Introduction: Low birth weight (LBW) is a major risk factor for neonatal death. However, most neonates in low-income
countries are not weighed at birth. This results in many LBW infants being overlooked. Female community health volunteers
(FCHVs) in Nepal are non-health professionals who are living in local communities and have already worked in a field of
reproductive and child health under the government of Nepal for more than 20 years. The effectiveness of involving FCHVs to
detect LBW infants and to initiate prompt action for their care was studied in rural areas of Nepal.
Methods: FCHVs were tasked with weighing all neonates born in selected areas using color-coded spring scales. Supervisors
repeated each weighing using electronic scales as the gold standard comparator. Data on the relative birth sizes of the infants, as
assessed by their mothers, were also collected and compared with the measured weights. Each of the 205 FCHVs involved in the
study was asked about the steps that she would take when she came across a LBW infant, and knowledge of zeroing a spring scale
was also assessed through individual interviews. The effect of the background social characteristics of the FCHVs on their
performance was examined by logistic regression. This study was nested within a community-based neonatal sepsis-management
intervention surveillance system, which facilitated an assessment of the performance of the FCHVs in weighing neonates, coverage
of FCHVs’ visits, and weighing of babies through maternal interviews.
Results: A total of 462 babies were weighed, using both spring scales and electronic scales, within 72 hours of birth. The
prevalence of LBW, as assessed by the gold standard method, was 28%. The sensitivity of detection of LBW by FCHVs was 89%, whereas the sensitivity of the mothers’ perception of size at birth was only 40%. Of the 205 FCHVs participating in the study, 70%
of FCHVs understood what they should do when they identified LBW and very low birth weight (VLBW) infants. Ninety-six per
cent could describe how to zero a scale and approximately 50% could do it correctly. Seventy-seven per cent of FCHVs weighed
infants at least once during the study period, and 19 of them (12%) miscategorized infant weights. Differences were not detected
between the background social characteristics of FCHVs who miscategorized infants and those who did not. On the basis of maternal
reporting, 67% of FCHVs who visited infants had weighed them.
Conclusions: FCHVs are able to correctly identify LBW and VLBW infants using spring scales and describe the correct steps to
take after identification of these infants. Use of FCHVs as newborn care providers allows for utilization of their logistical,
geographical, and cultural strengths, particularly a high level of access to neonates, that can complement the Nepalese healthcare
system. Providing additional training to and increasing supervision of local FCHVs regarding birth weight measurement will increase
the identification of high-risk neonates in resource-limited settings
