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Identifying high-risk babies born in the community using foot length measurement at birth in Uganda
E Nabiwemba1, T Marchant, G Namazzi
1School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda. enabiwem@musph.ac.ug
Insights
Foot length can effectively identify low birthweight and premature newborns in low-resource settings. A 7.6 cm cut-off accurately flags high-risk infants for timely intervention.
Area of Science:
- Neonatal health
- Pediatric medicine
- Public health in low-resource settings
Background:
- Low birthweight and prematurity are significant risk factors for neonatal mortality.
- Early identification and care are crucial for improving survival rates of vulnerable newborns.
- This study investigates foot length as a practical surrogate for identifying these high-risk infants.
Purpose of the Study:
- To assess the utility of foot length as a predictor of low birthweight and prematurity.
- To establish an operational foot length cut-off for identifying high-risk newborns in community settings.
- To inform interventions for neonatal care in resource-limited environments.
Main Methods:
- A hospital-based cross-sectional study involving 711 newborns in Uganda.
- Measurement of newborn foot length using three methods within 24 hours of birth.
- Utilized receiver operating characteristic (ROC) curve analysis to determine optimal foot length cut-offs for predicting low birthweight and prematurity.
Main Results:
- A foot length cut-off of 7.6 cm demonstrated high predictive value.
- This cut-off achieved 85% sensitivity and 81% specificity for identifying low birthweight infants (<2500g).
- For premature infants (<37 weeks), the cut-off showed 96% sensitivity and 76% specificity.
Conclusions:
- Newborn foot length is a reliable indicator for low birthweight and prematurity in the studied setting.
- The proposed 7.6 cm cut-off can aid in identifying infants needing extra care.
- Further research is recommended to evaluate the feasibility of community health worker implementation.
Background:
Low birthweight and prematurity are risk factors for neonatal mortality. Identifying low birthweight and premature babies at birth and giving them appropriate care could increase their chances of survival. This study aimed at assessing the use of foot length as a surrogate for low birthweight and prematurity, and recommending an operational cut-off for identifying high-risk babies at the community level in low resource settings.
Methods:
A hospital-based cross-sectional study was carried out between 1 September and 17 December 2009 in Uganda. Foot length of 711 newborns was measured using three different methods and their weight taken using a digital salter scale within 24 h of life. Gestational age of the newborns was also estimated using the Eregie method. Non-parametric receiver operating characteristic curve analysis was carried out to determine the foot length method with the highest predictive value to predict low birthweight and premature newborns. Sensitivity, specificity and predictive values for a range of foot lengths were estimated to determine the optimal cut-off to predict low birthweight and prematurity in this setting.
Results:
Of the 711 babies recruited on day 1, 85 (12%) babies were low birthweight (<2500 g) and 29 (4%) premature (<37 weeks). The operational cut-off for foot length to detect small babies was defined as 7.6 cm, with sensitivity 85% [95% confidence interval (CI) 75-92] and specificity 81% (95% CI 78-84) for low birthweight, and sensitivity 96% (95% CI 82-100) and specificity 76% (95% CI 73-79) for premature babies.
Conclusion:
Foot length in the first days of life can predict low birthweight and prematurity among newborn babies in this setting. Further evaluation is needed to assess the feasibility of its use by community health workers to identify babies that need extra care.
