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[Levels of low birth-weight in Europe: registration problems and effects of medical interventions]
S Alexander1, M Boutsen, F Kittel
1Laboratoire d'Epidémiologie et de Médecine Sociale, Ecole de Santé Publique, Université Libre de Bruxelles, Belgique.
Insights
The World Health Organisation
Area of Science:
- Perinatal health research
- Public health indicators
- Birth outcomes analysis
Background:
- Low birthweight (LBW) is a key perinatal health indicator.
- WHO recommends LBW rate as a measure of infant health.
- Significant data quality issues affect LBW rate accuracy globally.
Purpose of the Study:
- To review literature on the reliability of low birthweight as a global health indicator.
- To identify challenges and limitations in birthweight data collection and reporting.
- To assess factors influencing international comparisons of LBW rates.
Main Methods:
- Literature review of studies on birthweight data quality.
- Analysis of reporting issues including missing data and misclassification.
- Consideration of confounding factors in international comparisons.
Main Results:
- Birthweight data collection is inconsistent across countries.
- Significant "unknown birthweight" percentages and poor registration for very low birthweights (<1000g).
- Misclassification of stillbirths and small sample sizes impact rate accuracy.
Conclusions:
- The low birthweight rate is a problematic indicator due to data quality issues.
- Improvements in birthweight registration quality are essential.
- Caution is needed when interpreting and comparing international LBW rates.
Abstract:
The rate of low birthweight births, percentage of live births weighing less than 2500 grams is one of the perinatal health indicators recommended by the World Health Organisation. A review of the literature has revealed numerous problems related to this indicator. Some countries, including France and the Netherlands do not collect birthweight data. Elsewhere, there are more than 10% "unknown birthweight". The poorest registration is for birthweights below 1000 grams. Exclusion of babies who were registered as stillborn, when in fact they died shortly after birth can cause underregistration of low birthweights. Conversely, inclusion of true stillbirths will bring on an overestimation of low birthweight rate. Some countries have too few births to deliver accurate rates. Rates of medical interventions, such as infertility treatment and elective induction should be taken into account when analyzing differences between countries. Improvement in quality of registration and caution in the use of this indicator are warranted.