Maternal nutritional status & practices & perinatal, neonatal mortality in rural Andhra Pradesh, India.

BACKGROUND & OBJECTIVE: Despite a vast network of primary health centres and sub-centres, health care outreach in rural parts of India is poor. The Dangoria Charitable Trust (DCT), Hyderabad, has developed a model of health care outreach through trained Village Health and Nutrition Entrepreneur and Mobilisers (HNEMs) in five villages of Medak district in Andhra Pradesh, not serviced by the Integrated Child Development Scheme (ICDS) of the Government of India. Impact of such a link worker on perinatal/ neonatal mortality has been positive. The present study attempts to examine the association of maternal nutrition and related factors with perinatal, and neonatal mortality in these villages. METHODS: Women from five selected villages who had delivered between June 1998 and September 2003, were identified. Those who had lost a child before one month (28 days), including stillbirths, (group 1- mortality group), who could be contacted and were willing to participate, were compared with those who had not lost a child (group II- no mortality), through a structured questionnaire and physical examination for anthropometric status and signs and symptoms of nutritional deficiency. Categorical data were analysed using Pearson chi square analysis. Continuous data were analysed using Student's t test. RESULTS: Mortality during perinatal, neonatal period was 8.2 per cent of all births. Malnutrition was rampant. Over 90 per cent women had 3 or more antenatal check-ups, had taken tetanus injections and had complied with regular consumption of iron-folic acid tablets. Higher percentage of women in group I (mortality group) tended to have height less than 145 cm (high risk) and signs and symptoms of micronutrient deficiencies. However, differences between groups I and II were not statistically significant. Pre-term delivery, difficult labour (use of forceps), first parity, birth asphyxia (no cry at birth) and day of initiating breastfeeding showed significant association with mortality. INTERPRETATION & CONCLUSION: Significant association between signs and symptoms of malnutrition with perinatal, neonatal deaths may have been masked by high prevalence of malnutrition in the mothers of both the groups and the small study sample size. However, maternal malnutrition, may contribute indirectly through its effects on other pregnancy-related as well as delivery-related complications leading to adverse outcome of pregnancy. The HNEM experience of DCT suggests that a properly trained and supported village level worker can contribute to reduction in perinatal and neonatal mortality.

Effects of ovulen-50, diethylnitrosamine and phenobarbital on liver regeneration in female rats.

Short term effects of ovulen-50, a combination type oral contraceptive agent and phenobarbital—an established hepatic tumour promoter, were examined in the livers of diethylnitrosamine-initiated and uninitiated female rats. Liver mitotic activity as judged by liver weight, [3H] thymidine incorporation into DNA and levels of DNA, RNA and protein were measured in non-regenerating and regenerating liver. Hepatic γ-glutamyl transpeptidase activity and hepatocyte agglutination with concanavalin A were examined in diethylnitrosamine- and/or phenobarbital-treated rats. The results indicate that diethylnitrosamine or ovulen-50 individually are mitoinhibitory in regenerating liver. Phenobarbital alone has a slight mitostimulatory effects in nonregenerating liver, but no effect on liver regeneration. Administration of ovulen-50 and phenobarbital to diethylnitrosamine initiated rats mitigated the mitoinhibition during regeneration. Contrary to the earlier observation with ovulen-50, neither phenobarbital nor diethylnitrosamine induced hepatocyte agglutination in the presence of concanavalin A. Like ovulen-50, diethylnitrosamine also increased the level of hepatic γ-glutamyl transpeptidase. Phenobarbital produced only insignificant rise and did not substantially exacerbate the effect diethylnitrosamine. The data show that though some of the effects of ovulen-50 resemble those of diethylnitrosamine or phenobarbital, the changes observed may not be related to the neoplastic phenomenon since they were not seen in an initiator-promoter combination regimen.

In vitro effects of gossypol on testicular lactic dehydrogenase-X and other dehydrogenases.

The in vitro inhibition of several rat testis dehydrogenases by gossypol was examined. Inclusion of the coenzyme (substrate for NADP+-isocitrate dehydrogenase) in the preincubation mixture containing the enzyme and gossypol, protected the enzymes against inhibition by gossypol. Lactic dehydrogenase-X was amongst the least protected enzymes. This, coupled with its low Ki for gossypol makes it one of the most vulnerable target enzymes in vivo for gossypol action. The inhibition kinetics for lactic dehydrogenase-X were competitive when NADH was present during preincubation, but non-competitive when the coenzyme was excluded during preincubation. In the latter condition, the enzyme seems to undergo progressive inactivation with time causing a nonreversible type of inhibition.