Nutritional Status of Tribal Under‑Five Children in a Community Development Block of Birbhum District, West Bengal: A Cross‑Sectional Study

Introduction: One of the essential components for maintaining health is having proper and adequate nutrition. The absence of this might affect majorly the physical domain of health, especially in under‑five children as it is the age of development. The present study was conducted among the tribal under‑five children in a tribal predominant block, Mohammad Bazar in Birbhum District of West Bengal to find out their nutritional status, along with the estimation of prevalence of anemia among them; and the association, if any, between the nutritional status of the study population with their demographic, socioeconomic, and environmental characteristics. Materials and Methods: This community‑based cross‑sectional study was conducted among 378 tribal under‑five children residing in 21 villages of Mohammad Bazar Block during September 2018–August 2020 using Lot Quality Assurance Sampling (LQAS) technique. A predesigned, pretested schedule was used to collect necessary information regarding background characteristics. Anthropometric measurements (height and weight) and biochemical estimation (hemoglobin level in blood) were done to evaluate nutritional status. Ethical permission was obtained from Institutional Ethics Committee, Burdwan Medical College. Data were analyzed using the Statistical Package for the Social Sciences, version 20. Results: The present study showed that 31.0% of under‑five children were underweight, 16.6% severely underweight, 31.5% stunted, 17.2% severely stunted, 21.7% wasted, and 7.7% severely wasted. Nearly one‑third of the study participants were suffering from anemia and most of them (91.5%) had mild anemia. As per LQAS, none of the villages had acceptable nutritional status as far as the weight for age and height for age was concerned. Conclusions:This research unveiled that the undernutrition in various forms still persists among the tribal under‑five children. Rigorous implementation of various schemes, missions, and programs by both state and Central Government are the need of the hour to overcome this downhearted situation

Maternal anemia and low birth weight in a community development block of Purba Bardhaman, West Bengal: a retrospective cohort analysis

Background: Being both highly prevalent public health problems in India, anemia in pregnancy (AIP) is hypothesized as a potential risk factor for low birth weight (LBW) baby as pregnancy outcome. In this context, this study was conducted among pregnant mothers registered in last 2 years under Bhatar block of Purba Bardhaman district, West Bengal. Objectives of this study were to assess the relationship of LBW babies with maternal anemia in antenatal period and also with background characteristics and pregnancy related factors.Methods: A retrospective cohort analysis was conducted among postnatal mothers who were registered during their pregnancy in sub-centers of this block during a reference period from April’15th - March’17th. The study subjects were identified from the records of each sub-centre and further categorized into two groups: Exposed (anemic) - Hb <11 gm% in any antenatal visits and Non-exposed(non-anemic) - Hb ≥11 gm% in all antenatal visits. Sample size of 988 for each group was calculated. From each sub-centre’s antenatal record 26 subjects for each group were selected by simple random sampling. Data collected with predesigned pretested schedule and data analyzed using Microsoft Excel and SPSS 20. Logistic regression was performed to establish association.Results: Overall incidence of LBW was 8.1%; in anemic, non-anemic group incidence were 10.5%, 5.7% respectively. AIP had relative risk 1.85 (1.36-2.54) over LBW. On multivariable logistic regression, LBW was significantly associated with AIP (2.11, 1.51-2.95), multi-parity (0.63, 0.44-0.9), inadequate ANC visits (2.7, 1.75-4.15) and female gender (1.64, 1.19-2.27).Conclusions: Anemia in pregnancy significantly increases risks of LBW which also strongly associated with female new-born, primi-parity, and incomplete ANC visits

A cross sectional study on menstrual hygiene practices among the village women attending a primary health centre, Tripura

Background: Hygienic practices performed by the rural women during menstrual cycle is often remain unsatisfactory, resulting adverse health outcomes and poor productivity. Assessment of the practices among different population groups as well as different geographical locations thus has been a priority issue. The objective of this study is to assess the menstrual hygiene practices among the village women attending a Primary Health Centre of Sipahijala district, Tripura.Methods: The study was conducted among 141 village women of reproductive age group (15-49 years), visited Madhupur primary health centre, Sipahijala district, Tripura for some other health conditions. Unwilling individuals were excluded from the study. Data were collected using a pre-designed pre tested schedule by interviewing the participants for basic socio-demographic variables as well as questions related to hygienic practices during menstrual period. Data were analysed using IBM SPSS version 20 and presented using principles of descriptive statistics. Ethical clearance was obtained from Institutional Ethics Committee, Tripura Medical College.Results: Majority of the study subjects belonged to 21-30 years of age group (49.3%). Cloth was the major absorbent material (44.0%) followed by sanitary napkin (36.2%). 47.5% of the study subjects reused the material. Only 2.1% of the study subjects changed the material less than 2 times/day. More than 90% of the study subjects clean their private parts regularly. 66.0% of the study subjects disposed the material in dustbin.Conclusions: Majority of the participants were performing satisfactory menstrual hygienic practices. However, large scale analytical studies will be helpful to draw a definite conclusion about influence of sociodemographic factors on menstrual hygiene practices.

Awareness on standard precautions among auxiliary nurse midwives in a subdivision of Purba Bardhaman district, West Bengal

Background: Due to their occupation, health workers are always at-risk of developing life-threatening infections. “Standard precautions” acts as a protective barrier against this. There is a lack of information about awareness on standard precaution among auxiliary nurse midwives (ANMs), the frontline health personnel working at Sub-centres. The aim of the study was to assess the current awareness on Standard precautions among ANMs.Methods: This descriptive study with cross-sectional design was conducted at sub centre level of Bardhaman Sadar North subdivision, Purba Bardhaman district, West Bengal. In this study, conducted between September-November 2017, three blocks were chosen from the seven blocks in the subdivision through simple random sampling. All ANMs working in these blocks were approached and data were collected on background characteristics and knowledge on key elements of Standard precautions using a pre-tested and pre-designed self-administered questionnaire. Items assessing standard precaution were scored one (for correct response) and zero (for incorrect/missed response). Maximum possible score was fourteen and minimum was zero. Statistical analysis used association of acceptability of knowledge with background characteristics were assessed using bivariate analysis and binary logistic regression.Results: Median (IQR) of the score obtained was 10 (9, 12). Out of total 138 subjects, 64.5% had acceptable knowledge (score ≥10) regarding standard precautions. Participants’ age had a statistically significant association with acceptable knowledge in the bivariate analysis; however, in the final model, only training status of the participants remained significant [AOR-0.304 (0.098-0.938)].Conclusions: It emphasized the importance of regular training on Standard precautions for ANMs.

Evaluation of Clinical Outcome of Patients Undergoing Emergency Laparotomy with the Help of Portsmouth Predictor Equation for Mortality (P-Possum Score)

Introduction: Emergency laparotomy, though lifesaving, mayresult in significant morbidity and mortality. In an attempt toclinically evaluate patients undergoing emergency laparotomyand predict their mortality using the worldwide acceptedPortsmouth Predictor equation for mortality (P POSSUM), thepresent study was undertaken in the Surgery department of atertiary care hospital in eastern India.Material and methods: This observational cross-sectionalstudy included 60 patients aged between 15 to 75 years,undergoing emergency laparotomy during the specified studyperiod of one and half years.Results: It was observed that out of 60 patients, 63.3%were male, and mean age was 40.60 (16.67) years. Pepticperforation was the most common indication for laparotomy.Mean P POSSUM predicted mortality risk was 40.617%(Range-0.8 to 99.7). Twenty-four patients died during hospitalstay. ROC curve analysis of P POSSUM scores revealed thatif a cut off value of P POSSUM score of 42.45% was selected,mortality could be predicted with a sensitivity of 70.80% anda specificity of 83.30%.Conclusion: Thus, P POSSUM might be a useful tool inpredicting risk of short-term mortality following emergencylaparotomy

Knowledge of Auxiliary Nurse Midwives on Immunization Safety: A Cross-Sectional Study in a Sub-Division of Purba Bardhaman District, West Bengal

Introduction: Safe immunization is one of the prerequisites for successful routine immunization program. Awareness on various components of immunization safety among frontline health workers determines their practice. Objectives: This study was conducted to assess knowledge of Auxiliary Nurse Midwives (ANM) regarding various components of immunization safety and to determine association of their knowledge with some background characteristics (if any). Method: This cross-sectional study was conducted at four community development blocks of Sadar North sub-division of Purba Bardhaman district of West Bengal between June - September, 2017. All the 189 ANMs working in 107 sub-centres of these four blocks were interviewed for knowledge on various components of immunization safety with a pre- designed, structured, self-administered questionnaire. Results: Only 68 (36%) ANMs had adequate knowledge (score ≥ 33) combining all components on immunization safety. Chi-square test revealed that knowledge of ANM had statistically significant association with education level (p = 0.00) and last training status (p = 0.00). Education and last training status remained significant in binary logistic regression. Conclusion: Despite being trained, knowledge among ANMs regarding various components of immunization safety in the study area was still not satisfactory. Further emphasis on training and supportive supervision by local and district health authority is the need of the hour.

Goiter Prevalence, Urinary Iodine, and Salt Iodization Level in Sub-Himalayan Darjeeling District of West Bengal, India.

National iodine deficiency disorders control program needs to be continuously monitored. Hence, a cross-sectional study was conducted during the period from April-May 2011 to assess the prevalence of goiter, status of urinary iodine excretion (UIE) level and to estimate iodine content of salts at the household level in Darjeeling district, West Bengal. Study subjects were 2400 school children, aged 8-10 years selected through “30 cluster” sampling methodology. Goiter was assessed by standard palpation technique, UIE was estimated by wet digestion method and salt samples were tested by spot iodine testing kit. Overall goiter prevalence rate was 8.7% (95% confidence intervals = 7.6-9.8) and goiter prevalence was significantly different with respect to gender. Median UIE level was 15.6 mcg/dL (normal range: 10-20 mcg/dL). About 92.6% of the salt samples tested had adequate iodine content of ≥15 ppm. Findings of the present study indicate that the district is in a transition phase from iodine-deficiency to iodine sufficiency.

Limited Access to Iodized Salt among the Poor and Disadvantaged in North 24 Parganas District of West Bengal, India.

Iodine deficiency is endemic in West Bengal as evident from earlier studies. This community-based, crosssectional descriptive study was conducted in North 24 Parganas district during August-November 2005 to assess the consumption of adequately-iodized salt and to ascertain the various factors that influence access to iodized salt. In total, 506 households selected using the multi-stage cluster-sampling technique and all 79 retail shops from where the study households buy salt were surveyed. The iodine content of salt was tested by spot iodine-testing kits. Seventy-three percent of the households consumed salt with adequate iodine content (≥15 ppm). Consumption of adequately-iodized salt was lower among rural residents [prevalence ratio (PR): 0.8, 95% confidence interval (CI) 0.7-0.9], Muslims (PR: 0.8, 95% CI 0.7-0.9), and households with monthly per-capita income of ≤US$ 10 (PR: 0.7, 95% CI 0.6-0.8). Those who heard and were aware of the risk of iodine-deficiency disorders and of the benefit of iodized salt were more likely to use appropriate salt (PR: 1.2, 95% CI 1.1-1.3). Those who were aware of the ban on non-iodized salt were more likely to consume adequately-iodized salt (PR: 1.1, 95% CI 1.01-1.3). The iodine content was higher in salt sold in sealed packets (PR: 2.9, 95% CI 1.8-4.8) and stored on shelves (PR: 1.6, 95% CI 1.3-2.0). Seventy-two percent of the salt samples from the retail shops had the iodine content of ≥15 ppm. The findings indicate that elimination of iodine deficiency will require targeting the vulnerable and poor population.

Awareness and perception of mothers about functioning and different services of ICDS in two districts of West Bengal.

Integrated Child Development Services, a national programme of the Government of India has health, nutrition, and pre-school education components of services. To ascertain awareness, perception of mothers about functioning and different services of ICDS a cross-sectional community based study was conducted between June to September 2007 in Howrah and Purulia districts of West Bengal. A total of 1235 mothers were included as study subjects. As per opinion of the mothers 73% AWCs opened regularly, behaviour of the AWWs was friendly (71.6%) and 63% mothers opined that ICDS is beneficial to their children. 84.2% mothers were aware of any ICDS services. Quantity and quality of supplementary food was acceptable to 88% and 72.7% mothers respectively. 79.2% and 87.5% mothers did not receive any advice on child feeding and growth chart. Making beneficiaries aware about services by targeted interventions will ensure better utilization of ICDS.

Morbidity and treatment seeking behavior among adolescent girls in a rural area of North 24 Parganas district, West Bengal.

A community based, cross-sectional study, conducted in 1999 in a rural area of West Bengal, among 143 adolescent girls (10-19 years), selected through multistage sampling procedure revealed prevalence of acute and chronic morbidity as 30.8% and 7.7% respectively. 84.1% adolescent girls sought for treatment during acute morbidity from various sources; only 22.7% from Government health facilities. Non- availability of medicine (34%), long distance (24%) and poor quality of treatment (10%) were the main reasons for non-utilization of Government health facilities.

Availability and use of emergency obstetric care services in four districts of West Bengal, India.

Process indicators have been recommended for monitoring the availability and use of emergency obstetric care (EmOC) services. A health facility-based study was carried out in 2002 in four districts of West Bengal, India, to analyze these process indicators. Relevant records and registers for 2001 of all studied facilities in the districts were reviewed to collect data using a pre-designed schedule. The numbers of basic and comprehensive EmOC facilities were inadequate in all the four districts compared to the minimum acceptable level. Overall, 26.2% of estimated annual births took place in the EmOC facilities (ranged from 16.2% to 45.8% in 4 districts) against the required minimum of 15%. The rate of caesarean section calculated for all expected births in the population varied from 3.5% to 4.4% in the four districts with an overall rate of 4%, which is less than the minimum target of 5%. Only 29.9% of the estimated number of complications (which is 15% of all births) was managed in the EmOC facilities. The combined case-fatality rate in the basic/comprehensive EmOC facilities was 1.7%. Major obstetric complications contributed to 85.7% of maternal deaths, and pre-eclampsia/eclampsia was the most common cause. It can be concluded that all the process indicators, except proportion of deliveries in the EmOC facilities, were below the acceptable level. Certain priority measures, such as making facilities fully functional, effective referral and monitoring system, skill-based training, etc., are to be emphasized to improve the situation.

Nutritional status of adolescent girls in a rural area of North 24 Parganas district, West Bengal.

A community based, cross-sectional study was conducted during June to December 1999 in Amdanga block of North 24 Parganas district, West Bengal. Among a sample of 143 adolescent girls (10-19 years), selected through multistage sampling procedure. Data was collected by interviewing the adolescent girls and their parent, whenever necessary using pre-designed, pre-tested, semi-structured schedule. Anthropometric measurements were recorded using standardized methodology as recommended by WHO and standard clinical examination procedures were followed. Standard operational definitions were used. Appropriate statistical tests like Chi-square test were applied as and when required. Overall prevalence of 'thinness' and 'stunting' were found to be 14.7% and 37.8% respectively. There was no significant association (p > 0.05) of thinness or stunting with per capita monthly family income and literacy status of parents. Common nutritional deficiency disorders were anaemia (44.8%), dental caries (25.9%), angular stomatitis (15.4%) etc.

Iodine deficiency disorders among school children of Malda, West Bengal, India.

A community-based, cross-sectional study was conducted among 2,392 school children, aged 8-10 years, in Malda district of West Bengal, India, in January 2001 to assess their iodine status. The children were selected through a multistage 30 cluster-sampling technique to determine the status of iodine deficiency disorders (IDD) using recommended quantifiable indicators. The prevalence of goitre was assessed clinically using the standard palpation method by the teachers of Community Medicine, and a total goitre rate of 11.3% was found with no significant gender difference (p>0.05). Urinary iodine excretion (UIE) levels of 341 study subjects, selected through systematic random sampling, were analyzed by the wet digestion method to determine biochemical iodine deficiency by the teachers of Biochemistry Department. The median UIE was 15 mcg/dL, and no child had UIE value less than 5 mcg/dL. Iodine content of 1,060 salt samples tested with spot-testing kit revealed 85.1% with adequate iodine content of > or = 15 ppm. The finding of 11.3% of total goitre rate but with no evidence of current iodine deficiency (median UIE 15 mcg/dL) indicates that the Malda district is in the transition phase from iodine-deficient to iodine-sufficient.