ABSTRACT
Childhood pneumonia is still a significant clinical and public health problem. India contributes the highest number of deaths due to pneumonia, accounts for about 20% of global mortality among under five children. Various etiologic agents including bacteria, viruses and atypical organism are responsible for childhood pneumonia. Recent studies suggest that viruses are one of the major causes of childhood pneumonia. Among viruses, respiratory syncytial virus has got great attention and several recent studies are reporting it as an important organism for pneumonia. Lack of exclusive breast feeding during first six months, improper timing of start and content of complimentary feeding, anemia, undernutrition, indoor pollution due to tobacco smoking and use of coal and wood for cooking food and lack of vaccinations are important risk factors. X-ray chest is not routinely performed to diagnose pneumonia while use of lung ultrasound is increasing to detect consolidation, pleural effusion, pneumothorax and pulmonary edema (interstitial syndrome). Role of C-reactive protein (CRP) and procalcitonin is similar, to differentiate between viral and bacterial pneumonia, however duration of antibiotics is better guided by procalcitonin. Newer biomarkers like IL-6, presepsin and triggering receptor expressed on myeloid cells 1 are needed to be evaluated for their use in children. Hypoxia is significantly associated with childhood pneumonia. Therefore, use of pulse oximetry should be encouraged for early detection and prompt treatment of hypoxia to prevent adverse outcomes. Among the available tools for risk of mortality assessment in children due to pneumonia, PREPARE score is the best but external validation will be needed.
ABSTRACT
Introduction: In India, report says that we failed to achieve the Millennium Development Goals. The maternal mortality rate and infant mortality rate in developing regions are approximately 15 times higher than developed countries. Hence safe delivery and essential newborn care, besides neonatal care in domestic setting and timely referral for cases unmanageable are important areas to be addressed. This study was aimed to assess the current pattern of utilization of maternal and neonatal care services in rural areas of Lucknow. Material and Method: This community based cross sectional study was conducted in between August 2014 to July 2015. Study site was rural area of Lucknow. The study unit was a recently delivered woman, defined as a woman who gave live birth in last one year. A multi stage random sampling technique was used. We uses SPSS version 17 for our statistical analysis. Results: We interviewed 368 RDWs and found that 10.6 % of RDWs did not visit even once to health care facility and almost 62% of registered RDWs were registered early. About 70% RDWs completed at least three ANC visits, 67.7% received complete course of tetanus toxoid and 79.1% received at least one hundred of iron and folic acid (IFA) tablets. Approximately 90% deliveries were conducted by qualified physicians in government institution. There was a clear reduction in facilitating services by health care workers before and after delivery. We found that age less than 30 years, higher socioeconomic strata, educational level higher than matriculation of RDWs were likely to complete their ANC cares and these associations were statistically significant. Conclusion: We are still far away from health for all. To achieve SDG, a multi prong approach is need of hour.