Maternal Health Status in Tribal India: A 5-Year Intervention Program and its Outcome.

INTRODUCTION: There is poor penetration of evidence-based maternal health care provided under national health programs in resource-poor underserved regions. A well-planned locally acceptable community-driven comprehensive health promotion strategy and quality health care delivery mechanism is necessary to improve the situation. OBJECTIVE: The main objective was to find the gaps in the existing system and promote health literacy and health-seeking behavior. METHODOLOGY: 80,000 tribal population living in isolated conflict zone of Bastar district was covered for 5 years between 2012 and 2017. An integrated health-care plan was developed with community leaders, panchayat, and the local government to promote and provide quality evidence-based maternal health care. Available resources were mobilized and health technologies introduced. RESULTS: Regular home visits, point of care diagnostics, identification of high-risk mothers and their timely referral, and behavioral change communication increased the trust of the community. It resulted in higher demand for evidence-based health interventions. The adolescent pregnancy rate (<19 years) reduced to 6.8% (2016) from 13.5% (2012). Hemoglobin level >9 g% (third trimester) improved. Supervised births and high-risk referrals increased from 19.5% (2014) to 58% (2017) and 8.5% (2014) to 13.1% (2017), respectively. Although significant improvement was noted, key indicators continued to remain below rural Bastar (National Family Health Survey-4). CONCLUSION: Promotion of existing good practices, behavior change, health technologies, and evidence-based emergency care improved the maternal health status of the secluded and underserved tribal community, but persistent effort is needed to enable women access the quality maternal health services provided under National Health Mission.

A crucial role for HVEM and BTLA in preventing intestinal inflammation.

The interaction between the tumor necrosis factor (TNF) family member LIGHT and the TNF family receptor herpes virus entry mediator (HVEM) co-stimulates T cells and promotes inflammation. However, HVEM also triggers inhibitory signals by acting as a ligand that binds to B and T lymphocyte attenuator (BTLA), an immunoglobulin super family member. The contribution of HVEM interacting with these two binding partners in inflammatory processes remains unknown. In this study, we investigated the role of HVEM in the development of colitis induced by the transfer of CD4(+)CD45RB(high) T cells into recombination activating gene (Rag)(-/-) mice. Although the absence of HVEM on the donor T cells led to a slight decrease in pathogenesis, surprisingly, the absence of HVEM in the Rag(-/-) recipients led to the opposite effect, a dramatic acceleration of intestinal inflammation. Furthermore, the critical role of HVEM in preventing colitis acceleration mainly involved HVEM expression by radioresistant cells in the Rag(-/-) recipients interacting with BTLA. Our experiments emphasize the antiinflammatory role of HVEM and the importance of HVEM expression by innate immune cells in preventing runaway inflammation in the intestine.

Carboxylated glycans mediate colitis through activation of NF-kappa B.

The role of carbohydrate modifications of glycoproteins in leukocyte trafficking is well established, but less is known concerning how glycans influence pathogenesis of inflammation. We previously identified a carboxylate modification of N-linked glycans that is recognized by S100A8, S100A9, and S100A12. The glycans are expressed on macrophages and dendritic cells of normal colonic lamina propria, and in inflammatory infiltrates in colon tissues from Crohn's disease patients. We assessed the contribution of these glycans to the development of colitis induced by CD4(+)CD45RB(high) T cell transfer to Rag1(-/-) mice. Administration of an anti-carboxylate glycan Ab markedly reduced clinical and histological disease in preventive and early therapeutic protocols. Ab treatment reduced accumulation of CD4(+) T cells in colon. This was accompanied by reduction in inflammatory cells, reduced expression of proinflammatory cytokines and of S100A8, S100A9, and receptor for advanced glycation end products. In vitro, the Ab inhibited expression of LPS-elicited cytokines and induced apoptosis of activated macrophages. It specifically blocked activation of NF-kappaB p65 in lamina propria cells of colitic mice and in activated macrophages. These results indicate that carboxylate-glycan-dependent pathways contribute to the early onset of colitis.

NIK-dependent RelB activation defines a unique signaling pathway for the development of V alpha 14i NKT cells.

A defect in RelB, a member of the Rel/nuclear factor (NF)-kappa B family of transcription factors, affects antigen presenting cells and the formation of lymphoid organs, but its role in T lymphocyte differentiation is not well characterized. Here, we show that RelB deficiency in mice leads to a selective decrease of NKT cells. RelB must be expressed in an irradiation-resistant host cell that can be CD1d negative, indicating that the RelB expressing cell does not contribute directly to the positive selection of CD1d-dependent NKT cells. Like RelB-deficient mice, aly/aly mice with a mutation for the NF-kappa B-inducing kinase (NIK), have reduced NKT cell numbers. An analysis of NK1.1 and CD44 expression on NKT cells in the thymus of aly/aly mice reveals a late block in development. In vitro, we show that NIK is necessary for RelB activation upon triggering of surface receptors. This link between NIK and RelB was further demonstrated in vivo by analyzing RelB+/- x aly/+ compound heterozygous mice. After stimulation with alpha-GalCer, an antigen recognized by NKT cells, these compound heterozygotes had reduced responses compared with either RelB+/- or aly/+ mice. These data illustrate the complex interplay between hemopoietic and nonhemopoietic cell types for the development of NKT cells, and they demonstrate the unique requirement of NKT cells for a signaling pathway mediated by NIK activation of RelB in a thymic stromal cell.