# Exploring gestational age, and birth weight assessment in Thatta district, Sindh, Pakistan: Healthcare providers’ knowledge, practices, perceived barriers, and the potential of a mobile app for identifying preterm and low birth weight

## TL;DR

This study examines healthcare providers' knowledge and challenges in identifying preterm and low birth weight babies in Pakistan and explores the potential of a mobile app to improve identification and referral.

## Contribution

The study highlights the potential of mobile apps in addressing preterm and low birth weight identification despite logistical challenges.

## Key findings

- Healthcare providers prefer antenatal ultrasound for gestational age assessment but face practical barriers.
- Postnatal Ballard score assessments are underused due to insufficient training and subjectivity.
- Mobile apps show potential but are hindered by unreliable electricity and internet connectivity.

## Abstract

Reliable methods for identifying prematurity and low birth weight (LBW) are crucial to ending preventable deaths in newborns. This study explored healthcare providers’ (HCPs) knowledge, practice, perceived barriers in assessing gestational age and birth weight and their referral methods for preterm and LBW infants. The study additionally assessed the potential of using a mobile app for the identification and referral decision of preterm and LBW.

This qualitative descriptive study was conducted in Thatta District, Sindh, Pakistan. Participants, including doctors, nurses, lady health visitors, and midwives, were purposefully selected from a district headquarter hospital, and private providers in the catchment area of Global Network’s Maternal and Newborn Health Registry (MNHR). Interviews were conducted using an interview guide after obtaining written informed consent. Audio recordings of the interviews were transcribed and analyzed using NVIVO® software with an inductive approach.

The HCPs had extensive knowledge about antenatal and postnatal methods for assessing gestational age. They expressed a preference for antenatal ultrasound due to the perceived accuracy, though accept practical barriers including workload, machine malfunctions, and cost. Postnatal assessment using the Ballard score was only undertaken sparingly due to insufficient training and subjectivity. All HCPs preferred electronic weighing scales for birth weight Barriers encountered included weighing scale calibration and battery issues. There was variation in the definition of prematurity and LBW, leading to delays in referral. Limited resources, inadequate education, and negative parent past experiences were barriers to referral. Foot length measurements were not currently being used. While mobile apps are felt to have potential, unreliable electricity supply and internet connectivity are barriers.

The HCPs in this study were knowledgeable in terms of potential tools, but acknowledged the logistical and parental barriers to implementation