{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:14:42Z","timestamp":1790172882912,"version":"4.1.0"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.17463.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,5,17]],"date-time":"2022-05-17T00:00:00Z","timestamp":1652745600000}}],"reference-count":43,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2022,5,17]],"date-time":"2022-05-17T00:00:00Z","timestamp":1652745600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009053","name":"The Wellcome Trust DBT India Alliance","doi-asserted-by":"publisher","award":["IA\/CPHI\/14\/1\/501497"],"award-info":[{"award-number":["IA\/CPHI\/14\/1\/501497"]}],"id":[{"id":"10.13039\/501100009053","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns3:p>\n                    <ns3:bold>Background<\/ns3:bold>\n                  <\/ns3:p>\n                  <ns3:p>Low birth weight (LBW) is susceptible to neonatal complications, chronic medical conditions, and neurodevelopmental disabilities. We aim to describe the determinants of very low birth weight (VLBW) in India and compare it with the determinants of LBW based on the National Family Health Survey \u2013 4 (NHFS-4)<\/ns3:p>\n                  <ns3:p>\n                    <ns3:bold>Methods<\/ns3:bold>\n                  <\/ns3:p>\n                  <ns3:p>Data from the NFHS-4 on birthweight and other socio-demographic characteristics for the youngest child born in the family during the five years preceding the survey were used. Data of 147,762 infant\u2013mother pairs were included. Multiple logistic regression models were employed to delineate the independent predictors of VLBW (birth weight&lt;1500 g) or LBW \u00a0(birth weight: 1500-2499 g).<\/ns3:p>\n                  <ns3:p>\n                    <ns3:bold>Results<\/ns3:bold>\n                  <\/ns3:p>\n                  <ns3:p>Of the 147,762 children included in the study, VLBW and LBW were observed in 1.2% and 15.8% of children, respectively. The odds of VLBW were higher in female children (aOR: 1.36, 95% CI: 1.15\u20131.60), among mothers aged 13\u201319 years (aOR: 1.58, 95% CI: 1.22\u20132.07), mothers with severe or moderate anaemia (aOR: 1.61, 95% CI: 1.34\u20131.94), mothers without recommended antenatal care (aOR: 1.47, 95% CI: 1.31\u20131.90), maternal height less than 150 cm (aOR: 1.54, 95% CI: 1.29\u20131.85) and among mothers with multiple pregnancy (aOR: 21.34, 95% CI: 14.70\u201330.96) in comparison to their corresponding counterparts. In addition to the variables associated with VLBW, educational status of mothers (no education; aOR: 1.08, 95% CI: 1.02\u20131.15 and primary education; aOR: 1.16, 95% CI: 1.08\u20131.25), caste of the children (scheduled tribe; aOR: 1.13, 95% CI: 1.03\u20131.24), and wealthiness of the family (poorest wealth quintiles; aOR: 1.11, 95% CI: 1.03\u20131.19) were associated with LBW.<\/ns3:p>\n                  <ns3:p>\n                    <ns3:bold>Conclusions<\/ns3:bold>\n                  <\/ns3:p>\n                  <ns3:p>Interventions targeting improvements in antenatal care access, maternal health, and nutritional status may reduce the number of VLBW infants. Social determinants of LBW require further detailed study to understand the high propensity of low birth-weight phenotypes in the disadvantaged communities in India.<\/ns3:p>","DOI":"10.12688\/wellcomeopenres.17463.2","type":"journal-article","created":{"date-parts":[[2022,5,17]],"date-time":"2022-05-17T10:25:11Z","timestamp":1652783111000},"page":"20","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Determinants of very low birth weight in India: The National Family Health Survey \u2013 4"],"prefix":"10.12688","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2892-6898","authenticated-orcid":false,"given":"Liss","family":"Scaria","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0748-0839","authenticated-orcid":false,"given":"Biju","family":"Soman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babu","family":"George","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zulfikar","family":"Ahamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5590-841X","authenticated-orcid":false,"given":"Sankar","family":"Hariharan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4172-4307","authenticated-orcid":false,"given":"Panniyammakal","family":"Jeemon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2022,5,17]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"1853-60","DOI":"10.1016\/S0140-6736(10)61461-4","article-title":"Causes 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Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-20\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-20\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-20\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T05:35:17Z","timestamp":1654493717000},"score":1,"resource":{"primary":{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-20\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,17]]},"references-count":43,"URL":"https:\/\/doi.org\/10.12688\/wellcomeopenres.17463.2","relation":{"has-review":[{"id-type":"doi","id":"10.21956\/wellcomeopenres.19825.r50617","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/wellcomeopenres.19825.r50617","asserted-by":"object"}]},"ISSN":["2398-502X"],"issn-type":[{"value":"2398-502X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,17]]},"assertion":[{"value":"Indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-20\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.19311.r48520, Aditi Apte, Vadu Rural Health Program, KEM Hospital Research Centre, Pune, Maharashtra, India, 07 Mar 2022, version 1, 1 approved, 1 not approved","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-20\/v1#referee-response-48520","order":0,"name":"referee-response-48520","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Panniyammakal Jeemon<\/b>; \n<i>Posted: 10 May 2022<\/i>; Thank you very much for approving our manuscript. Our responses to the comments are given below.  \n<b>Comment:&nbsp;<\/b>Title&nbsp;- Informative and balanced summary of what was done but does not mention about study design.  \n<b>Response<\/b>: The study title mentions NFHS-4, which indicates that it is a secondary data analysis of an existing national survey.&nbsp;  \n<b>Comment:<\/b> Introduction: Variables - clearly defined all outcomes, exposure, predictors but does&nbsp;not mention about potential confounders and effect modifiers. Also, number of USGs done in ANC period not taken into consideration. \n<b>Response<\/b>: Number of USGs done were classified into less than four and more than four and was used to calculate the variable \u2018Antenatal care appropriate or not\u2019. The confounders were adjusted in Model-1 and Model-2.  \n<b>Comment:<\/b>&nbsp;Data sources -provide information about from where the data was extracted. \n<b>Response<\/b>: We have provided the source of NFHS-4 data. &nbsp; \n<b>Comment: <\/b>Bias - Not explained about efforts to address potential bias. \n<b>Response<\/b>: We used secondary data analysis for this study. National Family Health Survey data were collected by standardized techniques. This dataset was used widely in the Indian context. We have absolutely no control to address for any bias in the design or data collection. We have however identified potential confounding factors and included them in the multivariable model. \n<b>Comment:<\/b> Study Size - explained well about sample size. \n<b>Response<\/b>: Thank you. \n<b>Comment: <\/b>Statistical Methods - Multivariate analysis used but not mentioned how missing data was addressed. \n<b>Response<\/b>: The missing data in this study were considered missing and excluded from analysis. However, it was only a small fraction and may not have any significance in changing the effect estimates.  \n<b>Comment: <\/b>Results - details about participants, descriptive and outcome data given. But, in the main results, the unadjusted estimates not given. Which confounders were adjusted for and why they were included is not mentioned in the study? \n<b>Response:<\/b> We have modified Table 3 and Table 4 to include unadjusted estimates. We used the following variables in the model as potential confounders, gender, birth order, mother\u2019s age, education, social group, wealth index, geographic region, anaemia, tobacco use, alcohol use, ANC care, pregnancy type and height. &nbsp; \n<b>Comment:&nbsp;<\/b>Generalisability \u2013 External validity of study results not discussed. Above study has not taken into consideration one of the important social determinants i.e., about familial pressure on the woman for the want of male child which is responsible for higher birth order and subsequently LBW baby. \n<b>Response<\/b>: Thank you, NFHS-4 is a large database. It covers 28 states and 6 Union Territories. It is one of the large databases in India. Therefore, the findings are externally valid in the Indian population. &nbsp; Our study shows that birth order is a determinant of LBW. Further data and investigation are required to establish relationship between familial pressure on the woman for the want of male child which leads to higher birth order and subsequently having LBW baby.&nbsp;","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-20\/v2#referee-comment-4994","order":1,"name":"referee-comment-4994","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.19825.r50617, Malinee Laopaiboon, Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand, 06 Jun 2022, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-20\/v2#referee-response-50617","order":2,"name":"referee-response-50617","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Panniyammakal Jeemon was supported by the Wellcome Trust through a Wellcome Trust\/DBT India Alliance Clinical and Public Health Intermediate Fellowship [IA\/CPHI\/14\/1\/501497]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}