The Island-wide Multi-centre Study on Low Birth Weight in Sri Lanka
Perinatal Society of Sri Lanka in collaboration with Family Health Bureau and UNICEF embarks on an Islandwide Research Study to combat Low Birth Weight in Sri Lanka
Low birth weight (LBW; weight at birth <2500g) continues to pose significant challenges to perinatal teams working across the globe. It is estimated that 15% to 20% of all births worldwide are LBW, representing more than 20 million births annually. The two main causes of LBW are prematurity and small for gestational age (SGA). Prematurity is defined as neonates born before 37 completed weeks of gestation, and the SGA is defined as having a birth weight below the 10th percentile for the gestational age based on a sex-specific growth chart. In many instances, prematurity and SGA coexist. WHO and UNICEF had set a goal to achieve a 30% reduction in the number of infants born with LBW between 2012 to 2025.
The President and the Council of the Perinatal Society of Sri Lanka (PSSL) prioritised combating LBW as a primary task of their activities for 2023. Under the leadership of PSSL President Dr Susie Perera and Secretary Dr Asiri Hewamalage, the Council of PSSL appointed a Subcommittee to work on Reducing LBW in Sri Lanka. The Subcommittee comprised of Prof Sachith Mettananda (Professor of Paediatrics, University of Kelaniya), Dr Himali Herath (Consultant Community Physician and National Programme Manager for Intranatal and Newborn Care, Family Health Bureau), Prof Sampatha Goonewardena (Professor in Community Medicine, University of Sri Jayawardhenapura) and Dr Nimesha Gamhewage (Consultant Neonatologist, Colombo South Teaching Hospital).
The Subcommittee first looked at the available evidence on LBW in Sri Lanka. This evidence synthesis revealed the lack of essential scientific data to combat the issue of LBW in Sri Lanka. Specifically, the committee identified the following gaps in LBW research in Sri Lanka.
- Lack of local data on the composition of LBW (i.e. what proportion comprises preterm and what proportion comprises SGA)
- Lack of properly conducted large-scale studies that identify the determinants and risk factors of LBW
Based on these findings and the guidance from the President of the PSSL, the Subcommittee developed a proposal for an islandwide research study to determine the ‘Prevalence, composition, and determinants of low birth weight in Sri Lanka’. The Subcommittee built partnerships with the Intranatal and Newborn Care Unit of the Family Health Bureau to obtain the necessary administrative support for the study. The funding for the study (predominantly to cover expenses of data collection) was obtained from UNICEF Sri Lanka. The Ethics Review Committee of the Sri Lanka College of Paediatricians approved the research proposal.
The study commenced on 1 August 2023 and is conducted in thirteen selected hospitals in all nine provinces of Sri Lanka. The selected hospitals are De Soyza Hospital for Women, Colombo North Teaching Hospital and Kethumathi Hospital (Western Province); BH Gampola and DGH Nuwara Eliya (Central Province); TH Mahamodara (Southern Province); DGH Kegalle and BH Balangoda (Sabaragamuwa Province); PGH Badulla (Uva Province); TH Batticaloa (Eastern Province); TH Jaffna (Northern Province); BH Puttalam (North Western Province); and TH Anuradhapura (North Central Province).
Fifteen dedicated research assistants (pre-intern medical graduates) selected among over 100 applicants are currently engaged in the data collection of this study. The research assistants visit the hospitals daily to capture data on all live births occurring in those hospitals for two months, between 1 August to 30 September 2023. The Subcommittee aims to present the preliminary results of the study at the Annual Congress of PSSL in September 2023. Once completed, this research study is expected to give valuable information to direct National Policy Decisions towards reducing low birth weight in Sri Lanka.