|
 
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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 29
| Issue : 2 | Page : 131-137 |
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Anthropometric measurements of term babies delivered in a mission hospital in Southwest Nigeria
Victoria Iyabo Olafimihan1, Adekunle Joseph Ariba2, Iyabode Olabisi Florence Dedeke3
1 Department of Family Medicine, Sacred Heart Hospital, Lantoro, Abeokuta, Ogun State; International Institute of Tropical Agriculture Headquarter, Idi Ose, Ibadan, Oyo State, Nigeria
2 Department of Family Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
3 Department of Paediatrics, Federal Medical Centre, Abeokuta Ogun State, 3Department of Family Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| Date of Submission | 17-May-2021 |
| Date of Decision | 30-Dec-2021 |
| Date of Acceptance | 01-Jan-2022 |
| Date of Web Publication | 23-Apr-2022 |
Correspondence Address:
Victoria Iyabo Olafimihan
Medical Unit, International Institute of Tropical Agriculture Headquarters, PMB 5320, Oyo Road, Idi-Ose, Ibadan, Oyo State
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/npmj.npmj_556_21
Background: Babies birth anthropometric measurements are useful for retrospective assessment of foetal in utero health status, anticipatory care and growth monitoring. At community level, measurements other than birth weight (BW) may help predict low BW (LBW). Aim: The aim of the study was to determine the mean anthropometric measurements of term babies, its comparability with standard values, acceptable cutoff and surrogate for LBW. Materials and Methods: A cross-sectional study involving 257 term babies delivered by booked mothers at the Sacred Heart Hospital Abeokuta and selected by systematic random sampling. BW, occipitofrontal circumference (OFC), chest circumference (CC), mid-upper arm circumference (MUAC) and crown-heel length (CHL) were measured, and data were analysed using SPSS version 21 with significant P < 0.05 and confident interval of 95%. Results: Mean BW, CC, OFC, CHL and MUAC were 3.25 ± 0.47 kg, 33.32 ± 1.98 cm, 34.7 ± 1.93 cm, 48.16 ± 2.87 cm and 11.57 ± 1.41 cm, respectively, with no significant mean difference between male and female babies. The mean OFC was higher than the national standard, World Health Organization Multicentre Growth Reference Study (WHO-MGRS) and INTERGROWTH-21. The mean cutoff for LBW was OFC – 31.89 cm, CC – 29.56 cm, CHL– 43.33 cm and MUAC – 9.35 cm (P = 0.000) with OFC being the best surrogate of LBW at Sensitivity, Specificity and Degree of Accuracy/area under the curve of 66.7%, 97.6% and 82.1% respectively. Conclusions: LBW babies had lower mean anthropometric cutoff values at variance from the WHO-MGRS and INTERGROWTH-21. Mean OFC was higher than both standards reflecting the need for cautious interpretation to prevent misdiagnosis of macrocephaly. We recommend OFC as an alternative for predicting LBW when access to weighing scale is a challenge.
Keywords: Birth weight, chest circumference, crown-heel length, mid-upper arm circumference, occipitofrontal circumference, term babies
How to cite this article:
Olafimihan VI, Ariba AJ, Florence Dedeke IO. Anthropometric measurements of term babies delivered in a mission hospital in Southwest Nigeria. Niger Postgrad Med J 2022;29:131-7 |
How to cite this URL:
Olafimihan VI, Ariba AJ, Florence Dedeke IO. Anthropometric measurements of term babies delivered in a mission hospital in Southwest Nigeria. Niger Postgrad Med J [serial online] 2022 [cited 2022 Jul 1];29:131-7. Available from: https://www.npmj.org/text.asp?2022/29/2/131/343733 |
| Introduction | |  |
Anthropometry of babies is routinely measured in health facilities soon after each delivery.[1] These measurements are important tools in the assessment of intrauterine foetal growth and development.[1],[2] They serve as maturity indices and deviation from expected estimates may be pointers of intrauterine growth restriction, exposure to intra-uterine infections or presence of congenital anomalies.[3] Foetal malnutrition and early post-natal complications can also be diagnosed.[4] In addition, they serve as baseline tools for monitoring child's development, nutritional status and also reflect the social health of each individual and their family.[1],[4],[5],[6]
Birth weight (BW) has been an important measurement used to classify babies as high BW (HBW), normal BW (NBW) or low BW (LBW) in order to forecast the type of care needed by each newborn.[7] Other anthropometric measurements which are significant for identifying babies with LBW have been recognised and could be used as important predictors, especially in communities with limited resources and access to weighing scales.[8],[9] Paulsen's et al. identified chest circumference (CC), foot length and mid-upper arm circumference (MUAC) as tools useful in poor resource settings to rule out small for gestational age babies.[8] Chest circumference (CC) was also reported as the best surrogate for detecting LBW infants by Ndu et al. amongst Igbo babies in southeast Nigeria.[9]
Intrauterine foetal growth can be monitored by comparing baby's anthropometric measurement with established standards. World Health Organization Multicentre Growth Reference Study (WHO-MGRS) charts as well as the INTERGROWTH-21st growth chart, an improvement on the WHO-MGRS chart, allow for appropriate comparison and care decision for each newborn.[10],[11] Although, INTERGROWTH-21 project was an updated standard, various studies reported variability from it, and this may reflect the effect of ethnicity and socioeconomic status on babies' anthropometry as not all countries could be included in both studies.[2],[12] It is noteworthy that Onyekwelu in Nigeria reported a significant variation in head circumference of newborns from the INTERGROWTH-21 standard but had similarity with a large scale study, considered to be a national standard, done in Jos central region of Nigeria.[2],[12]
The maternal factors influencing the BW of the studied 257 babies have been previously published.[7] The index study aimed to determine the mean of BW, occipitofrontal circumference (OFC), MUAC, CC and crown-heel length (CHL) of term babies delivered by booked mothers in a missionary hospital setting, Sacred Heart Hospital (SHH) Abeokuta, Ogun state, in southwest Nigeria. It sought to identify the relationship of these measurements with LBW, especially with regard to fitting as its surrogate and also highlighted the degree of agreement of the mean values obtained with the national standard set by Pam et al. in Jos Nigeria, the INTERGROWTH-21 and the WHO-MGRS charts.[10],[12]
| Materials and Methods | | |
Study design
The study was a hospital-based cross-sectional study conducted amongst term babies delivered by mothers who had antenatal care and delivery at the SHH Abeokuta. The duration of the study was between 1st of August and 24th November 2017 after an ethical approval has been obtained.
Study site
The study site is a secondary healthcare centre of the Catholic mission located in Ogun State, south-west Nigeria and was founded as the first hospital in the country in 1895.[13] It provides reputable obstetric and neonatal services and offers postgraduate training in Family Medicine. It is an internship centre for medical doctors, nurses, pharmacist and laboratory technicians and scientists. It has a reputable School of Nursing in south-west Nigeria.
Ethical consideration
Ethical approval dated 29th November 2016 (permit number: SHH/EC/EA/011/16) was obtained from the Ethical Committee of the SHH Abeokuta before the study commenced. Voluntary informed consent was taken from mothers before recruitment of their babies as study participants and information related to personal identification were not recorded to maintain confidentiality.
Study population
The study population were term babies (estimated gestational age [EGA] of 37–42 weeks) delivered by mothers who booked for antenatal care at SHH before EGA of 20 weeks. The EGA at booking was confirmed with the last menstrual period and early ultrasound scan.
Sample size
The study sample size was calculated using the formula for descriptive studies (n = z2 pq/d2).[14]
Where: z (Standard normal deviate at confidence interval (CI) of 95%) is 1.96 P (Prevalence of babies with NBW obtained from a study done in Ibadan, located <100 km from Abeokuta) is 79.5% (0.795).[15] q (1 − p)-Proportion of babies with abnormal BW is 0.205 d-desired degree of accuracy is 0.05.
Hence, n = z2 pq/d2 = (1.96) 2 (0.795)(0.205)/(0.05) 2 = 250.434.[7]
Adjusting for population <10,000, the formula for non-finite sample (nf = n/[1 + n/N]) was applied).[14]
Where: Nf = Desired sample size when sample population is <10,000 n (Sample size of the population is >10,000) = 250.434.
N (Study population size of pregnant women who had antenatal care in 2015) = 3013.
Hence, nf = n/{1 + n/N} = 250.434/{1 + 250.434/3013} = 231.241.
With 11% attrition to make provision for none response, a sample size of 257 was used.
This sample size of 257 was used for the study earlier published on the mothers of these babies.[7] Permission to use this sample size and population was obtained from the previous journal.
Hence, 257 singleton term newborns were recruited using systematic random sampling technique at interval of 2 within 48 h of birth while in the post-natal ward.
Study procedure
Anthropometric measurements of babies are routinely taken by the midwives after the delivery of the babies. These were measured immediately a baby was born and resuscitated within the 1st hour of life. The measurements considered for this study were birth weight, OFC, CC, MUAC and CHL of the babies.
BW was measured using Camry® baby weighing scale previously calibrated with a known standard weight. Weighing was done with the baby unclothed and measurement taken to the nearest 0.1 kg.[5]
Occipitofrontal circumference measured to the nearest 0.1 cm was taken using a flexible tape measure round the head from the forehead around the supraorbital ridge above the eyebrow to the occipital protuberance.[4]
The CC was measured to the nearest 0.1 cm end expiratory at level of the nipple line using a flexible tape.[9]
The MUAC was measured with a flexible tape to the nearest 0.1 cm at the mid-point between the acromion and the olecranon process.[4]
The CHL was measured in between two firm board placed at the head and feet of the baby while in supine position. With the knee extended by an assistant, measurement was taking using a linen tape from the crown to the heel and was recorded to the nearest 0.1 cm.
Data analysis
Data collected were recorded in a questionnaire and were analysed with IBM SPSS for Windows, version 21 (IBM Corp., Armonk, N.Y., USA). The mean and its standard deviation, range and mode of each measured parameter were determined. The relationship between babies' gender and anthropometric measurements was also analysed. Mean values were compared with those from other regions of Nigeria, other countries and international standard (INTERGROWTH-21 project and WHO-MGRS). Student's t-test was used to determine the association between mean BW (categorize as <2.5 kg and ≥2.5 kg) and CC, OFC, CHL and MUAC. Linear regression analysis was done to determine the surrogates of LBW, and a precision analysis was performed to determine the predictability of the identified anthropometric measurement. Level of significance was set at P < 0.05 and CI of 95%.
| Results | | |
Babies' anthropometry
Of the 257 babies studied, 125 (48.6%) were male with a male-to-female ratio of 1:1.05. The number of babies who were LBW (<2.5 kg), NBW (2.5 kg– 3.9 kg) and HBW (≥4.0 kg) were nine (3.5%), 238 (92.6%) and 10 (3.9%), respectively, with a mean BW of 3.25 ± 0.47 kg. The mean CC, OFC, CHL and MUAC were 33.32 ± 1.98 cm, 34.7 ± 1.93 cm, 48.16 ± 2.87 cm and 11.57 ± 1.41 cm, respectively. The comparison of the mean values for all the anthropometric measurement based on gender showed no significant statistical difference [Table 1].
Comparison of babies' anthropometry with standards and other studies
The mean BW from this study of 3.25 kg (±0.47) was higher than the findings from the study in Jos, Abuja and other African countries but was slightly lower than the values from the developed countries (United State of America and United Kingdom) WHO-MGRS and INTERGROWTH-21 charts. The mean OFC of the babies of 34.71 cm (±1.93) was higher than that documented by other studies [Table 2]. | Table 2: Comparison of babies' anthropometry measurements with standards and other studies
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Association between birth weight and other anthropometric measurements
All other anthropometric measurements were significantly lower in babies with BW <2.5 kg compared with those with BW ≥2.5 kg. The mean OFC, CC, CHL and MUAC of 31.89 cm, 29.56 cm, 43.33 cm and 9.33 cm, respectively, were acceptable cutoffs for LBW amongst term babies in this study [Table 3]. | Table 3: Association between birth weight and other anthropometric measurements
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Linear regression analysis on anthropometric cut-offs for determining low birth weight among term babies
Simple linear regression was performed using cutoff for OFC (31.89 cm), CC (29.56 cm), CHL (43.33 cm) and MUAC (9.33 cm). All the cutoff had significant association with LBW. CC had the highest coefficient of determination (R2-0.436) and lowest standard error of estimate (SEE) of 0.138. This was followed by OFC (R2-0.313, SEE – 0.152). However, the multiple linear regression using all the four anthropometric measurements gave a higher R2(0.538) with lower SEE (0.126) when all the cut-offs were considered together as predictors of LBW in term babies [Table 4]. | Table 4: Linear regression analysis on anthropometric cut-offs for low birth weight among term babies
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Predictive performance of selected anthropometry cut-offs for low birth weight among term babies
The predictive analysis performed on the selected cut-offs for term babies with weight below 2.5 kg showed OFC of 31.89 cm had optimal cutoff with a sensitivity of 66.7%, specificity of 100% and area under the curve (AUC) of 0.821; degree of accuracy was 82.1% [Table 5] and [Figure 1]. | Table 5: Predictive performance of selected anthropometry cut-offs for low birth weight among term babies
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 | Figure 1: Combined Receiver Operating Characteristic curve for chest circumference, mid-upper arm circumference, occipitofrontal circumference and crown-heel length. Cut-off values are: mid-upper arm circumference – 9.33 cm; chest circumference – 29.56 cm; crown-heel length – 43.33 cm; occipitofrontal circumference – 31.89 cm
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| Discussion | | |
Birth weight remains an important independent predictor of newborn survival and a valuable tool for immediate decision of care.[4] The recorded mean BW of 3.25 ± 0.47 kg was higher than those reported in Jos (3.1 ± 0.8 kg) and Abuja (3.14 ± 0.6 kg); both in the central region of Nigeria as well as Sudan, Tanzania and Uganda.[3],[5],[8],[16],[17] On the contrary, it was lower than the value amongst Igbo babies in southeast Nigeria (3.28 ± 0.49 kg).[2] Previous studies have earlier reported that babies from this region of the country tended to be heavier than other Nigerian babies.[9],[18] This may be a reflection of the effect of ethnicity and genetic composition on in utero weight gain.[18],[19] On the overall, mean BW values from the index study as well as the other reviewed national and African studies were lower than that from the United States, United Kingdom as well as international standards (WHO-MGRS: 3.3±0.5 kg and Intergrowth standard: 3.3±0.56 kg).[10],[11] The enrolment of mothers with specific criteria in both WHO-MGRS and INTERGROWTH-21 may reveal the effect of the sociodemographic status on BW outcome.[11] This will agree with other studies on the need for national standards to assess the growth of babies and children from each country/region considering the fact that not all countries were included in the WHO-MGRS and INTERGROWTH-21 project.[2],[6],[11],[12]
Occipitofrontal circumference is one of the most common anthropometries used to assess the growth of babies due to the ease access of its measurement.[12],[16] It reflects the intra-uterine brain development of the babies and is considered an important tool for assessment of neurological development by neurologists.[6],[12] The mean OFC of the babies in this study (34.71±1.93 cm) was slightly higher than the report of the large-scale study of Pam et al. in Jos (34.4 ± 2.1 cm) assumed to be a National standard.[12] However, both studies along with another in southeast Nigeria (34.39 ± 1.74 cm) had values above the standard values reported by WHO-MGRS (34.2 ± 1 cm) and INTERGROWTH-21 project (33.9 ± 1.3 cm).[2],[10],[11] This will also agree with the report of Onyekwelu on the possibility of Nigerian babies having bigger heads and the need to be cautious in considering this as macrocephaly.[2] Thus, a review taking ethnicity into consideration may be necessary to prevent wrong diagnosis of babies as having microcephaly or macrocephaly based on comparison with standards.[20],[21]
The anthropometric sizes of the male babies were slightly higher than that of the females, although, these were not statistically significant. Similar but significant findings were reported by Onyechukwu in Enugu Nigeria.[2] Male babies are believe to be heavier than the female due to the higher lean mass in them and our finding is consistent with this report.[22]
Detecting LBW amongst babies can be a challenge, especially in rural areas when functional weighing scales are not available.[9],[23] Thus, the use of other anthropometric measurements may provide alternative methods for the identification of such babies to enhance appropriate care or referral. There is a strong positive association of other anthropometric measurements assessed with LBW (P = 0.000). This finding is comparable to other studies.[9],[17],[24] The cutoff of OFC – 31.89 cm, CC – 29.56 cm, CHL – 43.33 cm and MUAC – 9.33 cm are similar to findings reported in other studies in Africa.[3],[8],[9],[17],[23],[25] However, these values were lower than the cutoff reported by Achebe et al. in south-eastern Nigeria (OFC-35.15 cm, MUAC – 10.50 cm and CHL – 48.60 cm).[24] This supports the quest by other researchers on the need for local cutoffs of anthropometric measurements of babies putting into consideration the ethnicity of the babies.
Of all the assessed anthropometric measurements cutoffs for LBW, OFC was identified as the most reliable surrogate of LBW amongst term babies in this study (Sensitivity – 66.7%, Specificity – 97.6% and degree of accuracy/AUC – 82.1%), and this was followed by CHL (sensitivity – 55.6%, specificity – 95.6% and degree of accuracy/AUC – 75.6%). Head circumference as the best surrogate was also reported in studies conducted amongst term babies in Nepal and another in Jakarta.[26],[27] Olusanya also reported CHL and OFC as potential surrogates for identification of all categories of LBW in a study conducted in Lagos Nigeria.[28] OFC and CC were reported to be of similar effect in detecting LBW in a study involving both term and preterm babies in Ethiopia.[29] Although, most studies on this subject reported CC had highest predictor for LBW, this was identified as the least sensitive along with MUAC in this study (Sensitivity 44.4%).[3],[21],[23],[25] CC is considered to be easy to use due to the ease of landmark (nipple line) identification and less affectation of the surrounding soft tissue during birth process.[9],[30] However, the use of OFC especially in the community setting where maintenance of warm chain may be a challenge, will reduce babies' risk of hypothermia as it can be measured without necessarily removing the waddling clothes, especially during the cold weather. Although, the effect of moulding on the babies' head at birth is considered as factor that may affect the reliability of OFC in determining LBW, especially within the first 24 h of life,[17],[26] this effect may not be generalised considering its finding as a reliable surrogate in this study and others involving term babies. The OFC can also be a quick and easy tool to aid referral of babies at risk to centres where proper sorting/care can be offered.[27],[28] Creation of colour codes to assist identification of affected babies in the community health caregivers has also been recommended.[28]
Assessing the babies with multiple anthropometries had a higher correlation coefficient and similar pattern was reported by Ndu et al.[9] This will agree with the use of OFC along with other parameters such as CHL as identified in this study, to increase its accuracy in the identification of LBW babies. Thus, the finding of this study aligned with previous studies and the WHO recommendation on the use of other babies' anthropometry in the community and primary care setting for prompt decision for referral/care.[9],[30]
This study being hospital based, which may not be representative of babies delivered outside healthcare facility, and non-classification of babies by gestational age was a limitation identified.
| Conclusions | | |
The anthropometries of the babies in this study are comparable to findings in other developing countries, although, some variations were noted from other regions of Nigeria. They also varied from the WHO-MGRS and INTERGROWTH-21 project recommendation and the mean cutoff for LBW was lower than the recommended values. The OFC at value of 31.89 cm was the best surrogate for identification of LBW amongst term babies. The mean OFC of the babies was also higher than those of both standards. Thus, caution must be exercised in the interpretation of OFC to prevent misdiagnosis of macrocephaly. A local (national/regional) standard is recommended to allow for appropriate comparison and interpretation of babies' anthropometries.
Acknowledgements
We appreciate the management of the SHH Abeokuta for allowing the conduct of the study. Sincere appreciation goes to all the midwives in the maternity unit of the hospital for their support in ensuring accurate measurement and documentation of the babies' anthropometries. We also appreciate the mothers who gave consent to participate in the study on behalf of their babies.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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