Testing the Impact of Layered Health and Nutrition Interventions in Rajasthan, India: Baseline Findings on Birthweight

Abstract

Abstract Objectives The Children's Investment Fund Foundation (CIFF) in partnership with the Government of Rajasthan seeks to reduce prevalence of low birthweight through multi-faceted interventions to strengthen existing delivery of services during pregnancy continuing into early childhood. We employed a quasi-experimental matched case design with matching at district, block, and sub-center level to enable a difference-in-difference estimation of impact of the interventions at endline. Methods We conducted a retrospective baseline survey of mothers with children under three years in 2018 to assess prevalence of low birthweight in six districts of Rajasthan. Primary household survey data was collected on 8583 mothers with children under the age of three years and 2406 currently pregnant women. Birthweight records of 5702 children under three years were collected from public facilities where the children were reported to be delivered by the mothers surveyed. Results Matching facility birthweight records of children born to mothers in the sample confirmed heaping of data, consistent with studies from developing countries that rely on administrative or secondary sources of birthweight records. We observed heaping of birthweight readings around multiples of 500 gms; 23% of the new-borns weighed 2.5 kgs and 19% weighed 3 kgs. Possible reasons for misreporting include malfunctioning or mis calibrated spring scales, manual data entry errors in the labor room registers, poor knowledge of optimal weighing practices and misclassification of low birthweight new-borns as normal birthweight. Conclusions Concerns with reliance on facility records for the key impact indicator have highlighted the need for standardisation of birthweight measurement at public delivery facilities. All public delivery facilities in the evaluation's treatment and control areas will receive digital weighing scales in labor rooms, along with training and mentoring of labor room staff based on a standardised protocol. This has implications for endline assessment of impact - average birthweight (continuous variable) will be used as the primary outcome for difference-in-difference impact estimation at endline. Changes in prevalence of low birthweight will only be tested using endline sample conditional on baseline equivalence. Funding Sources Children's Investment Fund Foundation.