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Theme 2 – Low Birth Weight Almost all participants reported that “appearance of the newborn” is used as a criterion for judging the health of the newborn. Mother herself, daiyan or elder women in the family can tell whether newborn is healthy or not by having a look at him/ her. If the newborn appears to be chubby the newborn is termed as healthy. Activeness, good sleep, crying, normal breathing and suckling, were also reported as indicators of newborn’s health. On the other hand if a newborn has yellow skin, disturbed sleep and is very weak in appearance then s/he is perceived to be a weak baby. “<strong>Healthy</strong> newborn is heavy and thick/chubby and one assess from his round wrist that the newborn is healthy” (FGD-Sokar, DG Khan). “If the baby is chubby (motta) and his/her color is good we call her/him healthy and if s/he does not show proper activity we say that the baby is weak” (FGD- Turlanda, Charsadda). “If the stomach of the newborn is chubby it shows that the baby is healthy. If it is small and thin I recognize the baby as a weak one” (IDI, Dai- Johi, Dadu). “If she does not drink milk and keeps crying then his/ her health is not good and s/he is weak” (FGD- PD1, Jhelum). “I judge by appearance of the baby and by picking her/ him up. If the baby cries and breathes normally then s/ he is healthy. If the baby is smaller than usual babies then we consider them weak. People do not weigh babies here so we get to know only by guessing.” (IDI, Dai-Karakh, Khuzdar). The LHWs and the daiyan largely echoed what mothers and the family members had said about the criteria for judging the health of the baby i.e. appearance viz. chubby, red faced, no wrinkles and holding the baby. However, importantly, most LHWs said that they weigh the newborns and the normal weight for a newborn is 2.5 kg. One LHW also said that the weak baby does not cry. They associated weakness in newborns with blood deficiency in mothers and deficiency in food intake during pregnancy. In contrast, weighing the newborn as a routine practice was reported only in 7 areas out of 45 where FGDs were conducted (2 in Sukkur - one urban (UC 8) and one rural (Arain) area, both urban areas in Khuzdar (Faizabad and Ghazgi), and both urban (Killi Machan and Babu Mohallah) and one rural area (Faizabad) in Pishin. In both urban areas of Khuzdar and rural area of Pishin and Sukkur, weighing is done by LHW. While in urban Pishin it is by LHW, LHV or a health facility; and in urban Sukkur most of the deliveries take place at hospitals where the babies are weighed. “The LHW weighs our babies. The whole village goes to her to get their babies weighed.” (FGD-Arain, Sukkur) In some other areas babies are only weighed if they are taken to the doctor for immunization or in case of any illness. “If the newborn is taken to a doctor only then s/he is weighed otherwise we do not go for checking the weight of the newborn.” (IDI, Mo-Hangoro, Sukkur) In one district (Charsadda), some mothers thought that weighing was unnecessary. They reported that they do not let their babies get weighed because they are created by God no matter weak or healthy. One mother said; “We do not weigh the baby because God has created her/him weak or healthy” (FGD-MC4) Certain superstitions were also reported with regards to weighing of the newborns “Some people do not allow weighing the baby because they fear that the baby might catch evil eye” (FGD- Utman Zai, Charsadda). “Mostly the mothers-in-law do not allow weighing the baby they say that by doing this weight of the baby will stop increasing” (FGD- Nissata, Charsadda). Most mothers and decision makers had no idea of how much a baby should weigh at the time of birth in 5 out of 9 districts. “I do not know about the normal weight but my daughter was weak and small. She was of full nine months.” (IDI, Mo-Sarai Naurang) “We do not have any facility to weigh the baby so we do not know about the weight of the baby.” (IDI, Husband- Batezai, Pishin) 18 l Formative Research on Neonatal Sepsis, Low Birth Weight AND Birth Asphyxia
“The newborn is weighed in a balance and equivalent meat is given to the poor. This is how we get to know how much the baby weighs.” (IDI, Husband- Faizabad, Pishin). While in 4 districts (Pishin and Khuzdar in Balochistan, Haripur in NWFP, and Jhelum in Punjab) many participants, both from urban and rural areas, mentioned that the normal weight of the newborn is 2.5 to 3 or 4 kg or 6.5 to 8 lbs. “A newborn is healthy if s/he weighs 2.5 to 3 kg and has red skin.” (FGD-Arain, Sukkur). “LHW comes to weigh the baby and tells us that the newborn is healthy or not. 8 pounds is the normal weight of a newborn” (FGD- Faizabad, Khuzdar) Most Participants related LBW with mother’s diet during pregnancy. They said that the newborns are weak because the mothers do not take care of their own diet and cannot go for checkups. “If a mother does not take medicines for gaining strength and does not take good diet then the newborn is weak…if a mother vomits what she eats during pregnancy then the newborn is weak” (FGD-Arain, Sukkur). Various other reasons were also mentioned for LBW in different areas. These include: • Blood deficiency in mother • Mother suffers from some illness during pregnancy • Early marriage • TT is not sought during pregnancy • Tensions • No birth spacing (husband) • God’s Will • Parchanwa (shadow - meaning negative influence) of a possessed woman • Parchanwa of a women who had a baby aborted before “If the woman has some illness or suffers from any other problem during pregnancy then their babies are not healthy.” (IDI, Mo-Janjeel, Jhelum). “If a girl is married at the age of 18 or less, then her babies are born weak” (FGD-Johi, Dadu). “If TT immunization is not sought during pregnancy then the newborn is not healthy.” (IDI, Mo- Pind Dadan Khan, Jhelum). “If the dai touches inside the vagina with hand during pregnancy the newborn is weak” (IDI, Mo- Shadan Lund, DG Khan). “A baby is born of low weight because of the illness of mother. Mothers may suffer from TB or Yarqan (jaundice). For instance, in our village, one woman suffered from TB and her newborn was weak” (IDI, Husband-Ali Khan, Haripur) “One reason is that there are conflicts in the family between husband and wife and with the mother-in-law. If the mother is in tension the baby is born pre-mature or LBW” (IDI, Mo-Umer Zai, Charsadda). “One of the reasons for LBW is mothers’ diet and tensions and disconcert in the family” (IDI, FIL- Shadan Lund, DG Khan). “The babies are weak because the parents do not give spacing between them. That is to say that one baby is still very small and on breast and the next baby is born” (IDI, Husband-Pind Matey Khan, Jhelum). “Sometimes the mother eats well but the baby is still weak. Whatever the mother eats it doesn’t affect the baby. That is because of evil spirits (Bhari Uzar)” (FGD- Batezai, Pishin). “It is upon God’s will. Sometimes the mother takes great care of her diet and eats well but her baby is very weak and has yellow or blue skin” (IDI, Mo-Gol Pur, Jhelum) “The weak babies are like that because of the will of God” (FGD- Landiwah, Lakki Marwat) “If the mother is weak and suffers from blood deficiency then the newborn will also be weak. If a woman picks up heavy things such as bundles of grass she will be weak. Babies are born of low birth weight because of heavy work that a mother does during pregnancy” (IDI, FIL-Badal Bakus, Sukkur) Some mothers and decision makers from rural areas also related low birth weight of a newborn with evil spirits and measures are taken accordingly to ward off the spirits. 2.1 Local Terms for LBW The local terminologies for LBW baby are different in each area and are presented in Appendix 1. SAVE THE CHILDREN l 19
Page 1 and 2: National Report Formative Research
Page 3: National Report Formative Research
Page 6 and 7: Acronyms AAA ANC BPCR DTL FGDs FROs
Page 9: Background and Objectives of the St
Page 12 and 13: Tool 4: Guidelines for In-depth Int
Page 14 and 15: T:44 Janobi Noor Colony (U) 8 Pichi
Page 16 and 17: 8 l Formative Research on Neonatal
Page 18 and 19: Theme 1 - Antenatal Care to Prevent
Page 20 and 21: Some daiyan 1 reported that women a
Page 22 and 23: then they have to go for an operati
Page 24 and 25: dishes. Climbing stairs is also rep
Page 28 and 29: 2.2 Management of LBW Two most comm
Page 30 and 31: Factors Conclusions and Summary Fin
Page 32 and 33: “I did not receive any TT injecti
Page 34 and 35: have never seen misses (LHVs/Lady d
Page 36 and 37: put in newborn’s eyes for thee da
Page 40 and 41: Theme 4 - Asphyxia About 5-10% of a
Page 42 and 43: “If the baby does not cry it is n
Page 44 and 45: “This problem is not a disease it
Page 46 and 47: to an hour after delivery. The firs
Page 48 and 49: “In past the babies were given im
Page 52 and 53: Theme 7 - Care Seeking Outside Home
Page 54 and 55: “In civil hospital no body listen
Page 58 and 59: In contrast to above, LHWs services
Page 61 and 62: Recommendations The Project should:
Page 63 and 64: Appendix - 1: Terminologies for LBW
Page 65 and 66: Appendix - 2 : Terminologies for Co
Page 67 and 68: Appendix 3: Terminologies for Eye P
Page 69 and 70: Appendix 4: Terminologies for Skin
Page 71 and 72: Appendix 5: Local Terminologies for
Page 73 and 74: White small daney on baby’s skin
Page 75 and 76: Blue baby Unconscious and dies afte
Page 77 and 78:
Papules on the skin Swelling or red
Page 79 and 80:
Turning blue Unconscious Less activ
Page 81 and 82:
Blood deficiency Severe fever. It i
Page 83 and 84:
Breathing problems Mucous in chest
Page 85 and 86:
She stayed like that for seven days
Page 87 and 88:
At delivery, the newborn was not br
Page 89 and 90:
Case Study 7 (Charsadda): Low Birth
Page 92:
Pakistan Country Office P.O. Box 19
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