A Study To Assess The Maternal Factors Leading To Low Birth Weight Babies In Selected Hospitals Of Pune-India

Background: The birth weight of an infant is the single most important determinate of its chances of the survival, health growth and development. Objectives: Assessment of maternal factors leading to low birth weight babies and Associate it with some demographic variable of the babies. Methods: Non-experimental exploratory survey research was conducted from Jun 20 th to Dec 31 st 2011 in India. A Non-probability convenient sample consists of 100 postnatal mothers who delivered low birth weight babies were selected from Pune Hospitals. The tool used for data collection is a structured questionnaire consisted from two sections:


INTRODUCTION:
Motherhood is a beautiful and joyous experience to a woman.The health of the mother during pregnancy is so important to give birth to a healthy baby.Birth weight is a powerful predictor of infant growth and survival.Infants born with a LBW begin life immediately disadvantaged and face poor survival rates.The birth weight of an infant is the single most important determinate of its chances of the survival health growth and development.The averages weights of newborn vary from 2700 gm to 4000 gm. 1 Weight is considered as one of the finest indicator to measure physical health.It is also considered as an important attribute to the child survival. 2Low Birth Weights is the single most important factor determining the survival chances of the child.It is also one of the most serious challenges in maternal and child health in both developed and developing countries.Many of them die during their first year.The infant mortality rate is about 20 times greater for all LBW babies.Low birth weight is thus an important guide to the level of care needed by individual babies. 3he grouped risk factors of low birth weight into the following categories: genetic and constitutional, demographic and psychosocial, obstetric, nutritional, maternal morbidity during pregnancy, toxic exposures, and antenatal care.The incidence of LBW can be reduced if pregnant women "at risk" are identified.For this approach, the women need to be identified early in pregnancy and further reduction in child mortality.Therefore, it requires understanding of the determinants of neonatal mortality such as low birth weight, preterm birth and low Apgar score. 4The use of tobacco, alcohol and caffeine are three reasons for which evidence of the adverse effects of these substances on pregnancy outcome is increasing. 5 THIS STUDY AIMS to assess the maternal factors leading to low birth weight babies and to associate them with the selected demographic variables of babies.

CONCEPTUAL FRAMEWORK:
Conceptual framework deals with abstractions that are assembled by virtue of their relevance to a common theme.Conceptual models present an understanding of the phenomenon of interest and reflect the assumptions and philosophic views of the models designer.Conceptual models can serve as springboards for generating research hypothesis. 6The conceptual framework in this study is based on "General Systems theory" Developed by Ludwig Von Bertalanffy with input, process, output and feedback in 1968. 7

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Setting of the study: The setting refers to the area where the study is conducted.This study was under taken in selected hospitals.Bharati Hospital and Bharati Aurvedic Hospital situated in Pune city.

Population:
The populations of this study consist of all postnatal mothers (who delivered) low birth weight babies.

Sampling technique:
In the present study, Non probability convenient method of sampling is used.Samples were selected according to the criteria after obtaining permission from the directors of hospitals.

Sample and sample size:
The sample of this study consists of 100 postnatal mothers who delivered low birth weight babies.

Sample criteria
The following criteria were set to select samples:

Inclusion criteria:
Mothers who are willing to participate in the study.Mothers who are able to read or understand English, Hindi or Marathi.Mothers having low birth weight baby.

Exclusion criteria:
Mothers who are critically ill.The mothers who are admitted other than the selected hospitals of Pune city.1): shows that in age Majority of the mothers (45%) were belonging to the age group of 20-25 years.In education Majority 67% were illiterate.In occupation Majority of the mothers (59%) were housewife.In monthly income Majority of the mothers (77%) were within the income between Rs.5, 001-10,000.In Gravida Majority 84% of the mothers were primi.Association of the personal factors Shows that chi-square calculated value is less than chi-square table value for the parameter age, education, occupation, income and gravida with the birth weight and gestational age of babies.It indicates that there is no significant association between the above factors with birth weight and gestational age babies.As the calculated value of Fisher exact is less than table value for income with gestational age, there is no significant association between the incomes with gestational age babies.Table Number (2): shows that (62%) majority of the mothers' age at marriage belong to the age group of 20-25 years.In previous history of abortion (68%) Majority of the mothers did not have history of abortion.In family history of LBW (82%), Majority of the mothers did not have previous family history of LBW.In ANC Registration (81%), Majority of the mothers were registered.In decision taken for ANC Registration (70%), majority were by their family members.In hospitalization during pregnancy (66%), majority of the mothers had no history of admission.Association of the biological factors shows that since the calculate chi-square values are less than the chi-square table value for the following parameters: age at the time of marriage, any abortion, Previous family history of LBW, registered, decision maker, Admission, No. of babies delivered .It indicates that there is no significant association between the mothers' Biological factors with birth weight and gestational age S significant Table Number (3): shows that (67%) majority of the mother's were vegetarian.In number of meals (70%), Majority of the mothers had food thrice a day.In increasing dietary intake majority of the mothers (69%) had increased dietary intake.In Weight gain during pregnancy (80%), majority of the mothers got 9-10 kg increase.In Iron and folic acid supplementation (64%), majority of the mothers did not get Iron and folic acid.In HB (74%), majority of the mothers were between 9-11% gm.Association of the nutritional factors show that since the calculate chi-square values are less than the chi-square table value for the following parameters: Dietary history, normal meal pattern, dietary intake increase, and HB level.It indicates that there is no significant association between the mothers' Nutritional factors with birth weight and gestational age.As the calculated value of fisher exact is more than table value for gestational age, it indicates that there is significant association between the weight gain and gestational age of babies.As the calculated value of chi-square is more than table value for supplementation during pregnancy with gestational age.It indicates that there is significant association between the supplementation and gestational age babies.

HS height significant
Table Number 4: shows that (97%) majority of the mothers did not have history of medical illness.In medical disorder during pregnancy (95%) majority of the mothers did not have any medical disorder.In obstetrical problem (99%) majority of the mothers did not have any obstetrical problem.In medicine without permission (99%) majority of the mothers have not taken medicine without permission.In taking medicine during pregnancy (82%) majority of the mothers had not taken medicine.Association of the history of any major systemic disease factors show that since the calculate chi-square values are less than the chi-square table value for the following parameters: taken medicines.It indicates that there is no significant association between the mothers' History of any major systemic disease and birth weight.As the calculated value of chi-square is more than table value for taken medicines with gestational age, there is highly significant association between the taken medicines and gestational age of babies.5): shows that (82%) majority of the mothers did not have plan to the present pregnancy.In Response of the family (97%), majority of the mothers the Response of the family were Supportive.In Emotional status (50%), majority of mothers were Cheerful.In relationship with the husband (98%), majority of the mothers were satisfied.In Relationship with family members (96%), majority of the mothers had Good relationship.In worry about financial condition (51%), majority of the mothers worried.In Sleep pattern during pregnancy (92%) majority of the mothers had 8 hours sleep at night, and 2 hours at noon.Association of the psychological factors show that since the calculate chi-square values are less than the chisquare table value for the following parameters: plan to this pregnancy, relationship with family member, worry about your financial condition and sleep pattern.It indicates that there is no significant association between the mothers' Psychological factors with birth weight and gestational age.As the calculated value of fisher exact is less than table value for sleep pattern with gestational age.It indicates that there is no significant association between the sleep pattern and gestational age of babies.
(2) 2013 Table Number (8) shows that maximum of babies were (35.514%) belongs to birth weight group 1.5-2.0kg, the babies were (28.9719%) belongs to birth weight group 2.0 -2.499, the babies were(17.757%)belongs to birth weight group 1 -1.5 and the babies were (17.757%) belongs to birth weight group <1kg.Table Number (9) shows that maximum of babies were (51%) belongs to male sex and the babies were (49%) belongs to female sex.

DISCUSSION
The found another study by (Vidyullatha) on normal primi mothers (n=100)) in Government Maternity Hospital, Hyderabad, about risk factors of LBW reveals that 29% of mothers had low level of knowledge about risk factors of LBW, 39% of mothers had medium level of knowledge.(Makhija K.) who reveals that there is significantly more LBW for males (57.and%) than LBW males (42.0%) but findings in a Thailand study did not find any difference in the incidence of LBW between sexes.Harold, et al. (2003) reported that malnutrition is wide spread in the developing world.12 or more million low birth weight births occur per year. 9Anaemia diagnosed early in pregnancy is associated with increased risk of LBW and preterm delivery (Levy  et al, 2005).In several studies the association between anaemia and outcome of pregnancy reversed the direction during the third trimester. 10

CONCLUSION:
Researcher concluded that maternal factors (Personal, Biological, Nutritional, History of disease, Psychological and Social factors) can affect the weight of the babies.

RECOMMENDATIONS:
Keeping in view the findings of the study, the following recommendations were made: 1) A comparative study can be conducted about the risk factors of low birth weight in urban and rural area.2) An exploratory study can be undertaken to find out the educational needs of the antenatal mothers.3) A comparative study can be conducted among mothers of low birth weight babies in Gov. Hospital and private Hospital.
4) A similar study can be conducted effectiveness of planned teaching programme on factors effect low birth weight.5) A similar study can be conducted on mothers of normal weight babies and mothers of low birth weight.
6) A comparative study can be done between pre term and small for gestational age.

Table Number (
7) shows that maximum of babies were (31.7757%) belong to Gestation age group 37 weeks, the babies were (28.9719%) belong to Gestation age group38, the babies were (21.4953%) belong to Gestation age group39, the babies were(15.8878%)belong to Gestation age group <37 and the babies were (1.8691%)belong to Gestation age group 40+.