ABSTRACT
Background: Child mortality is a major public health issue. The studies on under‑five mortality that ignore the hierarchical facts mislead the interpretation of the results due to observations in the same cluster sharing common cluster‑level random effects. Objectives: The present study uses a multilevel model to analyze under‑five mortality and identify the significant factors for under‑five mortality in Manipur. Methods: National Family Health Survey‑5 (2019–21) data are used in the present study. Amultilevel mixed‑effect Weibull parameter survival model was fitted to determine the factors affecting under‑five mortality. We construct three‑level data, individual levels are nested within primary sampling units (PSUs), and PSUs are nested within districts. Results: Out of the 3225 under‑five children, 85 (2.64%) died. The three‑level mixed‑effects Weibull parametric survival model with PSUs nested within the districts, the likelihood‑ratio test with Chi‑square value = 10.98 and P = 0.004 < 0.05 indicated that the model with random‑intercept effects model with PSUs nested within the districts fits the data better than the fixed effect model. The four covariates, namely the number of birth in the last 5 years, age of mother at first birth, use of contraceptive, and size of child at birth, were found as the risk factor for under‑five mortality at a 5% level of significance. Conclusions: In the random‑intercept effect model, the two estimated variances of the random‑intercept effects for district and PSU levels are 0.27 and 0.31, respectively. The values indicate variations (unobserved heterogeneities) in the risk of death of the under‑five children between districts and PSUs levels.
ABSTRACT
Aim: Arsenic concentration in groundwater above the acceptable level is of global concern due to its serious human health effects. Application of certain fungi, due to their amazing skill to remove arsenic from arsenic contaminated water has received attention in recent years. The main aim of this study was to isolate arsenic tolerant fungi from arsenic-contaminated groundwater and assess their ability for arsenic removal from the aquatic system in-vitro.Methodology: Fungi were isolated from arsenic-contaminated groundwater (44.9–161.1 mg l-1). An experiment on bioremediation/ removal of arsenic by selected highly arsenic tolerant fungi was conducted by culturing them in arsenic supplemented medium and measuring the arsenic contents in initial and after incubation with fungi using Hydride Generation Atomic Absorption Spectroscopy (HG-AAS) to find out the arsenic removal percentage. Results: In all, ten out of forty-five fungi obtained from highly arsenic-contaminated groundwater (44.9–161.1 mg l-1) were able to remove high arsenic contents (>80%) from liquid medium with >85% arsenite (by 6 fungal isolates) and >85% of arsenate (by 9 fungal isolates). In arsenic tolerance assay, all 10 test fungi grew readily in liquid medium enriched with either arsenate (10 and 20 g l-1) or arsenite (2 g l-1) under laboratory conditions (27±2°C). These fungi showed log phase between 5 to 10 days with stationary phase of 11-15 days. High arsenite concentration (4 g l-1) however, completely inhibited the growth of 50% of these fungal isolates. Five of these isolates showed high tolerance index pattern (0.97- 0.91) as compared to others (0.22–0.13). These fungi greatly altered the pH of arsenic supplemented liquid medium (10 mg l-1) as compared to the control when they were individually cultured. These arsenic tolerant fungal isolates may effectively be used for the bioremediation of arsenic from groundwater. Interpretation: The study suggested that 10 fungal isolates were able to tolerate high arsenic concentrations (20 g l-1 of arsenate and 2 g l-1 of arsenite) and were able to enhance arsenic removal (more than 80%) in liquid medium at neutral pH (7.0) and 27°C temperature.
ABSTRACT
Childhood blindness is one of the priority targets of Vision 2020—Right To Sight due to its impact on the psychological and social growth of the child. An extensive search was performed to locate research papers on childhood blindness prevalence and its causes in the community based and blind schools, respectively, conducted from 1990 onward up to the present. Cross references were also manually searched along with expert consultation to enlarge the reference data. A total of five community-based studies on the prevalence including two refractive error studies conducted all over India in children less than 16 years were found. The causes of childhood blindness from the available blind school studies revealed that causes of childhood blindness have mainly shifted from corneal causes to whole globe abnormalities. This article highlights that though with the availability of proper healthcare facilities, the trend is changing for the causes but still a lot of effort in the form of timely neonatal eye care facilities, pediatric surgical services and proper refraction strategies is required.
ABSTRACT
Purpose: In India, teachers screen middle school children using the 6/9 Snellen's optotype. Recently, the National Program for Control of Blindness included primary school students also. The present cross-sectional study was planned to assess the inclusion of primary school students. Compliance to spectacles was ascertained after 6 months follow-up. Methods: Randomly selected 23 Government primary schools. A total of 30 teachers were nominated and given hands-on training in vision screening and recording formats. Teachers conducted vision screening of primary school students of their respective schools using the 6/12 Snellen's chart and referred students with subnormal vision to optometrist. Optometrist also validated the screening done by teachers. Optometrist screened the vision of 5% randomly selected children screened by teachers as having normal vision. Descriptive statistics used STATA version 13.0. Results: A total of 6056 students screened by the teachers. Sensitivity and specificity of teacher screening were 92.3% (confidence interval [CI] 88.6–95.0) and 72.6% (CI 68.2–76.6)), respectively. About 277 students underwent refraction and 186 prescribed spectacles. The prevalence of myopia, hypermetropia, and astigmatism is 2.5% (2.1–2.9), 0.6% (0.4–0.8), and 1.3% (1.0–1.6), respectively. Compliance to spectacles usage is 36%. Conclusion: Burden of refractive error in primary school is very low. Trained teachers can identify children with subnormal vision, but the false-positive rate is very high. Compliance to spectacle use among primary school children is also less. Vision screening by teachers prioritized in secondary schools and preschool screening should be done by more skilled eye care workers preferably optometrist.