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