Low Birth Weight, Maternal Nutrition and Antenatal Care
in Rural Jharkhand:Findings from Ranchi Low Birth Weight Project
Dr. Subrato K. Mondal
Ronita ChattopadhyayRanchi, 9th October 2006
Project Partners
Krishi Gram Vikas Kendra Child In Need Institute
Social Initiatives Group, ICICI Bank
In collaboration with:
Department of Health, Medical Education and Family Welfare, GoJ
Department of Social Welfare, GoJ
Reducing the Incidence of Low Birth Weight using a Community based Life Cycle
Strategy Aims to impact key maternal
and child health indicators Focus on community
mobilisation processes and enhancing linkages between the communities and the health systems
Action research – Seeking to understand and capture the processes of change (at the community and systemic level)
Research Objective: To evaluate the impact of a community level Life Cycle based intervention along with the improvement of primary health care delivery system on maternal and child health outcomes.
Study Design
Angara & Silli Sonahatu & Mandar
Intervention Blocks
Comparison Blocks (No intervention)
Ensuring Mandated Health Services
intervention in 50% SC areas
Ensuring Mandated Health Services +
Community Mobilisation intervention in 50% SC
areas
No intervention in
50% SC areas
4 Blocks in Ranchi District
Methodology
72 SCs from four
blocks195 villages
HH level: Married women having
live birth in last 5 year, and head of
household
ANC Cohort – women in last trimester of pregnancy
Young unmarried women (15-24
years)
Young unmarried men (15-24 years)
Ist stage 2nd stage
Survey Instruments
•Married Woman Questionnaire
•ANC Questionnaire
•Village Schedule
•Youth Questionnaire
•ANM and AWW Questionnaire
•TBA Questionnaire
Study areaReligion
Hindu
Muslims
Christians
Sarna
%
62.3
4.6
2.5
30.1
Average Household size 5.7
Household below poverty line 48.7
Households having toilets 3.6
Households with safe drinking water 33.1
Standard of living
Low
Medium
High
49.3
40.6
10.1
Birth Weight
Details of ANC cohort followed
Total number of pregnant women identified during third trimester
996
Information available (Followed) 830
Still Births 30
Birth weight taken 741
Neonatal deaths 34
Infant deaths 48
Birth Weight Distribution < 2 Kg 6.5%
2.0 -2.49 Kg 35.2%
> 2.5 Kg. (Normal)
58.3%
Proportion of LBW babies: 41.7%
Mean birth weight: 2516.3 gm, S.D. 383.5
83.4
16.6
Untrained personnel Trained personnel
Place and assistance during delivery
10.8
89.2Institutional Home
45.637.6 33.3
54.462.4 66.7
01020304050607080
15-24 yrs 25-34 yrs 35-49 yrs
Maternal Age
Per
cen
t (%
)
LBW (< 2.5 kg.) Normal (>= 2.5 kg.)
6956.9
3143.1
0
20
40
60
80
100
Institutional Home
Percen
t (%
)
Normal (>= 2.5 kg.) LBW (< 2.5 kg.)
Birth Weight: Some more findings
36.945.1
63.154.9
0
10
20
30
40
50
60
70
Normal or Mild Moderate or Severe
Anaemia status
Per
cent
(%)
LBW (< 2.5 kg.) Normal (>= 2.5 kg.)
Maternal Care
Mean Age at Marriage and Pregnancy (N=3635)
16.47
18.69
12 13 14 15 16 17 18 19 20
Mean age at Marriage
Mean age at FirstPregnancy
Age in Years
Tetanus Toxoid Immunisation and IFA consumption
1 TT6%
No TT18%
2 TT76%
62.1
44.4
29.8
0 10 20 30 40 50 60 70
Received IFA
Received enough IFA (3+months)
Consumed all
% of women
Received at least 3 Antenatal Check ups
Media Exposure
15.6
19
0
5
10
15
20
No Yes
Standard of Living Index
14
18.1
24.4
0
5
10
15
20
25
30
Low Medium High
Distance to village from road
17.5
13.6
0
5
10
15
20
≤4 Kms. >4 Kms
Maternal Diet and Workload
59.1
17.2
010203040506070
Having less food than usual Keep fasting duringpregnancy
89.6
36.9
79.4
35.6
25.1
6.4 3.80
10
20
30
40
50
60
70
80
90
Pe
rce
nta
ge
of
wo
me
n
FetchingWater
Fetchingfirewood
Grinding,pounding
Care ofanimals
Farmingactivities
Mud quary Constructionwork
Activities
Food pattern during pregnancy
Women performing heavy/risky work during pregnancy
Women’s decision making
68
7.73.6
7.813.2 10.8
0
10
20
30
40
50
60
70
80
What itemsto Cook
Obtaininghealth care
for self
PurchasingJewellary
Going andstaying with
parents
Go to themarket
Visit torelatives and
friends
Women’s autonomy and dietary practices
71.6
26.2
9.5 7.614.7
7.61.9 2.5
0
20
40
60
80
GLV Pulses Meat, fish, eggs Milk and milkproducts
Yes No
Poverty and health behaviour
0
10
20
30
40
50
60
70
fully imm(p<.001)
bednet(p<.001)
Vit A (p=.007)
pe
rce
nt
no redcard
redcard
Reasons for accessing health care: public and private
0
10
20
30
40
50
60
per
cen
t
public
private