Observations on intrauterine growth in urban Ethiopia

Basic anatomical and physiological data for use in radiological protection: reference values. A report of age- and gender-related differences in the anatomical and physiological characteristics of reference individuals. ICRP Publication 89

This report presents detailed information on age- and gender-related differences in the anatomical and physiological characteristics of reference individuals. These reference values provide needed input to prospective dosimetry calculations for radiation protection purposes for both workers and members of the general public. The purpose of this report is to consolidate and unify in one publication, important new information on reference anatomical and physiological values that has become available since Publication 23 was published by the ICRP in 1975. There are two aspects of this work. The first is to revise and extend the information in Publication 23 as appropriate. The second is to provide additional information on individual variation among grossly normal individuals resulting from differences in age, gender, race, or other factors. This publication collects, unifies, and expands the updated ICRP reference values for the purpose of providing a comprehensive and consistent set of age- and gender-specific reference values for anatomical and physiological features of the human body pertinent to radiation dosimetry. The reference values given in this report are based on: (a) anatomical and physiological information not published before by the ICRP; (b) recent ICRP publications containing reference value information; and (c) information in Publication 23 that is still considered valid and appropriate for radiation protection purposes. Moving from the past emphasis on 'Reference Man', the new report presents a series of reference values for both male and female subjects of six different ages: newborn, 1 year, 5 years, 10 years, 15 years, and adult. In selecting reference values, the Commission has used data on Western Europeans and North Americans because these populations have been well studied with respect to antomy, body composition, and physiology. When appropriate, comparisons are made between the chosen reference values and data from several Asian populations. The first section of the report provides summary tables of all the anatomical and physiological parameters given as reference values in this publication. These results give a comprehensive view of reference values for an individual as influenced by age and gender. The second section describes characteristics of dosimetric importance for the embryo and fetus. Information is provided on the development of the total body and the timing of appearance and development of the various organ systems. Reference values are provided on the mass of the total body and selected organs and tissues, as well as a number of physiological parameters. The third section deals with reference values of important anatomical and physiological characteristics of reference individuals from birth to adulthood. This section begins with details on the growth and composition of the total body in males and females. It then describes and quantifies anatomical and physiological characteristics of various organ systems and changes in these characteristics during growth, maturity, and pregnancy. Reference values are specified for characteristics of dosimetric importance. The final section gives a brief summary of the elemental composition of individuals. Focusing on the elements of dosimetric importance, information is presented on the body content of 13 elements: calcium, carbon, chloride, hydrogen, iodine, iron, magnesium, nitrogen, oxygen, potassium, sodium, sulphur, and phosphorus.

Development of a practical screening tool to identify preterm, low-birthweight neonates in Ethiopia

Preterm, low-birthweight (LBW) newborn infants are at high risk of neonatal mortality and morbidity and need early referral for special paediatric care. In developing countries, birthweight and gestational age often cannot be measured and a practical screening tool based on surrogate neonatal body measurements to identify high-risk infants would be very useful. We studied a consecutive series of 843 singleton infants born at a referral hospital in Addis Ababa, Ethiopia. Gestational age, birthweight, and four body measurements (chest, head, and mid-arm circumferences and length) were accurately recorded. We randomly divided the series into equal-sized training and validation groups. In the training group, we used a recursive partitioning technique to develop a simple predictive algorithm--infants were classified as high risk if head circumference was 31 cm or less or if chest circumference was 30 cm or less, and were classified as low risk otherwise. When tested in the validation group, this algorithm had sensitivity, specificity, and negative predictive value for prediction of preterm and LBW births above 90%. Thus, neonatal body measurements can be combined into a pragmatic, accurate screening tool suitable for clinical use in developing countries.

Infant care in rural Malawi. A prospective study of morbidity and growth in relation to environmental factors

In connection with the introduction of piped surface water delivered by community taps in a rural area of Malawi, 46 infants were studied prospectively during a 10-month period to monitor infant care and health. Compared with the reference population, newborn infants generally weighed less and were shorter. Breastfeeding was universal and appeared adequate for catch-up in weight during the 1st 3 months. Growth faltering occurred from the age of 3 months when the prevalence of infectious diseases gradually increased and suitable supplementary foods were lacking. Babies were given highly contaminated water from the 1st days of life, but, in spite of this, diarrhoea was infrequent during the 1st 5 months when respiratory tract infections and episodes of fever were the most common symptoms of disease. Diarrhoea became a problem from the age of 5-6 months. No differences in morbidity or growth patterns were observed between infants using piped and traditional water sources. Thus, the quality of drinking water seemed to have no substantial effect on the health of the studied infants during the 1st months of life.

Anthropometric standards in normal Saudi newborns at sea level

Normal anthropometric standards are presented for Saudi newborns at sea level between 38 and 42 weeks' gestation with a mean gestation age of 40.0 weeks for boys and 40.1 weeks for girls. These standards are based on cross-sectional measurements performed by the author and well-instructed nurses using standard measurement techniques. Each set of observations was normally distributed, except the head circumference of the girls, which was bimodal. A significant correalation was found between the five parameters when taken in pairs. Mean, standard deviation, and centiles were calculated. The results obtained in this study are presented and compared with national and international data. The need for a national study of perinatal growth is emphasized.

Maternal weight, weight gain and birthweight at term in the rural Tanzanian village of Ilula

In an area-based study in a rural Tanzanian village, the relations of maternal weight and weight gain during pregnancy to birthweight were analysed for 331 term deliveries. The distribution of body-mass index, used as an indicator of maternal nutritional status, was similar to the pattern seen in Sweden, although mean maternal height (156 cm) was 9 cm below that of Swedish women. Mean initial weight measured at week 14 was 53 kg and total pregnancy weight gain was 6 kg. Women weighing greater than or equal to 60 kg in early pregnancy gained less weight (0.16 kg/week) than those weighing less than 50 kg (0.22 kg/week). Birthweight was correlated both with maternal weight in early pregnancy and with weight gain during pregnancy, but only 10% of the variation in birthweight was explained by these maternal factors. Mean maternal weight 24 h postpartum was equal to the weight at 14 weeks of pregnancy, implying, on the average, no net weight gain. Women with a positive net weight gain had heavier babies than women with a negative net weight gain. Maternal anthropometric characteristics are important underlying determinants of intrauterine growth and birthweight, but they explain only a minor part of the variation and are of little value for screening purposes in individual women.

A prospective area-based study of the outcome of pregnancy in rural Tanzania

A prospective area-based study on the outcome of pregnancy was carried out in the rural village of Ilula in Tanzania. A coverage of 99% (n = 719) regarding the ultimate outcome for mother and child was achieved, including deliveries that took place in hospital (9%), at the dispensary (67%) and at home (23%). There were four maternal deaths (6/1,000). The mean birth weight for singletons was 3,070 g and the low birth weight (less than 2,500 g) rate 13%. From a gestational age of 37 weeks onwards there was a definite slowing of fetal growth. Perinatal mortality rate was 82 per 1,000 born, half of the deaths occurring in low birth weight babies. Twinning occurred in 3.5% and the mean length of gestation at delivery for these pregnancies was 35.5 weeks. Twins constituted 6.8% of newborns but accounted for 23.0% of perinatal losses, making twin pregnancy a major contributor to perinatal mortality. Post-term pregnancies carried no significant increase in mortality. It is concluded that reliable area-based data on the outcome of pregnancy in Tanzania can be obtained at village level, with good coverage of the study population, by properly instructed and motivated local staff with moderate supervisory support.

Low birth weight in a heterogenic population

In order to elucidate some of the factors which influence the low birth weight rate, 22,815 deliveries were studied. It is already known that low birth weight (LBW) underlies the majority of infant deaths. It is also associated with an increased risk of permanent disability such as cerebral palsy, learning difficulties, and mental retardation of various degrees in survivors. In modern society these problems require major resources from the health budget. The Israeli population is composed of Jews and non-Jews, who differ not only in their religion but also in their customs. Most of the Jews are immigrants from many parts of the world who still retain many of the habits, customs and lifestyles of the societies they had lived in for many generations. We evaluated the LBW rate in these different groups. Jews and non-Jews have similar rates of LBW and similar mean birth weights. Other factors such as maternal age, parity, and hypertensive disorders of pregnancy showed some statistically significant differences. LBW rates increase from 6.9% in the babies of women aged 24-40 years to 8.5% in those less than 24 years, and 9.5% in those over 40. The risk of LBW was increased in primiparae to 10%. The highest rates were found in babies of mothers with hypertension. Pregnancy induced hypertension is associated with a LBW rate of 15.6% and chronic hypertension with a rate of 23%. Moderate and severe preeclampsia are important risk factors since they increase the rate to 15% and 47.1%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Size at birth of infants in a Saudi maternity hospital

The size at birth was assessed of Saudi infants who were delivered in the main Maternity hospital in Riyadh and who represented a large proportion of infants born in the city. The mean (SD) weight, length and head circumference at birth of Saudi singletons were 3226 (534) g, 49.5 (2.0) cm and 34.5 (1.5) cm, respectively. Of all infants 5.9 percent were born preterm. The proportion of low birthweight infants was 7.9 percent, of which 44 percent were born at or past term. Teenage mothers had a low birthweight rate of 15.2 percent and primipara of 13.9 percent, however. Of all singletons 2.2 percent were small for gestational age and 3.7 percent of term infants had a Ponderal index less than 3rd percentile of the standard. During the final weeks of gestation the fetal growth rate was similar to that of Western populations. Compared with other developing countries the birth weight distribution was favorable and seemed to be influenced to a smaller extent than in these countries by socioeconomic and environmental factors.

Intra-uterine growth, birthweights and maturity of the African newborn

The prevalence of low birthweight in many African countries is higher than in developed countries. This is largely because of the greater number of babies who are light for gestational age. In general, mean birthweights of African babies at various gestational ages are lower than those of developed countries. This is due mainly to environmental factors, but an increased prevalence of twinning is one genetic factor. When babies of mothers in optimum health were studied, birthweights for gestational age were similar to Caucasian babies.

Vitamin A nutrition in the human foetus. A comparison of Sweden and Ethiopia

The accumulation of vitamin A during foetal development was investigated post mortem in foetuses and newborn infants of well-defined socio-economic groups of Swedish and Ethiopian women. The median vitamin A concentration in the liver was 37.0 micrograms/g in the Swedish foetuses (n = 39) and 9.1 micrograms/g in the Ethiopian ones (n = 49) (p less than 0.001). The liver vitamin A concentration in the Swedish foetuses increased exponentially during the second and third trimesters of pregnancy. This trend was not evident in the Ethiopian material. The mean serum concentration of retinol-binding protein was only slightly lower in the healthy Ethiopian newborns (18.6 mg/l; n = 70.) than in the Swedish newborns. This finding suggests that vitamin A is retained i the foetal circulation in preference to storage, much like the situation in a vitamin A deficiency state in the adult.