6
0
in the Caribbean, the level (14 per cent) is almost as
high as in sub-Saharan Africa. About 10 per cent of
births in Oceania are low birth weight. Among the more
developed regions, North America averages 8 per cent,
while Europe has the lowest regional average at 6 per
of length, occipitofrontal circumference, mid-arm cir-
cumference and maximum thigh circumference of the
newborn babies) in detecting LBW babies and also to
determine the local specific cut-off points for these
measurements in Nnewi, Southeast of Nigeria.
Subjects and methods
3
4
cent . In Nigeria, a study in the Southwest reco5rded a
rate of 11.4% while another from the North gave
1
2.2%.
The study site was Nnamdi Azikiwe University Teach-
ing Hospital (NAUTH), Nnewi, a tertiary health institu-
tion located in Anambra state, Southeast Nigeria. It of-
fers maternal and child health services to people of the
town, and constitutes a major referral centre for all hos-
pitals in the state and indeed some neighbouring states
in Nigeria.
Problems associated with LBW constitute a great strain
on the meagre resources available for health care deliv-
ery and family financing. Identification of LBW is cru-
cial as affected infants, either preterm or growth re-
stricted, have higher than normal mortality in the neona-
tal and perinatal period. Even in survivors, a high risk of
growth retardation and of impaired mental development
with attendant learning disabilities and attention disor-
The study design was cross-sectional involving babies
delivered at the maternity unit of NAUTH Nnewi, and
the neonates admitted into the Special Care Baby Unit
from other hospitals. Consecutive recruitment of all sin-
gleton, live-born infants and those referred to the Special
Care Baby Unit during the study period was carried out.
All assessments were done within 24 hours of delivery
of those babies after informed parental consent. Stillborn
babies, infants with clinically evident congenital anoma-
lies, those with oedema and asymmetry of the extremi-
ties from any cause were excluded from the study for
obvious reasons. Parents were given the liberty to with-
draw at any stage of the research, however, none de-
clined. Ethical approval for the research was given by
the Ethics Committee of the hospital. Data was collected
over a 6- month period from a total number of 428 ba-
bies. Measurements taken were birth weight, maximum
thigh circumference, length, occipitofrontal circumfer-
ence and mid-arm circumference using standard meth-
6
, 7
ders affecting their performance in school abound
LBW results from preterm and small for gestational age
deliveries and is directly related to the anthropometric
.
8
,9
measurements of the new born babies .
In developing countries, it is estimated that approxi-
mately 60%-800%,11 of births occur outside orthodox health
1
care facilities . Most deliveries take place either in
private homes or in rural maternities and are attended by
relatives, neighbours or ill-equipped attendants. This is
probably responsible for the finding that as simple as the
weighing procedure is, about two-thirds of newborn
1
2
babies in Sub-Saharan Africa are not weighed at birth .
Some primary health care centres and secondary health
facilities may lack suitable, functional, weighing scales,
hence the need to find alternative ways of identifying
low birth weight babies. Anthropometric techniques like
body length, occipitofrontal circumference, mid-arm
circumference, maximum thigh circumference, calf cir-
cumference and foot length require the use of measuring
tapes and are relatively simple to perform. This confers
on them a major advantage over the use of routine ana-
logue weighing scales in determining LBW in infants.
1
6
ods . All circumferences were assessed to the nearest
0.1cm with non-stretchable plastic coated insertion type
circumference tapes.
Birth weight (BW): BW was assessed with a Salter
spring scale (0-10kg), a simple to use tool with a sensi-
tivity of 0.1kg. The balance was tested against standard
set of weights at the onset of the study and weekly there-
after. Babies were weighed in a warm room without
clothing or diapers.
Several studies have shown that some simple anthro-
pometric measurements at birth can reliably predict birth
weight and can be used as valid indicators of LBW
1
3-15
.
There are serial cut-off points for the various anthro-
pometric parameters for normal birth weight babies,
below which any baby is termed low birth weight. Infor-
mation concerning the relative values of these measure-
ments in the identification of those at risk for postnatal
morbidity and mortality in Southeast Nige1r4i,a16is lacking.
Occipitofrontal circumference (OFC): The head was
measured at the largest occipitofrontal diameter with the
tape passing above the supraorbital ridges and glabella
anteriorly, and the occiput posteriorly.
The World Health Organization (WHO)
in conso-
Length (L): Length was measured using a horizontal
stadiometer to the nearest 0.1cm.
8
,17,18
have recommended that
nance with other workers
countries should derive their own serial cut-off points
for determining LBW using anthropometric measure-
ments. This stems from the observation of variations in
values in different localities and different ethnic groups
resulting from perceived differences in psychosocial,
econ,8omic and demographic variables by many research-
Mid-arm circumference (MAC): MAC was taken at
the mid-point between the tip of the acromium and the
olecranon process of the bare left tuispsupe6e,7r arm, gently to
avoid compression of the soft
snugly applied around the arm.
the tape being
7
ers .
Maximum thigh circumference (MTC): This was
measured with the infant lying supine and without a
diaper. The tape was then placed around the
The current study was carried out to evaluate the predic-
tive values of alternative anthropometric measurements