Anthropometric change in lactating mothers: a longitudinal study.

PIP: A longitudinal study was undertaken to observe the weight loss experienced by mothers during active lactation, and to assess the impact of breastfeeding on other anthropometric parameters. About 88 mothers, who had passed through a normal perinatal experience, were included in the study. The mothers were followed-up for a period of 6 months after delivery and were subjected to anthropometric measurements. The findings revealed fluctuations in three nutritional parameters: 1) body weight; 2) mid-arm circumference; 3) skinfold thickness at three body sites. Fluctuations in mid arm circumference and infrascapular sum fold thicknesses were minimal and insignificant, while triceps skin fold thickness showed significant decline with advancing lactation. In conclusion, breastfeeding imposes nutritional stress on lactating mothers and results to selective mobilization of nutrients from within the maternal body tissue.^ieng

Efficiency of various anthropometric measurements in determining low birth weight babies.

PIP: Anthropometric measurements were applied to 119 healthy, singleton, full-term infants born during June 1993-January 1994 in the obstetric ward of the community medicine department of SKIMS in Srinagar, Kashmir, India. Researchers aimed to identify an alternative simple and accurate measurement to birth weight for field conditions. The anthropometric measurements included weight, crown-heel length, mid-arm circumference, head circumference, thigh circumference, calf circumference, and chest circumference. The researchers applied their findings to a separate cohort of 250 newborns at the child health clinic of the same department to determine specificity, sensitivity, and predictive values. The mean birth weight was 2.8 kg. Mean mid-arm, calf, thigh, chest, and head circumferences were 10.45, 10.15, 015.73, 32.18, and 34.96 cm, respectively. Mean crown-heel length was 49.78 cm. Birth weight had a very significant correlation with calf circumference (r = 0.87), thigh circumference (r = 0.7), mid-arm circumference (r = 0.7), and chest circumference (r = 0.40). Calf circumference accounted for 75.69% of the total variance. Thigh circumference and mid-arm circumference accounted for 49% and 46.24%, respectively. The critical level value of birth weight to 2.5 kg was 9.78 cm for calf circumference, 14.8 cm for thigh circumference, 9.94 cm for mid-arm circumference, 32.23 cm for chest circumference, 34.72 cm for head circumference, and 49.58 cm for chest circumference. Calf circumference had the highest sensitivity and specificity (93.55% and 98.92%, respectively), compared to 77.42% and 92.63%, respectively, for thigh circumference and 64.52% and 93.55%, respectively, for mid-arm circumference. The likelihood of missing low birth weight infants was lowest for calf circumference (7-8% vs. 22-23% for thigh circumference and 30-35% for mid-arm circumference). These findings show that calf circumference is the most effective alternative anthropometric measurement to birth weight for identifying low birth weight newborns.^ieng

Epidemiological trend in the distribution of cancer in Kashmir Valley.

STUDY OBJECTIVE: To study the distribution of cancers, with particular emphasis on oesophageal cancer. DESIGN: Patient records for 1986-88 in the Department of Oncology, SK Institute of Medical Sciences, were searched to identify cases and types of cancer. SETTING: The Valley of Kashmir, India. SUBJECTS: Patients with cancer resident in the valley. MAIN RESULTS: The seven most common types of cancer in men were those of the oesophagus, lungs, stomach, skin, upper respiratory tract, and urinary tract. In women the most common types of cancer were those affecting the oesophagus, breast, cervix, stomach, skin, colon/rectum, and lungs. Cancer of the oesophagus was the most frequent type in both sexes, accounting for 42.9% of all types of cancer in the valley. This distribution of cancer types is strikingly different from that in the rest of India where oropharyngeal cancer is the most common form. Again, contrary to the trend in India as a whole, cervical cancer is not a leading type of cancer in the valley and is less frequent even than cancer of the breast in the women. CONCLUSIONS: The preponderance of oesophageal cancer was attributable to the local practice of drinking boiling hot salt tea. Universal male circumcision in the majority community in the valley was considered to be partly responsible for low cervical cancer frequency.

The role of health education in promoting acceptance of an ARI control project.

PIP: In India, acute respiratory infection (ARI) is responsible for 20% of all annual deaths of children under 5 years old (600,000-800,000 deaths). Children have from 3 to 5 ARI episodes a year. Thus, it is important to inform communities about ARI prevention and control. Health education activities of ARI control projects should convey knowledge, improve attitudes, and encourage health-inducing practices in such a way that a community should voluntarily assume responsibility to actively prevent and control ARI in children. These activities should empower communities to identify and report ARI in children, provide home care and supportive therapy, use the UIP cover to protect all infants, promote breast feeding, reduce indoor air pollution, and cooperate with health workers in ARI control as well as use oral rehydration therapy as soon as diarrhea starts. To design an effective health education program, planners need to interview a sample of the local population to learn the people's knowledge, attitudes, and practices toward ARI in children. Any ARI health education program should also include UIP, oral rehydration therapy, maternal and child health, and family welfare. The health educator can use 1 or more educational methods. Discussion is a 2-way process of exchanging ideas and should raise questions about ARI control, provide answers, and yield solutions. If an educator chooses the demonstration method, he or she should take the target audience to a health facility so the staff can demonstrate the clinical signs of a child with ARI, including the fast breathing, chest indrawing, cyanosis, wheezing, and stridor. The display method involves audiovisual aids, such as posters, puppet shows, and films. The health educator can use any of these methods when dealing with individuals, groups, or crowds. He or she must attune the approach and materials to the values of the community and present them so the individual can readily adapt the messages into his or her way of living.^ieng

Who is responsible for artificial feeding? An evaluation.

PIP: Artificial feeding has been found to be on the increases in India. In this research study, 320 infants who were artificially fed before 6 months of age and attended the child health clinic of the Department of Community Medicine, SKIMS Srinagar, between March and November, 1991, were surveyed. Information was obtained from mothers on personnel who advised artificial feeding by type of medical care unit. The sample of mothers included 59.3% who were illiterate. 52.25% of all mothers were housewives and 43.75% had a middle socioeconomic status, while 31.5% had a low socioeconomic status. 53.75% of the artificially fed babies were born at a hospital, of which 2.5% received intensive care. 46.25% were born at home. 76.87% were first or second births. 3.55% of babies were completely artificially fed from birth; at 3 months, 18.76% were exclusively artificially fed. Mixed feeding of breast and artificial milk was 10.76% at birth and 25.97% by 3 months and 42.10% by 6 months. 51.25% of mothers were advised by pediatricians to use artificial feeding; 24.65% of mothers were advised by general practitioners and 10.31% by paramedical. 40% were advised at private clinics and 26.25% in hospital wards at the time of discharge. 18.12% were advised in outpatient departments, and 15.62% at other health centers, such as immunization clinics, health clinics, or nutrition education centers. 66.25% received recommendations to use tinned milk (Lactogen/Milk-care) and 30%, for cows milk. 45.31% of mothers received advice from pediatricians about tinned milk and 5.93% about cow's milk. 5.93% of infants received advice from general practitioners about tinned milk and 5.31 about cow's milk. Over 80% of mothers were given instructions on the amount of dilution and frequency of feeding. 60.93% of mothers received information on feeding equipment and 56.15% on sterilization of feeding equipment. Only 59.37% and 65.37% were able to understand instructions on equipment and sterilization, respectively. The reasons given by mothers for using artificial feeding were low milk output (49.68%), nonacceptance of breast milk by the baby (22.50%), working mothers (12.18%), and baby illness (8.12%). Mothers attributed infections, colic, and regurgitation to artificial feedings. Clearly, the professional community is not complying with the professional code promoted by the World Health Assembly and Indian legislation in 1986 on not recommending milk formula.^ieng

A study on the impact of maternal knowledge and practice on the nutritional status of infants.

PIP: In India, health workers interviewed 123 mothers of infants attending the child health clinic of the S.K. Institute of Medical Sciences in Srinagar to determine whether maternal knowledge and practice were associated with the nutritional status of the infants. 28 children were considered to be well nourished, while the remaining 95 children were determined to be in various degrees of malnutrition. Mothers whose infants were well nourished had a higher level of breast feeding knowledge than did those whose infants were moderate to severely malnourished (score, 27.13 vs. 16.01-18.75; p .0001). None of the mothers of malnourished infants had an excellent score on breast feeding practices. Differences in the mean score values for breast feeding practices between all consecutive grades of nutrition were significant (20.22 for excellent score, 16.85, 15.53, and 14.18 for grades I, II, and III, respectively; p .001). The only mothers who had an excellent score for infant weaning awareness were 3 mothers whose infants had an excellent nutritional status. A significant difference in mean score values for knowledge of infant weaning between mothers of well nourished infants and grade I malnourished infants (26 vs. 17.19; p .001) as well as between those of grade II malnourished infants and grade III malnourished infants (17.06 vs. 13.64; p .01) were significant. Little difference in infant nutritional status existed between mothers who scored fair and those who scored poor, but, among mothers of well nourished infants, those who scored well were more likely to be have infants of good nutritional status than those who did not score well (47.05% v. 19.56% and 18.33%; p .001). These findings show a decreasing trend between awareness and practice of breast feeding/infant weaning, suggesting that further improvement of health education is needed to reduce the lag between breast feeding awareness and practice.^ieng

An epidemiological approach to the understanding and control of acute respiratory infections in Indian children.

PIP: Epidemiology is emerging as a promising tool for understanding and interpreting diseases in all dimensions and identifying levels of intervention for their control or eradication. Coupled with the discipline of health administration and management, epidemiology can offer viable and pragmatic solutions for tackling disease problems. Eradication of small pox in the recent past and the formulation of a strategy for the control of the modern epidemic of AIDS are 2 best known examples. An epidemiological approach to acute respiratory tract infection (ARI) in children can improve the understanding of the disease and help to prepare the ground for effective control. The principal areas of epidemiology are natural history, intervention strategy, and epidemiological inquiry. The principal viruses that have been identified to lead to ARI infection on the basis of systematic studies are rhinoviruses (100 different serotypes), parainfluenza viruses (several serotypes), respiratory syncytial virus, adenoviruses (about 8 important serotypes in children), enteroviruses (ECHO and Coxsackie with more than 70 serotypes), herpes simplex virus, measles virus, and Epstein-Barr virus. Based on the natural history of ARI, the scope of application of the 5 levels of intervention may be discussed individually as health promotion, specific protection, early diagnosis and prompt treatment, disability limitation, rehabilitation, and epidemiological inquiry. Epidemiological techniques may contribute substantially to the understanding and management of ARI control by: a) defining the ARI problem and its magnitude and behavior in relation to time, place, and person; b) identifying the epidemiological correlates of ARI in terms of agent, host, and environment, and their impact on morbidity and mortality in children; c) introducing epidemiological surveillance and monitoring techniques for effective supervision of intervention activities; and d) conducting longitudinal observational studies to evaluate efficiency and effectiveness of various intervention alternatives for ARI control.^ieng

Low birth weight: an outcome of poor socio-obstetric interaction.

PIP: Factors contributing to low birth weight (LBW) include poverty, ignorance, and inability to use health care services. Early marriage and low family income lead to poor maternal nutrition reserves, which lead to reduced fetal nutrition. Poor maternal nutrition is also the result of ignorance, short birth intervals, multi-parity, and lack of prenatal care. Both heavy manual labor and smoking contribute to placental ischemia, which, along with reduced fetal nutrition, leads to intrauterine growth retardation (IUGR). In developing countries, IUGR accounts for over 66% of all LBW neonates. About 7 million Indian babies annually are LBW. This study examined the incidence of LBW among 178 mothers delivering single births at the maternity hospital associated with the Department of Community Medicine of SKIMS, Srinagar, Kashmir, India, during 1989-90. 26.40% (47) of the 178 births were LBW (2500 g). Among 71 first-borns, marriage age was found to be statistically significantly associated with LBW. 31.82% of mothers younger than 20 years had LBW babies, compared to only 6.12% of mothers older than 20 years. The impact ratio, which measured excess LBW, was 4.20. Birth interval was statistically significantly associated with LBW outcome. 55.81% of women with a birth interval of less than 18 months had LBW babies, compared to 20.31% of mothers with longer birth intervals. The impact ratio was 1.75. Gravidity was also statistically associated with LBW babies. 34.58% of multigravida mothers had LBW babies, compared to 14.08% of primigravidae. The impact ratio was 1.46. Presence of prenatal care was statistically associated; the impact ratio was 1.42. 31.30% of illiterate women had LBW babies, compared to only 17.46% among literate women, which indicated significant associations with LBW. Other significant factors were manual labor, maternal smoking, and monthly family income. Reduction of LBW by 10-30% nationally by the year 2000 will be difficult and best accomplished by a high risk approach supplemented by health and nutrition education.^ieng

Maximum thigh circumference as an indicator of birth weight.

PIP: This study had the objective of estimating the strength of association between birth weight and maximum thigh circumference (MTC), sole length, and mid arm circumference (MAC), and on the basis of positive correlation, to identify the ideal anthropometric measurement that can give a reasonable estimate of the birth weight, especially where weight measurement facilities are nonexistent. A random sample of 75 singleton normal neonates was studied who had normal birth in the maternity hospital of the S.K. Institute of Medical Sciences, Srinagar, Kashmir, India, in the first half of 1990. The anthropometric measurements recorded within 24 hours of birth were birth weight, MTC, MAC, and sole length using the left arm and foot. The mean +or- SEM values derived were 3.20 +or- 0.05 kg for weight, 14.68 +or- 0.14 cm for MTC, 7.71 +or- 0.05 cm for sole length, and 9.55 +or- 0.09 cm for MAC. The correlation coefficients of weight were +0.50 for MTC, +0.16 for sole length, and +0.21 for MAC. Only MTC showed a correlation coefficient value of high significance (p .001). MTC was significantly interrelated and interdependent on birth weight inasmuch as MTC can safely be used as an indicator of birth weight in all situations. On the basis of this observation, a regression equation was developed exhibiting the form: Y = (1.48) x +9.4944, where Y represented the MTC. The corresponding values of MTC for birth weight of 2.5 kg and 2.0 kg obtained were 13.644 cm and 12.904 cm, respectively. The lower values constitute the dividing line for low birth weight babies by Indian standards. The comparable values reported by Sharma (1989) were 14.5 cm and 13.5 cm, respectively, presumably due to higher altitude in Kashmir associated with low birth weight. A graphic representation indicating the critical zone was developed for ready reference of paramedical staff in rural areas where weighing facilities for the newborns are not available. MTC, sole length, and MAC are all positively correlated with birth weight.^ieng

Fertility profile of a rural community of Kashmir in longitudinal association with maternal age.

PIP: The study was conducted among 264 rural women past menopause who had never used contraception and who attended Hajin Health Block attached to the Community Medicine Department of the SKIMS Srinigar, Kashmir Valley, India. Retrospective reports of pregnancy histories and outcomes were collected. 1405 live births occurred: 654 (46.55%) were male and 751 (53.45%) were female. The sex ratio at birth was 1148 females per 1000 males. 39.29% of births occurred to women 20-25 years old. By the age of 35 years and higher, only 5.90% of births occurred. 1217 children survived: 578 male and 639 female. The survival ratio was 1105 females to 1000 males. Child survival was 92.20% among women under 20 years old and only 57.83% among women 35 years and older. Child survival decreased with increasing age; maternal age and child survival were found to be highly significantly correlated for male children and for both sexes. Average number of children during the entire reproductive period was 5.32 children: 2.48 male and 2.84 females. 84.77% of children were born by the maternal age of 30 years. An average of 4.62 children survived per woman: 2.19 male and 2.43 female. 87.23% of infants born to mothers under 30 years old survived. 1.41 children were born to women by the age of 20 years; 1.30 children survived, which represented 26.50% of the average family size. The gross reproduction rate in this study was 2.84, and the net reproduction rate was 2.43. An increase in marriage age to 20 years would reduce fertility by 26.50%. The most cost effective approach to family planning would concentrate on women 20-25 years old, the most fertile years of the reproductive period. Permanent methods could be introduced among women 25-30 years old, because 85% of family size would have already been achieved.^ieng