Newborns weighed at birth
The number of most recent live births that were weighed at birth in a specified reference period is expressed as a percentage of the total number of most recent live births in the same period.
There are two common data sources for this indicator:
- Routinely collected administrative data
- Population-based household surveys.
Routinely collected administrative data
Data from routinely collected and compiled administrative data sources will provide information as recorded in medical charts/ records or registers and are entered into national and/or subnational health management information systems (HMIS).
Data from health information systems may collect information on newborns weighed at birth among all newborns born in a health facility. Routinely collected administrative data and health facility statistics are the preferred data source in settings with a high utilization of health facility services and where data are recorded in a manner that ensures good data quality for both the public and private health sectors. The compiled data in the national HMIS or District Health Information System (DHIS2) should include data from both public and private health sectors, especially when the private sector is a substantial source of service provision to the population. In settings where utilization of health facilities is not high (e.g., settings with a high prevalence of births occurring at home), data may suffer from incompleteness if information about births occurring outside facilities is not captured. In addition, there are often challenges in accurately measuring the numerator and the denominator when routine HMIS data are used to measure this indicator.
Key source of data: Administrative data sources include health facility and health services data abstracted from obstetric and neonatal medical records, including health services registers. Relevant information is recorded about newborns weighed at birth among all newborns delivered at health facilities on paper forms completed by health personnel and/or through an electronic medical record. Data from paper or electronic sources are entered or abstracted into a database or registry and are compiled and analyzed within the national and/or subnational HMIS. The Ministry of Health (MoH) and/ or National Statistical Offices (NSO) are usually responsible for the reporting of this indicator.
Indicator and calculation: The indicator is calculated as the percentage of newborns born in a health facility with a documented birthweight before discharge among all births in a health facility during a specified reference period (WHO, 2019).
Numerator: Number of newborns in a facility with a documented birthweight before discharge within a specified time period.
Denominator: Total number of live births in facility in a specified time period.
In contexts where stillbirths are weighed, this indicator should have a denominator that is inclusive of all births (live births plus stillbirths).
Frequency of measurement: The indicator can be calculated on an annual basis or may be tracked on a more frequent and ongoing basis (e.g. monthly, quarterly), depending on facility, subnational and national processes for data entry, compilation and analysis. As a guide, the recommended frequency of measurement based on reporting level is outlined below:
- Facility level: Monthly, quarterly, or as needed based on the country and/or facility need
- Subnational (first and second administrative) level: Monthly or quarterly
- National level: Annually (data can be aggregated to provide national-level data).
Disaggregation: By level of facility, location of facility (e.g., urban, rural), subnational administrative units (e.g. districts, provinces, regions), gestational age at the time of birth, maternal age at time of birth, and type of delivery health personnel.
Missing values: Missing values for documented birthweight are assumed to indicate the newborn was not weighed.
Population-based household surveys
The main source of data for this indicator has been through population-based household surveys collected through nationally or sub-nationally representative and structured questionnaires, such as:
- Demographic Health Surveys (DHS)
- Multiple Indicator Cluster Surveys (MICS)
- Reproductive Health Surveys (RHS)
- Other household surveys with a similar methodological design
Population-based household survey data or national/subnational census data are the preferred data source in settings where utilization of health facility services is not very high (e.g., settings with a high prevalence of births occurring at home) or where private health sector data are excluded from routinely collected administrative data sources.
Key source of data: Eligible women of reproductive age (15–49 years) are identified in the household survey for inclusion and interviewing using an individual women’s questionnaire. Women are considered eligible for survey interview if they are either usual residents or visitors of the household who stayed there the night before the interview.
All eligible and interviewed women (between 15 and 49 years old) who had a live birth during a specified reference period, typically 2–5 years prior to the time of interview, are asked “Was (NAME) weighed at birth?”, where “name” refers to the name of the live birth the individual woman had during the same reference period.
The MoH and NSO typically conduct household surveys and compile, analyze and report the results for this indicator in collaboration with the survey program (e.g., DHS, MICS, RHS) and funding agency.
Indicator definition and calculation: Individual women of reproductive age (15–49 years old) are asked if their newborn was weighed at birth, irrespective of the delivery location and child’s current living status (dead or alive), and are for the most recent live birth that they had during a specified reference period, which is typically 2–5 years before the time of the survey completion. For this indicator, the recommended reference period is two years preceding the survey interview. The definition is as follows:
The percentage of interviewed women (aged 15–49 years) with a live birth in the 2–5 years prior to survey completion whose most recent live birth was weighed at birth. The indicator consists of the following numerator and denominator:
Numerator: Number of women (15–49 years old) with a live birth whose most recent live birth was weighed at birth.
Denominator: Total number of women (aged 15–49) with a live birth
Frequency of measurement: Household surveys are typically conducted every 3–5 years.
Disaggregation at population level: Place of delivery, mode of delivery, place of residence (e.g. urban, rural), subnational administrative units (e.g. districts, provinces, regions), sex of live birth, birth order, socioeconomic status (e.g. education level, household wealth quintile), age of woman at the time of delivery, births attended by skilled health personnel, number of antenatal care (ANC) visits, timing of first ANC visit, and timing and location of the first postnatal health check.
Missing values: Included in the distribution as “don’t know” or missing.
A baby’s weight at birth is a strong indicator of maternal and newborn health and nutrition. Measuring and documenting an accurate weight of a newborn at birth is an indicator of newborn care, and the health facility/system functionality. The utilization of infant’s birthweight can be used to identify at-risk newborns. Low birthweight (LBW) is defined as the proportion of newborns weighing less than 2500 grams (g) and is associated with higher rates of mortality and neurodevelopmental morbidity. Universal, accurate and regular monitoring of birthweight can be challenging for many countries globally; nearly half of the world’s infants are not weighed at birth (UNICEF).
For live births, birthweight should preferably be measured within the first hour of life, before significant postnatal weight loss has occurred. Not being weighed at birth reflects a lack of appropriate newborn care and also presents a challenge to accurately estimating the incidence of LBW among newborns, which is associated with newborn health and survival.
Data collected from administrative and other routine data systems
Administrative data may suffer from poor quality such as irregularities in report generation, data duplication and inconsistencies (Abouzahr and Boerma, 2005). Reporting challenges exist at the facility level given data quality issues, including incomplete, inaccurate and lack of timely data due to insufficient capacity in the health system – including untrained human resources and problems in using technology in some rural areas – or inadequate system design. In low-income countries, many newborns are born outside of health facility settings and thus are not weighed at birth. As a result, information on birthweight and gestational age at birth are incomplete in many parts of the world and vary in quality. Administrative data should be interpreted with caution in settings where data quality is poor and the percentage of births at public and private sector health facilities is low, or where data from the private health sector is not compiled within the HMIS reporting. In settings where routine HMIS data lack information on pregnancies and/or births or deliveries that occur outside the public sector – for example, in homes or in private sector facilities – the total number of births in the HMIS should not serve to estimate the denominator for this indicator. Where data on the total numbers of live births for the entire population for the denominator are unavailable, evaluators can calculate total estimated live births using census data for the total population and crude birth rates in a specified area (total expected live births = estimated population x the total crude birth rate).
Data collected through household surveys
Women may not be able to accurately recall details around childbirth when data are collected through household surveys (Blanc, et al, 2016). There is also a time lag as the recall period is up to 3–5 years before the survey data were collected. The most commonly reported denominator is the number of women with a live birth in the years preceding the survey, which acts as a proxy for the number of pregnant women. This indicator is prone to survivor bias in that only those women who are alive at the time of interview would be included, and underestimates the total number of live births that would be weighed at birth. In these surveys, women are asked about their most recent live birth and when, if at all, their newborn’s health was checked following delivery. This should include both live births that were born at home and those born in a health facility. However, older iterations of household surveys may only obtain this information for births at home; this should be taken into consideration when reviewing older data.
For more information on this indicator, please see the MoNITOR indicator reference sheet developed by the World Health Organization: Who-indicators (srhr.org).
- Low birthweight data [online database]. In: UNICEF [website] (https://data.unicef.org/ resources/dataset/low-birthweight-data/)
- Analysis and use of health facility data: Guidance for RMNCAH programme managers. Working document. October 2019. Geneva: World Health Organization; 2019 (https://www. who.int/healthinfo/FacilityAnalysisGuidance_RMNCAH.pdf)
- The DHS Program [website]. Rockville: ICF International; 2020 (http://www.dhsprogram. com/)
- Multiple Indicator Cluster Surveys (MICS) [website]. New York: UNICEF; 2020 (http://mics. unicef.org)
- Abouzahr C, Boerma T. Health information systems: the foundations of public health. Bull World Health Organ. 2005;83(8):578–83 (https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2626318/)
- Blanc AK, Diaz C, McCarthy KJ, Berdichevsky K. Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care. BMC Pregnancy Childbirth. 2016;16(1):255 (https://doi.org/10.1186/s12884-016-1047- 0)