Measles elimination by 2020 - Current status and future challenges in India.

India, as a member of the World Health Organization South-East Asia Region, had committed to measles elimination by 2020. Efforts to increase immunization coverage, special immunization activities, and case-based surveillance have been implemented rigorously over the last 7 years, but India has not been able to eliminate measles. Multiple factors led to this namely inadequate vaccination coverage and COVID pandemic and others. The pandemic added its contribution in disruption of vaccine delivery services under Intensified Mission Indradhanush preventing the achievement of the elimination target, in stipulated time. India may need to think beyond strengthening the routine immunization activities and increasing the geographical coverage under Intensified Mission Indradhanush. Promising the future in the measles vaccine delivery system in the form of Measles-Micro-Array-Patches is seen on the horizon may prove to be a game-changer for targeting measles elimination, in the current decade.

Mid-Upper-Arm-Circumference as a Growth Parameter and its Correlation with Body Mass Index and Heights in Ashram School Students in Nashik District in Maharashtra, India.

BACKGROUND: Under nutrition is a major problem among Indian schoolchildren. Yet, routine height and weight measurements in schools are nor used for growth monitoring. This study attempts to evaluate mid-upper-arm-circumference (MUAC) as a quick assessment tool against body mass index (BMI) in schoolchildren. OBJECTIVE: The objective of the study was to evaluate MUAC against BMI, height, and average skin fold thickness (ASFT) parameters and to estimate MUAC values across age, sex, and social categories. SUBJECTS AND METHODS: The study was conducted in 2017-2018 in four randomly selected Ashram schools and an urban school in Nashik district. Girls (1187) and boys (1083) from age 6-18 were included, and height, weight, skinfold thickness, and MUAC were measured. MUAC was done on the left arm with Shakir's tape and tailor's tape (for MUAC >25 cm). Epi Info 7.1 and Excel were used for the data analysis. RESULTS: MUAC had a consistently high correlation with BMI at all ages for boys (r = 0.8786, P < 0.0001) and girls (r = 0.8586, P < 0.0001). ASFT too was strongly correlated with MUAC (r = 0.5945, P < 0.0001). MUAC had strong but nonlinear correlation with heights in girls (r = 0.7751, P < 0.0001) and boys (r = 0.8267, P < 0.0001). MUAC was higher for girls than boys at all ages. MUAC values for scheduled tribe (ST) children were highly significantly lower than non-ST students. CONCLUSION: MUAC is a good and quick proxy tool for BMI and can serve as a sensitive nutritional indicator for school ages across socioeconomic categories. However, it is necessary to construct age-wise cutoff points and bandwidths using multicentric studies across income quintiles.

Ethnotribal Growth Differences among Schoolchildren in a Northwestern Maharashtra District: An Analytical Cross-Sectional Study.

CONTEXT: In Ashram schools, scheduled tribes (ST) children from age 6 to 17 years belonging to various ethnic groups stay under common living and dietary provisions. However, there are scant reports on ethnotribal height differences. AIMS: The aims of the study are to (a) estimate height differences between schoolchildren of three major local STs, (b) compare heights and average skinfold thickness (SFT) of ST with non-ST and urban schoolchildren, and (c) compare median heights and weights of ST and non-ST schoolchildren with the Indian Academy of Pediatrics standards. SETTINGS AND DESIGN: Four Ashram schools and one urban school in Northwest Maharashtra. SUBJECTS AND METHODS: All children from age 6 to 17 years were included for height, weight, and mid-arm circumference (n = 2106). Data were processed with Excel and Epi info software for quantitative comparisons. STATISTICAL ANALYSIS USED: Quantitative methods including ANOVA were used for statistical comparison of heights. RESULTS: There were no differences among heights between ST students (ANOVA P > 0.05). However, there were significant differences between heights of boys and girls between ST and non-ST students across age groups (ANOVA P < 0.0001). ST boys and girls were mostly below 3rd or 10th percentile of IAP height and weight charts while non-ST children were between 25th and 50th percentiles. The average SFT values for prepubertal age groups were significantly lower in ST schoolchildren. CONCLUSIONS: ST students showed a significant growth disadvantage against general and other backward classes categories, although no intertribal anthropometry differences were observed.

Protein calorie intakes and growth profiles in ashram school students in Nashik district in Maharashtra.

BACKGROUND: Tribal ashram schools provide accommodation, food, and other services from 1st to 12th standards to children from marginalized sections of the society. Nutrition and growth are important aspects of this age group. OBJECTIVES: This study aims to estimate average macronutrient intakes in private and public ashram schools and to compare the growth of tribal with urban children and national standards. METHODS: This is a cross-sectional cluster-based study in Nashik district of Maharashtra in ashram schools with an urban day school for comparison. The study was conducted from November 2017 to February 2018. The study includes 1510 students in four rural ashram schools and 322 urban school day scholars. Daily food amounts used by the school kitchens were analyzed. Height and weight of students were recorded with standard methods. Excel was used to estimate nutrient intakes and Epi Info for analysis of growth parameters. RESULTS: Protein intakes were 76.5 g/student (2.9-3.1 g/kg body weight), with staples contributing 42%-50% and legumes and pulses contributing 22%-25%. Energy intakes were 2519 kcal/student (100-120 kcal/kg body weight) with oils contributing 13%. Boys ate 1.5-2 times than girls going by average intake of Chapattis. Height and weight of students at entry and exit age, respectively, of 7 and 15 years were significantly lower than urban students, ICMR and IAP standards. However, entry-level stunting had reduced by 15 years by 40%-50% in girls and boys. CONCLUSIONS: Macronutrient intakes in the ashram schoolchildren were sufficient, but growth gap persisted till adolescence. Protein quality in private schools needs improvement.