Profile of Published Cochrane Systematic Reviews in Child Health From Low- and Middle-Income Countries

Objective: Setting priorities in health research is a challenge at the global and national levels.Use of evidence-based approach is uncommon and needs to be promoted in low-and middle-income countries (LMIC). We describe profile of Cochrane systematic reviews focussing onparticipation from LMIC. Methods:We searched six Cochrane review groups producingreviews relevant to child health in low- and middle-income countries for published Cochranesystematic reviews from 1 March, 2009 till 18 March, 2015 in the Cochrane Library. Results:A total of 669 Cochrane systematic reviews from six review groups were found. Lowproportion of lead authors from low- and middle-income countries was found in 4 out of 6review groups. About 50% of the reviews showed inconclusive evidence. 101/669 (15%)empty reviews were found needing more primary studies. Conclusions:The proportion ofCochrane authors from low- and middle-income countries is low. Capacity-building insystematic reviews and good quality primary research in these countries is warranted.

Ventilatory Impairment In Petrol Pump Workers.

The lung functions of 133 subjects (33 controls and 100 petrol pump workers) were studied. The study group comprised of healthy non-smoking males in the age group of 20-40 years working in different petrol pumps in Jammu city and its outskirts within a radius of 10 km for more than one year. The control group comprised of 33 healthy non-smoking adult males between the age group of 20-40 years working in the hospital. The results show that ventilatory efficiency of lung is decreased in petrol pump workers. The decline in lung functions in petrol pump workers could be due to exposure to petrol fuel vapours, diesel exhaust and airborne particulate matter at petrol pumps.

Hypertension: Salt restriction, sodium homeostasis, and other ions.

Salt is composed of Sodium Chloride (NaCl) which in body water becomes essential electrolytes, viz., Sodium (Na + ) and Chloride (Cl - ) ions, including in the blood and other extracellular fluids (ECF). Na + ions are necessary cations in muscle contractions and their depletion will effect all the muscles in body including smooth muscle contraction of blood vessels, a fact which is utilized in lowering the blood pressure. Na+ ions also hold water with them in the ECF. Na + homeostasis in body is maintained by thirst (water intake), kidneys (urinary excretion) and skin (sweating). In Na + withdrawal, body tries to maintain homeostasis as far as possible. However, in certain conditions (e.g., during exercise, intake of drugs and in disorders causing Syndrome of Inappropriate Anti Diuretic Hormone Secretion (SIADH), diuretics, diarrhea) coupled with moderate or severe dietary salt restriction (anorexia nervosa), hyponatremia can get precipitated. Hyponatremia is one end point in the spectrum of disorders caused by severe Na + depletion whereas in moderate depletion it can cause hypohydration (or less total body water) and lower urinary volume (U v ). Moreover, salt sensitivity varies in various populations leading to different responses in relation to dietary Na + intake. Diabetes and Hypertension often co-exist but Na + withdrawal in salt sensitive subjects worsens diabetes though hypertension gets better and reverse occurs in salt loading. Therefore, Na + or salt restriction may be non-physiological. In hypertensive subjects other alternatives to Na + withdrawal could be Potassium (K + ) and Calcium (Ca 2+ ) supplementation. Further studies are required to monitor safety/side effects of salt restriction.

Teenage pregnancy--causes and concerns.

Adolescent pregnancy is alarmingly common in India. These young girls face considerable health risks due to higher maternal and perinatal mortality. Early child bearing is not only a health problem for mother and child but is also associated with serious socio-economic and demographic implications as well. In developing countries 20% to 60% of young women's pregnancies and births are unintended, most coming sooner than planned. In India some demographers have estimated that if marriages were postponed from the age of 16 to 20 years, the number of births would decrease by 20 to 30 per-cent. That is the reason one of the socio-demographic goals set by national population policy, 2000 is to promote delayed marriages for girls, not earlier than age of 18 years and preferably after 20 years of age. It is important to maximise utilisation of prenatal, intranatal and postnatal care services among adolescent mothers. Lastly, it is important to improve the heamoglobin status and nutrition and empower our girls by educating them and making them aware of disadvantages of anaemia, early marriage and also of legal laws against teenage marriages.

Bellary, India achieves negligible case fatality due to Japanese encephalitis despite no vaccination: an outbreak investigation in 2004.

OBJECTIVE: To confirm the existence of the outbreak of suspected Japanese encephalitis, identify the source, to understand the circumstances due to which the outbreak was taking place and to suggest measures for its control. METHODS: The team visited Bellary from 4th to 10th Sept, 2004. The team interviewed the key persons and analyzed the records at District Surveillance Unit and Entomological Surveillance Unit and case records of suspected JE cases admitted in Encephalitis ward in Vijay Nagar Institute of Medical Sciences (VIMS). Eco-entomological survey was done in houses and surroundings of 3 randomly selected cases of Encephalitis in rural and urban areas of District Bellary. Their family members and neighbors were also asked for the awareness and presence of disease. Data was analyzed for epidemiological and clinical profiles. RESULTS: The suspected JE cases were being reported from end of June 2004. The cases were sporadic and out of 34 cases reported to VIMS (till 10th of September), 32 were from Bellary district and 2 were from adjoining Andhra Pradesh. Among these 32, 22 were from Bellary Taluk, which in turn were mainly concentrated (10 were reported) in urban Bellary. The case fatality rate was zero as no death was reported. Entomological surveillance (done by District Surveillance Unit) revealed a high outdoor presence of Culex tritaeniorhynchus as well as an indoor rising density of this mosquito from 2 per man hour catch in January to 22 in the month of August in the affected villages. On the contrary, the investigations on 7th and 8th September revealed high densities of An.subpictus and An. peditaenatus and nil of Culex species in the urban areas. Amplifier host of pigs and water birds were occasionally sighted in the area. CONCLUSION: A good community awareness of encephalitis, a prompt referral system and a good supportive treatment for the patients and a good surveillance system and response were observed. Very close proximity with amplifying hosts of pigs was avoided by the community, though piggeries were still not very far away (1-3 Km). These may explain the reduction in cases, deaths and disabilities due to this disease in this district over the years. Possibilities of mutant strain which is less virulent and/or a better immune status of at risk population may also need to be explored. The impact of the mass vaccination with SA 14-14-2, imported from China in Bellary during July, 2006 remains to be evaluated. This will further decrease the case load.

An evaluation of diarrheal diseases and acute respiratory infections control programmes in a Delhi slum.

OBJECTIVE: Effective early management at home level and health seeking behavior in case of appearance of danger signs are key strategies in Acute respiratory Infections (ARI) and Acute Diarrheal Diseases (ADD) where majority of episodes are self-limiting and viral in origin. Integrated Management of Childhood illnesses (IMNCI) also envisages that family and community health practices especially health care seeking behaviors are to be improved to reduce childhood morbidity, mortality and cost of admissions to hospitals. Thus, a study was undertaken at an urban slum area--'Gokul Puri' in Delhi, among under-5 children with the aim to assess the magnitudes of ARI and ADD. METHODS: A Cross-sectional survey was conducted in this urban slum of Trans-Yamuna, covering 1307 under-5 children for five days starting from 9th of August, 2004. Survey team consisted of 14 FETP Participants (WHO Fellows) from India, Nepal, Myanmar, Bhutan and Sri Lanka. A pre-tested, house-hold tally marking form was used to interview the caretakers/mothers. History of episodes of ARI and/or ADD in the last two weeks was asked. Health care practices including use of ORS &home available fluids in diarrhea, continued feeding during diarrhea, awareness of danger signs of ARI &ADD and medical advice sought were asked of those mothers whose children had such an episode. RESULTS: 191 (14.6 %) of 1307 children surveyed, had an attack of ARI in the preceding two wk. The common symptoms of ARI cases were mild running nose (78%), cough (76.4%) and/or fever (45.5%). Only 8 (4%) had fast breathing. One or more danger signs were known to 80% (152/191) of mothers and an equal number (80%) of mothers had sought treatment. ARIs are mostly mild or self limiting but only 16% of caretakers perceived so and doctors also prescribed medicines. The attack rate of Acute Diarrheal Diseases was 7.73% in the study and ADD's annual adjusted morbidity rate was 1.69 episodes per child per year. Though nearly three-fourth of mothers (71.3%) had reported to be seeking medical advice (which is not needed in mild episodes of diarrhea) the ORS use was 38.6%, use of Home available fluids (HAF) was 42% and continued feeding was 50% during the ADD episode and awareness of at least two danger signs was present in 34%. CONCLUSION: Though aware of danger signs of ARI, care takers were still seeking medical advice for mild cases of ARI and doctors were prescribing drugs. Correct home based management e.g. use of ORS, continued feeding etc. was deficient in the community. Knowledge of danger symptoms was low and medical advice was being sought and drugs were being prescribed for ADD, too.

Preparing for adulthood--patterns of physical growth, sexual maturity and menarche of adolescent girls in selected urban slums and rural areas.

Adolescent girls are the future mothers. Height less than 145 cm and weight less than 45 kg are considered to be high obstetric risk factor for adverse maternal and perinatal outcome including low birth weight. Teenage pregnancy is another problem in our country. This study aimed to study height and weight of girls of vulnerable urban slums and rural areas. It also studied the pattern of onset of menarche and attainment of sexual maturity in relation to age. The longitudinal, multicentric, descriptive observational study was carried out by the Indian Council of Medical Research during the period of 1986 to 1991 in selected rural (Chandigarh, Hyderabad, Jabalpur, Varanasi, Vellore) and two urban slum areas (Vellore and Delhi) in different regions of India. Girls of ages 10-12 years were followed up till 16 years for their height and weight. Weight increased from 22.3 to 39.4 kg in rural and 23.4 to 41.9 kg in urban areas from 10 to 16 years. Height increased from 126.2 cm to 150.2 cm in rural and 128.2 to 153.0 cm in urban areas. Large variations from centre to centre were observed in ages for appearance of sexual characteristic and the order in which these appeared. Pubic hair was the first sexual characteristic to appear in majority of the girls in all the centres. The mean age at stages II, III and IV of breast development in girls varied between 11.3 to 12.3 years, 12.3 to 13.2 years and 13.3 to 14.1 years respectively. The percentage of girls who had attained menarche by the age of 15 years, ranged from 30 to 100 per cent between centres. Those children in whom the sexual characteristics had appeared earlier than others had higher mean body weight and height as compared to others at the same age points. The data on physical growth parameters during adolescence revealed that girls from rural areas, were shorter and weighed less compared to those from urban slums. Adolescent girls are undernourished in urban slums and rural areas.

Nonoxynol-9 vaginal pessary: a preliminary Indian experience.

BACKGROUND: Barrier methods of contraception do not have systemic effects and allow the user complete control over their use. For women, the ease of use of a contraceptive is often more important than its efficacy. Hence, barrier methods could be offered as a useful alternative method of contraception. Nonoxynol-9 (a spermicide) is a locally acting, non-hormonal method free from systemic side-efforts. It is a woman-controlled, reversible method which is to be used before intercourse. There are little data available on its efficacy, side-effects and acceptability among Indian women. METHODS: The vaginal pessary nonoxynol-9 was offered as a contraceptive option to 3200 women attending the Family Planning clinics at 31 Human Reproduction Research Centres (HRRCs) of the Indian Council of Medical Research. The other contraceptives offered included an intrauterine device, oral pills, condoms, Norplant, tubal sterilization and vasectomy using the cafeteria approach. Those who accepted nonoxynol-9 were followed up to assess the rates of continuation, failure and side-effects. RESULTS: The nonoxynol-9 pessary was accepted by 541 women who were followed up for 3470 woman-months of use. The reasons given for acceptance were that it was user-controlled and/or they did not wish to use other methods because of the side-effects or contraindications of these methods. The overall continuation rates were 41.2% and 33% at 9 and 12 months of use, respectively. Most women (31.3%) discontinued its use due to personal reasons such as husband dissatisfaction, desire for further pregnancy, irregular use of pessary and difficulty in insertion. Twenty-nine women became pregnant during the study period (15 due to method failure and 14 due to user failure) giving a use-effectiveness of 8.8% at 12 months. The method failure rate was 4.3% at 12 months of use. The failure rates were lower compared with the reported failure rates of barrier contraceptives (1%-30% at 1 year of use) and the side-effects were minimal. CONCLUSION: Nonoxynol-9 had low acceptability (16.9%) and overall continuation rates--41.2% and 33% at 9 and 12 months of use. It could be offered to women looking for a short term, user-controlled contraceptive.

Child survival and safe motherhood program in Rajasthan.

OBJECTIVE: This study was planned to evaluate the MCH services, particularly immunization in rural areas of the poor-performing state of Rajasthan. METHODS: A community-based, cross-sectional survey using the WHO 30 cluster technique was carried out as a field exercise by participants of 9th Field Epidemiology Training Programme (FETP) course by National Institute of Communicable Diseases (NICD) in rural areas of Alwar district of Rajasthan. RESULTS: Less than one third (28.9%) of children, aged 12-23 months, were fully immunized with BCG, 3 DPT, 3 OPV and Measles vaccines; around a quarter (26.5%) had not received even a single vaccine (non immunized), and little less than half (44.5%) were found partially immunized. Around half of the eligible children were vaccinated for BCG (55.9%) and Measles (43.6%). Though nearly two-third (66.8%) were covered with first dose of DPT and OPV, but about one third of these children dropped out of third dose of DPT and OPV for various reasons. National Family Health Survey (NFHS) data also had revealed that BCG coverage was 64.3%; measles was 36.2%; and coverage by DPT 1, 2, 3 and Polio 1,2 and 3 were 64.4%, 57.0%, 46.6% and 77.5%, 71.1% and 54.4% respectively in rural areas. The main reasons for drop-out or non-immunization was "lack of information about the immunization programme" (41.3%). Though nearly all (more than 96%) of the children were immunized through Government established centers, but immunization cards/documents were made available only to 27.6% of children. CONCLUSION: The problem of low coverage and high drop-out rate of immunization could be overcome by creating awareness of the program and relevance of 2nd and 3rd doses of DPT and polio vaccines. Increasing community participation through intensive and extensive health education campaign should also be undertaken. Since most of the deliveries were done at home under the supervision of untrained midwives, training programme as well as involving them in IEC activities should be contemplated.

An evaluation of post-campaign knowledge and practices of exclusive breastfeeding in Uganda.

Despite the benefits of exclusive breastfeeding for the health of mothers and children, its practice has markedly declined throughout the developing world. Mass media-communication programmes could play an important role in reversing this trend. This study evaluated the extent to which exposure to behaviour change communication (BCC) messages in the media determined recent improvements in exclusive breastfeeding knowledge and practices in areas targeted by the Delivery of Improved Services for Health (DISH) Project of Uganda. Data were drawn from the 1999 DISH Evaluation Survey. The survey collected information from representative samples of women and men of reproductive age. Multiple logistic regressions were used for assessing the independent influences of BCC exposure on breastfeeding knowledge and practices, controlling for several confounding factors. The results indicated that the exposure to BCC messages was strongly associated with women's knowledge of six months as the ideal duration for exclusive breastfeeding. Positive influences on knowledge of men were also found. Media effects on women's current practice of exclusively breastfeeding their infants up to six months were less conclusive, possibly because of the short interval between the launch of the BCC campaign and survey implementation. While there was some evidence of bias of self-reported exposure, results of exploratory analysis of the indirect effects of communication campaigns suggest that impacts may be compounded as overall awareness is increased at the community level eventually leading to improved knowledge among individuals.

Reproductive health awareness of school-going, unmarried, rural adolescents.

OBJECTIVE: In 1996, India included Adolescent Health in Reproductive and Child Heatlh Programme. This Task-Force Study was planned to test the awareness level of adolescents regarding various reproductive health issues and to identify lacunae in knowledge, particularly in legal minimum age of marriage, number of children, male preference, contraceptive practices, about STIs /AIDS etc. METHODS: It was a multicentre study, done in rural co-education/higher secondary schools of 22 districts located in 14 states through Human Reproductive Research Centre (HRRC's) of the Indian Council of Medical Research (ICMR). A sample of 8453 school going adolescents (aged 10-19 years) was surveyed by means of open ended, self-administered questionnaires maintaining confidentiality. RESULTS: Mean age of adolescents was 14.3 +/- 3.4 years. Awareness of legal minimum age of marriage was present in more than half of adolescents. Attitude towards marriage beyond 21 years in boys and 18 years in girls was favorable. Mean number of children desired was 2.2 +/- 1.4. However, number of children desired by boys (2.2+/-1.6) was significantly more (p< 0.000) than those desired by girls (2.0+/-1.1). More boys (23.7%) than girls (9.4%) wanted three or more children with male preference. Only 19.8% of adolescents were aware of at least one method of contraception. Only two-fifth (39.5%) were aware of AIDS and less than one-fifth (18%) were aware of STDs and most of them thought it is same as AIDS. Awareness of at least one method of immunization was present in three-fifth (60.1%) of students. It was least for DPT (13.5%) and most (55%) were aware of polio only. Awareness of all Reproductive Health matters was more in boys than girls and more in late teens (15-19) than earlier teens (10-14). CONCLUSION: The study showed tremendous lacunae in awareness of all Reproductive Health (RH) matters. There is a need for evolving information, education, and communication strategies to focus on raising awareness on RH and gender related issues. A sociocultural research is needed to find the right kind of sexual health services for young girls and boys.

Infertility: planning a prototype action plan in the existing health care system.

Infertility is considered as a social stigma in our country and has been incorporated in reproductive and child health programme. Research areas emphasised are (a) A database; (b) Management in primary, secondary and tertiary levels of health care services; (c) Training of doctors and health care workers; (d) Costing. Infertility is to be priortised as an important public health problem as it affects human being's mental, social, physical and reproductive health.