. The researchers also say that health professionals should voice demand for better birth weight data.

“With more births taking place in facilities, and given the minimal cost implications, weighing every baby at birth and having the data recorded in routine health information systems is not a monumental ask,” the Lancet editorial says.