Estimating the burden of 'weighing less': A systematic review and meta-analysis of low birth-weight in India.

Background. The National Family Health Survey-3 (NFHS- 3; 2005–06) reports that the prevalence of low birth-weight babies is 22% in India. This old figure is probably an underestimate as this nationwide survey acquired information on birth-weight of only 34% of babies. We aimed to make a fresh estimate of the proportion of low birth-weight babies. Methods. A systematic search was done through PubMed, Google Scholar, Cochrane Library, Medline, IndMed, Embase, WHO and Biomed Central databases. Studies published from 2004 to 2014 were included. Study quality was assessed using the adapted Mirza and Jenkins checklist. An ‘adjustment’ of 24% was applied to the published estimates where data were collected through records or through a combination of records and anthropometry. The adjustment was done to account for the heaping of birth-weight data at 2500 g. Metaanalysis using both random and fixed effects model was done to derive an estimate. Results. Nineteen studies with 44 133 subjects were included in the review. The pooled estimate for the prevalence of low birth-weight was 27% (95% CI 24%–30%) and the ‘adjusted’ pooled prevalence was 31% (95% CI 28%–33%). The prevalence in urban and rural areas was 30% (95% CI 23%– 38%) and 26% (95% CI 22%–30%), respectively. Regionwise estimates revealed that the prevalence at 33% was comparatively higher in eastern regions (95% CI 29%–37%). Conclusion. The pooled prevalence of low birth-weight is higher than that reported by NFHS-3. Updated estimates should be used to guide future interventions and policies. Natl Med J India 2016;29:73–81

A community-based study of menstrual hygiene practices and willingness to pay for sanitary napkins among women of a rural community in northern India.

Background. Hygiene-related practices of women during menstruation are of paramount importance. There is a lack of sizeable literature on menstrual practices from northern India. We documented the menstrual hygiene practices of rural women and assessed their willingness to pay for sanitary napkins. Methods. A cross-sectional study was done in villages under the Comprehensive Rural Health Services Project (CRHSP), situated in Ballabgarh, Haryana. The study participants were women in the age group of 15–45 years. Nine villages were selected randomly while the number of respondents in each selected village was decided through the probability proportionate to size sampling method. The households were selected using systematic sampling. One woman was interviewed in each household using a pre-tested questionnaire. Results. A total of 995 women were interviewed. A majority of them (62%) were unaware of the reason(s) for menstruation. The role of the health sector in providing information regarding menstruation was low as only a few women (1.5%) had got information from the auxiliary nurse midwife (ANM)/health worker (HW). For the majority of women, besides religious activities, other routine activities did not suffer during menstruation. Only 28.8% of women were using sanitary napkins and of those who did not use napkins, only one-fourth (25.3%) were willing to buy them. The mean (SD) price per napkin that these women were ready to pay was `0.54 (0.43), equivalent to US$ 0.01. Conclusion. Women in the reproductive age group should be provided with appropriate information about menstruation, and they should be told about the advantages of using sanitary napkins. Health sector functionaries should play a proactive role in the delivery of such information.

Public health approach to address maternal mortality.

Reducing maternal mortality is one of the major challenges to health systems worldwide, more so in developing countries that account for nearly 99% of these maternal deaths. Lack of a standard method for reporting of maternal death poses a major hurdle in making global comparisons. Currently much of the focus is on documenting the "number" of maternal deaths and delineating the "medical causes" behind these deaths. There is a need to acknowledge the social correlates of maternal deaths as well. Investigating and in-depth understanding of each maternal death can provide indications on practical ways of addressing the problem. Death of a mother has serious implications for the child as well as other family members and to prevent the same, a comprehensive approach is required. This could include providing essential maternal care, early management of complications and good quality intrapartum care through the involvement of skilled birth attendants. Ensuring the availability, affordability, and accessibility of quality maternal health services, including emergency obstetric care (EmOC) would prove pivotal in reducing the maternal deaths. To increase perceived seriousness of the community regarding maternal health, a well-structured awareness campaign is needed with importance be given to avoid adolescent pregnancy as well. Initiatives like Janani Surakhsha Yojna (JSY) that have the potential to improve maternal health needs to be strengthened. Quality assessments should form an essential part of all services that are directed toward improving maternal health. Further, emphasis needs to be given on research by involving multiple allied partners, with the aim to develop a prioritized, coordinated, and innovative research agenda for women's health.