Assessment of immunization among newborns: comparison between children delivered vaginally and by cesarean section

Background: Timely administration of vaccines, particularly for hepatitis B birth dose within 24 hours of birth is of immense importance. It is considered as an indicator of quality of immunization programme. This study aimed to assess effect of mode of delivery and type of hospital on immunization among newborns.Methods: This large multi-site study was conducted in Pune district having population of 9.43 million. A total of 13 hospitals were selected which included all government hospitals performing more than five cesarean sections per month, and one government and one private medical college hospital. Cesarean section and vaginally deliveries were enrolled in 1:1 ratio. Their children were followed till discharge. Data were collected by obstetrician or qualified nurse.Results: During study period 3,112 women were enrolled. The relative risk of not getting vaccine Hepatitis B birth dose before 24 hours among cesarean delivered newoborns was 1.08. The relative risk of not getting zero polio and BCG among cesarean delivered newborns was 0.71 and 0.76 respectively. All these differences were significant. The coverage for all vaccines was better in sub district hospitals than others. Coverage of all vaccines in government teaching hospital was better than private.Conclusions: Cesarean section enabled better coverage among newborns probably due to length of stay. Whereas the physical and mental stress after cesarean section resulted lesser coverage of hepatitis B birth dose within 24 hours. Opportunities of timely Hepatitis B birth dose administration were missed probably due to lack of knowledge among health workers about ideal timing.

Density of in-vitro fertilization centers and its correlation with socioeconomic factors in Maharashtra state, India

Background: The infertility due to various reasons is increasing and correspondingly the number in vitro fertilization (IVF) centers is also increasing. Some procedures in these centers can deliver desired sex of the unborn child. The gender discrimination in India has already resulted unfavorable child sex ratio for girls. Maharashtra is one of the badly affected states. It is feared that the child sex ratio may further decline due to IVF centers. The study was carried out to measure correlation between number of IVF centers with various indicators of sex ratio infertility, and some socio-economic factors.Methods: The study was conducted in 2014 using secondary data. District wise internet search by using words ‘In-Vitro Fertilization center’ and ‘infertility treatment center’ was carried out. Whenever IVF center/procedure was noticed on the internet, the center with its address was included in that district list.Results: There was positive correlation between IVF centers and urbanization, per capita income, female literacy and negative correlation with population sex ratio and no correlation with sex ratio at birth or child sex ratio. The best correlation was observed with urbanization, which explains the observed correlation with other variables.Conclusions: The number of IVF centers is not related with magnitude of infertility and not affecting sex ratio whereas IVF density seems to be an outcome of extent of urbanization.

Decline and Disparity in Maternal Mortality in Pre‑ and Post‑National Health Mission Period in India.

Country‑ and state‑wise maternal mortality shows the highest disparity among health statistics. The erstwhile National Rural Health Mission (NRHM) in India aimed reduction in maternal mortality ratio (MMR) to <100 per lakh live births. Accordingly, many new initiatives were planned and started. This analysis was carried out using data from the Sample Registration System. The data from 1997 to 1998 are available which dates 8 years prior to the launching of NRHM. Hence, comparison period was considered as 8 years of implementation of NRHM. The overall decline in MMR prior to NRHM was 36% and after NRHM implementation 30%. The difference is not significant. The best states and lowest states had changed, but the disparity also has remained almost at the ratio of 1:5. The pace of decline has not increased after NRHM. As well disparity ratio has not reduced indicating the differentially better treatment to the vulnerable states was not adequate.

Maternal Morbidity and Estimates from Community Studies in India.

First phase of implementation of national rural health mission was completed with 11th plan. Reviews are regularly conducted to monitor the achievements of goals which include reduction of maternal mortality ratio, which is an emerging priority. Due to inherent difficulties in definition, data compilation studies are infrequent. Maternal mortality to morbidity ratio varies from 5 to 223. The morbidities range from mild to severe almost near miss case. The criteria for inclusion of a patient in severe acute maternal morbidity on organ/system failure/dysfunction seem to be objective but availability of diagnostic facilities is the limiting factor. The simple criterion based on some diseases or conditions is widely accepted. Usually magnitude is recorded high when disease or condition criteria are used and low when failure or dysfunction criteria are used. Community-based studies are scarce. National level surveys provide limited information. In such type of studies, morbidities are self-reported and hence the magnitude is very high. The district level household survey-3 recorded morbidity in 93.3% women. Very few studies were carried out before 2001. Studies in this millennium have been deliberated. Women having some postnatal depression ranged from 11 to 33%.

Community Based Monitoring Under National Rural Health Mission in Maharashtra: Status at Primary Health Centers.

This study compares the implementation of community-based monitoring (CBM) in 45 primary health centers (PHCs) in the pilot phase in Maharashtra with the equal number of randomly selected PHCs not implementing CBM (non- CBM) from the same districts. Information was collected by teams from Community Medicine Departments by visiting selected PHCs. Establishment of monitoring committees and training of medical offi cers (MOs) had been completed as required but only 36.36% MOs were trained. Only 43.18% MOs received the facility report card. Most of the MOs (90.90%) attended Jansunwai and opined that it had increased community awareness and the barriers between the people and PHC staff were broken. There was no difference in fund utilization and meetings of Rugna Kalyan Samittees. Percentage of Institutional deliveries and women receiving Janani Suraksha Yojana benefi ts among home deliveries was more in the non-CBM group of PHCs.

A clinico-epidemiological study of chikungunya outbreak in Maharashtra state, India.

The year 2006 witnessed an extensive outbreak of Chikungunya fever in Maharashtra state. Out of 6467 sera of suspected patients sent to National Institute of Virology, Pune, 804 were serologically confirmed. This retrospective study was carried out by interrogating all those patients for their sickness experience. Adult females from rural area were more affected than males. In 68.2% families, there were multiple cases. Fever and multiple joint involvement were almost invariable. In 36.5% patients, there was history of recurrence. Along with pain, slight swelling was noticed in 55% patients. The commonest joints involved were wrist, inter-phalangeal, elbow, knee and ankle, in that order. The pain and swelling persisted for more than a month. After health education during outbreak, there was positive improvement in behavior pertaining to source reduction of vector. Inter-personal communication was best remembered. In health education, the role of paramedical workers and government doctors was prominent.