Validation of the foot length measure as an alternative tool to identify low birth weight and preterm babies in a low-resource setting like Nepal : a cross-sectional study

Background The majority of infants who die in the neonatal period are born with a low birth weight (LBW, <2500 grams), or prematurely (before 37 weeks). Most deaths among these infants could be prevented with simple, low-cost interventions like kangaroo mother care (KMC) or prevention and early identification of infection. It is difficult, however, to determine birth weight and gestational age in community settings, and therefore necessary to find an appropriate alternative screening tool that can identify LBW and preterm infants. Methods This cross-sectional study was conducted at a tertiary hospital in Nepal to compare the validity of using three different foot length measurement methods (plastic ruler, measuring tape, and paper footprint) as screening tools for identifying babies with birth weights <2000 grams or infants born preterm (<37 weeks). LBW was defined as less than 2000 grams because of the implication for use of KMC for these infants. Non-parametric receiver operating characteristics (ROC) analysis was completed to determine which measurement method best predicted LBW and preterm birth. For the method that was the best predictor for each outcome (i.e. highest area under the curve), further analyses were completed to determine sensitivity, specificity, likelihood ratios and predictive values of an operational screening cutoff to predict LBW or preterm birth in this setting. Results Of the 811 infants included in this study, 30 infants had LBW and 54 were born preterm. The plastic ruler was the measurement method with the highest area under the curve, and thus predictive score for estimating both outcomes, so operational cutoffs were identified based on this method. An operational cutoff of 7.2 cm was identified to screen for infants weighing <2000 grams at birth (sensitivity: 75.9%, specificity: 90.3%), and 7.8 cm was determined as the operational cutoff to identify preterm infants (sensitivity: 76.9%, specificity: 53.9%). Conclusions In Nepal, at least in community settings, foot length measurement with a hard ruler may be a valid proxy to identify at-risk infants when birth weight or gestational age is unavailable. Further studies and piloting should be conducted to identify exact cutoffs that can be used within community settings

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Not AvailableThis study explores whether conservation agriculture-based wheat production system (CAW) can better cope with climatic extremes than the conventional tillage-based wheat production system (CTW). To assess this, we used data collected from 208 wheat farmers in Haryana, India in 2013–14 (a period with normal rainfall i.e., normal year) and 2014–15 (a period with untimely excess rainfall i.e., bad year) wheat seasons. Our analysis shows that whilst average wheat yield was greater under CAW than CTW during both bad and normal years, the difference was two-fold greater during the bad year (16% vs. 8%). This provides new evidence that CAW can cope better with the climatic extremes, in this case untimely excess rainfall, compared to CTW. Absolute yield of the CAW and CTW was 10% and 16% lower in the bad year compared to the normal year, respectively. Extreme climate events, such as excess rainfall during wheat season, can occur once in every four years in Haryana and result in a loss of income to both farmers, through a loss of yield, and the government, through compensatory payments to farmers. If, as targeted by the Haryana government in 2011, one million ha of wheat was brought under CAW, the state would have produced an additional 0.66 million Mg of wheat in 2014–15, equivalent to US$ 153 million. This is an important finding given the increased vulnerability of wheat production to climatic variability in this region.Not Availabl

Conservation agriculture-based wheat production better copes with extreme climate events than conventional tillage-based systems: A case of untimely excess rainfall in Haryana, India

This study explores whether conservation agriculture-based wheat production system (CAW) can better cope with climatic extremes than the conventional tillage-based wheat production system (CTW). To assess this, we used data collected from 208 wheat farmers in Haryana, India in 2013–14 (a period with normal rainfall i.e., normal year) and 2014–15 (a period with untimely excess rainfall i.e., bad year) wheat seasons. Our analysis shows that whilst average wheat yield was greater under CAW than CTW during both bad and normal years, the difference was two-fold greater during the bad year (16% vs. 8%). This provides new evidence that CAW can cope better with the climatic extremes, in this case untimely excess rainfall, compared to CTW. Absolute yield of the CAW and CTW was 10% and 16% lower in the bad year compared to the normal year, respectively. Extreme climate events, such as excess rainfall during wheat season, can occur once in every four years in Haryana and result in a loss of income to both farmers, through a loss of yield, and the government, through compensatory payments to farmers. If, as targeted by the Haryana government in 2011, one million ha of wheat was brought under CAW, the state would have produced an additional 0.66 million Mg of wheat in 2014–15, equivalent to US$ 153 million. This is an important finding given the increased vulnerability of wheat production to climatic variability in this region