Awareness and Perceptions of School Children about Female Feticide in Urban Ludhiana.

BACKGROUND: Although the Indian girl child's position is precarious throughout the country, she remains the most vulnerable in Punjab. OBJECTIVES: To assess the awareness and perceptions of school children regarding female feticide. STUDY DESIGN: Crosssectional study. MATERIALS AND METHODS: The study involved collection of information regarding knowledge and perception of school students about female feticide using multiple choice questionnaire. A total of 527 students between the age group of 11-18 years of various schools of district Ludhiana, Punjab were the study subjects. They had come to participate in the poster competition on organ donation (SAARC Transplant games), organized by Department of Community Medicine, D.M.C and H, Ludhiana. RESULTS: Out of total 527 students, 97.9% were aware of female feticide. Main source of information was TV (56%), followed by newspaper (33%). Majority of the students (65.2 %) felt that discrimination between boys and girls is prevalent in the society. Regarding perception of school students for curbing this social evil, 37.8% school students were of the view that awareness among the masses is the solution to stop this practice, while 25% of the students responded that equal status to girls will stop this practice of female feticide. CONCLUSIONS: The school students had optimum level of awareness about female feticide and almost all of them strongly felt that this harmful practice should be stopped altogether.

Twinning and its correlates: community-based study in a rural area of India.

A retrospective study was carried out to investigate the twinning rate and its correlates from January 1991 to December 2005 in 10 villages of the Rural Health Centre, Pohir, a field practice area of the Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. During this study period, 5070 deliveries took place. A total of 5017 singleton births and 53 sets of twins were recorded, giving a twinning rate of 10.45 per 1000 total deliveries. Monozygotic and dizygotic twinning rates were estimated as 2.96 and 7.49 per 1000 deliveries, respectively. The twinning rate was strongly associated with maternal age; the twinning rate for mothers between 30 and 34 years of age was about 10 times higher than the rate for mothers younger than 20 years. This variation was due to variation in dizygotic twinning; the rate of monozygotic twinning was almost constant for all ages. The twinning rate was highest at gestational order 4 or higher. The perinatal mortality rate among the twins was 173.1 per 1000 total twin births and was significantly higher among the group in which diagnosis of twins was not done during the prenatal period. We should expect 1 twin birth per 100 births, and because perinatal mortality is alarmingly high in undiagnosed twin pregnancies, early recognition of twin pregnancy during prenatal visits and delivering in a health facility with adequately trained personnel should be encouraged.

Perinatal mortality in rural Punjab--a population-based study.

The results of a population-based case-control study are reported to examine the factors affecting perinatal mortality in rural Punjab, during the period 1991-1996. There were 91 perinatal deaths in 2424 of the pregnant women registered. The perinatal mortality rate was 34.57/1000 and the stillbirth rate was 30.94/1000. Odds ratio, 95 per cent confidence interval, prevalence and population attributable risk percent were calculated for the various risk factors; of the risk factors studied, material weight less than 40 kg, height less than 152 cm, body mass index < 20, illiteracy, a birth to conception interval less than 100 weeks, prematurity, late registration and home delivery were found to be significant on univariate analysis. When subjected to multiple logistic regression, the full model identified the significance of all the risk factors except late registration. However on the final model, only prematurity and short birth-interval were found to be significant. The highest population attributable risk, 35.16 per cent, was observed for prematurity.

A cross-sectional study of growth parameters of rural adolescent girls of Punjab.

PIP: To assess the adequacy of growth among female adolescents in rural Punjab, India, anthropometric data were collected on 386 females 9-14 years old and 312 females 15-19 years of age. Although most of the values increased with socioeconomic status, the difference was statistically significant only for head circumference. Compared to their urban counterparts, rural girls weighed less and reached their growth spurt a year later (at age 12 years). Nonetheless, comparison with large studies conducted previously by the Indian Council of Medical Research and the National Nutrition Monitoring Bureau documented significant advances in the past decade. At age 18 years, only 8% of girls in the present survey weighed less than 39 kg and just 9.6% had heights under 145 cm--measures considered to indicate obstetric risk. Overall, these findings indicate adequate growth among adolescent females in rural Punjab, despite high rates of malnutrition among girls under 5 years of age.^ieng

Efficacy of colour coded strip based on calf circumference for detection of low birth weight babies.

PIP: In India, a color-coded strip measuring calf circumference was tested for its efficacy in detecting low birth weight (=or 2.5 kg) among 306 normal singleton newborns within 48 hours of delivery. The strip has points marked at 6.5 cm and 8.25 cm. The area in-between these points correspond to 2-2.5 kg and is colored yellow. The area before 6.5 cm is colored red and the area beyond 8.25 cm is colored green. The strip correctly identified 60.38% of low birth weight newborns. It correctly identified 98.02% of normal weight newborns. Its efficacy for classifying newborns according to birth weight was significant (p 0.001; X2 = 151.88). The strip's sensitivity rates for low birth weight and for normal birth weight were 91.43% and 92.19%, respectively. These findings show that the color-coded strip is an effective means to determine low birth weight in the absence of a weighing score or spring balance. Health workers can use it to detect low birth weight babies born at home.^ieng

The role of secondary sex ratios in the declining sex ratio of India.

The sex ratio in India has been gradually declining since the beginning of this century during the intercensus period of 1981-91, this ratio declined from 933 to 929. In the past the difference in sex ratios was wholly attributed to higher mortality amongst the females. However date for the years 1990-92 on secondary sex ratios i.e. sex ratio at birth presented in this paper suggest that the difference in sex ratio can also be attributed to a statistically significant higher number of males being born most probably as a result of selective abortion of female fetuses.

Epidemiology of coronary heart disease in a rural Punjab population--prevalence and correlation with various risk factors.

An epidemiological study to find out the prevalence of coronary heart disease (CHD) and the influence of risk factors on the prevalence of CHD in a total rural community of Punjab was conducted in Pohir, situated near Ludhiana. A total of 1100 individuals (623 males and 477 females) out of a possible 1617 individuals (> 30 yrs) living in 3 villages were studied. In each case a detailed history, physical examination and a 12 lead electrocardiogram (ECG) were recorded. Samples for blood sugar and serum cholesterol were taken. By Epstein's criteria of ECG (using the Minnesota coding), the prevalence of CHD was 30.8/1000, being higher in women (37.7/1000) than in men (25.6/1000). By a clinical judgement method considering history, ECG and treadmill testing (TMT) collectively, prevalence was 31.8/1000, being still higher in women (33.5/1000) than in men (30.5/1000). The prevalence of various risk factors like hypertension, smoking, hypercholesterolemia and diabetes was found to be 14.5%, 8.9%, 7.0% and 4.6% respectively. Of the various risk factors tested, hypertension, hypercholesterolemia and a positive family history showed an association with CHD. Only 38% of patients with CHD, 37% of the hypertensives and 52% of the diabetics were aware of its presence. The knowledge in the general population about risk factors causing CHD is poor.

A simple approach for estimating birth weight in developing countries.

PIP: Health and nutritional status of an infant are accurately assessed with birth weight. In India, almost 30% of all births are low birth weight, which is related to a high risk of mortality and morbidity. Anthropometric measures have been found to be accurate indicators of birth weight. In this study, 483 normal singleton infants were measured at mid arm circumference and maximum thigh circumference; mid arm circumference measures were also taken from mothers. The precise position for the arm measurement was at the mid point between the tip of the acromion and the olecranon process in the left upper arm to the nearest .1 cm. Thigh measurement was just below the left gluteal fold. Measurements were taken within 48 hours of birth; information was also obtained on age, gravida, parity, and gestation. With control for gestation, there was a significant correlation between mid arm circumference, maternal arm circumference, and maximum thigh circumference. Maternal arm circumference had a predictive value of 6.54% infant mid arm circumference of 46.30%, and maximum thigh circumference of 44.0%. When all three measures are used concurrently, there is an increase in predicted value to 53.68%. With use of mid arm and maximum thigh circumference together, the predictive value is 54.6%. A correlation matrix shows the interaction of age, gestation, parity, weight, and the three anthropometric measures. The mean birth weight was 2851.5 g plus or minus 473.18 g, the mean infant mid arm circumference was 9.86 cm plus or minus 1.12 cm and the maximum thigh circumference was 16.20 cm plus or minus 1.78 cm. Maternal mid arm circumference was 25.08 cm plus or minus 2.90 cm; mother's age averaged 25.35 plus or minus 3.94 years. Gestation averaged 38.76 weeks plus or minus 1.64 weeks. Birth weights ranged from a low of 1600 g to a high of 4120 g.^ieng

Efficacy of colour coded strips for classifying birth weights.

PIP: Color-coded measuring tapes have been developed as surrogates for measuring birth weight with a scale. The tapes have been correlated with birth weight to indicate low birth weight. In this study, arm circumference and thigh circumference were measured with tapes indicating low birth weight: 7.0 to 8.5 cms for mid arm circumference and 11.5 and 14.5 cms for thigh circumferences. The area in between the numbers was color coded in yellow to indicate a birth weight of 2.0 to 2.5 kg. The area under the lowest number was coded red, and the are above the highest number was coded green. The strips were tested on 281 infants to determine the accuracy of this form of measurement. Use of strips and birth weights were recorded within 48 hours of the birth. The results indicated that 54% of the low birth weight infants were correctly identified with the mid arm circumference tapes. There were 13.88% who were recorded with low birth weight out of the 281 sampled. The tape reliably measured 90% of the normal birth weight infants. The thigh circumference tape was a better measure of low birth weight. 80% of low birth weight infants were identified with the thigh circumference tape, but only 85% of normal weights were identified. When the tapes were used concurrently, accuracy of low birth weight classification was increased to 87%, but normal weight remained much the same at 85% accuracy. It is recommended that these tapes be used in combination by traditional birth attendants and other grassroots workers to identify low birth weight infants and then refer these infants for special care.^ieng

Calf circumference as a birth weight surrogate.

PIP: There remains a need to determine low birth weight in settings such as the home, where scales are not easily available. This study examined the calf circumference at a prominent point on a semi-flexed leg with a standard measuring tape to the nearest .1 cm and birth weight to the nearest 5 g. The sample included 257 full term singleton infants. The results of the correlation coefficient analysis was r = .74, which indicates a high degree of correlation between the two measures. The mean of birth weight was 2.96 g plus or minus .41 and the mean calf circumference was 9.87 cm plus or minus 1.07. Birth weight can be calculated from calf circumference by adding .172 to the multiplication of .283 times calf circumference. The calf circumference appears to exhibit the strongest correlation with birth weight regardless of the sample. A color-coded tape had been prepared which demarcated in yellow 6.5 cm and 8.25 cm as the range equivalent to 2.0 kg and 2.5 kg low birth weight. The area below 6.5 cm was colored red and the area below 8.25 was colored green. Currently, data is being collected on the efficacy and positive predictive value of using the tapes.^ieng

Consistent accuracy of mid arm circumference and calf circumference as birth weight surrogates during first few days.

PIP: Measurement within 24 hours and then daily for 10 days after birth was made of mid arm, calf, and thigh circumference, and birth weight among infants delivered by the Dayanand Medical College and Hospital in Ludhiana, Punjab State, India. The results of the correlation procedures was that mid arm an calf circumference were highly correlated with birth weights: r = .60 and r = .76 respectively. Thigh circumference data was discarded, due to technical errors. Analysis of variance found that there were not significant differences between the values of arm and calf circumference and birth weight. This information was found useful for determining birth weight with colored strips during the first 10 days after birth. The criteria of health workers in field conditions to assess birth weight with surrogate measures were satisfied: high correlation, easy measurement, and consistently accuracy over the first few days of life. Health workers do not always see new borns in the first few days. The significance of measuring birth weight is in the determination of low birth weight and the need for special care or monitoring as a means of enhancing child survival.^ieng

Correlation of some maternal variables with birth weight.

PIP: Infant survival and birth weight are dependent on the health of the mother during pregnancy. In this study, maternal weight gain in pregnancy, prepregnancy weight, height, and body mass index (BMI) were examined in terms of their correlation with birth weight. The Dayanand Medical College and Hospital in Ludhiana, Punjab State, India, conducted the study of the pregnant women in the surrounding 10 villages. Prenatal care was provided to all pregnant women and maternal variables were grouped into the BMI for 18, 18-21, and 21. The results showed a positive correlation of birth weight with prepregnancy weight, height, and BMI. A BMI of 18, which indicated chronic dietary energy insufficiency, had a correlation of r = .43 an a low prepregnancy weight of 41.44 plus or minus 2.65 kg. Prepregnancy weight had a correlation with birth weight of r = .42; height was correlated with birth weight with a r = .23. A positive correlation was apparent for BMI of 18-21 and 21, but the correlations were statistically insignificant. The objective of any prenatal health intervention would be to assure that women have a prepregnancy weight of greater than 40 g and a BMI of 18. Weight gain was the highest among women who had the lowest prepregnancy weight, but this was still insufficient to meet the recommendations.^ieng

Past, present and future of Integrated Child Development Services (I.C.D.S.).

PIP: India's Integrated Child Development Services (ICDS) was established in 33 projects in 1975 and is spread over 22 states; 67 additional projects were begun in 1977, and over the next 2 years; 100 additional projects were added. By 1991=92, coverage was almost 50% of the country with 2696 projects; the expectation is for 100% coverage by the year 2000. An infrastructure chart identifies the organization and integration between level and social welfare and health departments. Objectives are clearly identified and the departments functionally linked. Linkages are achieved by shared space and activities at various levels. Over the past 17 years, services have included minimum needs programs, integrated rural development and poverty alleviation, national health policy and education policy, universal immunization, and the development of women and children in rural areas. ICDS is sponsored 100% by the status and uniquely relies on the honorary anganwadi worker (AWW), who is a woman, recruited and chosen by the community, aged 21-45 years and middle-school educated. The AWW was responsibility for 2000 households or 1000 persons in rural areas and 700 persons in tribal areas. The AWW is crucial to the functioning of the program and receives an honorarium of Rs. 225-275/month for implementing the ICDs program; AWWs have helpers who are paid Rs. 110/month. Training over a 3-year period is conducted at the Bal Sevika Training Institute by the Indian Council of Child Welfare. Additional health personnel and their role and the number of persons/per area AWWS are responsible for, equipment, and functions are also described. The AWW is responsible for nonformal preschool education, organization of supplementary nutrition feeding, health and nutrition education of women and families, immunization of women and children, treatment and referral of common illnesses, growing monitoring, and community participation. Presently, there are 2506 central sector projects and 190 state sector projects and 250,000 AWWs. The preschool education, health, and nutrition programs are summarized. Future directions will encompass future child and mother development and expansion to cover all 90 districts having a birth rate higher than 39/1000. Lessons learned from the past will be integrated and may involve cost containment, acceleration of development of services, alternative services, and giving mothers more responsibility for improving health and nutrition.^ieng

The impact of preschool education component of ICDS on mental and cognitive development of children.

PIP: The aim of this evaluation was to assess the impact of nonformal preschool education of the mental and cognitive development of rural and urban children from the Ludhiana Integrated Child Development Services (ICDs) district, Punjab, India; comparisons were made with non-ICDs attenders. 30 anganwadi community workers (AWWs) with ICDs were randomly selected equally from a total of about 200 workers in urban and rural blocks. 360 children aged 3-6 years; equally divided among urban and rural areas, were selected; 180 of these children, equally divided between urban and rural areas, were controls of nonattenders of preschool. Information about cognitive and mental development was obtained from AWWs records and interviews, parents, and a cognitive ability test. Mean test scores among rural ICDS attenders aged 3-4 years of age were 73.77 compared with 67.33 for nonattenders. The scores for rural ICDs attenders 4-5 years old was 95.60 vs. 82.20 for nonattenders. For the 5-6 year old group, scores for rural ICDs attenders were 104.23 compared with 93.27 for nonattenders. The scores were statistically significant for score differences for all age groups in the rural population and the urban population. Urban ICDS attenders scored 73/87 compared with 65.57 for nonattenders aged 3-4 years. Urban ICDS attenders aged 4-5 years scored 92.97 compared with 83.23 for nonattenders. Urban ICDS attenders aged 5-6 years scored 105.03 compared with 92.57 for nonattenders. There were no significant differences between rural and urban attenders or nonattenders for any age group. There was a significant (p .001) correlation between age and cognitive ability: rural attenders, r = .81; rural nonattenders, r = .78; urban attenders, r - 84, urban nonattenders r = 86. The findings supported previous studies, by, for instance, Adhish et al. on cognitive differences between children in ICDs and non ICDs villages. Place of residence was not found to be related to mental development. There was an increase in the cognitive development with the advancement of age.^ieng

A comparative study of sterilisation acceptors.

PIP: This study was conducted retrospectively at the Family Welfare and Post Partum Center, Dayanand Medical College and Hospital, Ludhiana. The data on sterilization acceptors for 1986-87 to 1989-90 were utilized. The acceptors were divided into: 1) direct acceptors (women who accept a family planning method before leaving the hospital or within 3 months of delivery or abortion); 2) indirect acceptors (women who adopt a family planning method 3 months later); and 3) total acceptors (direct acceptors plus indirect acceptors). During 1989-90, 97.80% of sterilizations were performed on females, while only 2.20% were performed on males. The acceptance of vasectomy was highest in 1987-88 (14.55%) owing to an enhanced incentive. Females aged 25-29 years were the most receptive group for tubectomy, followed by those aged 30-34 years. During 1987-88, 40.78% of women accepted tubectomy at 25-29 years of age vs. 33.98% at 30-34 years. During 1989-90, 44.58% of females accepted sterilization at 25-29 years of age vs. 30.85% at 30-34 years. The difference between direct and indirect acceptors was statistically highly significant (p 0.001). There were 78.20% direct and 21.80% indirect acceptors during 1988-89. In 1989-90, 48.93% and 24.04% of direct acceptors and 42.08% and 32.02% of indirect acceptors with 3 and 4 living children, respectively, accepted sterilization. However, in all years, sterilization remained the ideal choice for all acceptor couples with 3 living children. During 1988-89, 33.50% of direct and 36.07% of indirect acceptors had tubectomy at parity 2, as compared to 17.64% and 23.42% at parity 4, respectively. A highly significant correlation was observed between the age of the mother and the number of living children (r = 0.95). Surprisingly all the vasectomy cases were indirect acceptors. In 1986-87, 87.86% accepted tubectomy after abortion and delivery vs. only 12.14% after the discharge from the hospital. 59.30% of these immediate acceptors had tubectomies postpartum and only 40.65% after abortion. Tubectomy acceptance along with abortion rose to 76.90% and 71.50% during 1988-89 and 1989-90, respectively. Most couples opted for tubectomy concurrently with abortion after having 3 living children.^ieng

Effect of child loss on contraception acceptance.

PIP: In India, interviews were conducted with 250 couples who had at least 2 living children and at least 1 son so researchers could examine the effect of child loss on contraceptive usage. The interviewees lived in the area served by the rural health center in Pohir. 67 couples had lost a child. The child loss group had an acceptance rate for contraception of 41.7% compared to 44.8% for the group who had not experienced child loss. The difference was insignificant. Caste, literacy, and parity did not affect contraceptive usage. These findings suggest that child loss does not play a crucial role in contraception acceptance. On the other hand, some studies show that it is a barrier to fertility limitation. Additional studies are needed to resolve the issue of child loss and fertility.^ieng

Relationship between maternal rest during pregnancy and birth weight.

PIP: The objective was to develop an arbitrary scoring system to quantify maternal rest and to study the relationship between maternal rest and birth weight. 474 women delivering at term in various hospitals and nursing homes in Ludhiana, India, were studied. An hour-to-hour inventory of their activity and rest was made for the whole 24 hours. The hours were logged for heavy, moderate, and light work. Similarly, hours of rest were logged for various grades of rest. The various hours of rest and activity were converted into scores by using an arbitrary scoring system and then totaled to give rest and activity scores. The Rest minus Activity Score (R-A score) gives a measure of absolute rest taken by the women. Theoretically the range of R-A score could be from +120 (a woman sleeping for 24 hours) to -120 (a woman performing heavy work for 24 hours). However, the majority of actual R-A scores ranged from 0 to 90. On this basis the women were arbitrarily divided into groups: R-A score of 30 or less, 31 to 60, and above 60. Women were also stratified according to their socioeconomic status into four groups, the criteria being total family income. For finding the relationship between rest and birth weight, the coefficient of correlation (r) was calculated between R-A score and birth weight. Although overall a low degree of correlation was observed between maternal rest and birth weight, in the lower socioeconomic groups the correlation was stronger. In all socioeconomic groups birth weights increased with increasing maternal rest. Maternal rest is an important determinant of birth weight particularly in women of lower socioeconomic level. Any program for prevention of low birth weight must emphasize adequate maternal rest throughout pregnancy to restrict energy expenditure, particularly for women of lower socioeconomic status.^ieng