New Tools Measure Babies' Feet to Identify Home Births Needing Care in Ethiopia

ADDIS ABABA, (December 19, 2024) – New low-cost tools that measure newborn babies' feet to screen for prematurity or low birth weight are under trial in Ethiopia in an initiative to help tackle the leading cause of death among young children, particularly those born at home.

Developed by Save the Children and Hawassa University College of Medicine & Health Sciences (HUCMHS), the easy-to-use screening tools are color-coded and include a laminated card and a plastic tool with a 90-degree "heel holder" to guide where to place a baby's heel for the measurement.

The tools – which were informed by health workers and mothers and have already been tested in a hospital-based study – are to be rolled out in a controlled trial in the south of Ethiopia as the first step towards a potential adoption in mainstream health services across the country.

These tools can be used by mothers, family members and health workers to help identify small babies born at home who are less likely to receive the care they need to survive and thrive. These tools could increase the number of small babies who receive life-saving care.

In Ethiopia, over 50% of babies are born at home, and 14% of babies are born with low birth weight.^[1]

The tools were developed based on a body of research that shows foot length to be directly correlated with babies' weight and designed using Human Centered Design (HCD), an approach that creates products and services rooted in the needs of the people using them.

In Hawassa in Ethiopia, Save the Children and HUCMHS designed and prototyped multiple tools with mothers and community health workers in rural areas, whose feedback directly contributed to the designs of the laminated card and plastic tool.

Simple in their design, the tools can help mothers and community members identify whether their newborns are at risk. If the baby's longest toe falls within a green zone indicated on the tool, the baby is likely to be a healthy birth weight and size.  If the baby's longest toe is in a red zone on the tool, it suggests that the child has low birth weight and may need medical intervention, alerting families of the need to urgently take their baby to a health center.

Save the Children and HUCMHS conducted a hospital-based study involving nearly 400 mothers in the Sidama region of Ethiopia who used the tools to measure their babies' feet. Both tools showed high levels of sensitivity, specificity and accuracy in identifying low birth weight and preterm newborns when used by mothers.^[2]

The leading cause of death in children under the age of five globally is complications associated with preterm birth, being premature or low birthweight. This is associated with an increased risk of death in the first month and year of life and poorer developmental outcomes and lifelong health conditions than their peers born at term and of appropriate weight.

With appropriate care, many of these deaths and complications can be prevented, allowing these small babies to survive and thrive.

Save the Children's Country Director for Ethiopia, Dragana Strinic, said:

"We know that a major cause of neonatal mortality is complications associated with preterm birth and low birth weight. This situation can be prevented when mothers know whether their baby is at risk or not. Yet, according to a recent national survey, half of women in Ethiopia are still giving birth at home with limited access to qualified health-care personnel and/or tools to screen their newborns right after birth.

"For many mothers, the opportunity to measure their own newborn's foot length to understand a baby's health status has brought happiness and fulfilment. One mother told our staff - "…there is nothing that makes mothers happier than measuring their babies by themselves and knowing the body weight condition."

Ethiopia has a neonatal mortality rate of 33 deaths per 1,000 live births,^[3] which is nearly double the global average of 17 neonatal deaths per 1,000 live births.  Ethiopia needs to accelerate the reduction of neonatal deaths as it is currently not on track to meet the United Nation's global goals target of 12 deaths per 1,000 live births by 2030, said Save the Children.

Save the Children has been operating in Ethiopia for over 60 years. The organization focuses on health, nutrition, water and sanitation, protection services, education, cash and in-kind distributions.
 

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Notes

[1] As of 2019, the most recent statistics available show 51% babies in Ethiopia were delivered at home: https://dhsprogram.com/pubs/pdf/FR363/FR363.pdf (page 58); 14% babies are born LBW in Ethiopia: Prevalence and Determinants of Low Birth Weight in Ethiopia: A Systematic Review and Meta‐Analysis - Katiso - 2020 - Advances in Public Health - Wiley Online Library; WHO definition of LBW as under 2500 grams: Low birth weight

[2] In 2024, Save the Children and Hawassa University College of Medicine & Health Sciences published a systematic review on the Feasibility and diagnostic accuracy of neonatal anthropometric measurements in identifying low birthweight and preterm infants in Africa: a systematic review and meta-analysis | BMJ Paediatrics Open that determined FL to be a feasible proxy measure for screening for LBW where weighing scales are not available

[3] According to Ethiopia's national survey conducted in 2019.