A cross-sectional study on the frequency and risk factors for neonatal hypoglycemia in babies born in rural Kerala.

Introduction: Glucose is the main source of energy for the developing brain. Hypoglycemia is a commonly encountered and treatable problem in the neonatal period. The newborn baby should be breastfed soon after delivery and continued on demand breastfeeding. As families become nuclear, mothers may not have the necessary skills and knowledge about the importance of exclusive breastfeeding. Health care workers play an important role in preparing the mothers for exclusive breastfeeding and ensuring that the newborn remains euglycemic. Problems encountered during breastfeeding should be corrected on an individual basis, and uninterrupted feeding should be ensured as per BFHI guidelines. Aim: To find out the frequency and risk factors of hypoglycemia and its relation to feeding in babies of GDM mothers, large for gestational age, and small for gestational age babies in a baby-friendly hospital adhering to the BFHI guidelines. Materials and Methods: A single-center, observational study was carried out among 160 consecutively born babies born to mothers with gestational diabetes, large for gestational age and small for gestational age for a period of one year from October 2018 to September 2019. Data was collected using an interviewer administered proforma and from antenatal and postnatal records. Glucose monitoring was done and values were recorded. Data was analysed using SPSS software. Qualitative data was expressed as percentage. and quantitative data was expressed as mean and standard deviation. Association with risk factors was studied using the Chi-squared test. Results: The overall incidence of hypoglycemia was 15.3% in our study. The main risk factors identified were prematurity and small for gestational age. Maximum incidence of hypoglycemia was noted in the first 24 hours after birth. Incidence of hypoglycemia in exclusively breastfed babies was only 10.5% compared to those on formula feeds where breastfeeding was contraindicated due to medical reasons and where the incidence was found to be 33.3%. Incidence of hypoglycemia was 50%. The most common symptoms of hypoglycemia were jitteriness and poor feeding. Eleven per cent of babies had asymptomatic hypoglycemia. In babies detected to have hypoglycemia, prompt treatment with oral feeds or intravenous (IV) dextrose was started. There was no mortality in the study population. Conclusion: Incidence of hypoglycemia was maximum in the first hour of life, highlighting the need to start early feeds and to do meticulous monitoring in high-risk babies like pre-term babies, small for gestational age, large for gestational age and babies of diabetic mothers. The incidence of hypoglycemia in exclusively the breastfed group was 10.5%. This showed that confident and successful breastfeeding with the support of health care staff should be the norm to prevent hypoglycemia, and preparation for breastfeeding should begin right from the antenatal period.

Patients' perception towards directly observed treatment - A qualitative study from Kollam district, Kerala, southern India.

BACKGROUND: The Direct Observation of Treatment (DOT) is an important component of the country's TB Control strategy. Standards of TB care in India and the End TB strategy emphasised the importance of a patient-centered approach to foster adherence. A qualitative study was conducted to explore the perception of people with Tuberculosis in Kerala regarding DOT, mechanisms to make the treatment of TB more patients centered and to identify the preferable mechanisms to ensure adherence. METHODS: Six focus group discussions were conducted - two among people with TB from rural area, two among people with TB in urban area, one among multipurpose health workers of rural area and one among key field staff of TB control in urban area. RESULTS: Patients who were on a strict DOT were unhappy about the issues of confidentiality, patient inconvenience and provider centered approach. A flexible, patient centered approach were a family member can act as the DOT provider with guidance from a trained health worker was evolved as the most acceptable and comfortable mode of treatment to majority of the TB patients. They felt that a strict external monitor as a DOT provider was not a necessity in majority of the cases. Only practical way to effectively incorporate ICT in monitoring patient compliance in current scenario was identified as daily phone call reminders. Patients also expressed their concerns in keeping the medicines for entire duration at home. CONCLUSION: A flexible patient wise individualized system based on patient's behavior, literacy and awareness along with attitude of family members is needed to ensure adherence to anti TB drugs.

Investigation of an Outbreak of Acute Gastroenteritis in Kollam, Kerala, India.

An outbreak investigation was initiated following a report of unusual occurrence of acute gastroenteritis in Ashramam area, Kollam district, Kerala, India. House to house survey was conducted to identify cases. Person, place, and time analysis was done. Hypothesis was generated based on findings from cross sectional study, anecdotal evidences, laboratory investigation, and environmental observations. Univariate analysis was done generating odds ratios and confidence intervals to identify factors associated with the disease. A total of 57 cases were reported. Attack rate was highest among children younger than 14 years (22%). Among them, 91.2% (52/57) of the cases and 45.8% (169/369) of the people who had not developed the disease were dependent on pipe water (OR 12.31; 95% CI 4.81-31.52) for drinking purpose. The time frame of the disease occurrence, environmental observations, anecdotal evidences, and the results of analytical study indicated the possibility of the acute gastroenteritis outbreak as a result of pipeline contamination. The study warrants establishment of a good water quality surveillance system.