Low birth weight has been defined by the World Health Organization (WHO) as weight at birth of less than 2,500 grams (5.5 pounds). This is based on epidemiological observations that infants weighing less than 2,500 g are approximately 20 times more likely to die than heavier babies. More common in developing than developed countries, a birth weight below 2,500 g contributes to a range of poor health outcomes. WHO estimates that about 30 million low birth weight babies are born annually (23.4% of all births) and they often face short and long term health consequences. Whereas the global prevalence of LBW has slightly declined, the rate in many developing countries is still quite high [1].

Babies are born small for two main reasons: They were born early or they were born on time but didn't grow enough during pregnancy (called intrauterine growth restriction, or IUGR). There are many specific causes of low birth weight, including prematurity, preeclampsia, or other problems with the pregnancy, smoking or substance abuse, multiple birth (twins or more), poor pregnancy nutrition, infection in the mother or baby prior to birth, including Cytomegalovirus (CMV), toxoplasmosis, chickenpox, and rubella [2].

Many factors affect the duration of gestation, fetal growth and birth weight. They relate to the infant, mother or physical environment and play an important role in determining the infant’s birth weight and future health: For the same gestational age, girls weigh less than boys, firstborn infants are lighter than subsequent infants, and twins weigh less than single ones. Birth weight is affected by the mother’s own fetal growth and her diet during pregnancy, and thus, her body composition at conception.

A baby’s low weight at birth is either the result of preterm birth (before 37 weeks of gestation) or due to restricted fetal (intrauterine) growth. Low birth weight is closely associated with fetal and neonatal mortality and morbidity, inhibited growth and cognitive development, and chronic diseases later in life. Many factors affect the duration of gestation and fetal growth, and thus, the birth weight. They relate to the infant, the mother, or the physical environment and play an important role in determining the birth weight and the future health of the infant.

More than 20 million infants worldwide, representing 15.5% of all births are born with low birth weight, 95.6 per cent of them in developing countries. The level of low birth weight in developing countries (16.5%) is more than double the level in developed regions (7%). 

About 20.5 million newborns, an estimated 14.6% of all babies born globally that year, suffered from low birth weight. These babies were more likely to die during their first month of life and those who survived face lifelong consequences including a higher risk of stunted growth, lower IQ, and adult-onset chronic conditions such as obesity and diabetes.  To grow a healthy baby, mothers need good nutrition and rest, adequate antenatal care and a clean environment. Together, these ingredients for a healthy pregnancy can help to prevent, identify and treat the conditions that cause low birth weight and thus foster achievement of the World Health Assembly (WHA) nutrition target to reduce low birth weight by 30% between 2012 and 2025 [3,4].

Management of LBW babies Depends upon birth weight. If birth weight is 2500-2000 gm – baby requires special care at home, if birth weight is <2000 gm – baby requires special care at hospital, if the birth weight is <2000 gm and >1800 gm and stable hemodynamically-baby requires kangaroo mother care. Special care include- Prevention of infections, Prevention of hypothermia and Correction of malnutrition [5]. 

Objectives of the Study

• To assess the knowledge regarding management of low birth weight babies among nursing personnel working in selected Government Hospitals Shimla, (H.P.)

• To develop and administer self-instructional module on knowledge regarding management of low birth weight babies among nursing personnel working in selected Government Hospitals Shimla, (H.P.)

• To evaluate the effectiveness of self-instructional module on knowledge regarding management of low birth weight babies among nursing personnel working in selected Government Hospitals Shimla, (H.P.)

• To find out the association of level of knowledge regarding management of low birth weight babies among nursing personnel working in selected Government Hospitals Shimla, (H.P.) with selected demographic variables

• Research Approach: Quantitative research approach

• Research Design: Pre-experimental research design with one group pre-test post-test design

• Research Setting: Selected Government Hospitals Shimla, (H.P.)

• Study Population: Nursing personnel of selected Government Hospitals Shimla, (H.P.)

• Sample Size: About 60 nursing personnel

Sampling Technique

Convenient sampling technique.

Sampling Criteria

About 60 staff nurses were selected from selected Government Hospitals Shimla, (H.P.) and nursing personnel who were present on the day of the study were selected conveniently after explaining the purpose of the study.

Informed Consent

Was taken from selected nursing personnel and confidentiality of the nursing personnel was also maintained.

Inclusion Criteria

Nursing personnel who were willing to participate, Nursing personnel who were working in Pediatric ward, NICU, Labour Room, Nursery, surgery ward, Maternity ward and Special ward and Nursing personnel who were available at the time of data collection.

Exclusive Criteria

Nursing personnel who were not be willing to participate in the study, Nursing personnel who were not be working in Pediatric ward, NICU, Labour Room, Nursery, surgery ward, Maternity ward and Special ward and Nursing personnel who were not be available at the time of data collection.

Description of Tool

Section A: It deals with socio-demographic variables of the nursing personnel (Age, Educational status, Work experience, Wards in which Nursing personnel are working, previous knowledge and Source of information regarding Management of Low Birth Weight Babies. 

Section B

There were 30 structured knowledge questionnaire having four options. The nursing personnel has to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 30 and minimum score was zero. Scoring was done on the basis of marks as. 

Validity of Tool

By the experts in this field.

Permission

Permission was taken from Sr. Medical Superintendent and Nursing Superintendent of selected Government Hospitals Shimla, (H.P.).

Data Collection

• Formal approval was taken from concerned authority prior to the study

• Permission was taken from Head of department/Medical superintendent and nursing Superintendent of selected Government Hospitals Shimla, (H.P.)

• Purpose of the study was explained to the study subjects

• Written consent was taken from study participants

• Pre-test was conducted and therefore self-instruction module was administered

• Post test was conducted after one week

Data Analysis

The data obtained would be analyzed by using both descriptive and inferential statistics.

Descriptive Statistics

The demographic variables and level of knowledge was analyzed by using frequency, percentage, mean, median and standard deviation.

Inferential Statistics

Pre-test and post-test difference was analyzed by using paired-t test within group. Association between the demographic variable and posttest level of knowledge was analyzed by using chi-square.

The data presented in the Table 1 revealed that maximum number of nursing personnel 21 (35.0%) were in the age group 20-30 years and 21 (35.0%) were in the age group >30-40 years followed by 17 (28.3%) were in the age group >40-50 years and 1 (1.7%) in the age group >50 years.

With regards to marital status majority of nursing personnel 44 (73.3%) were married and 16 (26.7%) were unmarried whereas 0(0%) was divorced and widow.

Majority of nursing personnel 42 (70.0%) had done GNM followed by 10 (16.7%) had done Basic B.Sc. Nursing, 7 (11.7%) had done Post Basic Nursing and 1 (1.7%) had done M.Sc. Nursing and above.

Maximum number of nursing personnel 27 (45.0%) were working in pediatric ward followed by 17 (28.3%) were working in Post-natal ward, 12 (20.0%) were working in Neonatal intensive care unit and 4 (6.7%) were working in Pediatric surgical ward.

Largest share of nursing personnel 23 (38.3%) had 0-5 years of experience followed by 16 (26.7%) nursing personnel had >15 years of experience, 12 (20.0%) nursing personnel had >5-10 years of experience and 9 (15.0%) nursing personnel had >10-15 years of experience.

Table 1: Frequency and Percentage Distribution of Demographic Characteristics of Nursing Personnel n = 60                                                                                         

Majority of nursing personnel 60 (100%) had prior information about the topic.

The data presented in the Table 2 shows that (0%) of nursing personnel had good knowledge whereas (88.3%) of nursing personnel had average knowledge and (11.7%) of nursing personnel had poor knowledge regarding Management of Low Birth Weight Babies.

Table 2: Frequency and Percentage Distribution of Pre-Test Knowledge Score of Nursing Personnel According To Their Level of Knowledge Regarding Management of Low Birth Weight Babies n = 60

The data presented in the Table 3 shows that in post-test (86.7%) of nursing personnel had good knowledge whereas (13.3%) of nursing personnel had average knowledge and (0%) of nursing personnel had poor knowledge regarding Management of Low Birth Weight Babies.

Table 3: Frequency and Percentage Distribution of Post-Test Knowledge Score of Nursing Personnel According To Their Level of Knowledge Regarding Management of Low Birth Weight Babies n = 60

The data presented in the Table 4 shows that the association between pre-test knowledge score with selected demographic variables. The chi-square value shows that there was no significant association between the knowledge with demographic variables.

Table 4: Association between Pre-Test Knowledge with Selected Demographic Variables. The Chi-Square Test Was Used To Determine the Association between the Knowledge Score Levels with Selected Demographic Variables n = 60

The data presented in the Table 5 shows that the association between post-test knowledge score with selected demographic variables. The chi-square value shows that there was no any significance association between the knowledge of nursing personnel with demographic variables.

Table 5: Association of Post-Test Knowledge of Nursing Personnel Regarding Management of Low Birth Weight Babies with Selected Demographic Variables n = 60

Present study showed that (86.7%) of nursing personnel had good knowledge whereas (13.3%) of nursing personnel had average knowledge and (0%) of nursing personnel had poor knowledge regarding Management of Low Birth Weight Babies. The results are contrary to the study done by Josh.

There was no significant association of their age, Educational status, Work experience, Wards in which Nursing personnel are working, previous knowledge and Source of information with their knowledge regarding Management of Low Birth Weight Babies. Similar results were reported in the study done by Swapna et al.

Study reveals that the knowledge of nursing personnel was not appropriate before administration of self-instructional module but after the administration of self-instructional module the knowledge of nursing personnel increased gradually which means that the intervention given to the nursing personnel was effective. Therefore, it was concluded that a brief ongoing teaching programmes in nursing education is an effective intervention for improving knowledge in management of low birth weight babies among hospital-based nurses caring for patient with low birth weight.

Ethical Approval

Official approval from the ethical and research committee of sister Nivedita Govt. Nursing College Shimla and ethical committee of IGMC was taken to conduct the research study.

1. Louis, B. et al. "Prevalence and factors associated with low birth weight among teenage mothers in new Mulago hospital: a cross sectional study." Journal of Health Science (El Monte), vol. 4, 2016, p. 192.

2. Khan, A. et al. "Frequency and risk factors of low birth weight in term pregnancy." Pakistan Journal of Medical Sciences, vol. 32, no. 1, 2016, p. 138.

3. Sharma, K.S. "Nursing research and statistics." New Delhi: Reed Elsevier India Private Limited, 2014, pp. 101-102.

4. Polit, D.F. and Hungler, B. "Essentials of nursing research." 5th Edn., Philadelphia: J.B. Lippincott Co. Publishers, 1999.

5. Copper H. "Synthesizing research: A guide for literature review." 1998.

6. Kapadiya, M.N. "A descriptive study to assess the knowledge regarding prevention and management of low birth weight babies among postnatal women in selected hospital of Visnagar." Asian Journal of Nursing Education Research, vol. 11, no. 1, 1999, pp. 5-6.

7. Jayanthi, V. et al. "A study to assess the knowledge regarding low birth weight babies among the nurses working in NICU at Narayana Medical College Hospital, Nellore." International Journal of Recent Scientific Research, vol. 10, no. 10, 1999, pp. 35457-35460.

8. Wachamo, T.M., Bililign Yimer N. and Bizuneh A.D. "Risk factors for low birth weight in hospitals of North Wello zone, Ethiopia: A case-control study." PLoS One, vol. 14, no. 3, 2019, e0213054.

9. Romana, A.B.Y. "The relationship between the nurse’s knowledge and attitude with their skills in preventing hypothermia among the low birth weight babies at the NICU of RSUD Prof. W.Z. Johannes Kupang." Proceedings of the 1st International Conference Health Polytechnic of Kupang, 2018, pp. 527-537.

10. Anuja K. and Shristi S. "Knowledge regarding assessment of high risk neonates among nurses working in selected hospitals of Rupandehi." Journal of Universal College of Medical Sciences, vol. 6, no. 2, 2018, pp. 51-55.