Reproductive risk factors and Breast cancer: a case control study from rural India.

Background: Breast cancer is the most common type of cancer in women and is influenced by reproductive factors perceived by women worldwide. Aims: To identify the reproductive risk factors of breast cancer in newly diagnosed cases and to find out the strength of association of the risk factors with the breast cancer. Material and Methods: A hospital based case-control study was conducted in Satara district, India during year 2009 to 2011 among newly diagnosed cases of breast cancer and matched controls. A total of 434 participants including 217 cases and 217 controls were enrolled by purposive sampling technique from selected hospitals of study area. The information was collected by employing pre-tested questionnaire by utilizing interview method. Statistical Analysis used: Descriptive statistics, Odds ratio and Chi-square test was used to find out strength of association and statistical significant difference. Results: Highest proportion [31.80%] breast cancer cases was in age group 40-49 years with lowest age of 25 years at diagnosis of the disease. A very high proportion of both cases [88.02%] and controls [67.28%] were Hindu by religion and were from rural residence. Maximum proportion of breast cancer cases were housewives [63.59%], literate [71.42%] and from upper economic class [56.68%]. The proportions of cases were higher as compared to the controls with respect to risk factors like unmarried status, nulliparity, history of abortion, post menopausal status, absence of breast feeding and the history of exposure to hormonal contraceptives. The risk of getting breast cancer as indicated by Odds ratio was 8 times higher in unmarried women, 2.8 times in nulliparous women, 2.4 times with post menopausal status, 10.4 times with absence of breast feeding, 1.5 times with exposure to hormonal contraceptives and 4.5 times with history of ovarian disease respectively. Conclusion: The reproductive risk factors such as unmarried status of women, nulliparity, menopause, absence of breast feeding, history of ovarian disease and use of contraceptives were strongly associated with breast cancer

Untoward obstetric outcome among Smokeless Tobacco (ST – Mishri) users in Western Maharashtra.

Background: Use of tobacco and new products is increasing not only among men but also among children, teenagers, women of reproductive age group. Mishri (ST) is one among them. Smoking is an established cause of adverse pregnancy outcome. There are indications that using smokeless tobacco could be as detrimental to fetal health as cigarette smoking. Objective: To compare the outcome of pregnancy among women who were using Mishri during pregnancy and those not using it at Krishna hospital, Karad. Materials and Methods: Pregnant women using Mishri during pregnancy were selected for study from Krishna hospital, Karad and equal numbers of pregnant women not using tobacco were selected as comparison group after matching for age and parity. Observations: The proportion of pregnant women using Mishri during pregnancy was 12%. A significant number of users was found to be anemic (69.8%). Significantly higher number of Mishri users experienced complications like Oligohydramnios, fetal distress, delivery before EDD (91.9%) and birth of Low birth weight babies (81.7%) with short stature and increased Ponderal Index. Conclusion: Special attention should be given to avoid or at least reduce the use of Mishri during pregnancy as a part of routine antenatal care to reduce the adverse perinatal outcome.

Making healthy baby contests more objective.

STUDY OBJECTIVES: To assess the objectivity of the criteria chosen to judge a healthy baby contest. DESIGN: Cross-sectional study design. SETTING: Urban Health Centre, Pune. PARTICIPANTS: Of the 998 children attending twelve anganwadis, who were screened preliminarily, 32 were chosen for the healthy baby contest. The contest was assessed using a specified scoring system in which due weightage was given to personal hygiene, growth, development, immunisation status and mother's knowledge about nutrition and vaccination. RESULTS: There was a significant intraobserver correlation (rs = 0.85, p < 0.05) and intraobserver correlation (rs = 0.92, p < 0.05). The scores were age independent. CONCLUSIONS: The criteria chosen were objective in nature. The objectivity of the criteria can make the assessment of the participants more unbiased, quick and easy. The results of the contests can be explained more easily and are more readily accepted. Thus, the healthy baby contests can be made more successful.

Monitoring of presterile disposable syringes and needles marketed in Pune.

Out of hundred syringes and hundred needles (both presterile, disposable) tested, 41 syringes (41%) and 6 needles (6%) showed aerobic growth. Forty of the above syringes were tested simultaneously for fungi and anaerobes. Fungi isolated were 5.7% and no anaerobe was grown. Fifty glass syringes and fifty needles autoclaved in the departmental laboratory served as controls and did not show any growth. As a preventive measure, proper disposal of used disposable material should be made mandatory so that it does not find its way into the market. Or has the time come to switch back to the former conventional practice of using in house autoclaved articles?

Disaster management knowledge attitude & practice of urban slum dwellers.

A KAP study was done in the area of Disaster Management in urban slums of Pune City. The Youth Organisations' members and the members of Mahila Mandals were the study subjects. It was found that there was marked improvement in the knowledge and attitudes of these subjects towards disasters. It is recommended that members of Mahila Mandals and members of Youth Organisations can act as 'frontline workers' in the situations of disasters after imparting some training in disaster management.

Retrospective prediction of birth weight by growth velocity curves during neonatal period.

In this prospective study, birth weight of 304 babies born at Kamla Nehru Hospital Pune during study period was recorded. From these 304 babies, babies with birth weight above 2000 grams were selected (260 babies) to prepare growth velocity curves. Daily weight of these 260 babies was recorded for 30 days. The mean birth weight of study population was 2742.5 grams. Among the daily weight recorded babies, all the babies lost weight ranging from 92 to 218 grams (mean 121 grams) after birth. The weight loss continued upto 5 days. Days required to gain weight equal to birth weight ranged from 5 to 13 days. Total weight gain observed in 30 days was 734.7 grams. Predictive value of these curves was tested in 49 infants. Deviation upto 50 grams of predicted birth weight from actual birth weight was observed in 90% of babies on day-2, 79% on day-4, 65% on day-8 and 39% on day-30.

Risk prediction charts for low birth weight.

OBJECTIVE: To develop intrauterine fetal growth monitoring charts for prediction of babies with low birth weight (LBW). DESIGN: Prospective study. SETTING: Antenastal clinic of a government and a private hospital. SUBJECTS: Two hundred and eighty one healthy pregnant women were enrolled before 28 weeks of pregnancy. MAIN OUTCOME MEASURES: The uterine fundal height and abdominal girth were recorded fortnightly. Following delivery, the neonatal birth weight was correlated with these measurements. RESULTS: Graphs were plotted for the mean fundal height and abdominal girth in relation to gestational age for neonatal weight categories of 2000 g, 2500 g and 3000 +/- 200 g. Measurement of the fundal height and abdominal girth predicted the neonatal weight category with a sensitivity of 87.5%, specificity of 90% and positive predictive value of 77.8%. CONCLUSIONS: The uterine fundal height and abdominal girth, when related to the gestational age, can accurately predict the neonatal birth weight category. The charts prepared in this study can help in prediction of LBW babies and allow appropriate intervention to be undertaken in the antenatal period at grass root level.

Epidemiological aspects of school dropouts in children between 7-15 years in rural Maharashtra.

A study on school dropouts from primary and secondary school children was undertaken in September '91 from 16 schools at the headquarters of 8 Primary Health Centres, where 172 school dropouts were identified. A home visit was paid and information about socio-economic and cultural aspects was collected and a psychological screening was undertaken. Although there was no significant difference in overall dropout rates for both sexes, it increased sharply at 11 years of age in girls. The majority of children dropped out due to financial problems or unsatisfactory scholastic performance, and 142 (82.5%) of the 172 children studied were poor performers in one or more function tests. Maximum difficulty was observed in concept formation 87 (50.5%), followed by numerical ability in 78 (45%). Identification of children with learning difficulties and intervention using special educational methods within the framework of existing network of primary and secondary schools in rural areas is suggested.

Indian experience of home based mothers card: ICMR task force study.

To improve the quality of MCH services, a Home Based Mothers Card (HBMC) prepared and recommended by World Health Organization was adapted to Indian situation, and introduced in 1.5 lakh population of rural area covered by 6 participating centres under the aegis of Indian Council of Medical Research. Two thousand four hundred and forty six mothers were given this card and were followed up for a period of 2 years. Only 89.2 percent retrieval of the cards was possible after a period of 18 months. Screening of the population for "at risk" women monitoring and referral could be undertaken with the help of this card. Improved antenatal, and referral services were observed during the study period. The card (HBMC) was acceptable to the mothers as well as to the health workers, as a tool for improving the quality and coverage of MCH services being rendered at the Primary Health Centre.