ABSTRACT
Background: The increasing trends for Caesarean section (CS) in India and worldwide have been a cause of concern. The aim is to compare and analyse CS rates across the globe, WHO recommends the Robson’s ten group classification system (TGCS). This will help to target appropriate group of women for reduction of overall CS rates.Methods: This was a retrospective study design using hospital records for women delivered in December 2017. Data was entered and analysed using excel 2007 and presented using modified Robson’s ten group classification system.Results: Out of total 650 women delivered during the study period, 184 (28.3%) delivered by CS. Group 1 and group 2 included a total of 49.53% women in the present study. The CS rates varied from 100% in group 5 (previous CS), group 7 (breech, multiparous) and group 9 (abnormal lie) to as low as 0.9% in group 3. The present study highlights that group 5 i.e. women with previous CS, contributed maximum (37%) to the overall surgical deliveries with group 2 being the second largest contributor (21%).Conclusions: The findings of the study indicate that group 5-women with prior CS and group 2-women with induced labour contributed maximum to overall CS rates. TOLAC should be a routine and not optional. Simultaneously Judicious selection of women for induction, strict implementation of induction protocols to decrease the cases of failed inductions will also reduce primary CS. To monitor the CS rates and take appropriate actions it is recommended that Robson’s TGCS be used continuously in all health institutions.
ABSTRACT
Background: Integrated Child Development Services (ICDS) is one of the world’s largest community based schemes running in India for over three decades. Frequent evaluations of the scheme have been conducted to make it more effective to promote early childhood care. Objectives: Comprehensive assessment of services provided under ICDS in urban slums of Jamnagar city of Gujarat state. Methods: It was decided to study 15% of the total 297 AWCs of the city through Simple Random Sampling technique. The AWCs visited were evaluated with respect to infrastructure facility of the centre, record keeping activity & knowledge of AWWs, availability of essential drugs & logistics. Results: A total of 48 centers were evaluated. 24 centers operated from Kutcha or semi-pucca buildings and toilet facilities were lacking at 20 of the centers. Only about 44% of the enrolled 3-6 years children were present at the AWC on the day of visit. Nearly 40% of the enrolled children had varying grades of malnutrition. Unavailability of medicine kits & other logistics, was observed. Three fourth of the AWW described providing non-formal preschool education & supplementary nutrition as their only responsibilities forgetting other essential components of their service. One fourth of the AWW did not know proper time to initiate Breast Feeding and over one third (37.5%) of them did not know the Universal Immunisation Program schedule fully. Less honorarium & poor quality of supplementary food were their main difficulties. Conclusion: the AWC currently acts merely as a food distribution centre with minimal provision of other services. Regular growth monitoring of the children along with supervision of the services provided would be far more effective in improving the nutritional status of the children than supplementary nutrition alone.