Making healthy baby contests more objective.

STUDY OBJECTIVES: To assess the objectivity of the criteria chosen to judge a healthy baby contest. DESIGN: Cross-sectional study design. SETTING: Urban Health Centre, Pune. PARTICIPANTS: Of the 998 children attending twelve anganwadis, who were screened preliminarily, 32 were chosen for the healthy baby contest. The contest was assessed using a specified scoring system in which due weightage was given to personal hygiene, growth, development, immunisation status and mother's knowledge about nutrition and vaccination. RESULTS: There was a significant intraobserver correlation (rs = 0.85, p < 0.05) and intraobserver correlation (rs = 0.92, p < 0.05). The scores were age independent. CONCLUSIONS: The criteria chosen were objective in nature. The objectivity of the criteria can make the assessment of the participants more unbiased, quick and easy. The results of the contests can be explained more easily and are more readily accepted. Thus, the healthy baby contests can be made more successful.

Monitoring of presterile disposable syringes and needles marketed in Pune.

Out of hundred syringes and hundred needles (both presterile, disposable) tested, 41 syringes (41%) and 6 needles (6%) showed aerobic growth. Forty of the above syringes were tested simultaneously for fungi and anaerobes. Fungi isolated were 5.7% and no anaerobe was grown. Fifty glass syringes and fifty needles autoclaved in the departmental laboratory served as controls and did not show any growth. As a preventive measure, proper disposal of used disposable material should be made mandatory so that it does not find its way into the market. Or has the time come to switch back to the former conventional practice of using in house autoclaved articles?

Disaster management knowledge attitude & practice of urban slum dwellers.

A KAP study was done in the area of Disaster Management in urban slums of Pune City. The Youth Organisations' members and the members of Mahila Mandals were the study subjects. It was found that there was marked improvement in the knowledge and attitudes of these subjects towards disasters. It is recommended that members of Mahila Mandals and members of Youth Organisations can act as 'frontline workers' in the situations of disasters after imparting some training in disaster management.

Retrospective prediction of birth weight by growth velocity curves during neonatal period.

In this prospective study, birth weight of 304 babies born at Kamla Nehru Hospital Pune during study period was recorded. From these 304 babies, babies with birth weight above 2000 grams were selected (260 babies) to prepare growth velocity curves. Daily weight of these 260 babies was recorded for 30 days. The mean birth weight of study population was 2742.5 grams. Among the daily weight recorded babies, all the babies lost weight ranging from 92 to 218 grams (mean 121 grams) after birth. The weight loss continued upto 5 days. Days required to gain weight equal to birth weight ranged from 5 to 13 days. Total weight gain observed in 30 days was 734.7 grams. Predictive value of these curves was tested in 49 infants. Deviation upto 50 grams of predicted birth weight from actual birth weight was observed in 90% of babies on day-2, 79% on day-4, 65% on day-8 and 39% on day-30.

Risk prediction charts for low birth weight.

OBJECTIVE: To develop intrauterine fetal growth monitoring charts for prediction of babies with low birth weight (LBW). DESIGN: Prospective study. SETTING: Antenastal clinic of a government and a private hospital. SUBJECTS: Two hundred and eighty one healthy pregnant women were enrolled before 28 weeks of pregnancy. MAIN OUTCOME MEASURES: The uterine fundal height and abdominal girth were recorded fortnightly. Following delivery, the neonatal birth weight was correlated with these measurements. RESULTS: Graphs were plotted for the mean fundal height and abdominal girth in relation to gestational age for neonatal weight categories of 2000 g, 2500 g and 3000 +/- 200 g. Measurement of the fundal height and abdominal girth predicted the neonatal weight category with a sensitivity of 87.5%, specificity of 90% and positive predictive value of 77.8%. CONCLUSIONS: The uterine fundal height and abdominal girth, when related to the gestational age, can accurately predict the neonatal birth weight category. The charts prepared in this study can help in prediction of LBW babies and allow appropriate intervention to be undertaken in the antenatal period at grass root level.

Community-based projects in rural internships: an alternative approach.

Supervision of medical interns posted to various primary health centres and rural health training centres by specialists in preventive and social medicine and other clinical disciplines is becoming less and less effective for a number of unavoidable reasons. Because of lack of proper and timely guidance, interns feel that during the 6-month rural internship they do not get enough experience of rural life. In order to provide them with learning experiences in community medicine and orient them in the social dynamics of the community, a new approach involving interns in small community-based projects, probably for the first time, was tried on a pilot basis at the Rural Health Training Centre (RHTC), Sirur, a field practice area of B.J. Medical College, Pune, Maharashtra, India. Interns working at RHTC Sirur completed these community-based projects successfully. Identification of problems, study design analysis and drawing conclusions, based on observation, were all undertaken by the interns under the guidance of the staff of the Department of Preventive and Social Medicine, B.J. Medical College. The opinion poll at the end of the rural internship revealed that 76% of interns considered this experience valuable for improving their knowledge and skills, and 56% though that interaction during these projects was beneficial to the community as well. This experience with community-based projects for interns during their rural posting provides them with an opportunity for interaction with the community.

Epidemiological aspects of school dropouts in children between 7-15 years in rural Maharashtra.

A study on school dropouts from primary and secondary school children was undertaken in September '91 from 16 schools at the headquarters of 8 Primary Health Centres, where 172 school dropouts were identified. A home visit was paid and information about socio-economic and cultural aspects was collected and a psychological screening was undertaken. Although there was no significant difference in overall dropout rates for both sexes, it increased sharply at 11 years of age in girls. The majority of children dropped out due to financial problems or unsatisfactory scholastic performance, and 142 (82.5%) of the 172 children studied were poor performers in one or more function tests. Maximum difficulty was observed in concept formation 87 (50.5%), followed by numerical ability in 78 (45%). Identification of children with learning difficulties and intervention using special educational methods within the framework of existing network of primary and secondary schools in rural areas is suggested.

Indian experience of home based mothers card: ICMR task force study.

To improve the quality of MCH services, a Home Based Mothers Card (HBMC) prepared and recommended by World Health Organization was adapted to Indian situation, and introduced in 1.5 lakh population of rural area covered by 6 participating centres under the aegis of Indian Council of Medical Research. Two thousand four hundred and forty six mothers were given this card and were followed up for a period of 2 years. Only 89.2 percent retrieval of the cards was possible after a period of 18 months. Screening of the population for "at risk" women monitoring and referral could be undertaken with the help of this card. Improved antenatal, and referral services were observed during the study period. The card (HBMC) was acceptable to the mothers as well as to the health workers, as a tool for improving the quality and coverage of MCH services being rendered at the Primary Health Centre.

PIP: Health workers at 6 primary health centers in different areas of India introduced the home-based mothers card (HBMC) to 2446 pregnant and mostly illiterate women in November 1984-October 1985 and followed them for 2 years to evaluate the acceptability and feasibility of the HBMC among rural women. Overall retrieval of the HBMCs after 18 months was 89.2%. 66.9% had at least 1 maternal risk factor. The most common risk factors were previous abortions (7.8%), neonatal deaths (5.9%), and fetal deaths (5%). The risk factors associated with the highest perinatal mortality rates were eclampsia (133.3) and fetal deaths (118.2). The researchers learned that they needed to revise the criteria for identifying at-risk mothers by using risk factors associated with the higher risk of perinatal mortality. Women with 3-4 risk factors were more likely to experience perinatal mortality than those with 1-2 risk factors (39.7 and 56.5 vs. 122.5 and 105). Health workers should refer women at highest risk (3-4 risk factors) to a health care facility for delivery. Of the 66.9% at-risk mothers, only 10% experienced risk factors during delivery. The risk factors during delivery were associated with a high relative risk (RR) of perinatal death, e.g., RRs ranged from 1.8 to 4.6. Prenatal care can detect the 2 delivery risk factors with the highest perinatal mortality (multiple pregnancy and abnormal presentation). Health workers should also refer mothers with these risk factors to a health care facility. 78% of at-risk mothers who had been referred to a health facility did indeed go for referral care. Health workers at the centers found the HBMC to be helpful, but it would be more so if it were to include infant health. Anganwadi workers would be more accepting of the card if it had pictorial illustrations.

Risk of teen-age pregnancy in a rural community of India.

PIP: In India, there has been a declining trend in teenage pregnancy between 1977-79 and 1981-84. Teenage pregnancy tends to occur within marriages, often arranged by parents, and few pregnancies occur among unmarried teenagers. There are nevertheless concerns about the higher rates of nutritional and obstetric problems associated with adolescent pregnancy and the ignorance and immaturity which can result in higher morbidity and mortality among mothers and babies. The change to a minimum age of 18 years for marriage has been suggested as a means of reducing the number of adolescent pregnancies. The study sample included 5994 deliveries in the rural health district area of Sirur, Maharashtra state, India, between 1981 and 1984. Adolescent pregnancies (to women under 20 years old) amounted to 598 deliveries, or 10% of deliveries. The perinatal mortality rate among teenage first births to high-risk mothers (238) under 18 years old was 67.2 per 100 births; the neonatal mortality rate was 61.4. Risk factors such as prolonged labor, short stature, and anemia were associated more with women under 18 years old. Statistically significant differences were found in the rate of low birth weight infants, stillbirths, and late neonatal deaths among women aged under 18 years compared to other women. The perinatal mortality rate was 7-16 times greater when associated risk factors, except anemia, were present. The neonatal mortality rate was 2.5-18 times greater when associated risk factors, except anemia and edema, were present. Late neonatal mortality was 2.2 times higher among infants with mothers under 18 years old. Recommendations were to provide general health education about risks of teenage pregnancy, strictly enforce the minimum age at marriage law, screen all pregnant mothers for risk factors, and provide at-risk mothers with education about child bearing and rearing and referral to a hospital for safe delivery. Referrals are particularly important among first pregnancies among women under 18 years old with multiple risk factors.^ieng

Maternal mortality in Sirur.

PIP: The research aim was 1) to determine the incidence of maternal mortality in a rural health center area in Sirur, Maharashtra state, India; 2) to determine the relative risk; and 3) to make suggestions about reducing maternal mortality. The data on deliveries was obtained between 1981 and 1984. Medical care at the Rural Training Center was supervised by the Department of Preventive and Social Medicine, the B.J. Medical College in Pune. Deliveries numbered 5994 singleton births over the four years; 5919 births were live births. 15 mothers died: 14 after delivery and 1 predelivery. The maternal mortality rate was 2.5/1000 live births. The maternal causes of death included 9 direct obstetric causes, 3 from postpartum hemorrhage of anemic women, and 3 from puerperal sepsis of anemic women with prolonged labor. 2 deaths were due to eclampsia, and 1 death was unexplained. There were 5 (33.3%) maternal deaths due to indirect causes (3 from hepatitis and 2 from thrombosis). One woman died of undetermined causes. Maternal jaundice during pregnancy was associated with the highest relative risk of maternal death: 106.4. Other relative risk factors were edema, anemia, and prolonged labor. Attributable risk was highest for anemia, followed by jaundice, edema, and maternal age of over 30 years. Maternal mortality at 30 years and older was 3.9/1000 live births. Teenage maternal mortality was 3.3/1000. Maternal mortality among women 20-29 years old was lowest at 2.1/1000. Maternal mortality for women with a parity of 5 or higher was 3.6/1000. Prima gravida women had a maternal mortality rate of 2.9/1000. Parities between 1 and 4 had a maternal mortality rate of 2.3/1000. The lowest maternal mortality was at parity of 3. Only 1 woman who died had received more than 3 prenatal visits. 11 out of 13 women medically examined prenatally were identified with the following risk factors: jaundice, edema, anemia, young or old maternal age, parity, or poor obstetric history. The local hospital death rate was 5.7/1000 and the district referral hospital death rate was 13.9/1000. The home delivery death rate was 1.2/1000. 5 (33.3%) who died had preterm deliveries. 5 infants died perinatally, 5 died neonatally, and 1 died postneonatally. Infant mortality was 6 times greater among mothers who died.^ieng

Infant mortality in rural India: a strategy for reduction.

PIP: A risk-approach-strategy project sponsored by WHO was undertaken in 22 villages of Surur, Pune, by BJ Medical College. All births in the study population of 47,000 were followed, comparing the 3 cohorts born between January 1981 to December 1983. Female village health guides were trained in screening for 11 maternal risk factors, infant risk factors, infant monitoring, and basic health support such as maternal nutrition, rest, breastfeeding and home cleaning, heating, humidifying and infant isolation. There were 123, 97 and 87 infant deaths in the 1981, 1982, and 1983 cohorts, giving infant mortality rats of 91.2, 72.3 and 67.3 respectively. The proportion of neonatal deaths remained at 61 to 62.1% over the period. The most common risk factors seen were illness, low birth weight and growth retardation, often associated with illness. Incidence of low birth weight and prolonged labor both decreased significantly over the duration of the program. Mortality was high among infants with feeding problems and prematurity. 40% of deaths were due to infections, 28% to low birth weight and prematurity, and 9% to birth asphyxia. The lower infant mortality rate achieved here is comparable to urban levels reported in India. These results show that primary health workers are capable of referring and managing risks, and risk management could be applied on a larger scale.^ieng

Risk-approach strategy in neonatal care.

PIP: This study applied a risk-approach strategy involving extra care to at-risk neonates by optimum utilization of existing resources to a cohort of newborns in rural India. Included in the analysis were all births in the study population of 47,000 people in 22 villages in 1981-82. 5 risk factors were identified (low birth weight and small size, preterm birth, feeding problem, illness, and history of prolonged and difficult labor). A management plan was developed for individual risks, and 40 community health workers were trained to implement these plans. During the 2-year study period, 851 newborns (28%) were designated as at-risk and adequate intervention was possible in 412 cases (48%). Neonatal mortality declined from 51.9 to 38.8/1000 live births between 1981 and 1982. The neonatal mortality rate was significantly higher among the infants designated as at-risk and increased with the number of risk factors present simultaneously. Neonatal mortality was highest among infants with feeding problems (439.2/1000) and illness (471.4/1000). 42% of neonatal deaths were related to low birth weight and associated complications; another 20% resulted from neonatal infections and 18% from asphyxia at birth. The neonatal mortality rate for the adequately intervened group (89.8/1000) was significantly lower than that for the group with inadequate intervention (200.5/1000). 92% of neonatal deaths occurred in 28% of the newborns who formed the at-risk groups. It is concluded that this strategy is effective and could be applied in rural areas with similar problems. Continued training of community health workers, greater cooperation with families through health education, and meetings with local leaders and traditional birth attendants are recommended to facilitate identification of at-risk neonates.^ieng