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  • Department: HEALTH EDUCATION
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1.0 BACKGROUND OF THE STUDY Birth weight has been described as the single most useful health indicator in perinatal medicine and epidemiology; indicating both the pregnancy experience and the risk of morbidity and mortality (Cogswell M.E. et al.,1995) and a sensitive indicator of changes in living conditions (Silva A.A et al., 2004, Vågerö D, et al., 1999). Birth weight is the body weight of a baby at birth, low Birth Weight (LBW) is the birth weight that is less than 2500 gm (WHO, 1984) and prenatal mortality are important public health problems in developing countries (Tafari, 1981; Edouard, 1985) particularly in the Indian subcontinent, where the LBW rates are 30-50%, which are among the highest in the world (UNICEF-ICMR, 1987). Birth weight, a function of both gestational age and fetal growth, is the most important determinant of a newborn infant’s chances to survive and grow in health (WHO 1980, McCormick 1985). Gestational age is more difficult to ascertain than birth weight (Behrman and Stith-Butler 2007). In 1967 Lubchenko and Battaglia introduced the terms small-for-gestational age (SGA), appropriate-for-gestational age (AGA) and large-for-gestational age (LGA). Although risk factors for growth restriction and preterm birth are partly overlapping, few studies have tried to study risk factors for SGA by gestational age. In the Chilean case, the health care provider estimates gestational age based on last menstrual period (LMP) and early pregnancy sonogram. The information is considered reliable for women with at least one prenatal care visit. It is well known that infants who are small or born before 37 weeks gestational age have a higher risk for morbidity and mortality. Anthropometry is the science of measuring size, weight and other physical dimension of the human body and its parts. It is a part of physical anthropology that deals with differences in measurements of various structures of living and deceased people (Dorland, 1994). In general anthropometry is a techniques of measuring the human body in terms of dimensions, proportions and ratio such as those provided by subnasal to gnathion distances. Also applied anthropometry has been useful as a standard approach to racial classification in assessing the nutritional and health status of population, it is also important in drawing up nomogram for population to determine standard sizes that will assist in prediction anthropology. Anthropometric data on neonate provide useful information and at any given time indicated the development status of the child. Birth weight is recognized as a reliable indicator of intrauterine growth and one of the major factor determining child survival and future growth .In assessing and monitoring the nutritional status of a low birth weight infant. It is helpful to evaluate a pattern of measurements obtained on regular basis overtime. Different studies have reported the distribution of birth weight for Iranian babies ranging from 3123.75 to 492.04 and low birth weight rate of 8.1% -15%. The mean length of Iranian infant was higher by 5cm as compared to Saudi and Ethiopian infants 49.5 ± 2.0cm, 48.6 ± 3.3, respectively (Hofvander .1963; Zein ,et al., 1985; Nadebo TA.1990; Serenius, et al., 1988). Many studies showed that babies born of mothers aged 20 years and below had birth weight of 100g- 300g lower than those mothers older than 20 years. Similarly, the low birth weight rate is significantly higher in this age group (Shajari1 H., 2013). In Hanoi, the capital of Vietnam, Hop (2003) found that the average birth weight increased by 190 grams in the period 1980-2000 (Hop le, 2003).Hoffman et al. (2007) in their studies stated that mother`s high age is an indirect factor for low birth weight (Hoffman . 2007). , according to estimates by the World Health Organisation (WHO), about 1/3 of children under five years of age in Vietnam are stunted and/or underweight for age and 9 percent of newborns have low birth weight (<2500 grams) (UNICEF/WHO 2004;WHO 2009). A high risk of stillbirths has been reported in rural communities (Cripe S.M. et al.,2007) as well as a high prevalence of anaemia and hookworm infestation (Aikawa R, et al., 2006). Maternal health and foetal health and growth are impacted negatively by malnutrition, certain infections, and environmental contamination (WHO 2009; Kramer M.S et al., 2003; Perera F.P et al., 2005), factors that have been widespread in Vietnam (Trinh L.T. et al., 2007; Mai T.A. et al., 2007). Based on studies in other countries, the mean birth weight tends to increase with parity (Cogswell M.E. et al.,1995; Goldstein H.1981) especially among live pre-term neonates. According to the new WHO growth standard, a 50th percentile infant born at term weighs 3.2 kg and the 5th to 95th percentile range is 2.5 – 4.0 kg (WHO 2006). Several studies relating the effect of mother’s age and parity on birth weight indicate that parity is the more important factor of the two (Kam and Penrose, 1951; Millis and Seng, 1954; Neel and Schull, 1956; Warburton and Naylor, 1971). A possible explanation of lower birth weight (LBW) among first-born infants could be a consequence of biological immaturity as compared to later-born infants. It is now universally acknowledged that maternal age is an important factor influencing the incidence of LBW. Moreover, the rate of LBW decreases significantly with the increasing age of mother after 18 years of age. The increase in body mass index (BMI) among pregnant women worldwide has become one of the most significant public health concerns (Yazdani et al., 2012). Kelly et al in (1996) have discovered that maternal anthropometry including BMI varies across different populations of the world. They found that women from ethnic groups characterized by small body size have been reported to gain less weight on average during pregnancy than larger women. In 2012, Yadzani et al, however, established an inverse relationship between maternal BMI and weight gain during pregnancy. For women with a pregnancy BMI < 19.9 kg/m2, they could have a weight gain of 12-18.5 kg; those with a pregnancy BMI of 19.8-24.9 kg/m2 might have a weight gain of 11.5-16 kg; and those with a BMI of ≥ 25.0 might have weight gain of 7- 11.5 kg. Neonatal birth weight is an important determinant of infant’s well being, and maternal BMI during pregnancy is one modifiable factor influencing neonatal birth weight outcome (Upadhyay et al., 2011). In 2007, Berghoft et al published that high maternal BMI is related to neonatal macrosomia. Low maternal BMI during pregnancy is long recognized risk factor for delivery of neonates with low birth weight (LBW). Low birth weight is more common among blacks than among whites and is a major determinant of infant mortality (Wegman M. 1992 and Kleinman J.C. et al 1987). The role of inheritance and environment in determining birth weight remains unresolved, although recent evidence suggests that genetic influences may not be the overriding determinant (David R.J, and Collins J. W, 1997), Low birth weight is a powerful predictor of several negative life outcomes: poor survival, asthma, hypertension and non-insulin dependent diabetes (Seidman D.S et al., 1992; Wilcox A.J, 2001). In other study it is documented that Caribbeans, who had the highest birth weight, also had the lowest cardiovascularm mortality in New York (Fang J. et al., 1996), insulin resistance can affect body weight. However, the association between socioeconomic position and insulin resistance is not with the same size or even in the same direction in all countries. Among Danish children, those with the most educated and highest earning parents had least insulin resistance, whereas the opposite was true for children from Estonia and Portugal. A recent study from Detroit suggests that educating women about the effects of substance use in pregnancy could help to reduce preterm birth and lower birth weight.In recent studies it have being documented that children with a low birth weight (less than 2,500 g) are at risk for reduced intelligence test scores when they have reached the school age, even if their birth weight is corrected for gestational age (Klein NK et al., 1989; Bhutta AT et al., 2002). In early pregnancy, when neuronal multiplication and organ formation are occurring, the effects of alcohol may result in craniofacial anomalies, organ malformations, microcephaly, or a normal-sized brain with decreased cells.Fetal damage occurs as a result of either decreased cellular proliferation or cell death (Abel E.,1998.). The aim of this study is to examine the combined effect of maternal weight, gestational age as well as maternal habits (maternal smoking and alcohol drinking) on birth weight of new born in Baptist hospital, Eku within a duration of fiv