Residential environmental tobacco smoke exposure during pregnancy and low birth weight of neonates: Case control study in a public hospital in Lucknow, India

Objective

To determine whether residential environmental tobacco smoke (ETS) exposure during pregnancy is associated with low birth weight (LBW) neonates and establish a dose response relationship.

Design

Case control study.

Setting

Tertiary care hospital.

Methodology

Mothers giving birth to LBW neonate (<2.5 kg) were cases and those whose neonates weighed ≥2.5 kg at birth were controls. Excluded were women smokers and tobacco chewers, high parity (>3), multiple pregnancy and still births. Included were 100 cases and 200 controls, aged 20 to 30 years. Information was collected on ETS exposure and other risk factors of LBW within 24 hours of delivery. Clinical information like maternal haemoglobin levels, birth weight and gestational age of the neonate was extracted from hospital records.

Results

On univariate analysis, preterm pregnancy, low socioeconomic status, previous LBW neonate, no utilization of antenatal care (ANC), severe anemia and ETS exposure were statistically significantly associated with LBW neonate and controlling for these in logistic regression analysis, adjusted Odds ratio for ETS exposure association with LBW neonate was 3.16 (95% CI=1.88–5.28). A dose response relationship was also found which was statistically significant (10–20 cigarettes smoked/day: OR = 4.06, 95% CI=1.78–9.26 and >20 cigarettes smoked/day, OR = 17.62, 95% CI= 3.76–82.43).

Conclusion

Exposure to ETS during pregnancy is associated with LBW of neonates. Hence, there is an urgent need to increase awareness about health hazards of ETS during pregnancy and bring about behavioural changes accordingly as a one of the strategies to reduce LBW deliveries in India.     

Zinc supplementation in acute diarrhea is acceptable, does not interfere with oral rehydration, and reduces the use of other medications: a randomized trial in five countries

OBJECTIVE: Assess the impact of zinc supplementation with locally developed culturally specific educational statements (messages) on oral rehydration solution (ORS) and antibiotics or antidiarrheal use in children with acute watery diarrhea as well as to assess adherence and side effects of zinc. METHODS: This was a randomized effectiveness trial conducted in outpatient health facilities of six sites in five countries, namely, Fortaleza (Brazil), Addis Adaba (Ethiopia), Cairo (Egypt), Lucknow and Nagpur (India), and Manila (Philippines). Participants were 2,002 children aged 2 to 59 months. Intervention was zinc (20 mg orally, once daily for 14 days) with ORS (zinc group) compared with ORS alone (control group). Primary outcomes were ORS use on day 3 to 5; adherence to zinc; and any use of an antibacterial/antidiarrheal up to day 14. RESULTS: One thousand ten and 992 children enrolled in zinc and control groups, respectively. Loss to follow-up on days 3 to 5 and 15 to 17 was 1.2% and 2.8% in the zinc group and 0.8% and 1.7% in the control group. In five of six sites, ORS use in cases with continued diarrhea on days 3 to 5 was the same in the two groups or higher in zinc group. Overall adherence to zinc supplementation was 83.8% (95% confidence interval [CI] 81-86). There was no difference in vomiting by group. In consideration of the six countries overall, less antibiotic/antidiarrheal use occurred in the zinc group (absolute difference, 3.8% [95% CI 1.7-5.9]). CONCLUSIONS: In the management of acute watery diarrhea, zinc plus ORS along with culturally appropriate, site-specific messages in local language does not affect overall ORS use generally and decreases antibiotic/antidiarrheal use; children had good adherence without side effects.     

Four-country surveillance of intestinal intussusception and diarrhoea in children

Aim:   Establishment of baseline epidemiology of intussusception in developing countries has become a necessity with the possibility of reintroduction of rotavirus vaccine. The current study assessed the seasonal trend in cases admitted with intussusceptions and dehydrating acute watery diarrhoea in children aged 2 months to 10 years.
Methods:   In a prospective surveillance study, teaching and research hospital sites in India (Lucknow and Nagpur), Brazil (Fortazela), Egypt (Ismailia) and Kenya (Nairobi) established a surveillance where a network of hospitals with surgical facilities catered to a reference population of about 1–2 million for reporting of intussusception. One large hospital per site also recruited admitted cases of acute watery diarrhoea.
Results:   From April 2004 to March 2006, 173 and 2346 cases of intussusception and diarrhoea, respectively, were recruited. Cases of intussusception had no apparent seasonality. Most cases of intussusception (61.3%) (107/173) were in the ≤1 year age group, with males comprising 68.8% (119/173) of all cases. Hospital mortality of intussusception was 4.2% (4/96). Cases of diarrhoea peaked in March, with 56.6% (1328/2346) of admitted cases being males. Majority (83.1%) of cases of diarrhoea had received antibiotics, and the hospital mortality was 0.8% (18/2280).
Conclusion:   Intussusception in the four participating countries exhibited no seasonal trend. We found that it is feasible to establish a surveillance network for intussusception in developing countries. Future efforts must define population base before the introduction of rotavirus vaccine and continue for some years thereafter.     

Serum 25 Hydroxy Vitamin D Insufficiency Associated with Bronchial Asthma in Lucknow,India

Objectives

To assess the association between serum 25 hydroxy vitamin D levels and asthma and its control in Indian children.

Methods

This was a prospective case–control study conducted in tertiary care hospital. Cases of asthma and healthy age-matched controls were included, aged 1–15 y, who had not received any vitamin D supplementation in the last year and had no other co-morbidity, after obtaining written informed parental consent. 25 hydroxy vitamin D insufficiency was taken below level of ≤ 30 ng/mL.

Results

Fifty asthmatics and 25 age-matched controls were recruited from August 2011–July 2012. 25 hydroxy vitamin D insufficiency was associated with occurrence of asthma (OR?=?13.5; 95 % CI?=?4.25–42.85: p?=?0.000). With decreasing level of asthma control there was increasing strength of association with 25 hydroxy vitamin D insufficiency [χ ² for trend?=?24.96 (p?=?0.000)].

Conclusions

25 hydroxy vitamin D insufficiency is associated with bronchial asthma as well as its level of control.