Low birth weight (LBW) is one of the risk factors for neonatal mortality which increases the odds of deaths by 20-30 times [1]. A birth weight less than 2500 gram is defined as low research only birth weight irrespective of the weeks of gestation [2]. The low birth weight infants are at risk of developing cerebral palsy, or more susceptible to infection in short run and they are more likely to develop breathlessness, physiological immaturity and lower weight and shorter stature in long term [2,3]. Poor social adaptation in school and other settings has also been reported among the LBW infants when they are grown [3-6]. The prevalence of LBW is around 15% in developing countries [3]. However, in many developing countries, the majority of births occur in home, therefore, the information on birth weight is not available.

For those countries the Demographic and Health Surveys (DHS), conducted every five years, are the sources of population health indicators. In these surveys, birth weight is recorded based on mother��s recall or the birth certificate and the prevalence of LBW is reported as an important indicator of neonatal health [7,8]. Risk factors for LBW have been of interest for researchers over a long period. As many as 50 risk and protective factors have been identified by different reviews on LBW infants. Genetic make up, demographic factors, maternal nutritional factors, obstetric factors, maternal health condition and service utilisation are some of the factors that have been of recent interest [7,9].

Maternal health status and the use of antenatal care (ANC) service during pregnancy have been reported to be one of the major determinants of birth weight [9,10]. ANC provides an opportunity for a pregnant woman to have her health checked, manage any problems that arise during pregnancy and obtain counselling services. Counselling advice to pregnant woman revolves around taking adequate rest, reducing physical workload, and eating adequate nutrition including iron-folic acid supplementation in Nepal [11]. In Nepal, iron-folic acid supplementation is provided at no cost at government health facilities throughout the country [11]. An earlier double blinded cluster randomised study from the Eastern Nepal reported the beneficial effect of iron-folic acid supplementation during pregnancy in reducing LBW [relative risk: 0.84; 95% CI (0.072-0.

99)] showing an increase in the mean birth weight by 37 grams [12]. Nepal is one of the exemplary countries successful in reducing the child and maternal mortality in this century. However, recent Nepal Demographic and Health Survey (NDHS) 2011 showed Cilengitide that neonatal death rate remained stagnant (33 per 1000 births) since 2006 despite having tremendous efforts from the Government of Nepal to reduce neonatal, infant and child deaths [8,13].

Discussion The main objectives of EHES Pilot Joint Action were to plan and prepare for full-size surveys in the European countries actively planning or already carrying out national HESs. These objectives were met well in the twelve countries which completed the Palbociclib msds Joint Action. The Joint Action revealed the power of collaboration in the planning and preparation for surveys and of learning from the experiences of others. This was appreciated both by the countries which were planning their first national HES and those with existing periodic or annual HESs. The same is true regarding the training programme and external quality assessment. Support in sampling design was important to ensure that representative health indicators and their precision can be estimated accurately.

Germany, Italy, Netherlands and UK/England started their full-size HESs before or early during the Joint Action period. Slovakia conducted a full-size HES after the pilot survey at the end of year 2011, and Finland conducted one in the beginning of 2012. The other six piloting countries are expected to start in 2012�C2014, depending on funding. In addition, Luxembourg is planning to start a national HES in 2012 and France in 2013. Although these did not participate in the Joint Action, they have collaborated with EHES for the standardization. The pilot surveys are too small to provide precise estimates of health indicators, and represent only small areas of the countries. Therefore they cannot be used to infer information about health in these countries or across Europe, but they are important for testing and further developing the survey methods and their national adaptations.

This paper was written soon after the end of the Joint Action. The assessment of the data from the pilot surveys is ongoing, and will provide more information on the quality of the pilot surveys. The piloting countries have used the pilot survey data to test local reporting. DG Health and Consumers of the European Commission has prepared the HEIDI data tool for the European level reporting of health indicators [16]. The suitability of HEIDI for reporting the EHES data will be tested. The EHES Pilot Project has set up a structure for EHES to provide high quality comparable health indicators on major public health issues which cannot be monitored in other ways.

The structure consists of nationally conducted HESs and the EHES Reference Centre, to provide information to the HEIDI reporting system. Each country is responsible for conducting and primarily funding the national surveys. However, partial financial support from the EU would lower significantly the threshold for countries joining EHES. An EHES Reference Centre is needed to maintain the European standards; provide support to the countries, to ensure the comparability of the national data; Carfilzomib and to facilitate joint European level reporting of the forthcoming full-size HESs.