Nepas Journal 32-1 cs5 final.indd Original Article <1>J. Nepal Paediatr. Soc. Antropometric Measurements in Different Ethnic groups of Nepalese New Borns Malla K1, Mall T2, Rao S3, Gauchan E4, Basnet S5, Koirala DP6 1Dr. Kalpana K Malla, MBBS, MD, Associate Professor, 2Dr. Tejesh Malla, MBBS, MD, Associate Professor, 3Sheshagiri Rao, MBBS, MD, Professor, 4Dr. Eva Gauchan, MBBS, MD, Lecturer, 5Dr. Sahisnuta Basnet, MBBS, MD, Lecturer, 6Dr. Deepak Prasad Koirala, MBBS, MD, Lecturer. All from the Department of Paediatrics, Manipal College of Medical Science, Pokhara, Nepal. Address for correspondence: Dr. Kalpana Malla, E-mail: kalpana_malla@hotmail.com Abstract Introduction: There is a wide variation in normal birth weight, length and head circumference of newborns. The standards formulated by Western workers may not be very reliable to this part of world because of wide variations in normal range of length, weight and head circumference in different ethnic groups. This study aims to determine the anthropometric values – birth weight, length and head circumference in Term and Preterm newborns of different ethnic groups in this region of the country and to see if this can be used as a standard for taking the anthropometric measurements. Materials and Methods: A prospective study of 600 newborns born in Manipal Teaching Hospital, Pokhara from July 2009–June 2010. A detailed anthropometric measurement (weight, length, and head circumference) of all newborns was taken on 3rd day of life. Results: Six major Ethnic groups were noted Brahmin, Gurung, Dalit, Chettri, Magar and Newar. There were 54 % males and 46% females among which 18.16% were preterms, 20.66% small for gestation age, 81.50% term and 0.33% posterm. The mean weight, length and head circumference of term babies were 2.817±0.61 gms, 47.68±2.48 cm, 33.56±2.02 cm and for preterm babies it was 2.215± 0.41 gms, 46.36±2.39 cm, 32.23±2.03 cm respectively. There were 25% low birth weight (n=151, highest number in Brahmins-27%), 74.16% normal weight (n=445) and 0.66% over weight (n=4, all were gurungs) babies. In Term newborns weight, length and head circumference was noted to be highest in Gurungs (3.3004gms, 49.35cm, 34.72cm) and was statistically significant (p<0.000). Weight and length of Brahmins was lowest (2.578 gms, 45.49cm) and head circumference was lowest in Dalits (30.88cm, statistically significant<0.000). In case of preterms highest weight and length was seen in Magars (2.387gms, 47.90cm) but head circumference was highest in Gurungs (34.18cm) whereas weight was lowest in chettri (2.1609gms), length in Brahmin (44.61cm) and OFC in Dalits (29.92cm). These parameters were directly proportion with gestation age and was statistically significant (p<0.000). Conclusion: The present study highlights the mean weight, length and head circumference of term and preterm newborns in different ethnic groups and gestation age. These parameters were directly proportion to gestation age but were variable in different Ethnic groups. Therefore a study in larger population could give us a different standard for anthropometric measurements in Nepalese newborns. Key words: Anthropometry Measurements, N.ewborn, Nepal Introduction There is a wide variation in normal birth weight, length and head circumference of newborns. Diff erent standards of norms are used in diff erent parts of the world. Therefore the standards formulated by Western workers may not be very reliable to this part of world because of wide variations in normal range of length, weight and head circumference in diff erent ethnic groups. This study aims to determine the anthropometric values – birth weight, length and head circumference in Term and Preterm newborns of diff erent ethnic groups in this region of the country and to see if this can be used as a standard for taking the anthropometric measurements. Materials and Methods This is prospective observational study which was undertaken over a period of 1 year from July 2009 to June 2010. Cases were enrolled from postnatal ward, these included babies delivered in Manipal Teaching Hospital, Pokhara (A tertiary care hospital of western region of the January-April, 2012/Vol 32/Issue 1 doi: http://dx.doi.org/10.3126/jnps.v32i1.4880 <2> J. Nepal Paediatr. Soc. country). Consent was taken from mothers after they were explained about the measurements. A total of 2000 healthy term and preterm neonates were subjected to clinical examination. Gestational age was assessed according to the fi rst day of last menstrual period and was cross checked by Ballard scoring1. Anthropometric parameters that included; weight, length and occipito frontal circumference (OFC) were recorded on day 3 of life so that the error due to skull molding and caput succedaneum for the head circumference and excess body fl uid loss in the initial days for weight loss could be eliminated. Common ethnic groups noted were Brahmins, Gurungs, Chettris, Dalits, Magars and Newars. Out of these 2000 babies 100 consequitive babies from each of the above mentioned ethnic groups (n= 600) were selected for the study. The remaining 1400 babies were excluded from the study. Normal and caeserian delivered babies of any sex, gestation age >32weeks and those from a high socioeconomic background (family income >5000 Rupees per month) were also included in the study. Exclusion criteria consisted of babies with congenital anomalies, chromosomal anomalies, babies measured 3 days before or after birth, gestational age ≤ 32 weeks, birth weight ≤ 1500gms, preterm babies with complications, ill babies and maternal illness during antenatal period. Detail anthropometric measurements were taken by the same persons to minimize subjective error. Same weighing scale and same measuring tape were used to take the weight and head circumference respectively. Infantometer was used to take the length. Data collected was tabulated and analyzed using statistical package SPSS 19.0 version. Microsoft Excel (2003) and SPSS were used for plotting fi gures. Two tailed t-test was used to compare the anthropometric parameters (birth weight, length, head circumference) of diff erent ethnic groups. Results There were 326/600 (54%) males and 274/600 (46%) females (Figure 1). Classifi cation of newborns in relation to gestation age showed that small for gestation age (SGA) babies (20.66%) were more than the preterm babies (18.16%, Table 1). There were 77.16% appropriate for age (AGA) and 2.16% large for gestation age (LGA) babies. Highest number of both SGA (27.41%) and Preterms (33.02%) were observed in the Brahmin population (Figure 2). Preterms were higher in Brahmin, Newar and Magar and SGA was higher in Dalit, Gurung and Chettri populations (Figure 2). 9/13 LGA was noted in Gurungs (Figure 2 and Table 1). The Mean±SD for weight, length and OFC for term babies were 2.8177±0.61gms, 47.68±2.48cm, 33.56±2.02cm respectively and for preterm babies it was 2.2153±0.41gms, 46.36±2.39cm, 32.23± 2.03 cm respectively (Table 2). Table 2 also shows these parameters in diff erent Ethnic groups where the mean±SD for weight, length, OFC for Brahmin was 2.5788±0.59gms (Term), 2.2016±0.49gms (preterm); 45.49±3.48cm (term) 44.61±3.22cm (Preterm); 33.41±2.29cm (Term) 33.02 ±2.16cm (Preterm) respectively. Similarly for Gurung this was 3.3004±0.58gms (Term) 2.1166±0.48gms(preterm); 49.35±1.41cm (Term), 47.83±1.38cm(Preterm); 34.72±0.81cm (Term), 34.18±0.78cm(Preterm); Dalit 2.6079± 0.43gm (Term), 2.2153±0.41gms (Preterm); 46.49±2.22cm (Term), 45.07±2.16cm (Preterm); 30.88 ±1.96cm (Term), 29.92±1.87cm (Preterm); Chettri 2.7305±0.52gms (Term) 2.1609±0.38gms (Preterm; 47.93±1.84cm (Term), 47.45cm±1.81 (Preterm; 34.08±1.10cm (Term), 33.81±0.98cm (Preterm); Magar 2.8870±0.6gms (Term), 2.3875±0.87gms (Preterm), 48.49±1.61cm (Term), 47.90±1.56cm (Preterm); 33.79±1.52cm (Term), 33.55±1.46cm (Preterm); Newar 2.8000±0.56gms (Term), 2.3260±0.48gms (Preterm); 48.33±1.37cm (Term) 47.69±1.28cm (Preterm); 34.51±1. (Term) 34.09±1.27cm (Preterm) respectively. Figure 3 shows weight and Figure 4 shows OFC in diff erent ethnic groups where it is observed that highest number of Low birth babies (LBW) was found in Brahmins (27.15%) followed by Magar (19.86%), Newar (17.21%), Dalit (14.56 %), Chettri (13.90%). Only 7.28% LBW was seen in Gurung population (Figure 3). OFC was < 33cm in maximum babies (80%) in Dalits, which was statistically signifi cant (Table 3). Correlation of weight, length and OFC with gestation age was also seen (Table 4) and these parameters were directly proportion to gestation age and was statistically signifi cant (p<0.000). Female - 46% Male - 54% Fig 1: Distribution of sex of babies Antropometric Measurements in Different Ethnic groups of Nepalese New Borns <3>J. Nepal Paediatr. Soc. Table 1: Mean birth weight for gestational age in six ethnic groups. Gestation age SGA AGA LGA Total Brahmin : Preterm Term Posterm 19 15 0 17 49 0 0 0 0 36 64 0 Gurung: Preterm Term Posterm 3 4 0 3 81 0 0 9 0 6 94 0 Dalit : Preterm Term Posterm 6 12 0 7 75 0 0 0 0 13 87 0 Chettri: Preterm Term Posterm 9 10 0 2 75 2 0 2 0 11 87 2 Magar: Preterm Term Posterm 10 14 0 10 64 0 0 2 0 20 80 0 Newar: Preterm Term Posterm 13 9 0 10 68 0 0 0 0 23 77 0 Total 124 (20.66%) 463 (77.16%) 13 (2.16%) 600 *Preterm (<37 weeks) n=109 (18.16%), **Term (37-42 weeks) n= 489 (81.50%), ***Posterm (>42 weeks) n=2 (0.33%), ***Small for gestation age n=124 (20.66%) Table 2: Mean± SD of weight, length and OFC of babies in diff erent ethnic groups Ethnic group of babies Mean Weight ± SD Mean Length± SD Mean OFC± SD Brahmin: Term Preterm 2.5788±0.59632 2.2016 ± 0.49012 45.4900±3.48299 44.6109±3.22456 33.4100±2.29666 33.027±2.16751 Gurung: Term Preterm 3.3004±0.58373 2.2166± 0.48465 49.3500±1.41689 47.8331±1.38796 34.7200±0.81749 34.1830±0.78910 Dalit : Term Preterm 2.6097±0.43009 2.2153±0.41981 46.4900±2.22699 45.0760±2.16589 30.8800±1.96062 29.9230±1.87675 Chettri: Term Preterm 2.7305±0.52709 2.1609±0.38976 47.9300±1.84913 47.4541±1.81987 34.0800±1.10718 33.8180±0.98478 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Brahmin Chettri Magar Newar Preterm SGA Gurung Dalit Fig 2: Distribution of preterm and SGA babies in diff erent Ethnic Groups Malla K et al <4> J. Nepal Paediatr. Soc. Magar: Term Preterm 2.8870±0.65738 2.3875±0.8798 48.4900±1.61117 47.9000±1.56689 33.7900±1.52617 33.5500±1.46876 Newar: Term Preterm 2.8000±.56707 2.3260±0.48065 48.3300±1.37109 47.6956±1.2887 34.5100±1.30651 34.0998±1.27651 Total: Term Preterm 2.8177±0.61149 2.2153±0.41075 47.6800±2.48083 46.3600±2.39100 33.5650±2.02961 32.2310± 0.03891 Table 3: Comparison of Anthropometric measurements in diff erent Ethnic groups t Df p value t df p value Brahmin vs Gurung Weight Length OFC -8.647 -10.266 -5.374 198 198 198 0.000 0.000 0.000 Gurung vs Newar Weight Length OFC 6.149 5.173 1.363 198 198 198 0.000 0.000 0.000 Brahmin vs Dalit Weight Length OFC -.420 -2.419 8.378 198 198 198 0.675 0.016 0.000 Dalit vs Chettri Weight Length OFC .171 -1.279 -13.519 198 198 198 0.864 0.203 0.000 Brahmin vs Chettri Weight Length OFC -1.906 -6.188 -2.628 198 198 198 0.058 0.000 0.009 Dalit vs Magar Weight Length OFC -1.289 -1.279 -9.522 198 198 198 0.199 0.203 0.000 Brahmin vs Magar Weight Length OFC -3.472 -7.817 -1.378 198 198 198 0.001 0.000 0.170 Dalit vs Newar Weight Length OFC .186 -1.396 -10.446 198 198 198 0.754 0.138 0.000 Brahamin vs Newar Weight Length OFC -2.688 -7.587 -4.163 198 198 198 0.008 0.000 0.000 Chettri vs Magar Weight Length OFC -1.461 .000 2.443 198 198 198 0.146 1.000 0.015 Gurung vs Dalit Weight Length OFC -.469 3.590 17.910 198 198 198 0.640 0.000 0.000 Chettri vs, Newar Weight Length OFC -.898 -1.738 -2.511 198 198 198 0.370 0.084 0.013 Gurung vs Chettri Weight Length OFC -.315 2.809 4.820 198 198 198 0.753 0.005 0.000 Magar Vs Newar Weight Length OFC 1.002 .756 -3.584 198 198 198 0.318 0.450 0.000 Gurung vs Magar Weight Length OFC -1.643 2.809 6.482 198 198 198 0.102 0.005 0.000 Antropometric Measurements in Different Ethnic groups of Nepalese New Borns <5>J. Nepal Paediatr. Soc. 100.00% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Brahmin NewarGurung LBW Normal Weight Overweight Dalit Chettri Magar Fig 3: Distribution of weight in diff erent Ethnic Groups ***LBW (<2500gms, n=151) 25%, **Normal weight (2500gms-3.999gms, n=445) 74.16%, * Overweight (>4000gm, n=4) 0.66% Table 4: Correlation of weight, length and OFC with gestation age Gestation age of children Weight Spearman Correlation Value Approx. Sig p value Normal LBW LGA N0. % No. % No. % <37 weeks (n=109) 25 22.9 84 77 0 0 0.544 0.000 37-42 weeks (n=489) 418 85 67 13.7 4 0.81 >42 weeks (n=2) 2 100 0 0 0 0 Total (N=600) 445 100 151 0 4 0 Gestation age of children Length Spearman Correlation Value Approx. Sig <45cm 45-50cm >50cm No. % No. % No. % <37 weeks (n=109) 30 27.5 78 71.55 1 0.91 0.262 0.00037-42 weeks (n=489) 34 6.92 405 82.8 50 10.22 >42 weeks (n=2) 0 0 1 50 1 50 Total (N=600) 64 485 51 Gestation age of children OFC Spearman Correlation Value Approx. Sig <33cm 33-35cm >35cm No. % No. % No. % <37 weeks (n=109) 38 34.86 71 65.13 0 0 0.146 0.006 37-42 weeks (n=489) 107 21.88 351 71.77 31 6.33 >42 weeks (n=2) 0 0 1 50 1 50 Total (N=600) 145 424 31 Malla K et al <6> J. Nepal Paediatr. Soc. Discussion The term anthropometric refers to comparative measurements of the body and is important indicator of child survival. The periodic measurement of anthropometric variables in diff erent populations and regions of a country refl ect changes in nutrition and health status of the country and is a reliable tool to evaluate social health2,3. the anthropometric measurements commonly used as indices of growth include length, weight, and head circumference. These measurements utilized at present time are based on the results obtained for more than fi ve decades, which are not able to determine a national pattern most likely due to some ethnic infl uences4 In addition Genetic diff erences exist among races regarding growth and body composition3. Some investigators have also argued for ethnic-specifi c standards 5,6. Although the World Health Organization (WHO) advises a single international growth standard for developing countries7,8, the ideal is to establish local national growth charts refl ecting each country’s own genetic characteristics. Hence this analytical descriptive study was carried out to observe the diff erences in these parameters in diff erent gestation age and ethnic groups. In this study, out of 600 newborns there were 326 (54%) males and 274 (46%) females. Brahmin, Gurung, Dalit, Chettri, Magar and Newar were the 6 major ethnic groups attending this hospital for delivery. There were 124(20.66%) SGA {birth weight < 10th percentile for gestational age}, 109 (18.16%) preterms {born at < 37 completed weeks}, 463(77.16%). Appropriate for age (AGA) and 13 (2.16%) Large for gestation age (LGA- weight 90th percentile for gestational age) babies- using the reference ranges provided by Alexander et al9. Our fi nding was diff erent from another study10 where prematurity was observed in 25.5% and SGA in 14.1% of the neonates. The reason for this may be that the adverse intrauterine environment and other risk factors vary in diff erent countries. Highest number of SGA (27.41%) and preterms (33.02%) were seen in Brahmin compared to other Ethnic Groups. Whereas highest number of large for date babies (LGA) 9/13 was seen in Gurung population. Number of preterms was higher than SGA in Brahmin, Newar and Magar and SGA was higher than Preterms in Dalit, Gurung, Chettri populations. Prematurity and SGA prevalence refl ects an adverse intrauterine environment; hence comparisons of risk factors at birth like primiparous vs multiparous mothers, smoker’s vs nonsmokers, twin’s vs singletons, in detail should be considered which was not seen in this study. If these factors were considered maybe we could explain why in some ethnic groups SGA was common and preterm in others. The observed Mean± SD of weight, length and OFC for term babies were 2.8177±0.61 gms, 47.68±2.48cm, 33.56±2.02cm respectively and for preterm babies it was 2.2153±0.41075 gms, 46.36±2.39 cm, 32.23±2.03 cm respectively. The fi ndings of term babies were comparable to study conducted by Manandhar K, Manandhar DS et al 11 in Kathmandu and S Muthayya, P Dwarkanath et al12 in south India. This similarity could have been due to similar population and cultural backgrounds. In another study conducted by B. Telatar, S. Comert et al13 mean birth weight, height and head circumference was 3334 (SD 494) gm, 48.3 (SD 2.2) cm and 34.4 (SD 1.3) cm respectively which was greater than our study. Yet another study by Nahar et al14 reported a birth weight of 2690gm (SD= 0.36) which was Fig 4: OFC in diff erent Ethnic Groups 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Brahmin Gurung NewarDalit Chettri Magar Brahmin Gururng Dalit Chettri Magar Newar <33 cm 20% 0% 80% 11% 24% 10% 33-35 cm 75% 90% 20% 89% 76% 74% >35 cm 5% 10% 0% 0% 0% 16% Antropometric Measurements in Different Ethnic groups of Nepalese New Borns <7>J. Nepal Paediatr. Soc. lower than in our study. These two studies were carried out in Iceland and Bangladesh respectively and the diff erences in demographic factor, diff erent population and cultural backgrounds again could have made a diff erence in the results. A study by Hickey states that sociocultural dimensions, ethnicity, social support etc can also aff ect the gestational weight gain15. The mean weight of preterm babies was much less (1780 gm) in another study16 compared to ours (2.2153gms). The reason for this is that in our study gestation age ≤32 weeks and weight ≤ 1500gms was not taken into consideration whereas all preterms was included in above mentioned study. For preterm comparable study was not available for length and OFC. These parameters when compared with diff erent Ethnic groups showed that in Term newborns weight, length and OFC was noted to be highest in Gurungs (3.3004gms, 49.35cm, 34.72cm) and was statistically signifi cant (p<0.000).Weight and length of Brahmins was lowest (2.578 gms, 45.49cm) and OFC was lowest in Dalits (30.88cm, statistically signifi cant<0.000). In case of preterms highest weight and length was seen in Magars (2.387gms, 47.90cm) but OFC was highest in Gurungs (34.18cm) whereas weight was lowest in chettri (2.1609gms), length in Brahmin (44.61cm) and OFC in Dalits (29.92cm). The diff erence between the diff erent Ethnic groups could be due to varying, socioeconomic, nutritional and environmental factors of the underlying population as already mentioned earlier. Factors other than ethnicity include altitude, maternal size, parity, smoking, parental social position which can aff ect fetal growth and could confound the ethnic diff erences which has been observed in numerous other studies5,6,17, 18. These factors were also present in our study but was not analyzed in detail. WHO defi nes Low Birth Weight (LBW) as birth weight less than 2500gms. The defi nition of LBW does not take into account the gestation period.LBW observed in our study was 25% which is lower than that observed in another study which was 37.75 %10. Even within the country 29.8% and 28.6% LBW was noted in two other studies carried out in western region hospital, Pokhara in 2004 (7 years ago)19 and Sarlahi in 2007(5years ago)20. The fi rst study was done in same city Pokhara but it is observed that in present study the rate of LBW has decreased. The probable cause for this diff erence may be the low educational and socioeconomic status of the mothers in the previous study. As western region hospital is a government hospital, so mothers attending that hospital are probably from lower socioeconomic group. Lower birth weight in this study indicates the poor socioeconomic status of the mothers. Decrease in LBW cases in 7 years time may also indicate improvement in health status of the country, awareness in people regarding antenatal care. Yet in another study21 carried out in same city pokhara 3 years ago (2008) out of 400 newborns only 8.5% was found to be LBW, which is much lower than our fi ndings. This diff erence may be due to the fact that their study included only term babies whereas our study has included term as well as preterm babies. Highest number of Low birth babies (LBW) were found in Brahmins (27.15%) followed by Magar (19.86%), Newar (17.21%), Dalit (14.56%), Chettri (13.90%). Only 7.28% LBW was seen in Gurung population. The reason for the Gurungs to be heavier, longer, and with larger heads than other groups may be due to the fact that genetically they are of heavy built and has a good nutrition status. A data analysis done in 200419 where the group was divided as Indo-Aryan (Brahmin, Chettris of our group) and lower caste (Dalit of our group) ethnic groups had signifi cantly lower weight babies than Tibeto-Burman (Gurung, Magar of our group) and Newar groups. This was consistent with our study. Like their fi ndings Brahmin and Dalit had lower weight than other Ethnic groups. Again they found that Tibeto – Burman group and Newars had higher birth weight, this was again similar with our study. This similarity in the fi ndings may support our fi nding in establishing ethnic specifi c standard. Other two parameters of length and head circumference in diff erent Ethnic groups were also compared in our study. A comparable study for this in diff erent Ethnic groups of the country was not available. Hence we can state that possibly this is the fi rst study of this kind, so it is not possible to conclude anything for these parameters. However irrespective of any ethnic groups the mean length and OFC of Nepalese newborns noted by Manandhar K, Manandhar DS et al11 was 49cm and 33.8cm respectively and mean OFC noted by Sreeramareddy CT, Chuni N, Patil R, Singh D, Shakya B21 was 33.5cm which was comparable to our study. Correlation of gestation age with weight, length and OFC was also seen and these parameters were directly proportion to gestation age and was statistically signifi cant (p<0.000). Similar correlation was also observed in another study22. Conclus ion Periodical updating of anthropometric variables in diff erent populations in a country is necessary to refl ect ongoing changes in local conditions. The limitation of this study is that the anthropometric values obtained refl ect the results of only one hospital and a limited population; hence generalization to the whole Nepalese Population cannot be made. Furthermore our study is population- based, rather than hospital-based, which makes the selection biased. Other factors which could aff ect fetal Malla K et al <8> J. Nepal Paediatr. Soc. growth were not analyzed. Despite these limitations, we believe that our results could provide a useful analytic comparison tool for future research. Therefore we would reccomend parallel studies to be made in various regions of the country comprising multiple socio-economic, nutritional, cultural backgrounds, so that comparative analyses could be made with newfound results. The practical application of ethnic-specifi c standards requires further research in a larger scale. Acknowledgements: None Funding: None Confl ict of Interest: None Permission from IRB: Yes References 1. Ballard JL, Khoury JC, Wedig K, et al: New Ballard Score expanded to include extremely premature infants. J Pediatr 1991;119:417-23. 2. Tanner JM. Growth as a mirror of the condition of society: secular trends and Class distinctions. Acta Pediatric Japonica 1987;29:96–103. 3. Neyzi O, Saka HN. Anthropometric studies in Turkish children. Istanbul Med Faculty J 2002;65: 221–8. 4. K.  Kalra, N.  Kishore, R.  S.  Dayal: Anthropometric measurements in the newborn. Indian J Pediatr 1967:34:73-82. 5. Davies DP, Se nior N, Cole G, Blass D, Simpson K: Size at birth of Asian and white Caucasian babies born in Leicester: implications for obstetric and pediatric practices. Early Hum Dev 1982;6:257-63. 6. Wang X, Guyer B, Paige DM: Differences in gestational age-specific birth weight among Chinese, Japanese and White Americans. Int J Epidemiol 1994;23:119-28. 7. Ulijaszek SJ. Between population variation in pr-adolescent growth. European J Clin Nutrition 1994;48:5–13. 8. A growth chart for international use in maternal and child health care: guidelines for primary health care personnel. Geneva, World Health Organization, 1978. 9. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996;87:163-8 10. Gozal D, Ndombo PK, Ze Minkande J, Kago I, Tetanye E, Mbede J.Anthropometric measurements in a newborn population in west Africa: a reliable and simple tool for the identification of infants at risk for early postnatal morbidity. J Pediatr 1991;118(5):800-5. 11. Manandhar K1, Manandhar DS2, Baral MR3One year follow up study of term babies born at Kathmandu medical college teaching hospital. Kathmandu Univ Med J. 2004;2(4):286-90. 12. S Muthayya, P Dwarkanath, T Thomas, M Vaz, A Mhaskar, R Mhaskar, A Thomas, S Bhat and AV Kurpad. Anthropometry and body composition of south Indian babies at birth. Public Health Nutr 2006;9:896-903 13. B. Telatar, S. Comert, A. Vitrinel and E. Erginöz. Anthropometric measurements of term neonates from a state hospital in Turkey. Eastern Mediterranean Health J 2009;15(6)1412–419. 14. Nahar S, Mascie-Taylor CGN, Begum HA. Maternal anthropometry as a predictor of birth weight. Public Health Nutr 2006;10:965-70. 15. Hickey CA. Sociocultural and behavioral infl uences on weight gain during pregnancy. Amer J Clin Nutr 2000;71:1364-70. 16. Jaya DS, Kumar NS, Bai LS.Anthropometric indices, cord length and placental weight in newborns. Indian Pediatr 1995;32(11):1183-8. 17. Singh GK, Yu SM: Birthweight diff erentials among Asian Americans. Am J Public Health 1994;84:1444- 49. 18. Munroe M, Shah CP, Badgley R, Bain HW: Birth weight, length, head circumference and bilirubin level in Indian newborns in the Sioux Lookout Zone, northwestern Ontario. Can Med Assoc J. 1984;131:453-56 19. Pratima Poudel Acharya;  Fiona Alpass Birth Outcomes Across Ethnic Groups Of Women in Nepal. Health Care for Women International 2004; 25(1)40–54. 20. L C Mullany; G L Darmstadt; S K Khatry; S C Leclerq; J M Tielsch Relationship between the surrogate anthropometric measures, foot length and chest circumference and birth weight among newborns of Sarlahi, Nepal. Eur J Clin Nutr 2007;61:40-6. 21. Sreeramareddy CT, Chuni N, Patil R, Singh D, Shakya B.Anthropometric surrogates to identify low birth weight Nepalese newborns: a hospital-based study. BMC Pediatr 2008;25;8:16. 22. B. F. Kalanda, S. Van Buuren, F. H. Verhoeff , B. J. Brabin. Anthropometry of Malawian live births between 35 and 41 weeks of gestation: Annals Human Biol 2005;32(5):639–49. Antropometric Measurements in Different Ethnic groups of Nepalese New Borns How to cite this article ? Malla K, Mall T, Rao S, Gauchan E, Basnet S, Koirala DP. Antropometric Measurements in Diff erent Ethnic groups of Nepalese New Borns. J Nepal Paediatr Soc 2012;32(1):1-8.