High prevalence of bacteriuria in pregnancy and its screening methods in north India.

The study aims at finding out the prevalence of bacteruria in pregnancy in an urban setting and ascertaining methods to screen them in primary care clinics. A total of 1 61 pregnant ladies visiting a primary care clinic were screened for bacteriuria based on the symptomatology. Urine culture was done to know the prevalence of bacteriuria. Sensitivities and specificities were calculated for each symptom and risk assessment. A score card was developed based on combination of positive risk assessment and constellation of symptoms. Prevalence of symptomatic and asymptomatic bacteriuria was found to be 19.87% and 4.34% respectively. Prevalence of bacteriuria was significantly high among those who had intercourse more frequently and those with less water intake. Those with a score of more than or equal to 4, as per score card were 60% more likely to suffer from bacteriuria. When combined with microscopic examination for leucocytes on positively screened, the positive predictive value was found to be 89%. It is concluded that prevalence of symptomatic bacteriuria is common among pregnant women. Syndromic management of cases on the basis of score card is helpful in resource constraint areas. This may be combined with microscopic examination of urine to entail rational use of antibiotics.

Are primary health workers skilled enough to assess the severity of illness among young infants?

OBJECTIVE: To evaluate the skills of health workers in assessing the severity of illness among young infants. DESIGN: Cross sectional. SETTING: Five different health institutions viz, subcenter, primary health center, community health center, sub-divisional hospital, district hospital. METHODS: 110 young infants aged <2 months who attended the selected health institutions on specific week days were assessed by a physician. Subsequently 10 female health workers assessed these babies. Physician and health workers used same symptom and sign based guidelines for classification of the illness. Level of agreement between the physician and the health workers were assessed using kappa statistics. RESULTS: Physician classified 37.3% infants as not sick or mildly sick, 42.7% as moderately sick and 20% as severely sick. In comparison to the physician, the sensitivity and specificity of the health workers' assessment of severe illness was 77% and 76% respectively. Of 22 babies classified as severely sick by the physician, female health workers classified 5 as not sick or mildly sick, 8 as moderately sick and 9 as severely sick. On the other hand health workers classified one not sick or mildly sick and 9 moderately sick infants as severely sick. Level of agreement between the physician and health workers was poor (Kappa value = 0.39, 95% CI = 0.26, 0.52). Health workers misclassified illness mainly due to 'not counting the respiratory rate and 'not looking for chest retractions, purulent discharge and jaundice'. CONCLUSION: Trained health workers' skills were not satisfactory for assessment of illness severity among young infants. During training, importance of these signs needs to be emphasized.

History of son preference and sex selection in India and in the west.

In the history of mankind, there was a time when women dominated the world. In due course of time, as the patriarchal societies evolved, the status of women gradually declined. Sons were preferred to daughters. In India, the Brahmin community promoted such customs and rituals, which gave more and more importance to sons eg. Lighting the funeral pyre of the father was told to be a pre-condition for salvation of his spirit. Similarly, in western civilization also women were considered to be weak. In consonance with such a mind-set man has been trying various techniques for sex-selection since antiquity eg. for acquiring a son choosing a special day, time and posture for sexual intercourse, special diet, charms and amulet and prayers etc. In Vedas also punsavana karma has been described as a technique for acquiring a son. Apart from these techniques, female infanticide has also been used as a way to create a male dominated, son-worshipping society. On development of the technique of ultrasonography as an example of progress of science and technology, man has devised a new way of killing females in womb itself, which has resulted in continuous decline in female: male sex ratio in India. To stop this, Indian Govt. promulgated PNDT Act 1994. But considering the widely prevalent practice of use of various regimen of sex-pre-selection by people as well as unscrupulous medical practitioners, Govt. of India has amended this Act (2002). Still, as authors have found in one of their studies, sex-selection drugs are being used widely by north Indians for getting a son. Here, it should be noted that sex-selection methods are being used in west also. But the perspective is different. There, it is not used for female feticide or for acquiring a son. Rather, it is more an effort towards demonstrating the control of man over the NATURE.