Evaluation of the Prevention of Parent to Child Transmission Program in a Rural Tertiary Care Hospital of West Bengal, India

Background:

In India, 67,500 infants acquire HIV infection yearly due to mother to child transmission.

Objective:

The objective was to assess the operational aspect of the Prevention of Parent to Child Transmission (PPTCT) program in a tertiary care hospital and explore its bottleneck.

Materials and Methods:

A 5-year (2004-2008) prospective evaluation study was conducted among the pregnant women attending Obstetrics Department of a rural tertiary care hospital, since the year of implementation. Indicators were used according to UNAIDS/WHO guideline.

Results:

Out of 40,140 registered pregnant women, 23,812 were counseled of which 19,794 were agreed to undergo HIV testing and 111 were found HIV positive with a prevalence of 0.56%. Overall HIV counseling and testing rates were 59.32% and 83.13%, respectively. The nevirapine (NVP) dispensing rate of the mother and newborn were 29.72% and 85.4%, respectively. At 18 months of age, 85% babies were found HIV negative in the mother baby pair who received NVP with absolutely formula feeding but it was 42.8% without such intervention.

Conclusion:

Majority of the pregnant women who came to the labor room directly were deprived of the program (PPTCT) coverage. Although the HIV testing rate reached the WHO target which was excellent, but the NVP dispensing rate lagged far behind.     

Where and How Breastfeeding Promotion Initiatives Should Focus Its Attention? A Study from Rural Wardha

Background:

In India, the practice of breastfeeding is almost universal, but initiation of breastfeeding is generally quite late and colostrum is discarded. Integrated Management of Neonatal and Childhood Illness (IMNCI) strategy recommended systematic assessment of breastfeeding and emphasized counseling of the mother on proper positioning and attachment of infant to the breast.

Objective:

To assess breastfeeding among mothers of below six months children in rural Wardha.

Materials and Methods

The present cross-sectional study was undertaken in surrounding 23 villages of Kasturba Rural Health Training Center (KRHTC), Anji. Two Auxiliary Nurse Midwives (ANMs) trained in IMNCI paid house visits to 99 mothers during the study period and undertook the assessment of breastfeeding using IMNCI assessment form for young infants. Auxiliary Nurse Midwives observed and recorded the positioning and attachment of infant to the breast as per IMNCI guidelines. The data were entered and analyzed using Epi_Info (version 6.04d) software package.

Results:

Most of the deliveries 94 (94.9%) took place in the healthcare facilities. Majority 61 (61.6%) newborn babies had received breastfeeding within half an hour. About half of the mothers had any of the feeding problems like feeding less than eight times in 24 h, giving any other food or drinks or is low weight for age. Significantly more mothers with feeding problems had problems in positioning and attachment of infant to the breast as compared with those mothers who did not have any feeding problems.

Conclusions:

In the settings, where practice of institutional delivery is high, the staff of healthcare facility should ensure education of the mothers regarding position and attachment of infant to the breast before discharge from the healthcare facility. At the village level, Village Health Nutrition Day (VHND) can be utilized for health education of future mothers and support for the breastfeeding mothers. The IMNCI assessment form for young infant should also include assessment of positioning of infant.     

Community Based Maternal and Child Health Nutrition Project,Uttar Pradesh: An Innovative Strategy Focusing on “At Risk” Families

Research Question:

Use of community based volunteers, frequently reaching and counseling a selected group of prioritized families, can make a substantial difference in improving maternal and child care practices and in reducing child undernutrition.

Setting:

Program Rural Uttar Pradesh, India.

Study Design:

A comparison of baseline and endline surveys following 4 years of community based project intervention

Participants:

“At risk” undernutrition families comprising mothers of under twos, newlyweds, and severely undernourished children below 6 years.

Intervention:

Mapping and counseling of “at risk” families. Measuring impact on maternal-child care practices, underweight status.

Results:

Trained community mobilizers identified and counseled selected “at risk” families. Following 4 years of implementation in 907 villages of 8 blocks of four districts, significant improvement was noted in practices of early initiation of breastfeeding, feeding colostrum, timely introduction of complementary feeding, and washing the hands after defecation. Percentage of mothers exclusively breastfeeding at 6 months was only 2.1% with 78% receiving prelacteal feeds. A small increase in normal and mild malnutrition and a significant reduction of 43% in severe malnutrition was noted.

Conclusion:

Frequently counseling by accredited social health activists by focusing on selected defined “at risk” families of under twos and those with severe malnourished children could result in increasing acceptability of correct child health, feeding, and care practices and in contributing to improving nutritional status scenario.     

Factors Associated with Morbidities Among Infants in Three Sub Centre Areas of Belgaum District of South India: A Longitudinal Study

Background:

Health status of infants is a sensitive indicator of development and factors influencing it need to be better understood.

Objectives:

This study was conducted to search for factors associated with morbidity among infants and to find out their influence on weight gain during infancy.

Materials and Methods:

This longitudinal study was undertaken in south India from November 2004 till April 2006. A birth cohort of all children born during first 6 months of the study period were assessed at enrollment and followed up monthly till they attained 1 year of age.

Results:

Incidence of morbidity among infants was found to be least among those exclusively breast fed (EBF) for 6 months and most when EBF for less than 6 months (P = 0.045). It was also more when infants were weaned with a combination of animal milk, formula milk, semi-solids and solid diet and least when weaned only with semi-solids and solids (P = 0.018). Diarrheal episodes were more in infants who were bottle-fed (P < 0.001). Weight gain between 6^th and 12^th month of infancy was found to be significantly affected by various morbidities (P = 0.001). Incidence of morbidities was less among preterm babies and more among partially immunized (P < 0.001) babies with birth order ≥ 3 (P = 0.012), babies of mothers with low socio-economic and educational status. Delayed milestones during infancy was seen more in babies with history of birth asphyxia (P = 0.018).

Conclusion:

Several factors influenced incidence of morbidities and these morbidities had a negative effect on weight gain. Hence these factors need to be addressed to promote better child health.     

Assessment of Immunization Status in the Slums of Surat by 15 Clusters Multi Indicators Cluster Survey Technique

Research Question:

What is the immunization status of children in the slums of Surat and what changes has it undergone in recent times?

Objective:

To assess the immunization status of children between the ages of 12 and 23 months in the slums of Surat and to compare it with the MICS from previous years.

Study Design:

This was a community-based cross-sectional study conducted in 15 clusters.

Settings:

15 urban slums selected out of a total of 299 slums using the cluster sampling method.

Study Tool:

The Multi Indicator Cluster Sampling (MICS) method was used for sample selection and the proforma designed by UNICEF was used as a study tool.

Statistical Analysis:

Simple proportions and a Chi-square test.

Results:

Only 25% of the children between the ages of 12 and 23 months were fully immunized; coverage was highest for BCG (75%) and lowest for measles (29.9%). As far as the dropout rate is concerned, it was 60.2%, 31.9%, and 31.5% for BCG to measles, DPT₁ to DPT₃, and OPV₁ to OPV₃, respectively. Vitamin A was taken by only 28.9% of the subjects. Between the two, female children were more disadvantaged in terms of vaccination. When compared with the coverage of 1997 and 1998, the current coverage is poor, more so in relation to DPT and OPV.     

Are we Underestimating the Real Burden of Malnutrition? An Experience From Community-Based Study

Background:

Since the inception of childhood nutritional programs in India, underweight has been taken to judge the nutritional status of children; but is it a true indicator of overall prevalence of malnutrition in a community?

Objective:

To estimate the overall prevalence of malnutrition by using Composite Index of Anthropometric Failure (CIAF) and to assess its usefulness over various conventional anthropometric indicators among under 5 children residing in Agra city.

Materials and Methods:

A cross-sectional, community-based study was conducted among under 5 years age children, from June 2012 to July 2013 in an urban slum of Agra. Nutritional status was assessed using anthropometry and clinical examination, and classified as per World Health Organization (WHO) 2006 Growth Standards and CIAF.

Results:

Of the 458 children studied, 42.8% were underweight, 41.9% had stunting, while 22.7% had wasting. However, 60.04% of children were found to be malnourished as per the CIAF. Unlike three conventional anthropometric indicators of malnutrition, CIAF was observed to have a much consistent association with morbidity like diarrhea episodes in past 3 months (odds ratio (OR) = 2.09), acute respiratory tract infection (ARI) episode in past 3 months (OR = 1.58), and any illness requiring hospitalization (OR = 1.29).

Conclusion:

The CIAF should supplement the conventional indices of malnourishment, to provide a single, aggregated figure of actual number of undernourished children in a given population.     

Routine Immunization - Do People Know About It? A Study Among Caretakers of Children Attending Pulse Polio Immunization in East Delhi

Research question:

Do caretakers of children under five years have sufficient knowledge regarding routine immunization (RI)?

Objective:

To assess the knowledge about RI among caretakers of young children.

Settings:

Pulse polio immunization centres in East Delhi.

Study design:

Cross-sectional study.

Participants:

Six hundred and eighty-two caretakers accompanying children under 5 years to pulse polio booths in November 2006.

Study tool:

Pre-tested semi-open-ended questionnaire.

Statistical analysis:

Proportions, Chi-square test.

Results:

The proportions of respondents who had awareness about different aspects of RI, such as weekday of RI (37.0%), age group for RI (49.1%), number of visits required in the first year of life (27.0%), were all low. When asked to name the four diseases covered under the RI program in Delhi, only 268 (39.3%) could name at least three. The education level of respondents was strongly associated with their knowledge about RI.

Conclusion:

The need of the hour is to make RI a ‘felt need’ of the community. Making caretakers more aware about RI is a vital step in achieving this goal.     

Prevalence, Awareness, Treatment, and Control of Hypertension in Rural Areas of Davanagere

Objective:

To study the prevalence, awareness, treatment, and control of hypertension in the rural areas of Davanagere.

Type of Study:

Cross-sectional community-based study.

Setting:

Villages belonging to six sectors of the Davanagere Taluk.

Materials and Methods:

General population above 18 years.

Methodology:

A community-based sample was chosen by a multistage sampling technique. Subjects were screened for hypertension by a house-to-house survey. Subjects with systolic blood pressure more than 140 and diastolic blood pressure more than 90 mm of Hg, on hypertensive treatment, and history of hypertension were classified as hypertensives. The data thus obtained was compiled and analyzed.

Results:

The prevalence rate of hypertension in the study population was 18.3% (95% CI, 16.7-19.9%). Prevalence of hypertension was more in males 19.1% (95% CI, 16.7-21.5%) than in females 17.5% (95% CI, 14.9-20.1%); 11.6%, 5.6%, and 1.2% of the total subjects had Grade I, Grade II, and Grade III, respectively. Only 33.8% of them were aware of their hypertensive status. Hypertensives of 32.1% were on treatment, and 12.5% adequately controlled their BP. About 6.9% of the total hypertensives had severe hypertension.

Statistical Analysis:

Proportions, One way Analysis of Variance, Chi-square test.     

Effectiveness of 7-valent pneumococcal conjugate vaccine against radiologically diagnosed pneumonia in indigenous infants in Australia

Objective

To evaluate the effectiveness of the 7-valent pneumococcal conjugate vaccine (PCV7) in preventing pneumonia, diagnosed radiologically according to World Health Organization (WHO) criteria, among indigenous infants in the Northern Territory of Australia.

Methods

We conducted a historical cohort study of consecutive indigenous birth cohorts between 1 April 1998 and 28 February 2005. Children were followed up to 18 months of age. The PCV7 programme commenced on 1 June 2001. All chest X-rays taken within 3 days of any hospitalization were assessed. The primary endpoint was a first episode of WHO-defined pneumonia requiring hospitalization. Cox proportional hazards models were used to compare disease incidence.

Findings

There were 526 pneumonia events among 10 600 children – an incidence of 3.3 per 1000 child-months; 183 episodes (34.8%) occurred before 5 months of age and 247 (47.0%) by 7 months. Of the children studied, 27% had received 3 doses of vaccine by 7 months of age. Hazard ratios for endpoint pneumonia were 1.01 for 1 versus 0 doses; 1.03 for 2 versus 0 doses; and 0.84 for 3 versus 0 doses.

Conclusion

There was limited evidence that PCV7 reduced the incidence of radiologically confirmed pneumonia among Northern Territory indigenous infants, although there was a non-significant trend towards an effect after receipt of the third dose. These findings might be explained by lack of timely vaccination and/or occurrence of disease at an early age. Additionally, the relative contribution of vaccine-type pneumococcus to severe pneumonia in a setting where multiple other pathogens are prevalent may differ with respect to other settings where vaccine efficacy has been clearly established.     

Breast Feeding Practices and Newborn Care in Rural Areas: A Descriptive Cross-Sectional Study

Context:

Breastfeeding practices play an important role in reducing child mortality and morbidity. This study was aimed to describe the breastfeeding practices prevalent in rural areas.

Objectives:

The primary objective of this study was to describe the breastfeeding and newborn care practices in rural areas and the secondary objective was to describe the factors affecting the initiation and duration of breastfeeding.

Settings and Design:

The study was conducted in primary health care center (PHC) that is attached to a medical college in Kengeri, rural Bangalore, Karnataka.

Materials and Methods:

Mothers with children who were 9 months old who came to the PHC for measles vaccination were included in the study and data was collected using the pre-tested questionnaire on breastfeeding and newborn practices.

Results:

Our study shows 97% of the mothers initiated breastfeeding, 19% used pre lacteal feeds, 90% had hospital deliveries and 10% had home deliveries, and 50% used a house knife to cut the umbilical cord among home deliveries.

Conclusions:

This study emphasizes the need for breastfeeding intervention programs especially for the mother during antenatal and postnatal check-ups and practices like discarding the colostrum and early/late weaning are still widely prevalent and need to be addressed.     

Global strategies to reduce the price of antiretroviral medicines: evidence from transactional databases

Objective

To estimate the impact of global strategies, such as pooled procurement arrangements, third-party price negotiation and differential pricing, on reducing the price of antiretrovirals (ARVs), which currently hinders universal access to HIV/AIDS treatment.

Methods

We estimated the impact of global strategies to reduce ARV prices using data on 7253 procurement transactions (July 2002–October 2007) from databases hosted by WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Findings

For 19 of 24 ARV dosage forms, we detected no association between price and volume purchased. For the other five ARVs, high-volume purchases were 4–21% less expensive than medium- or low-volume purchases. Nine of 13 generic ARVs were priced 6–36% lower when purchased under the Clinton Foundation HIV/AIDS Initiative (CHAI). Fifteen of 18 branded ARVs were priced 23–498% higher for differentially priced purchases compared with non-CHAI generic purchases. However, two branded, differentially priced ARVs were priced 63% and 73% lower, respectively, than generic non-CHAI equivalents.

Conclusion

Large purchase volumes did not necessarily result in lower ARV prices. Although current plans for pooled procurement will further increase purchase volumes, savings are uncertain and should be balanced against programmatic costs. Third-party negotiation by CHAI resulted in lower generic ARV prices. Generics were less expensive than differentially priced branded ARVs, except where little generic competition exists. Alternative strategies for reducing ARV prices, such as streamlining financial management systems, improving demand forecasting and removing barriers to generics, should be explored.     

Study on Prevalence of lodine Deficiency Disorder and Salt Consumption Patterns in Jammu Region

Research Question:

What is the situation of iodine deficiency disorder (IDD) and salt consumption in Jammu region?

Hypothesis:

The prevalence of IDD has decreased markedly as a result of medical as well as socio-economic factors.

Objective:

To assess the magnitude of IDD in Jammu region and also assess the salt consumption patterns in the region.

Design:

Cross-sectional study.

Setting:

Primary schools in both urban and rural areas.

Study Tools:

Clinical examination of study population for goiter, laboratory assessment of casual urine sample for urinary iodine estimation of I₂ content of salt samples collected from sub-samples of study population.

Participants:

School children in the age group of 6-12 years were selected for study using WHO 30-cluster methodology, urine samples were collected from 15% of selected children and salt samples from 5% of sub-sample.

Ethical Concern:

No ethical issues were involved.

Results:

An overall goiter prevalence of 11.98% was observed in the region. Females had a prevalence of 16.1% and males 10.1%. The median urinary iodine excretion in the region was 96.5 μg/l (range: 29.0-190.0 μg/l). Forty-nine percent of subjects had biochemical iodine deficiency with 6.7% having moderate and 42.53% mild iodine deficiency. In Jammu region, 74.47% of households consume powdered salt with 98.17% powdered salt samples having an I₂ content of greater than 15 ppm.

Conclusion:

Iodine deficiency remains a public health problem in the region, though the region seems to be in a state of nutritional transition from iodine deficiency to iodine sufficiency.     

Information, Education, and Communication Services in MCH Care Provided at an Urban Health Center

Background:

Regular IEC programs during antenatal and intranatal period, through individual or group approach, brings desirable changes in health practices of people, resulting in a healthy mother and a healthy baby.

Materials and Methods:

This study was conducted to assess the level of IEC services regarding pregnancy and child care, received by the women at an MCH clinic of an urban health center, where the study subjects comprised 400 antenatal (AN) and postnatal (PN) women and mothers of children under five years.

Results:

Warning signs of danger was explained to only 10% of the AN and PN women. Advice regarding family planning appeared to be the most frequently covered, though that too was explained to less than half of the subjects. About one third of the women were advised on breast feeding. Only 8% of the mothers had been told about all issues regarding pregnancy and child care. Breast feeding and weaning was properly explained to 85.7 and 81.1% of the total mothers of U5 children. Advice regarding subsequent nutrition was given to 60.9% of mothers. About only a quarter of the total mothers were advised on home management of diarrhea and acute respiratory infections. Very few mothers were counseled about the growth pattern of the children and none were shown the growth chart. Only 12.9% of the mothers were informed about all issues.

Conclusion:

IEC regarding maternal and child care other than feeding practices is a neglected service in the health facility where the study was conducted.     

Risk Behaviors Related to Inter-personal Violence Among School and College-going Adolescents in South Delhi

Background:

Injuries are a major cause of death and disability among the adolescents in the world.

Objective:

To study risk behavior related to interpersonal violence amongst school- and college-going adolescents in South Delhi and its epidemiological correlates.

Study Design:

Cross-sectional study.

Setting:

Three schools and two colleges in South Delhi.

Participants:

Five hundred and fifty adolescents aged 14-19 years.

Statistical Analysis:

Proportions, Chi-square test, multivariate logistic regression.

Results:

Among the study participants, 65 (11.8%) reported having carried a weapon in past 30 days. Seventy-four (13.5%) respondents had threatened or injured someone with a weapon in past 12 months. Almost one in every two boys (49.1%) reported being involved in a physical fight in past 12 months. Involvement in interpersonal violence was found to be significantly more amongst males than females. Adolescents who were working part time were more likely to be ‘at risk’ (67.5%) than those not working (48.5%). In logistic regression analysis, the significant correlates of interpersonal violence were male gender, lower age, number of close friends, having seen role models smoke/drink, and residing in resettlement colonies, slums or villages. The findings regarding violence-related behaviors among adolescents are remarkably similar to those in other countries.     

Socio-cultural and Knowledge-Based Barriers to Tuberculosis Diagnosis for Women in Bhopal,India

Background:

In India, only one woman is diagnosed with tuberculosis (TB) for every 2.4 men. Previous studies have indicated gender disparities in care-seeking behavior and TB diagnosis; however, little is known about the specific barriers women face.

Objectives:

This study aimed to characterize socio-cultural and knowledge-based barriers that affected TB diagnosis for women in Bhopal, India.

Materials and Methods:

In-depth interviews were conducted with 13 affected women and 6 health-care workers. The Bhopal Diagnostic Microscopy Laboratory Register (n = 121) and the Bhopal district report (n = 261) were examined for diagnostic and care-seeking trends.

Results:

Women, especially younger women, faced socio-cultural barriers and stigma, causing many to hide their symptoms. Older women had little awareness about TB. Women often sought treatment from private practitioners, resulting in delayed diagnosis.

Conclusions:

Understanding these diagnostic and help-seeking behaviors barriers for women is critical for development of a gender-sensitive TB control program.     

A Qualitative Exploration Into the Parent–Child Feeding Relationship: How Parents of Preschoolers Divide the Responsibilities of Feeding With Their Children

Objective

To explore the extent to which parents divide responsibilities of feeding (what, when, where, how much, and whether) with their children and the factors that influence parents' approach to feeding.

Prevalence of HIV/AIDS and Prediction of Future Trends in North-west Region of India: A six-year ICTC-based Study

Background:

The study was conducted to analyze previous six-year prevalence data of HIV infection in the Northwest region of India and predict future trends for a couple of years.

Objectives:

The study was conducted to aid SACS and NACO to plan and arrange resources for the future scenario.

Materials and Methods:

All the attendees of ICTC, Jaipur, from January 2002 to December 2007 were included and variables like age, sex, marital status, occupation, place of residence, pattern of risk behavior and HIV serostatus were studied. As per the strategy and policy prescribed by NACO, tests (E/R/S) were performed on the serum samples. Data was collected; compiled and analyzed using standard statistical methods. Future trends of HIV-prevalence in north-west India were anticipated.

Results:

The overall positivity rates among attendees of ICTC, were found to be 12.2% (386/3161), 11.8% (519/4381), 11.1% (649/5867), 13% (908/6983), 14% (1385/9911) and 17.34% (1756/10133) in the years 2002, 2003, 2004, 2005, 2006 and 2007 respectively. Future trends for the next couple of years depict further increase in prevalence without any plateau.

Conclusion:

Epidemiological studies should be carried out in various settings to understand the role and complex relations of innumerable behavioral, social and demographic factors, which will help, interrupt and control the transmission of HIV/ AIDS.     

Factors Related to Attempted Suicide in Davanagere

Research Question:

What are the factors responsible for suicidal attempts?

Objectives:

To study the socio-demographic factors, methods and reasons for suicidal attempts.

Type of Study:

Cross-sectional study.

Setting:

Bapuji and C.G. Hospitals attached to J.J.M. Medical College, Davanagere.

Participants:

A total of 540 suicidal attempters admitted to emergency wards.

Methodology:

A pretested proforma was administered to the subjects relating the factors responsible for the attempt. The data thus obtained was compiled and analyzed.

Statistical Analysis:

Proportions, Z-test and Chi-square test.

Results:

In this study, 61.3% were males and 38.7% were females. Peak occurrence of suicidal attempts was found in the second and third decades (15-29 years). Hindus constituted about 94.6% of the total suicidal attempters. Almost half (52.2%) of the subjects had education below or up to matriculation and 83% of them were from the lower (classes IV and V) socio-economic groups. Agriculturists, housewives and unskilled workers represented 75% of the total subjects. Fifty-five percent of the subjects were from nuclear families and most (62.4%) of them were married; frequent mode of attempting suicides was by organo-phosphorus compounds (66.3%) followed by overdosage of tablets (17.8%). Common cause was family problem (27.2%) followed by illness (27%).     

School-based Intervention to Promote Healthy Lifestyles in Sousse, Tunisia

Background:

Integrated actions against selected risk factors (i.e. smoking, physical inactivity, and unhealthy diet) can lead to the reduction of major chronic diseases.

Objective:

To implement and evaluate a school-based intervention program to prevent cardiovascular risk factors among children.

Materials and Methods:

Design:

Pre- test post-test quasi experimental design with a control group.

Setting:

Four secondary schools in Sousse, Tunisia.

Intervention:

The overall intervention program lasted for a school year and incorporated educative actions concerning tobacco use, physical activity, and healthy diet.

Results:

Globally, knowledge, behaviors, and intentions concerning smoking improved in both groups between baseline and the end of the study, particularly in the intervention group. Nutrition knowledge, behaviors, and intentions improved in both groups between baseline and final stage, particularly in the intervention group. At the final stage, there was an increase in the proportion of children walking to and from school in the intervention group. There was also an increase in the percentage of children with intention of practicing sport in the future particularly in the intervention group. There were no significant differences in BMI after the intervention neither in intervention nor in control groups. At the end of the study, the incidence of overweight and obesity was similar to that at baseline.

Conclusions:

This pilot study has demonstrated the potential of school as a suitable setting for the promotion of healthy lifestyles in children. The study resulted in substantial improvements concerning knowledge, behaviors, and intentions in the intervention group.