Shiyam Sunder: A gestational age and birth weight assessment tool for frontline healthcare workers: Diagnostic Accuracy of Foot Length measurement for Identification of Preterm and Low Birth Weight in a Rural Setting of Sindh Province Pakistan
- Datum: 12 september 2024, kl. 13.15
- Plats: Fåhræussalen, Rudbeck Laboratory, Dag Hammarskjölds väg 20, Uppsala
- Typ: Disputation
- Respondent: Shiyam Sunder
- Opponent: Ola Anderson
- Handledare: Nick Brown
- Forskningsämne: Medicinsk vetenskap
- DiVA
Abstract
Introduction: In Pakistan, 20% of neonates are born preterm or low birth weight (LBW), posing challenges to neonatal healthcare especially for those born in rural setting. Early identification of such babies is crucial for improved outcomes.
Aim: This study aimed to evaluate the diagnostic accuracy of foot length (FL) measurement within 48 hours of birth with rigid plastic transparent ruler for the identification of preterm and LBW for frontline healthcare workers.
Study I was a systematic review assessed the diagnostic accuracy of postnatal clinical scoring (PCS) methods and fetal length (FL) for identifying low birth weight (LBW) and preterm births in low- and middle-income countries (LMICs). This review included 45 studies. PCS methods had a precision of ±2.8 to ±3.2 weeks. FL <7.5 cm showed 64.0-98.9% sensitivity and 35.0-60.9% specificity for preterm birth, while FL <7.7 cm showed 58.0-84.7% sensitivity and 67.0-83.0% specificity for LBW. High heterogeneity (Higgins' I² >70%) was found and could be attributable to variations in settings, data collection, and lack of standardization in reference standards.
Study II was a qualitative study which explored the knowledge, practices, and barriers which healthcare providers (HCPs) face while assessing gestational age (GA) and birth weight. Ten in-depth interviews revealed that HCPs preferred antenatal ultrasounds (A-US) for GA estimation due to its accuracy, despite challenges like workload, machine malfunctions, and cost. HCPs rarely used the Ballard score due to insufficient training and subjectivity. Electronic weighing scales were favoured for taking birth weight but had issues with calibration and batteries. Referral delays were caused by varying definitions of prematurity and LBW, limited resources, parent’s education, and negative parent experiences. HCPs found mobile apps useful for GA and birth weight calculation, but power failures and internet issues hindered their use.
Studies III and IV are test validation studies to test the diagnostic accuracy of FL measurement for identifying preterm and LBW newborns in rural Sindh, Pakistan, enrolling 336 newborns. The optimal FL cut-off for identifying pre-term newborns was ≤7.6 cm, with 90.8% sensitivity and 96.0% specificity, and LBW, the ≤7.6 cm cut-off showed 90.3% sensitivity and 81.8% specific-ity.
Conclusion: FL measurement as a simple diagnostic tool for frontline healthcare workers to identify preterm and LBW newborns in rural areas aiding in triage, earlier intervention and, hence, improving neonatal outcomes.