Tackling Anemia in Pregnant Women in India: Reviewing the Obstacles and Charting a Path Forward.

This study examined the obstacles and factors influencing the prevention and treatment of anemia among pregnant women in India. Maintaining antenatal care is essential, leading to favorable birth outcomes and healthier offspring. However, inadequate consumption of essential nutrients is widespread among pregnant women, particularly in lower and middle-income economies such as India, contributing to high maternal and infant mortality rates. The factors influencing anemia prevention and treatment are categorized into individual, socioeconomic, interpersonal, and organizational levels. This study discussed the prevalence of anemia among pregnant women in different states of India. It highlights the interventions and initiatives the government and World Health Organization (WHO) have implemented to address the issue while also emphasizing the need for comprehensive approaches that effectively address the multiple levels of influence needed to prevent and treat anemia. It calls for increased awareness, improved education, and better healthcare services to ensure proper nutrition and iron supplementation. Strengthening healthcare systems and involving family members and healthcare providers in supporting pregnant women are crucial for successful anemia prevention and treatment programs.

Significados de vivencias en cuidados gestacionales de nacidos con bajo peso

El bajo peso al nacer se considera un problema en salud pública multifactorial, con consecuencias como la morbimortalidad neonatal, deficiencias en el desarrollo cognitivo y el aumento del riesgo de desarrollo de enfermedades crónicas en etapas posteriores de la vida. Objetivo: interpretar los significados de las vivencias en cuidados gestacionales de las mujeres con hijos con bajo peso al nacer a término, que permitan identificar aspectos de salud, socioeconómicos, emocionales, entre otros, que sean relevantes durante la gestación y que puedan ser caracterizados e incluidos en el marco de las políticas públicas vinculantes en Sincelejo, Sucre. Metodología: fenomenología aplicada a ocho mujeres madres de niños/as con bajo peso al nacer a término. La información fue procesada con el método Colaizzi. Resultados: derivaron cinco macro categorías: 1) Cuidado y cuidado de sí en la gestación. 2) La salud en movimiento durante los cuidados de la gestación. 3) El cambio como vivencia permanente en la gestación. 4) Economía y gestación. 5) Las emocionalidades habitan la gestación. Conclusiones: El estudio atiende al nacimiento y a los factores contextuales, sociales y familiares relacionados. Se convirtió en una vía hacia el conocimiento protagonizado por las gestantes de gran utilidad para las políticas públicas.

Low birth weight is considered a multifactorial public health problem with consequences such as neonatal morbidity and mortality, deficiencies in cognitive development and increased risk of developing chronic diseases in later stages of life. Objective: To interpret the meanings of the experiences in pregnancy care of women with low birth weight babies at term, which allow the identification of health, socioeconomic and emotional aspects, among others, that are relevant during pregnancy, and that can be characterized and included in the framework of binding public policies in Sincelejo, Sucre. Method: Phenomenology applied to eight mothers of low-birth-weight babies at term. The information was processed with the Colaizzi method. Results: Five macro-categories were derived: 1) Care and self-care during pregnancy; 2) Health in motion during pregnancy care 3) Change as a permanent experience in pregnancy 4) Economy and gestation 5) Emotionality inhabiting gestation. Conclusions: The study addresses birth, contextual, social and family related factors. This study became a path towards knowledge carried out by pregnant women, which is very useful for public policies.

O baixo peso ao nascer se considera um problema na saúde pública multifatorial, com consequências como a morbimortalidade neonatal, deficiências no desenvolvimento cognitivo e o aumento do risco de desenvolvimento de doenças crônicas em etapas posteriores da vida. Objetivo: interpretar os significados das vivências em cuidados gestacionais das mulheres com filhos com baixo peso ao nascer a termo, identificar aspeitos de saúde, socioeconómicos, emocionais, entre outros, que sejam relevantes durante a gestação e que possam ser caracterizados e incluídos no marco das políticas públicas vinculantes em Sincelejo, Sucre. Metodologia: fenomenologia aplicada a oito mulheres mães de meninos/as com baixo peso ao nascer a termo. A informação foi processada com o método Colaizzi. Resultados: derivaram cinco macro categorias: 1) Cuidado e cuidado de si na gestação. 2) A saúde em movimento durante os cuidados da gestação. 3) O câmbio como vivência permanente na gestação. 4) Economia e gestação. 5) As emocionalidades tem a gestação. Conclusões: O estudo atende ao nascimento e aos fatores contextuais, sociais e familiares relacionados. Tornou-se em uma via para o conhecimento protagonizado pelas gestantes é de grande utilidade para as políticas públicas.

Evaluation of the impact of continuous Kangaroo Mother Care (KMC) initiated immediately after birth compared to KMC initiated after stabilization in newborns with birth weight 1.0 to < 1.8 kg on neurodevelopmental outcomes: Protocol for a follow-up study.

BACKGROUND: Preterm birth or low birth weight is the single largest cause of death in newborns, however this mortality can be reduced through newborn care interventions, including Kangaroo Mother Care (KMC). Previously, a multi-country randomized controlled trial, coordinated by the World Health Organization (WHO), reported a significant survival advantage with initiation of continuous KMC immediately after birth compared with initiation of continuous KMC a few days after birth when the baby is considered clinically stable. Whether the survival advantage would lead to higher rates of neurodevelopmental morbidities, or the immediate KMC will also have a beneficial effect on cognitive development also, has not been investigated. We therefore propose to test the hypothesis that low-birth-weight infants exposed to immediate KMC will have lower rates of neurodevelopmental impairment in comparison to traditional KMC-treated infants, by prospectively following up infants already enrolled in the immediate KMC trial for the first 2 years of life, and assessing their growth and neurodevelopment. METHODS: This prospective cohort study will enroll surviving neonates from the main WHO immediate KMC trial. The main trial as well as this follow-up study are being conducted in five low- and middle-income countries in South Asia and sub-Saharan Africa. The estimated sample size for comparison of the risk of neurodevelopmental impairment is a total of 2200 children. The primary outcome will include rates of cerebral palsy, hearing impairment, vision impairment, mental and motor development, and epilepsy and will be assessed by the age of 3 years. The analysis will be by intention to treat. DISCUSSION: Immediate KMC can potentially reduce low-birth-weight-associated complications such as respiratory disease, hypothermia, hypoglycemia, and infection that can result in impaired neurocognitive development. Neuroprotection may also be mediated by improved physiological stabilization that may lead to better maturation of neural pathways, reduced risk of hypoxia, positive parental impact, improved sleep cycles, and improved stress responses. The present study will help in evaluating the overall impact of KMC by investigating the long-term effect on neurodevelopmental impairment in the survivors. TRIAL REGISTRATION: Clinical Trials Registry-India CTRI/2019/11/021899. Registered on 06 November 2019. Trials registration of parent trial: ACTRN12618001880235; Clinical Trials Registry-India: CTRI/2018/08/015369.

Effect of Fortified Human Milk on the Growth Parameters of Babies With Very Low Birth Weight.

Objective The objective of this study is to assess the effect of fortified human milk on growth parameters of very low birth-weight babies. Study place and duration This randomized controlled trial took place at the neonatal intensive care unit (NICU), Children's Hospital, and Institute of Child Health in Multan from the 1st of January 2020 to the 1st of July 2021. Material and methods In group I, 25ml human milk was fortified with a 1g human milk fortifier (HMF) sachet (1g of HMF gives 4kcal added to 25ml of human milk). In group II, newborns were fed preterm formula (493 kcal/100 g where 0.8 g=4 kcal added to 25 ml of human milk) mixed with human milk. Infants were administered human milk + olive oil (0.4 mL = 4Kcal per 25ml human milk) in group III. Everyday weight gain, digestive intolerance (vomiting and/or abdominal distension), sepsis, hospital stay, electrolyte imbalance (derangement of serum sodium, potassium, chloride, and magnesium levels), albumin, and cholesterol/triglyceride levels were assessed. The data was analyzed through descriptive and inferential means using Pearson's chi-square tests and one-way analysis of variance (ANOVA). Results Results indicate that preterm formula infants gain higher weight compared to human fortifier infants and olive oil. Similarly, the difference was statistically significant (p=0.001). However, olive oil infants gained a lower head circumference compared to the other two groups, and the difference was statistically significant as well (p=0.000). Moreover, feeding intolerance and electrolyte imbalance were higher in olive oil infants, p=0.020 and p=0.024, respectively. Conclusion It can be concluded that the use of and preterm formula can prove beneficial in increasing the growth rate in terms of weight gain, length gain, and head circumference.

Pulmonary artery dopplers for early prediction of risk for bronchopulmonary dysplasia in extremely low birth weight babies.

OBJECTIVE: The early abnormal pulmonary vasoreactivity observed in babies at risk of Bronchopulmonary dysplasia (BPD) increases the pulmonary vascular resistance. This can be assessed non-invasively using Time to Peak Velocity:Right Ventricular Ejection Time ratio (TPV:RVET) measured from pulmonary artery Doppler waveform obtained using echocardiogram. We postulate that screening for this early can predict BPD in this cohort. The objective of the study was to determine the utility of TPV:RVET in early prediction of BPD in Extremely Low Birth Weight (ELBW) babies born less than 1250grams Birth Weight. METHODS: This was a single-center retrospective cohort study of ELBW babies born<29 weeks over 4 year period who had echocardiogram between 7-21 days of life. TPV:RVET ratio was measured from pulmonary artery Doppler waveform obtained using echocardiogram. The main outcome was BPD at 36 weeks corrected gestation. The predictive ability of TPV:RVET (cut off 0.34) for subsequent development of BPD was analyzed using ROC. RESULTS: Of 589 ELBW<29 weeks, 207 babies were eligible. BPD was found in 60.4%. The TPV:RVET at 0.34 had sensitivity 76.8% (95%CI 68.4-83.9), specificity 85.4% (95%CI 75.8-92.2), positive predictive value 88.9% (95%CI 81.4-94.1), negative predictive value 70.7% (95%CI 60.7-79), and ROC area 0.811 (95%CI 0.757-0.864). Odds ratio of having BPD for TPV:RVET at 0.34 was 19.9 (95%CI 8.19-48.34) and increased by 1.07 (95%CI 1.05-1.09) with every additional days of mechanical ventilation. TPV:RVET ratio had 92.75% inter-observer agreement with kappa 0.83. CONCLUSION: TPV:RVET ratio is a good and reliable early screening tool for subsequent development of BPD in ELBW babies with substantial inter-observer agreement.

Maternal serum uric acid: a reliable prognostic indicator of foetal outcome among pre-eclamptic patients in a low resource setting.

BACKGROUND: Pre-eclampsia is a major cause of maternal and fetal morbidity and mortality in both developed and developing countries. Hyperuricemia is often associated with pre-eclampsia and when this occurs, fetal outcome may become worse. We evaluated the role of maternal serum uric acid as a prognostic indicator of fetal outcome in pre-eclamptic mothers. METHODS: A prospective case-control study in which 55 eligible pre-eclamptic patients at term were matched in maternal age and gestational age with 55 consecutive normotensive pregnant women. Venous blood samples were obtained and analyzed for serum uric acid. Following delivery, the fetal outcomes in the pre-eclamptic group and controls were determined. Data analysis was carried out using SPSS (version 21) and the level of statistical significance was set at p-value <.05. RESULTS: The mean serum uric acid levels of the pre-eclamptic subjects was significantly higher compared to their normotensive counterparts (12.7 ± 7.8 vs. 4.9 ± 1.2 mg/dL, p = .000). Babies with low birth weight, poor Apgar scores (at 1st and 5th minute of life) and those who required neonatal unit admission occurred more significantly among the pre-eclamptic women when compared with the controls (p = .000). However, the live birth rate of the case and control groups was comparable (94.5% vs. 100%, p = .079), Binary logistic regression analysis revealed a positive association between hyperuricemia and pre-eclampsia (OR = 18.8; 95% CI = 1.22-289.35, p = .035). Pre-eclamptic mothers with hyperuricemia had 4.41 odds of delivering babies with low birth weight when compared with pre-eclamptics without hyperuricemia (OR = 4.41; 95% CI = 0.76-25.5, p = .097); but Apgar scores and need for neonatal admission showed no association with maternal serum uric acid levels. CONCLUSION: This study therefore suggests that hyperuricemia is a strong prognostic indicator of LBW babies among women with pre-eclampsia.

Impact of continuous Kangaroo Mother Care initiated immediately after birth (iKMC) on survival of newborns with birth weight between 1.0 to < 1.8 kg: study protocol for a randomized controlled trial.

BACKGROUND: Globally, about 15% of newborns are born with a low birth weight (LBW) as a result of preterm birth or intrauterine growth restriction or both. Up to 70% of neonatal deaths occur in this group within the first 3 days after birth. Kangaroo Mother Care (KMC) applied after stabilization of the infant has been shown to reduce mortality by 40% among hospitalized infants with a birth weight of less than 2.0 kg. In these studies, infants were randomly assigned and KMC was initiated after about 3 days of age, when the majority of neonatal deaths would have already occurred. The aim of this trial is to evaluate the safety and efficacy of continuous KMC initiated as soon as possible after birth compared with the current recommendation of initiating continuous KMC after stabilization in neonates with a birth weight between 1.0 and less than 1.8 kg. METHODS: This randomized controlled trial is being conducted in tertiary-care hospitals in five low- to middle-income countries (LMICs) in South Asia and sub-Saharan Africa. All pregnant women admitted to these hospitals for childbirth are pre-screened. After delivery, all neonates with a birth weight between 1.0 and less than 1.8 kg are screened for enrollment. Eligible infants are randomly assigned to intervention and control groups. The intervention consists of continuous skin-to-skin contact initiated as soon as possible after birth, promotion and support for early exclusive breastfeeding, and provision of health care for mother and baby with as little separation as possible. This efficacy trial will primarily evaluate the impact of KMC started immediately after birth on neonatal death (between enrollment and 72 h of age and deaths between enrollment and 28 days of age) and other key outcomes. DISCUSSION: This is the first large multi-country trial studying immediate KMC in LMICs. Implementation of this intervention has already resulted in an important enhancement of the paradigm shift in LMIC settings in which mothers are not separated from their baby in neonatal intensive care units (NICUs). The findings of this trial will have future global implications not only on how the LBW newborns are cared for immediately after birth but also for the dissemination of designing NICUs in accordance with the mother-neonatal intensive care unit (M-NICU) model. TRIAL REGISTRATION: Clinical Trials Registry - India (CTRI): CTRI/2018/08/01536 (retrospectively registered); Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001880235 (retrospectively registered).

In Search of Imprints Left by the Impairment of Nephrogenesis.

Clinical aspects dealing with the impairment of nephrogenesis in preterm and low birth weight babies were intensely researched. In this context it was shown that quite different noxae can harm nephron formation, and that the morphological damage in the fetal kidney is rather complex. Some pathological findings show that the impairment leads to changes in developing glomeruli that are restricted to the maturation zone of the outer cortex in the fetal human kidney. Other data show also imprints on the stages of nephron anlage including the niche, the pretubular aggregate, the renal vesicle, and comma- and S-shaped bodies located in the overlying nephrogenic zone of the rodent and human kidneys. During our investigations it was noticed that the stages of nephron anlage in the fetal human kidney during the phase of late gestation have not been described in detail. To contribute, these stages were recorded along with corresponding images. The initial nephron formation in the rodent kidney served as a reference. Finally, the known imprints left by the impairment in both specimens were listed and discussed. In sum, the relatively paucity of data on nephron formation in the fetal human kidney during the late phase of gestation is a call to start with intense research so that concepts for a therapeutic prolongation of nephrogenesis can be designed.

Key features of the nephrogenic zone in the fetal human kidney-hardly known but relevant for the detection of first traces impairing nephrogenesis.

In healthy newborn babies, nephrogenesis proceeds unnoticed until birth. With start of the perinatal period, morphogenetic activity in the renal outer cortex consisting of an inner maturation zone and an outer nephrogenic zone is downregulated by unknown signals. One of the results is that the entire nephrogenic zone as well as the contained progenitor cells and niches disintegrate. In contrast, a too early inactivation of the nephrogenic zone takes place in the kidneys of preterm and low birth weight babies. Although they are born in a period of active nephrogenesis, pathological findings show that they evolve to a high incidence oligonephropathy. However, very few data exist about cell biological changes that are evoked by harming, further most of causing molecules, exact cell targets, and related molecular pathways are not identified. Although impairment of nephrogenesis was the subject of research in animal species, there is only limited information available pertaining to the pathological traces in the nephrogenic zone of the human fetal kidney. In this situation, the lack of basic morphological data is particularly aggravating. Surprisingly, there are not even ultrastructural investigations available. Since concrete information is lacking also in relevant textbooks, the current contribution likes to present key features of the nephrogenic zone in the fetal human kidney. Simultaneously, it is a call to explore systematically a hardly known area.

[Topics on Child Development in Pediatrics].

Over the past few decades, advances in neonatal medicine have increased survival rates among very-low-birth-weight (VLBW) babies. Despite improvements in short-term outcomes, there is increasing concern about the probability of mild cognitive dysfunction in this population. Our analysis of VLBW babies born in our hospital revealed that the incidence of mild developmental disorders including autism spectrum disorder (ASD) and attention deficit hyperactive disorder (ADHD) at the age of 3 years is 7.2%, which is markedly higher than the 2.8% incidence of ASD in the general population. Because problems related to ASD or ADHD tend to become more prominent as children grow up, the ages at diagnosis of developmental disorders are generally 6 years or above. Thus, in our follow up study of VLBW babies at age 6, the incidence of these developmental disorders had risen to 30%. These patients are apparently obstinate and difficult to train, causing parental problems with child care. It is important to support these children and help them establish good relationships with their parents. Given these problems, it is necessary to follow up VLBW children in the longterm, at least until they are elementary school students.

Reading First Coordinates from the Nephrogenic Zone in Human Fetal Kidney.

While substantial information is available on organ anlage and the primary formation of nephrons, molecular mechanisms acting during the late development of the human kidney have received an astonishing lack of attention. In healthy newborn babies, nephrogenesis takes place unnoticed until birth. Upon delivery, morphogenetic activity in the nephrogenic zone decreases, and the stem cell niches aligned beyond the organ capsule vanish by an unknown signal. However, this signal also plays a key role in preterm and low birth weight babies. Although they are born in a phase of active nephrogenesis, pathological findings illustrate that they evolve to a high incidence oligonephropathy and prematurity of renal parenchyma. Different extra- and intrauterine influences seem to be responsible, but independent from chemical nature, all of them culminate in the nephrogenic zone. One assumes that the marred development is caused either by an overshoot of metabolites, misleading signaling of morphogens, unbalanced synthesis of extracellular matrix or restricted contact between mesenchymal and epithelial stem cells. Even more surprising is that there is only a few vague morphological information of the nephrogenic zone in the human fetal kidney available and ultrastructural data is severely lacking. On this account, the first coordinates were determined by optical microscopy and morphometry. Without claiming to be complete, generated results made it possible to create schematic illustrations true to scale for orientation. It will help graduating students, young pediatricians, pathologists, and scientists working in the field of biomedicine to interpret professionally the nephrogenic zone and contained niches.

Increasing Confidence and Ability in Implementing Kangaroo Mother Care Method Among Young Mothers.

Mothers giving birth to low birth weight babies (LBWBs) have low confidence in caring for their babies because they are often still young and may lack the knowledge, experience, and ability to care for the baby. This research aims to determine the effect of education about kangaroo mother care (KMC) on the confidence and ability of young mothers to implement KMC. The research methodology used was a controlled-random experimental approach with pre- and post-test equivalent groups of 13 mothers and their LBWBs in the intervention group and 13 mothers and their LBWBs in the control group. Data were collected via an instrument measuring young mothers' confidence, the validity and reliability of which have been tested with a resulting r value of .941, and an observation sheet on KMC implementation. After conducting the education, the confidence score of young mothers and their ability to perform KMC increased meaningfully. The score of confidence of young mothers before education was 37 (p = .1555: and the ability score for KMC Implementation before education was 9 (p = .1555). The median score of confidence of young mothers after education in the intervention group was 87 and in the control group was 50 (p = .001, 95% CI 60.36-75.56), and ability median score for KMC implementation after education in the intervention group was 16 and in the control group was 12 (p = .001, 95% CI 1.50-1.88). KMC education should be conducted gradually, and it is necessary to involve the family, in order for KMC implementation to continue at home. A family visit can be done for LBWBs to evaluate the ability of the young mothers to implement KMC.

Impact of community-initiated Kangaroo Mother Care on survival of low birth weight infants: study protocol for a randomized controlled trial.

BACKGROUND: Around 70% neonatal deaths occur in low birth weight (LBW) babies. Globally, 15% of babies are born with LBW. Kangaroo Mother Care (KMC) appears to be an effective way to reduce mortality and morbidity among LBW babies. KMC comprises of early and continuous skin-to-skin contact between mother and baby as well as exclusive breastfeeding. Evidence derived from hospital-based studies shows that KMC results in a 40% relative reduction in mortality, a 58% relative reduction in the risk of nosocomial infections or sepsis, shorter hospital stay, and a lower risk of lower respiratory tract infections in babies with birth weight <2000 g. There has been considerable interest in KMC initiated outside health facilities for LBW babies born at home or discharged early. Currently, there is insufficient evidence to support initiation of KMC in the community (cKMC). Formative research in our study setting, where 24% of babies are born with LBW, demonstrated that KMC is feasible and acceptable when initiated at home for LBW babies. The aim of this trial is to determine the impact of cKMC on the survival of these babies. METHODS/DESIGN: This randomized controlled trial is being undertaken in the Palwal and Faridabad districts in the State of Haryana, India. Neonates weighing 1500-2250 g identified within 3 days of birth and their mothers are being enrolled. Other inclusion criteria are that the family is likely to be available in the study area over the next 6 months, that KMC was not initiated in the delivery facility, and that the infant does not have an illness requiring hospitalization. Eligible neonates are randomized into intervention and control groups. The intervention is delivered through home visits during the first month of life by study workers with a background and education similar to that of workers in the government health system. An independent study team collects mortality and morbidity data as well as anthropometric measurements during periodic home visits. The primary outcomes of the study are postenrollment neonatal mortality and mortality between enrollment and 6 months of age. The secondary outcomes are breastfeeding practices; prevalence of illnesses and care-seeking practices for the same; hospitalizations; weight and length gain; and, in a subsample, neurodevelopment. DISCUSSION: This efficacy trial will answer the question whether the benefits of KMC observed in hospital settings can also be observed when KMC is started in the community. The formative research used for intervention development suggests that the necessary high level of KMC adoption can be reached in the community, addressing a problem that seriously constrained conclusions in the only other trial in which researchers examined the benefits of cKMC. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02653534 . Registered on 26 December 2015 (retrospectively registered).

Bovine Colostrum in Prevention of Necrotizing Enterocolitis and Sepsis in Very Low Birth Weight Neonates: A Randomized, Double-blind, Placebo-controlled Pilot Trial.

OBJECTIVE: To study the efficacy of bovine colostrum in prevention of necrotizing enterocolitis (NEC) and sepsis in very low birth weight (VLBW) infants. STUDY DESIGN: Randomized, double-blind, placebo-controlled pilot trial. PARTICIPANTS: Neonates with birth weight ≤1500 g, gestation ≤32 weeks and postnatal age ≤96 h. INTERVENTION: Enteral bovine colostrum or placebo, four times a day, till 21 days of life or discharge or death. MAIN OUTCOME MEASURES: Definite NEC. Secondary outcomes included sepsis, mortality and stool interleukin-6 (IL-6) levels. RESULTS: Of the total 86 subjects (43 in each group), there were no statistically significant in the main outcome measures. In the colostrum group, there were trends toward higher stool IL-6 values and higher incidence of ileus and radiological signs of NEC. CONCLUSION: The use of prophylactic enteral bovine colostrum in VLBW infants shows a trend toward increased stool IL-6 and features of NEC. We were unable to detect clinical benefits.

Factors Related To Low Birth Weight Babies In Baghdad City, Iraq

Great importance has been attributed to birth weight all over the world because it is considered as one of the best predictors of prenatal survival and a good indicator of quality life. The objective of this study was to determine the prevalence of low birth weight babies (LBW) and factors related to it in Baghdad city. A cross sectional study was carried out in four general hospitals in Baghdad city, Iraq. A total of 225 newborn babies, alive, singleton and without congenital malformation were selected randomly from these four general hospitals.The result of the study showed the prevalence rate of low birth weights was 21.3%. Mothers’ educational level, monthly family income, mothers with chronic hypertension, mothers with history of previous low birth weight infants and anemic mothers were significantly associated with low birth weight babies (P= 0.03, 0.01, 0.02,<0.01, 0.02) respectively. It is clearly evidenced the lack of equity in populations and disparity in socioeconomic status are common related factors for the low birth weight babies as can be seen as a public and global health problem.