Hydrodynamic behavior of bubbles at gas-evolving electrode in ultrasonic field during water electrolysis.

In electrochemical processes, gas bubbles on the electrode can cause an increase in both overpotential and ohmic voltage drop which leads to higher energy consumption. Applying power ultrasound during water electrolysis can help to reduce the overpotential, enhance mass transfer, and save energy. In this study, we investigated the effect of ultrasound (20 kHz) on the hydrogen evolution reaction (HER) on a stainless steel plate with varying concentrations of NaOH solutions at 298 K, using linear sweep voltammetry (LSV). We especially focused on understanding the bubble behavior on the stainless steel plate during HER using high-speed imaging in ultrasonic field. When ultrasound was applied to solutions with NaOH concentrations of 0.1, 0.5, 1 M, the current density increased by about 9.0, 5.9, 2.8 %, respectively. As the ultrasound irradiation began, the bubbles tended to hover around on the electrode surface, coalescing with other bubbles, rather than rising. When the size of the coalesced bubbles became too large to stay on the surface of the electrode, they were expelled from the ultrasonic field. The repeated collapse and coalescence of these bubbles was observed while they were rising. The velocity increased about 2 times when ultrasound irradiation began, and increased by more than 6 times in the ultrasonic field. More nucleation of bubbles was observed on the electrode in the ultrasonic field. Using ultrasound reduced the critical diameter of bubbles which detached from the electrode, from 58.0 to 15.9 µm, and the residence time of the bubbles, from 533 to 118 ms. Further, when the ultrasound was applied, the mean diameter of bubbles decreased from 71.8 to 17 µm. Hence, bubble coverage on the electrode surface decreased from 8.3 to 1 % despite an increase in the total number of bubbles. As a result, ultrasound was found to be effective for hydrogen production during water electrolysis, increasing current by the faster removal of gas from the stainless steel plate.

Efficacy and tolerability of treatment with single doses of diethylcarbamazine (DEC) and DEC plus albendazole (ABZ) for three consecutive years in lymphatic filariasis: a field study in India.

Lymphatic filariasis (LF) affects 73 countries, causes morbidity and impedes socioeconomic development. We had found no difference in safety and micro (Mf) and macro filarial action of single-dose diethylcarbamazine (DEC) and DEC + albendazole (ABZ) in an F01 study done in India (year 2000). There was a programmatic need to evaluate safety and efficacy of multiple annual treatments (F02). Subjects (155) from the F01 study, meeting inclusion-exclusion criteria, were enrolled in F02 and treated with further two annual doses of DEC or DEC + ABZ. Efficacy was evaluated for Mf positivity by peripheral smear (PS) and nucleopore (NP) filter, circulating filarial antigen (CFA) and filarial dance sign (FDS) positivity and Mf count at yearly follow-up. Safety was assessed for 5 days after drug administration. Total of 139 subjects evaluated for efficacy (69 DEC and 70 DEC + ABZ group). Mf positivity prevalence declined progressively by 95% (PS), 66% (NP), and 95% (PS) and 86% (NP); CFA positivity prevalence declined by 15% and 9%; FDS by 100% each; Mf count declined by 75.5 and 76.9% with three annual treatment of DEC and DEC + ABZ, respectively. Addition of ABZ did not show any advantage over DEC given as three annual rounds for LF. DEC and DEC + ABZ were well tolerated. There was no correlation between result of CFA and FDS, (both claimed to be indicative of adult worm). Analysis of published studies and our data indicate that macrofilaricidal effect of DEC/DEC + ABZ may be seen in children and not adults, with three or more annual dosing.

Social capital and adverse treatment outcomes of tuberculosis: a case-control study.

SETTINGS: 'Social capital' refers to social norms, relationships, networks and values that affect the functioning and development of society. Social capital influences health positively, but its role in the treatment outcomes of tuberculosis (TB) is not known. OBJECTIVES: To study the role of social capital in determining adverse TB treatment outcomes. DESIGN: Of 516 patients registered under the Revised National Tuberculosis Control Programme in 2014 in Wardha Tuberculosis Unit, Wardha, India, we included 88 patients with adverse treatment outcomes as cases and 187 controls from among those without adverse outcomes. Multiple logistic regression was used to compare standardised Z-scores. RESULTS: A greater proportion of controls than cases belonged to higher quartiles of social capital and its domains than cases, and the mean standardised Z-score was also consistently higher among controls than cases. Respectively 47% and 15% of cases and controls were in the poorest quartile of social capital, whereas respectively 10% and 33% of cases and controls were in the richest quartile. Each unit increase in Z-score of overall social capital reduced the odds of adverse treatment outcomes by 63.1%. CONCLUSION: Appropriate interventions for building social capital for TB patients and linking them with the programme would improve programme performance.

A Study of VO2 Max and Body Fat Percentage in Female Athletes.

INTRODUCTION: Aerobic capacity of athletes is an important element of success in sports achievements. It is generally considered the best indicator of cardio respiratory endurance and athletic fitness. Body fat percentage affects VO2 max and thus the cardiovascular status of the athletes. The present study was undertaken to assess the VO2 max and body fat percentage in athletes. The secondary objective of the study was to study the relationship between VO2 max and body fat percentage. MATERIALS AND METHODS: Twenty five female athletes of age group 17-22years were selected for the study. VO2 max was determined by Queen's college step test and body fat percentage by skin fold calipers. The VO2 max and body fat percentage were determined in non athletes of same age group for comparison. The statistical analysis was done by Student's t-test and Pearson correlation test. OBSERVATION AND RESULTS: The mean VO2 max in athletic group was 39.62 ± 2.80 ml/kg/min. In non-athletic group, VO2 max was 23.54 ± 3.26 ml/kg/min. The mean body fat percentage in athletes was 24.11 ± 1.83% and in non-athletes it was 29.31 ± 3.86%.The difference in VO2 max and body fat percentage was statistically significant in our study. The VO2 max and body fat percentage in both the groups showed negative correlation by Pearson test but, was not statistically significant. CONCLUSION: The present study showed a statistically significant higher VO2 max in female athletes. The study showed a negative correlation between VO2 max and body fat percentage but was not statistically significant.

Where and how breastfeeding promotion initiatives should focus its attention? A study from rural wardha.

BACKGROUND: In India, the practice of breastfeeding is almost universal, but initiation of breastfeeding is generally quite late and colostrum is discarded. Integrated Management of Neonatal and Childhood Illness (IMNCI) strategy recommended systematic assessment of breastfeeding and emphasized counseling of the mother on proper positioning and attachment of infant to the breast. OBJECTIVE: To assess breastfeeding among mothers of below six months children in rural Wardha. MATERIALS AND METHODS: The present cross-sectional study was undertaken in surrounding 23 villages of Kasturba Rural Health Training Center (KRHTC), Anji. Two Auxiliary Nurse Midwives (ANMs) trained in IMNCI paid house visits to 99 mothers during the study period and undertook the assessment of breastfeeding using IMNCI assessment form for young infants. Auxiliary Nurse Midwives observed and recorded the positioning and attachment of infant to the breast as per IMNCI guidelines. The data were entered and analyzed using Epi_Info (version 6.04d) software package. RESULTS: Most of the deliveries 94 (94.9%) took place in the healthcare facilities. Majority 61 (61.6%) newborn babies had received breastfeeding within half an hour. About half of the mothers had any of the feeding problems like feeding less than eight times in 24 h, giving any other food or drinks or is low weight for age. Significantly more mothers with feeding problems had problems in positioning and attachment of infant to the breast as compared with those mothers who did not have any feeding problems. CONCLUSIONS: In the settings, where practice of institutional delivery is high, the staff of healthcare facility should ensure education of the mothers regarding position and attachment of infant to the breast before discharge from the healthcare facility. At the village level, Village Health Nutrition Day (VHND) can be utilized for health education of future mothers and support for the breastfeeding mothers. The IMNCI assessment form for young infant should also include assessment of positioning of infant.

An evaluation of ROME Camp: forgotten innovation in medical education.

BACKGROUND AND OBJECTIVES: Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, India's first rural medical institute, has been implementing its community-based public health teaching with the aim of building a physician workforce for the rural poor. For the past four decades, the MGIMS has organized and run the Re-orientation of Medical Education (ROME) camp for final year medical undergraduates at one of the rural centres of the department of Community Medicine. The objectives of the present study were to learn students' perceptions of the value and effectiveness of various components of the ROME camp and learn the factors they perceive facilitate and inhibit learning. METHODS: A mixed-method research design of quantitative (survey) and qualitative (force field analysis) methods was used. The study participants were all 61 of the final year medical undergraduates participating in the ROME camp in 2008. The quantitative data was analyzed using SPSS software package and summative content analysis of the qualitative data was undertaken. RESULTS: Students were generally very positive about all aspects of the camp and its component parts. The greatest consensus (88.9%, on a 0 to 100% scale) was for the contribution to student learning of the visit to the Primary health centre and Sub-centre, as offering direct exposure and interaction with the village-level service providers. There was poorer consensus for students' involvement with the field-based clinics, as this was felt by some not to contribute significantly to their understanding of socio-economic and environmental factors related to cases (78.8%) and their ability to diagnose health problems in resource poor settings (76.5%). The major strength of the camp was felt to be its exposure visits and hands-on experiences in surveys and interaction with village-level health care providers. Students reported poor interactions with teachers in some educational sessions, including the field-based clinics and classes on theories of national health programs. CONCLUSIONS: The curriculum of the ROME camp was generally well regarded by students, but based on their views it should emphasize interactive theory sessions. The ROME scheme can be revitalized in all medical colleges as it is an effective practical approach for teaching public health principles and practice to medical students.

On-line capacity-building program on "analysis of data" for medical educators in the South Asia region: a qualitative exploration of our experience.

BACKGROUND AND OBJECTIVE: In medical education, using the World Wide Web is a new approach for building the capacity of faculty. However, there is little information available on medical education researchers' needs and their collective learning outcomes in such on-line environments. Hence, the present study attempted: 1)to identify needs for capacity-building of fellows in a faculty development program on the topic of data analysis; and 2) to describe, analyze and understand the collective learning outcomes of the fellows during this need-based on-line session. MATERIALS AND METHODS: The present research is based on quantitative (on-line survey for needs assessment) and qualitative (contents of e-mails exchanged in listserv discussion) data which were generated during the October 2009 Mentoring and Learning (M-L) Web discussion on the topic of data analysis. The data sources were shared e-mail responses during the process of planning and executing the M-L Web discussion. Content analysis was undertaken and the categories of discussion were presented as a simple non-hierarchical typology which represents the collective learning of the project fellows. RESULTS: We identified the types of learning needs on the topic 'Analysis of Data' to be addressed for faculty development in the field of education research. This need-based M-L Web discussion could then facilitate collective learning on such topics as 'basic concepts in statistics', tests of significance, Likert scale analysis, bivariate correlation, and simple regression analysis and content analysis of qualitative data. CONCLUSIONS: Steps like identifying the learning needs for an on-line M-L Web discussion, addressing the immediate needs of learners and creating a flexible reflective learning environment on the M-L Web facilitated the collective learning of the fellows on the topic of data analysis. Our outcomes can be useful in the design of on-line pedagogical strategies for supporting research in medical education.

Childhood morbidity, household practices and health care seeking for sick children in a tribal district of Maharashtra, India.

OBJECTIVES: To find out the magnitude of childhood morbidities, health care seeking behavior and explore the status of 'some desired practices' at household level during episodes of illness in two tribal blocks of Chandrapur district. MATERIALS AND METHODS: The present explanatory mixed-method design of quantitative (survey) and qualitative (focus group discussions, FGDs )methods was undertaken in nine Primary health centers of Warora and Bhadrawati blocks in Chandrapur district. The information of 2,700 under-five children on morbidity, health care seeking behavior and some desired practices at household level was collected by paying home visits and using pre-designed and pre-tested questionnaire. The data was entered and analyzed by using SPSS 12.0.1 and C sample program of epi_info (version 6.04d) software package. The conventional content analysis of FGD data was undertaken. RESULTS: The prevalence of morbidities was high among newborns and children. About 1,811 (67%) children had at least one of the morbidities. Private health care providers and village level faith healers were preferred for seeking treatment of newborn danger sings and childhood morbidities. The status of some desired household practices such as frequent feeding and giving extra fluid to drink during episodes of illness was poor. CONCLUSIONS: In conclusion, considering high prevalence of child morbidities and poor status of some desired household practices of caregivers at household level for sick children, household and community IMNCI strategy needs to be implemented to promote child health and nutrition. Apart from this, health care delivery at village level should be strengthened.

Acute childhood morbidities in rural Wardha: some epidemiological correlates and health care seeking.

BACKGROUND: In India, common morbidities among children under 3 years of age are fever, acute respiratory infections, diarrhea. Effective early management at the home level and health care-seeking behavior in case of appearance of danger signs are key strategies to prevent the occurrence of severe and life-threatening complications. OBJECTIVES: To find out the prevalence of acute child morbidities, their determinants and health-seeking behavior of the mothers of these children. SETTING AND DESIGN: The cross-sectional study was carried out in Wardha district of central India. MATERIAL AND METHODS: We interviewed 990 mothers of children below 3 years of age using 30-cluster sampling method. Nutritional status was defined by National Center for Health Statistics (NCHS) reference. Composite index of anthropometric failure (CIAF) was constructed. Hemoglobin concentration in each child was estimated using the 'filter paper cyanm ethemoglobin method.' Using World Health Organization guidelines, anemia was defined as hemoglobin concentration less than 110 g/L. Post-survey focus group discussions (FGDs) were undertaken to bridge gaps in information obtained from the survey. STATISTICAL ANALYSIS: The data was analyzed by using SPSS 12.0.1 software package. Chi-square was used to test the association, while odds ratios were calculated to measure the strength of association. Multiple logistic regression analysis was applied to derive the final model. RESULTS: Anemia was detected in 80.3% of children, and 59.6% of children were undernourished as indicated by CIAF. The overall prevalence of acute morbidity was 59.9%. Children with mild anemia, moderate anemia and severe anemia had 1.52, 1.61 and 9.21 times higher risk of being morbid, respectively. Similarly, children with single, 2 and 3 anthropometric failures had 1.16, 1.29 and 2.27 times higher risk of being morbid, respectively. Out of 594 (60%) children with at least one of the acute morbidities, 520 (87.5%) sought health care, where majority (66.1%) received treatment from private clinics. The final model suggested that anemia and mother's poor educational status are predictors of childhood morbidity. CONCLUSIONS: Nutritional anemia and mother's poor educational status are the most important risk factors of acute childhood morbidity. There is need to revitalize existing health care delivery and child health programs in rural India with emphasis on immediate correction of nutritional anemia.

Evaluation of WHO haemoglobin colour scale & palmar pallor for screening of anaemia among children (6-35 months) in rural Wardha, India.

BACKGROUND & OBJECTIVE: Anaemia is a public health problem in India, particularly in women and children. Clinical diagnosis by health workers may be inaccurate. It is therefore important to evaluate simple methods for diagnosis of anaemia in rural set up with no or minimal laboratory facilities. We carried out this study to evaluate the performance of haemoglobin colour scale and palmar pallor against filter paper cyanmethaemoglobin method as screening methods for anaemia in children 6-35 months of age. METHODS: A total of 772 children between 6-35 months were studied from three primary health centres of Wardha district, central India, by house-to-house visit. The child was examined for presence of palmar pallor and haemoglobin estimated by haemoglobin colour scale (HCS) and filter paper cyanmethaemoglobin method independently by two persons. RESULTS: Haemoglobin colour scale had sensitivity of 89 per cent and specificity of 97 per cent in detecting anaemia in children. Pallor had sensitivity of 73 per cent and specificity of 98 per cent. The predictive values were 99 per cent and 69 per cent for positive and negative HCS result. Similarly, the predictive values were 99 and 48 per cent for positive and negative pallor result. Correct diagnosis of anaemia was 34 and 0.1 times common if HCS test result was positive (Hb < 110.0 g/l) and negative (Hb > 110.0 g/l) for anaemia. INTERPRETATION & CONCLUSION: HCS fulfills the requirement of field test for screening of anaemia in resource poor country. It also has acceptable precision and accuracy and hence can be used in national anaemia control programmes.

Correlates of overweight & obesity among school going children of Wardha city, Central India.

BACKGROUND & OBJECTIVE: Overweight and obesity are important determinants of health leading to adverse metabolic changes and increase the risk of non communicable diseases. Following the increase in adult obesity, the proportion of overweight and obese children and adolescents has also been increasing. Hence, the present study was undertaken to study the magnitude of overweight/obesity and its correlates among school going children of Wardha city in central India and suggest interventions. METHODS: The cross-sectional study was carried out in all the 31 middle-schools (5th to 7th standard) and high-schools (8th to 10th standard) of Wardha city. Probability proportionate to size of population technique (PPS) was used to decide the number of children to be studied from each school, each class and then each section. Systematic random sampling technique was used to select the children from each section. Pre-designed and pre-tested questionnaire was used to elicit the information on family characteristics and individual characteristics. Height and weight was measured and BMI was calculated. Overweight and obesity was assessed by BMI for age. Student who had BMI for age >or=85th and < 95th percentile of reference population were classified as overweight and BMI for age >or=95th percentile of reference population were classified as obese. RESULTS: Overweight and obesity was found to be 3.1 per cent (95% CI: 2.5-3.8%) and 1.2 per cent (95% CI: 0.8-1.8%) respectively; together constitute 4.3 per cent (95% CI: 3.6-5.2%) for overweight/ obesity. Final model of the multivariate logistic regression showed that the important correlates of overweight/obesity were urban residence, father and/or mother involved in service/business, English medium school and child playing outdoor games for less than 30 min. INTERPRETATION & CONCLUSION: The magnitude of overweight/obesity among school going children of Wardha city was found to be 4.3 per cent. Family characteristics play important role in predisposing the children to overweight/obesity and hence the interventions need to be directed towards the families.

Effectiveness of weekly supplementation of iron to control anaemia among adolescent girls of Nashik, Maharashtra, India.

A national nutritional anaemia-control programme in India, focusing on supplementation of iron to pregnant women after the first trimester of pregnancy, failed to make an impact. It is prudent to recommend the correction of iron stores before the woman becomes pregnant. 'Efficacy' of weekly supplementation of iron has been proved to improve iron stores in adolescence in many studies abroad and in India. The objective was to study the 'effectiveness' of a weekly iron-supplementation regimen among urban-slum, rural, and tribal girls of Nashik district, Maharashtra, India. A baseline and the mid-term assessments were done using the cluster-sampling techniques. In each stratum, 30 clusters were identified. Twelve and 10 adolescent girls from each cluster were identified in the baseline and mid-term surveys respectively. The haemoglobin estimation was done using the HemoCue system. Data were analyzed using the Epi Info software (version 6.04). The overall prevalence of anaemia came down significantly to 54.3% from 65.3%. The decline was statistically significant (p<0.001) in tribal girls (48.6% from 68.9%) and among rural girls (51.6% from 62.8%). But the decline was not statistically significant among urban slum girls. Similarly, a significant rise in the mean haemoglobin levels was seen among tribal and rural girls. However, it did not increase significantly among urban slum girls. The programme had performed poorly in urban-slum areas, as the mean number of tablets consumed in urban-slum areas was only 5.6+/-3.3, as against 6.7+/-2.6 tablets in tribal girls and 7.2+/-2.2 tablets in rural girls. Considering the biological and operational feasibility and the effectiveness of the intervention, weekly supplementation of iron to adolescent girls should be universally started to correct the iron stores of a woman before she becomes pregnant.

Perceptions and health care seeking about newborn danger signs among mothers in rural Wardha.

OBJECTIVE: To know mothers' knowledge and explore their perceptions about newborn danger signs and health care seeking behaviors. METHODS: A cross-sectional study was undertaken in three of the 27 primary health centres of Wardha district with a population of 88187. Out of 1675 expected mothers, 1160 mothers in the area were interviewed by house-to-house visits. Data was entered and analyzed in SPSS 12.0.1. In order to explore mothers' perception of danger signs and actions taken, a triangulation of formative research methods like chapatti diagram and Focus Group Discussion (FGD) was undertaken. The analysis of free list and pile sort data obtained was undertaken using Anthropac 4.98.1/X software. RESULTS: About 67.2 % mothers knew at least one newborn danger sign. Majority of mothers (87.4%) responded that the sick child should be immediately taken to the doctor but only 41.8% of such sick newborns got treatment either from government hospital (21.8%) or from private hospital (20%) and 46.1% of sick babies received no treatment. As told by mothers, the reasons for not taking actions even in presence of danger signs/symptoms were ignorance of parents, lack of money, faith in supernatural causes, non availability of transport, home remedy, non availability of doctor and absence of responsible person at home. For almost all the danger signs/symptoms supernatural causes were suspected and remedy was sought from traditional faith healer (vaidu) followed by doctor of primary health centre and private doctor. CONCLUSION: The present study found gap between mothers' knowledge and their health seeking behavior for sick newborn and explored their deep perceptions, constraints and various traditional treatments. Comprehensive intervention strategies are required to change behavior of caregivers along with improvement in capacity of Government health care services and National Health Programs to ensure newborn survival in rural area.

Epidemiological correlates of nutritional anemia among children (6-35 months) in rural Wardha, Central India.

BACKGROUND AND OBJECTIVES: Nutritional anemia is associated with impaired performance of a range of mental and physical functions in children, along with increased morbidity. Iron supplementation at a later age may not reverse the adverse effects. National Nutritional Anemia Control Program was launched in India in 1970, but it failed to make any impact. The present study was undertaken to find out prevalence of anemia and its correlates in rural Wardha in children 6-35 months of age. MATERIALS AND METHODS: Seven hundred seventy-two children between 6 months and 35 months of age were studied for anemia by cluster-sampling method. The hemoglobin was estimated in the child by 'Filter paper cyanmethemoglobin method.' Pre-designed and pre-tested questionnaire was used to collect data on socio-demographic and other variables. Data was analyzed by SPSS 12.0.1. RESULTS: Mean hemoglobin level was 98.5+/-12.9 gm/L. Prevalence of anemia was 80.3%. Only 1.3% children had severe anemia (hemoglobin<70 gm/L). The univariate analysis showed that anemia is significantly associated with age of the child, education of mother and father, occupation of father, socioeconomic status, birth order and nutritional status as measured by weight for age. The final model suggested that only educational status of the mother, occupation of the father, birth order and nutritional status of the child were significantly associated with anemia. INTERPRETATION AND CONCLUSION: For short-term impact, appropriate nutritional interventions remain the only operational intervention as only the nutritional status (weight for age) is a modifiable factor. But for long-term sustained impact, policy makers need to focus on improving maternal education and reducing family size.

Newly developed WHO growth standards: implications for demographic surveys and child health programs.

OBJECTIVE: To compare estimates of undernutrition based on the World Health Organization (WHO) Child Growth Standards ('WHO standards') and the National Center for Health Statistics NCHS/ WHO international growth reference ('NCHS reference') and discuss implications for child health programs and reporting of prevalence of underweight in demographic surveys. METHODS: A cross-sectional study was carried out in 20 Anganwadi centers under Primary Health Centre, Anji. Total of 1491 under-six year children attending the Anganwadi centers were studied for nutritional status. Nutritional status was analyzed by NCHS standards by using EPI_INFO 6.04 software package and also by newly introduced WHO Child Growth Standards by Anthro 2005 software package. Chi-square test was used to compare the results. RESULTS: According to WHO standards, the prevalence of underweight and severe underweight for children 0-6 year was 47.4% and 16.9% respectively. By NCHS reference, the overall prevalence of underweight and severe underweight for children 0-6 years was 53% and 15% respectively. The prevalence of underweight as assessed by WHO standards was significantly lower when compared with the assessment based on NCHS reference (p< 0.01). But, WHO standards gave higher prevalence of severe underweight than NCHS reference though the difference was not statistically significant (p>0.05). CONCLUSION: In the light of newly developed WHO Child growth standards, all the nutrition-related indicators in demographic surveys like NFHS should now be derived using the WHO standards. There is need to reanalyze NFHS - I and NFHS - II data using WHO standards and findings should be made available so that it becomes comparable and trends over the years can be studied.

A comparison of HIV/AIDS awareness between self-help group leaders and other women in the villages of Primary Health Centre, Anji.

A Cross-sectional study was undertaken to compare the level of awareness about HIV/AIDS between women's self-help group leaders and other women in the villages of primary health centre area, Anji. 82 leaders of women's self-help groups i.e. president and secretary of each 41 women's self-help groups promoted by Kasturba Rural Health Training Centre, Anji in area Primary Health Centre, Anji and 98 women other than leaders of self-help group from the same villages were selected for the study. Both the groups were in reproductive age groups. The leaders of Self-help groups had better level of education and awareness about HIV/AIDS than other women in the village. Considering the significant high level of awareness regarding HIV/AIDS, the leaders of women's self-help groups could act as potential resource persons for the delivery of health education about prevention of HIV/AIDS to other women in the villages of Primary Health Centre, Anji.

The effect of community-based health education intervention on management of menstrual hygiene among rural Indian adolescent girls.

OBJECTIVE: To study the effect of a community-based health education intervention on awareness and behaviour change of rural adolescent girls regarding their management of menstrual hygiene. MATERIALS AND METHODS: A participatory-action study was undertaken in Primary Health Centres in 23 villages in Anji, in the Wardha district of Maharashtra state. Study subjects were unmarried rural adolescent girls (12-19 years). We conducted a needs assessment for health messages with this target audience, using a triangulated research design of quantitative (survey) and qualitative (focus group discussions) methods. Program for Appropriate Technology for Health (PATH) guidelines were used to develop a pre-tested, handmade flip book containing needs-based key messages about the management of menstrual hygiene. The messages were delivered at monthly meetings of village-based groups of adolescent girls, called Kishori Panchayat. After 3 years, the effect of the messages was assessed using a combination of quantitative (survey) and qualitative (trend analysis) methods. RESULTS: After 3 years, significantly more adolescent girls (55%) were aware of menstruation before its initiation compared with baseline (35%). The practice of using ready-made pads increased significantly from 5% to 25% and reuse of cloth declined from 85% to 57%. The trend analysis showed that adolescent girls perceived a positive change in their behaviour and level of awareness. CONCLUSION: The present community health education intervention strategy could bring significant changes in the awareness and behaviour of rural adolescent girls regarding management of their menstrual hygiene.

Relationship of anthropometric indicators with blood pressure levels in rural Wardha.

BACKGROUND AND OBJECTIVES: Overweight and obesity are important determinants of health leading to adverse metabolic changes, including increase in blood pressure. Being overweight is associated with two- to six-fold increase in the risk of developing hypertension. Studies in urban Indian population showed strong relationship between different anthropometric indicators and blood pressure levels. Surprisingly, little is known about these relationships in rural population of India. The present study was carried out to examine the relationship between different anthropometric indicators and blood pressure levels in rural population of Wardha district in central India. METHODS: This cross-sectional study was carried out in the areas of two Rural Health Training Centres (RHTC) of Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram; namely Bhidi and Anji through house-to-house visits. Two stage sampling method (30 cluster followed by systematic random) was used to reach the respondents' households. Partial correlation coefficients were used for continuous variables. Linear regression analysis was used to assess the influence of different anthropometric indicators on the systolic and diastolic blood pressure. ROC analysis was done to identify optimal cut-off values while likelihood ratios were calculated to identify the odds of having hypertension in comparison to those with lower values of anthropometric indicators. RESULTS: The mean systolic blood pressures were 120.2 and 118.4 mmHg while the mean diastolic blood pressures were 77.7 and 76.3 mmHg in men and women respectively. There was a significant positive correlation of obesity indicators with both systolic and diastolic blood pressure. For SBP, the correlation coefficient was 0.23 with BMI, 0.23 with waist circumference, 0.11 with WHR and 0.22 with WHtR. For DBP, it was 0.13 with BMI, 0.12 with WC, 0.04 with WHR and 0.11 with WHtR. Step-wise linear regression suggested that BMI and WC were important predictors of hypertension. The suggested cut-off values for BMI were 21.7 for men and 21.2 for women; for waist circumference, the cut-offs were 72.5 for men and 65.5 for women. INTERPRETATION AND CONCLUSION: BMI and WC had strong correlation with systolic and diastolic blood pressure. The suggested lower cut-off values of the anthropometric indicators will cover maximum of the population with higher odds of having hypertension and may help in reducing the mean population blood pressure levels.

Nutritional status of adolescents in rural Wardha.

OBJECTIVE: The objective of the study was to study the nutritional status of adolescents in rural area of Wardha. METHODS: The cross-sectional study was carried out in two PHC areas of Wardha district with two stage sampling method. In the first stage, cluster-sampling method was used to identify 30-clusters in each Rural Health Training Centre (RHTC) area separately. In the second stage, systematic random sampling method was used to identify 10 households per cluster. All adolescents in the household thus selected were included in the study. The mean body mass index (BMI) for age was used for classifying the nutritional status with CDC 2000 reference. Data thus generated was entered and analyzed using epi_info 2000. RESULTS: Overall, 53.8% of the adolescents were thin, 44% were normal and 2.2% were overweight. The mean body mass index (BMI) for boys and girls was 16.88 and 15.54 respectively. The difference was statistically significant (p<0.05). The prevalence of thinness was significantly (p<0.05) higher in early adolescence, girls, lower education (<8th standard) and lower economic status. CONCLUSION: Majority (53.8%) of the adolescents in this study area are thin and only 2.2% were overweight.

Safety, tolerability, efficacy and plasma concentrations of diethylcarbamazine and albendazole co-administration in a field study in an area endemic for lymphatic filariasis in India.

Filariasis control programmes are moving towards a strategy of repeated single-dose mass treatment of endemic populations. Using a combination, such as albendazole (ALB) to diethylcarbamazine (DEC) gives both macrofilaricidal and anti-helmintic activity. However, the safety of the combination versus DEC alone should be established in field studies in large populations prior to incorporation into national programmes. The present study compared the safety, tolerability, and efficacy of single doses of DEC 6 mg/kg + ALB placebo with DEC 6 mg/kg + ALB 400 mg in populations living in two filariasis endemic villages in the district of Wardha in western India. The study was double blind, parallel group, and randomized. Safety and tolerability study were studied in males and females older than 5 years. Safety was assessed by monitoring if adverse events (AEs) over 5 days affected daily acivities. Subjects in the 2 treatment groups experienced insignificantly different effects on daily activities and the combination was shown to be safe. Efficacy was evaluated by microfilaraemia (Mf), immunochromatographic test (ICT) and ultrasonography (USG) at 0, 3, 6, and 12 months of follow up. The efficacy study enrolled 103 male patients (aged 18-50 years) in microfilariae positive, clinical disease and asymptomatic, amicrofilaremic groups. There was no significant difference in efficacy between groups at 12 months. Within the Mf positive group, significant differences were seen in microfilaraemia (P < 0.001) with both treatments, and in USG (P < 0.001 and P < 0.004 respectively), at 12 months. The present field study has shown the combination of DEC + ALB to be as safe as the single drug DEC and thus the combination can be put in use in the national filariasis control programmes. Both drugs were adequately absorbed. The study at present does not provide evidence for the greater efficacy of the combination at 12 months follow up. While the safety of the combination has been ascertained, the incorporation or otherwise of ALB into national programmes for greater efficacy must await results of studies with longer follow up.