Preparing for adulthood--patterns of physical growth, sexual maturity and menarche of adolescent girls in selected urban slums and rural areas.

Adolescent girls are the future mothers. Height less than 145 cm and weight less than 45 kg are considered to be high obstetric risk factor for adverse maternal and perinatal outcome including low birth weight. Teenage pregnancy is another problem in our country. This study aimed to study height and weight of girls of vulnerable urban slums and rural areas. It also studied the pattern of onset of menarche and attainment of sexual maturity in relation to age. The longitudinal, multicentric, descriptive observational study was carried out by the Indian Council of Medical Research during the period of 1986 to 1991 in selected rural (Chandigarh, Hyderabad, Jabalpur, Varanasi, Vellore) and two urban slum areas (Vellore and Delhi) in different regions of India. Girls of ages 10-12 years were followed up till 16 years for their height and weight. Weight increased from 22.3 to 39.4 kg in rural and 23.4 to 41.9 kg in urban areas from 10 to 16 years. Height increased from 126.2 cm to 150.2 cm in rural and 128.2 to 153.0 cm in urban areas. Large variations from centre to centre were observed in ages for appearance of sexual characteristic and the order in which these appeared. Pubic hair was the first sexual characteristic to appear in majority of the girls in all the centres. The mean age at stages II, III and IV of breast development in girls varied between 11.3 to 12.3 years, 12.3 to 13.2 years and 13.3 to 14.1 years respectively. The percentage of girls who had attained menarche by the age of 15 years, ranged from 30 to 100 per cent between centres. Those children in whom the sexual characteristics had appeared earlier than others had higher mean body weight and height as compared to others at the same age points. The data on physical growth parameters during adolescence revealed that girls from rural areas, were shorter and weighed less compared to those from urban slums. Adolescent girls are undernourished in urban slums and rural areas.

Induced abortion and concurrent adoption of contraception in the rural areas of India (an ICMR task force study).

BACKGROUND: Despite a liberal Medical Termination of Pregnancy (MTP) act and awareness of family planning, maternal mortality attributable to induced abortion is high. AIMS: Assess attitude, behavior, practices and utilization of services by rural women for induced abortion and concurrent acceptance of contraception. SETTINGS AND DESIGN: Cross sectional survey of eligible married women in 13 states in India over one year. MATERIAL AND METHODS: A total of 1851 women who had an induced abortion during the previous 3 years were interviewed. STATISTICAL ANALYSIS USED: Includes proportions, rates and chi-square test. RESULTS: The main reason for seeking abortion was "don't need any more children" (42%), and in 12.4 per cent they specifically mentioned that they "don't need any more daughters". Around 46% of women accessed abortion services from private clinics as compared to government hospital (37.1%) and Primary Health Centre/Community Health Centre (14.0%). The decision to terminate the pregnancy and place of abortion was made by the husband in 42.8% and 52.5% respectively. Regret for abortion was expressed by 29.6% of the women. However, only 7.2% said they would not advice others for induced abortion. Nearly one half of the women undergoing abortion accepted a family planning method concurrently; of these Intra Uterine Device/oral contraceptives and a permanent method was adopted by 37.2% and 49.1% respectively. Acceptance of vasectomy by male partner was found to be low (1.3%). "Husband objected" (32.3%) was the main reason for not accepting post abortal contraception. Majority of the acceptors said they would recommend to others the same place where they had undergone abortion, thus indicating their satisfaction with the source and services received. CONCLUSIONS: Counselling for post-abortal contraceptive should be provided to the couple so that they can make an informed choice.

Iodine deficiency disorders in 15 districts of India.

METHODS: A multicentre study to assess iodine deficiency disorders (goitre and deaf-mutism/cretinism) in 1, 45, 264 children (6 - <12 years old) from 15 districts of ten states was carried out during 1997-2000. Urinary iodine excretion was also determined in 27481 children, while iodine content was estimated in 5881 samples of edible salt. The sampling methodology followed was a "30 cluster survey". RESULTS: The overall prevalence of goitre was 4.78% (4.66% of grade I and 0.12% of grade II) amongst the children examined. The highest prevalence of 31.02% goitre was observed in Dehradun district, while the lowest prevalence of 0.02% goitre was recorded in Bishnupur and Badaun districts. The overall prevalence of cretinism among children examined from seven districts was 0.072% whereas that of deaf-mutism was 0.27% among children examined from 8 districts. Median urinary iodine values was marginally less than the WHO cut-off values only in children of the 3 out of the 15 districts surveyed. Iodine content was found to be adequate in 55.45% of the salt samples. CONCLUSION: The results suggested a significant decline in the prevalence of goitre in most parts of the country.

Contraceptive knowledge, practices and utilization of services in the rural areas of India (an ICMR task force study).

To obtain information from rural women regarding their contraceptive knowledge, practices and utilization of services, a cross-sectional survey of 117,465 eligible women was carried out in the sampled areas of 28 districts from January 1996 to February 1997. From among the current contraceptive users all of IUD, OC and acceptors of a permanent method in the last one-year (14,276) were interviewed in detailed. In addition a systematically selected sample of 17,082 non users were also interviewed. Overall contraceptive prevalence was 45.2% of which 34.2% had used a permanent method. Among the current users, the contraceptive had been availed mainly from either PHC (31.5%) or hospital (42.1%). Around half the women (53.1%) had received counseling and in 20.3% information regarding other methods. Pelvic examination was done in 39.1% Most of the women (>97%) expressed satisfaction with the method, provider and services. Almost all the women (98.8%) were using a contraceptive method with the knowledge of their husband and had his support for continuing the same. There was no concept of using any family planning method for either postponing the first conception after marriage or spacing between the two child births. A large majority of women (70.5%) used a family planning method for the first time only after completing their desired family size. Among the never users, 73.5% mentioned at least one modern method of family planning available in the national programme and 64.3% mentioned the service source where it would be available. Fewer women in most of the districts mentioned spacing methods as compared to female sterilization. The main reason given for not using any family planning method was "family not complete" (34.6%). There is need to promote spacing methods by policy makers and field workers and motivate couples to accept them.

Vitamin A deficiency disorders in 16 districts of India.

A multicentre study to assess vitamin A deficiency disorders (Bitot's spot and corneal scars) in 164,512 children (< 6 years) and night blindness among 113,202 children (24-71 months) from 16 districts of 11 states was carried out during 1997-2000. The prevalence of night blindness among 6,633 pregnant women from 15 districts was also assessed. The sampling methodology followed was a "30 cluster survey". The highest prevalence of Bitot's spot (4.71%), corneal scar (0.5%) and night blindness (5.17%) in children was found in Gaya district whereas the highest prevalence of night blindness (19.62%) among pregnant women was observed in Dibrugarh. No case of Bitot's spot was found in children screened from Mandi, Dehradun and Badaun districts. Similarly prevalance of night blindness was 'nil' among pregnant women of Badaun, Baramulla, Dehradun, Mainpuri, Srinagar, Bikaner and Raigarh.

Foetal growth parameters--clinical versus ultrasonographic.

The study was conducted in 2831 pregnant women with no diagnosed complication at the time of registration to obtain normal foetal growth pattern for clinical and ultrasonographic parameters. Normal values for maternal weight, fundal height and abdominal girth for clinical and biparietal diameter, abdominal circumferences and femoral length for ultrasonographic parameters are presented. Clinical and ultrasonographic parameters were compared for their efficacy in prediction of low birth weight. Neither clinical nor ultrasonographic parameters were found to be satisfactory in identifying the foetus at risk of low birth weight. It has been found that clinical parameters for routine monitoring are as effective as ultrasonographic parameters and have the added advantage of being easily replicable at the peripheral level of health care.