Study to assess the home-based newborn care (HBNC) visit in rural area of Lucknow: A cross-sectional study.

INTRODUCTION: Home-based newborn care (HBNC) is a strategy adopted by government of India to overcome the burden of newborn deaths in the first week of life, it provides continuum of care for newborn and post-natal mothers. HBNC introduced since 2011 is centred around Accredited Social Health Activist (ASHA) and it is the main community-based approach to newborn health. AIMS AND OBJECTIVES: The objective of the present study was to assess the HBNC during HBNC visit in rural area of Lucknow, Uttar Pradesh (U.P.). MATERIALS AND METHODS: The present cross-sectional study was carried out in the field practice area of Primary Health Centre Sarojini Nagar, Lucknow UP. A total of 200 mothers of newborn (age 03 days to 60 days) born in the catchment area of PHC Sarojini Nagar during 8 months period were included in cross-sectional study. RESULTS: The result of study showed that majority of newborns got all the age appropriate home visit. None of the mothers had knowledge and awareness about the HBNC provision for home visits and the number of home visit by ASHA decreases as age of baby increases. All the ASHAs were aware about the schedule of home visit, the number of home visit in case of home delivery and institutional delivery. CONCLUSION AND RECOMMENDATION: ASHA was found to be the major facilitator for HBNC programme. Knowledge and awareness of ASHA on importance of postnatal care needs to be enhanced via hands on training.

Postnatal newborn care practices and knowledge of newborn danger signs among mothers in rural area of Lucknow, Uttar Pradesh: A cross-sectional study.

INTRODUCTION: The postnatal period is the most critical period for mothers and her newborn especially during the hours and days after birth. Proper utilization of postnatal care services plays a vital role in dropping the maternal mortality ratio and infant mortality rate. METHODS: The community based, cross-sectional study was carried out in the field practice area of Primary Health Centre (PHC) Sarojini Nagar, Lucknow UP. A total of 200 mothers of newborn (age 03 days to 60 days) born in the catchment area of PHC Sarojini Nagar during eight months period were included in this study. A semi-structured pre-tested questionnaire was used for interview of eligible mother. The objective of study was to assess the postnatal newborn care practices and the knowledge of newborn danger sign among mothers in rural area of Lucknow, U.P. RESULTS: The results showed that 49.50% of mothers applied substances to the stump after birth. 52.5% of mothers applied Kajal on the eye of the baby after birth. More than half of the mothers breastfed the baby within 1-4 hours of birth and Exclusive breastfeeding were practiced by nearly half (47%) of the mothers. Less than one-third of mothers used ambulance service 102/108 as their means of transportation to the health facility. CONCLUSION: Unsafe and harmful traditional newborn care practices are more prevalent in the rural areas. Health education and awareness programmes are recommended to improve maternal knowledge on the various aspects of newborn care.

Care seeking for childhood pneumonia by rural and poor urban communities in Lucknow: A community-based cross-sectional study.

CONTEXT: Globally, around 16% of under-five children die due to pneumonia. Childhood pneumonia, if identified early is a readily treatable through low-cost antibiotics. Access to timely and appropriate care is a key action to control pneumonia. AIMS: The aim of the study was to understand the caregiver's care-seeking behavior for the management of childhood pneumonia among rural and urban poor communities in Lucknow. SETTINGS AND DESIGN: Rural areas and urban slums of Lucknow district, from September 2014 to August 2015. SUBJECTS AND METHODS: A community-based cross-sectional study. Total of 1065 under-five children were selected by multistage random sampling method. Caregivers of children (<5 years of age) were interviewed through pretested, semi-structured interview schedule. Information was gathered on episode of cough, difficult breathing, and or chest indrawing in child within 2 weeks preceding the survey, and caregiver's treatment seeking practices. RESULTS: Out of total 1065 children, 52 (%) had pneumonia within 2 weeks preceding the survey. At the onset of illness, difficult/fast breathing was identified by 86.5% caregivers, but majority of them did not perceive it as a serious condition and resort to home remedies. Only 9.6% sought appropriate care at onset of illness. Appearance of chest indrawing in the child was identified by caregivers as a serious condition and sought treatment from outside. The mean time taken from onset of illness to the seeking care from health facility was around 2½ days (2.39 ± 0.75). Qualified private practitioners (70.5%) were the preferred choice and majority (87.0%) of the children received antibiotic for pneumonia. However, even after perception of seriousness of the illness, 26.8% and 11.1% caregivers in urban slums and rural areas, respectively sought inappropriate care at the first consultation. CONCLUSIONS: Caregivers were unable to perceive the severity of fast breathing leading to the delayed initiation of the appropriate treatment. There is a need of community mobilization through behavior change communication interventions to promote early symptom recognition and appropriate care seeking for pneumonia.

Predictors of Sexually Transmitted Infections among Female Sex Workers (FSWs) in a City of Northern India.

INTRODUCTION: Sexually transmitted infections (STIs) and Reproductive tract infections RTIs are important public health problems in India. The prevalence of these infections is considerably higher among high risk groups (HRGs) ranging from 20-30%. It is high time that a study should be conducted to explore different factors and conditions responsible for the practice of unsafe sex among female sex workers (FSWs) in Uttar Pradesh (UP) and the impact of this on social life and health of FSWs. As Lucknow provides a comprehensive opportunity in terms of tourism, occupation, and economy, it becomes a potential hub for sex work. Studying FSW in Lucknow can thus be considered as a yardstick for the entire FSW population of UP population. The present study was thus planned with the objective of knowing the STI prevalence and its determinants among FSWs. MATERIALS AND METHODS: A cross-sectional descriptive study was conducted on FSWs registered with Targeted Intervention-Non-government Organization (TI-NGO), registered with Uttar Pradesh State Acquired Immuno Deficiency Syndrome (AIDS) Control Society (UPSACS) of Lucknow city. Total 288 subjects were studied. RESULTS: The average age of FSWs was 31 years. FSWs were mostly Hindus and illiterate. The overall prevalence of STI as per Syndromic diagnosis was found to be 35.8%. However, the percentage of FSWs with STI was higher in street-based (50.6%) than home-based (29.8%). Majority (42.7%) of sex workers with STI had non-regular partners only while majority (52.4%) of sex workers without any STI had only regular partners. Condom usage with regular partners was poor. However, with the non-regular partners the condom usage was better. On multivariate analysis being single, having sex work as a sole means of earning, duration of sex work > 2 years, having pallor, and giving in to client's demand for unsafe sex were found to be significant in causing STI. CONCLUSIONS: Prevalence of STI among the female sex workers as per Syndromic diagnosis was found to be 35.8%. Unemployment, anemia, and having sex without condom for extra money, failure to persuade the client and not doing anything were found to be important predictors for presence of STI.

Genetic changes in influenza A(H3N2) viruses circulating during 2011 to 2013 in northern India (Lucknow).

Genetic variability in the hemagglutinin (HA1) and the neuraminidase (NA) genes of influenza viruses results in the emergence of new strains which differ in pathogenicity and severity. The present study was undertaken for genotypic characterization of the HA1 and NA genes of the influenza A(H3N2) strains, detected during the 2011-2013. A total of fifty five influenza A(H3N2) positive samples [2011 (n = 20), 2012 (n = 4) and 2013 (n = 31)] were studied. The 824 bp segment of HA1 gene and 931 bp segment of NA gene were amplified and sequenced by Big-Dye terminator kit on ABI3130, Genetic analyzer. Molecular and phylogenetic analysis was done by MEGA 5.05 software and PhyML program (v3.0). Mutations were determined by comparing the deduced amino acid sequences of study strains with that of 2009-2013 vaccine strains. The studied influenza A(H3N2) strains showed 98.1-99.6% similarity in HA1 and NA amino acid sequences with the influenza A/Victoria/361/2011 vaccine strain. Four mutations in the HA1 amino acid sequences (T128A, R142G, L157S and N278K) and three unique mutations in the NA amino acid sequences [D251V, S315G and V313A] were found. These mutations were observed only in strains from the year 2013 (cluster II). None of the strains showed the presence of mutations, N294S and R292K, markers of oseltamivir resistance. In conclusion, Lucknow strains have accumulated the significant number of mutations in the antigenic sites of the HA and the NA coding sequences and continue to be evolving from the 2013 vaccine strain [A/Victoria/361/2011], however, mutations specific for oseltamivir resistance were not detected.

A multicenter prospective hospital-based surveillance to estimate the burden of rotavirus gastroenteritis in children less than five years of age in India.

BACKGROUND: Rotavirus is the leading cause of severe, dehydrating diarrhea in children aged <5 years globally, with an estimated 25 million outpatient visits and 2 million hospitalizations attributable to rotavirus infections each year. The aim of this hospital-based surveillance was to summarize the local epidemiological and virological features of rotavirus and to estimate the disease burden in the population under surveillance in India. METHODS: During the 16 months surveillance period from April 2011 through July 2012, a total of 4711 children under the age of 5 years were admitted with acute diarrhea at 12 medical centers attached to medical schools throughout India. Stool samples were randomly collected from 2051 (43.5%) subjects and were analyzed for rotavirus positivity using commercial enzyme immunoassay kit (Premier Rotaclone Qualitative Elisa) at the respective study centers. Rotavirus positive samples were genotyped for VP7 and VP4 by reverse-transcription polymerase chain reaction (RT-PCR) at a central laboratory. RESULTS: During the study period, maximum number of rotavirus related hospitalizations were reported from December 2011 through February 2012. Out of the 2051 stool samples tested for rotavirus, overall 541 (26.4%) samples were positive for rotavirus VP6 antigen in stool. The highest positivity was observed in the month of December, 2011 (52.5%) and lowest in the month of May, 2011 (10.3%). We found that majority of the rotavirus positive cases (69.7%) were in children <24 months of age. The most common genotypes reported were G1 (38%), G2 (18%), G9 (18%), G12 (9%) and mixed strains (17%). CONCLUSIONS: The results of this study confirm the significant burden of acute rotavirus gastroenteritis as a cause of hospitalizations in under five children in India.

Retrospective surveillance for intussusception in children aged less than five years at two tertiary care centers in India.

BACKGROUND: A rotavirus vaccine could soon become part of India's national immunization program. However the occurrence of intussusception due to rotavirus vaccine is a potential safety concern. This surveillance aimed at the collection of baseline data on childhood intussusception which would facilitate the monitoring of intussusception cases after the introduction of rotavirus vaccines. METHODS: We retrospectively reviewed medical records of confirmed intussusception cases in children under the age of five, treated during 2007-2012 at two tertiary care hospitals attached to medical schools in India. Demographic, clinical, diagnostic and treatment practices data were obtained from hospital records. RESULTS: Over a five to six year observation period, we identified 187 confirmed cases of intussusception, of which 75% were males. The median age of intussusception was 8 months, and we observed a possible trend in the distribution of cases with the highest number of cases being reported in the month of April and lowest in the month of October. The most common diagnostic methods used were ultrasonography and abdominal radiography with most cases being treated surgically (71%). The median length of hospital stay was 8 days (range 1-40) and mean was 10.2 days. Records of any fatality due to intussusception were not found during the review of the records. CONCLUSIONS: This analysis provides an estimate of the baseline data of childhood intussusception prior to the introduction of the rotavirus vaccination as a part of routine immunization in India. A prospective surveillance system using a standardized case definition is needed in order to better examine the incidence of intussusception in developing countries.

Influenza virus genotypes circulating in and around Lucknow, Uttar Pradesh, India, during post pandemic period, August 2010--September 2012.

BACKGROUND & OBJECTIVES: During the post influenza pandemic period, continuous surveillance of influenza virus and its subtypes is mandatory to help the policy makers to take effective and appropriate decisions. Therefore, this study was planned to determine the pattern of influenza virus activity in context to various meteorological and clinical parameters in and around Lucknow, Uttar Pradesh, India, during post pandemic period August 2010 - September 2012. METHODS: Nasal swabs/throat swabs/nasopharyngeal aspirates of 2669 patients were collected. One-step real time PCR for detection of influenza virus was done according to the Centers for Disease Control and Prevention (CDC) protocol. RESULTS: Influenza positivity was 15.8 per cent (423/2669) in symptomatic patients. Of the 423 total positives, 192 (7.2%) were influenza A and 231 (8.7%) were influenza B. Positivity for influenza virus was significantly (P=0.001, OR=2.9, CI=1.9-4.3) higher in patients with Influenza like illness (ILI) (17.4%, 396/2271) than those with severe acute respiratory illness (SARI) (6.8%, 27/398). Influenza A positive samples were subtyped as; pdmH1N1 (67.2%, 129/192) and seasonal H3N2 (32.8%, 63/192). It significantly correlated with monthly mean rainfall, humidity and dew point while atmospheric pressure was inversely related. No significant association was found with temperature and wind speed. Clinical variations were observed between different strains of Influenza virus. INTERPRETATION & CONCLUSIONS: The findings provide a clear picture of different clinical presentations of various strains of influenza A and B viruses and epidemiology of influenza infection from Lucknow (UP), India. The seasonality of influenza virus infection showed variation in relation to different environmental factors. Pandemic H1N1 caused more systemic infection than seasonal influenza A/H3N2 virus.

Molecular characterization of circulating pandemic strains of influenza A virus during 2012 to 2013 in Lucknow (India).

The pandemic H1N1 strain of Influenza A virus [A(H1N1)pdm09] is now well adapted in human populations. However, it is still causing sporadic outbreaks worldwide with different severity. The present study was planned to understand the genetic diversity (based on the HA1 gene) of influenza A(H1N1)pdm09 strains circulating during the post pandemic period. The HA1 gene was selected because the HA1 protein is immunogenic, functions as a receptor binding site and indirectly affects transmission and pathogenicity of virus. A total of 2,818 cases were enrolled. Nasal/throat swabs from all cases were tested by one-step real time PCR for detection of influenza virus types and subtypes according to the CDC protocol. Of these, 134 cases were A(H1N1)pdm09 positive, 34 of which were screened for HA1 gene (position 434-905) sequencing (Big-Dye terminator using 3130 ABI, Genetic analyzer). Molecular and phylogenetic analysis was performed using PhyML approach (v. 3.0). All A(H1N1)pdm09 positive and negative cases were clinically characterized. Phylogentically, all Lucknow strains (n = 33) except one fall with the clade seven reference strain. One strain showed 99.9% similarities with clade one reference strain A/California/07/2009. In mutational analysis, 33 strains had the S220T mutation, which is at an antigenic site and characteristic of clade seven along with few minor mutations; K180I/T/Q, V190I, S200P, S202T, A203T, A214T, S220T, V251I, and A273T. These results suggest that clade seven was the most widely circulating clade in Lucknow and A(H1N1)pdm09 cases showed mild clinical symptoms as compared to A(H3N2) or influenza B cases.

Viral aetiology of acute lower respiratory tract illness in hospitalised paediatric patients of a tertiary hospital: one year prospective study.

CONTEXT: Acute lower respiratory tract infections (ALRI), ranked as the second leading cause of death are the primary cause of hospitalisation in children. Viruses are the most important causative agents of ALRI. AIM: To study the viral aetiology of ALRI in children at a tertiary care hospital. SETTING AND DESIGN: One year prospective observational study in a tertiary care hospital of King George's Medical University, Lucknow. MATERIAL AND METHODS: Nasopharyngeal aspirate (NPA) was collected from children admitted with signs and symptoms of ALRI who were aged 0-14 years. Samples were transported to the laboratory at 4°C in viral transport media and processed for detection of respiratory syncytial virus (RSV) A and B, influenza virus A and B, adenovirus (ADV), human Boca virus (HBoV), human metapneumo virus (hMPV) and parainfluenzavirus 1, 2, 3 and 4 using mono/multiplex real-time polymerase chain reaction (RT-PCR). STATA was used for statistical analysis. RESULTS: In one year, 188 NPAs were screened for respiratory viruses, of which 45.7% tested positive. RSV was most commonly detected with 21.3% positivity followed by measles virus (8.5%), influenza A virus (7.4%), ADV (5.3%), influenza B virus (1.6%), hMPV (1.1%) and HBoV (0.5%). Month wise maximum positivity was seen in December and January. Positivity rate of RSV was highest in children aged < 1 year, which decreased with increase in age, while positive rate of influenza virus increased with increasing age. CONCLUSION: The occurrence of viral predominance in ALRI is highlighted.

Neonatal health program management in a resource-constrained setting in rural Uttar Pradesh, India.

This analysis identifies salient features of team management that were critical to the efficiency of program implementation and the effectiveness of behavior change management to promote essential newborn care practices in Uttar Pradesh, India. In May 2003, the Johns Hopkins Bloomberg School of Public Health and King George Medical University initiated a cluster-randomized, controlled neonatal health research program. In less than 2 years, the trial demonstrated rapid adoption of several evidence-based newborn care practices and a substantial reduction in neonatal mortality in intervention clusters. Existing literature involving research program management in resource-constrained areas of developing countries is limited and fails to provide models for team organization and empowerment. The neonatal research project examined in this paper developed a unique management strategy that provides an effective blueprint for future projects. Transferable learning points from the project include emphasizing a common vision, utilizing a live-in field site office, prioritizing character and potential in the hiring process, implementing a learning-by-doing training program, creating tiers of staff recognition, encouraging staff autonomy, ensuring a broad staff knowledge base to seamlessly handle absences, and maintaining the flexibility to change partnerships or strategies.

Gender differences in perception and care-seeking for illness of newborns in rural Uttar Pradesh, India.

Although gender-based health disparities are prevalent in India, very little data are available on care-seeking patterns for newborns. In total, 255 mothers were prospectively interviewed about their perceptions and action surrounding the health of their newborns in rural Uttar Pradesh, India. Perception of illness was significantly lower in incidence (adjusted odds ratio=0.56, 95% confidence interval 0.33-0.94) among households with female versus male newborns. While the overall use of healthcare providers was similar across gender, the average expenditure for healthcare during the neonatal period was nearly four-fold higher in households with males (Rs 243.3 +/- 537.2) compared to females (Rs 65.7 +/- 100.7) (p=0.07). Households with female newborns used cheaper public care providers whereas those with males preferred to use private unqualified providers perceived to deliver more satisfactory care. These results suggest that, during the neonatal period, care-seeking for girls is neglected compared to boys, laying a foundation for programmes and further research to address gender differences in neonatal health in India.

Community perceptions of birth weight in rural Uttar Pradesh, India: implications for care of low-birth-weight infants.

Effective implementation of interventions targeting low birth weight (LBW) and preterm infants, who contribute 60 to 80% of all neonatal deaths, requires an understanding of local people's perceptions of birth weight. This study was conducted to understand how birth weight is perceived in a low-resource setting, including the etiology, signs and care given to infants of various weights. In this qualitative research study, in-depth interviews and focus group discussions were conducted with recently delivered women (RDW) and their families, as well as local health stakeholders in a rural North Indian community. Birth weight per se is not considered a determinant of newborn health. Instead, newborns are classified into types, and care is provided based on these types. Classification is based on observable criteria, including feeding, vigor and alertness, and interviewees did not always consider low weight a criterion for weak type. In communities that do not perceive birth weight to be an important determinant of health, public health programmes and practitioners must reframe messages regarding additional care for LBW infants at home and care seeking outside the home in locally relevant ways.

Effectiveness of 3-day amoxycillin vs. 5-day co-trimoxazole in the treatment of non-severe pneumonia in children aged 2-59 months of age: a multi-centric open labeled trial.

This cluster randomized, open labeled trial was conducted to compare the effectiveness of 3 days of oral amoxycillin and 5 days of co-trimoxazole treatment in terms of clinical failure in children with World Health Organization (WHO) defined non-severe pneumonia in primary health centers in rural India. Participants were children aged 2-59 months with WHO defined non-severe pneumonia, with or without wheeze, who were accessible to follow up. From seven primary health centers in each arm, 2009 cases were randomized, 993 and 1016 in treatment with amoxycillin and co-trimoxazole, respectively. Fever was present in 1247 (62.1%) and wheeze in 443 (22.1%). There was good adherence and low loss to follow-up. Clinical failure on amoxycillin and co-trimoxazole on intention to treat analysis was 137 and 97, respectively (absolute difference = 0.04, 95% confidence interval: - 0.035-0.12). We conclude that there was no difference in effectiveness of oral co-trimoxazole or amoxycillin in treating non-severe pneumonia.

A study on determinants of immunization coverage among 12-23 months old children in urban slums of Lucknow district, India.

CONTEXT: To find out the suitable factors for raising the coverage of immunization. AIMS: To determine the coverage and to identify the various factors of primary immunization. SETTINGS AND DESIGN: Urban slums of Lucknow district. METHODS AND MATERIAL: WHO 30-cluster sampling technique was used for the selection of the subjects. Mother, father or relative of a total of 510 children with 17 children per cluster were interviewed in the study. STATISTICAL ANALYSIS: Chi-square test, binary logistic regression and multinomial logistic regression analysis were done to test the statistical significance of the association. RESULTS: About 44% of the children studied were fully immunized. Multinomial logistic regression analysis revealed that an illiterate mother (OR=4.0), Muslim religion (OR=2.5), scheduled caste or tribes (OR=2.3) and higher birth order (OR approximately 2) were significant independent predictors of the partial immunized status of the child; while those associated with the unimmunized status of the child were low socioeconomic status (OR=10.8), Muslim religion (OR=4.3), higher birth order (OR=4.3), home delivery (OR=3.6) and belonging to a joint family (OR=2.1). CONCLUSIONS: The status of complete immunization is about half of what was proposed to be achieved under the Universal Immunization Program. This emphasizes the imperative need for urgent intervention to address the issues of both dropout and lack of access, which are mainly responsible for partial immunization and nonimmunization respectively.

Validation of accuracy and community acceptance of the BIRTHweigh III scale for categorizing newborn weight in rural India.

OBJECTIVE: To determine the accuracy and acceptability of a handheld scale prototype designed for nonliterate users to classify newborns into three weight categories (>or=2,500 g; 2,000 to 2,499 g; and <2,000 g). STUDY DESIGN: Weights of 1,100 newborns in Uttar Pradesh, India, were measured on the test scale and validated against a gold standard. Mothers, family members and community health stakeholders were interviewed to assess the acceptability of the test scale. RESULT: The test scale was highly sensitive and specific at classifying newborn weight (normal weight: 95.3 and 96.3%, respectively; low birth weight: 90.4 and 99.2%, respectively; very low birth weight: 91.7 and 98.4%, respectively). It was the overall agreement of the community that the test scale was more practical and easier to interpret than the gold standard. CONCLUSION: The BIRTHweigh III scale accurately identifies low birth weight and very low birth weight newborns to target weight-specific interventions. The scale is extremely practical and useful for resource-poor settings, especially those with low levels of literacy.

Feasibility of community neonatal death audits in rural Uttar Pradesh, India.

OBJECTIVE: Medical audit is a widely promoted strategy in hospitals, but experience within community settings is scant. Community neonatal death audit is a form of audit, which involves a systematic analysis of the quality of care provided in the home, danger sign recognition and care seeking decision making for neonatal illness. This research was conducted in Uttar Pradesh, India, to investigate the feasibility and cultural acceptability of community neonatal death audits. STUDY DESIGN: During November-December 2004, we conducted three in-depth interviews with family members of deceased neonates, and six focus group discussions with family and community members. Three approaches were evaluated: in-depth interview with the family before engaging them in an audit with the community; preliminary meeting to build rapport with the family and community before conducting an audit; and audit with the family and community in a single focus group. Approaches were interactive processes, involving the community, to identify avoidable factors in a particular death and discuss solutions. RESULT: Carried out in a culturally sensitive and non-punitive manner, community neonatal death audit was found to be acceptable and feasible. All approaches provoked formal investigation by community members, and stimulated sharing of views, leading to the self-discovery that community perception was a cumulatively amplified effect of individual perceptions. Presence of an educated/experienced community member or health worker served as a catalyst. No one optimal approach was identified. CONCLUSION: Community neonatal audit is an acceptable approach that shows promise as an effective intervention for improving neonatal health outcomes.

Obstetric history and reproductive tract infections among married female (15-44 yrs.) in rural area of district Meerut, U.P.

The prevalence of RTIs in 600 married females (15-44 yrs.) representing 12 subcentre villages of Daurala block of Meerut was 35.3%. The reproductive tract infections were significantly associated with place of last delivery (P< 0.001), person conducted the last delivery (P< 0.001) and in women had history of abortions (P< .005).

Introduction of community-based skin-to-skin care in rural Uttar Pradesh, India.

OBJECTIVE: Two-thirds of women globally give birth at home, yet little data are available on use of skin-to-skin care (STSC) in the community. We describe the acceptability of STSC in rural Uttar Pradesh, India, and measured maternal, newborn, and ambient temperature in the home in order to inform strategies for introduction of STSC in the community. STUDY DESIGN: Community-based workers in intervention clusters implemented a community mobilization and behavior change communication program that promoted birth preparedness and essential newborn care, including adoption of STSC, with pregnant mothers, their families, and key influential community members. Acceptance of STSC was assessed through in-depth interviews and focus groups, and temperature was measured during home visits on day of life 0 or 1. RESULTS: Incidence of hypothermia (<36.5 degrees C) was high in both low birth weight (LBW) and normal birth weight (NBW) infants (49.2%, (361/733) and 43% (418/971), respectively). Mean body temperature of newborns was lower (P<0.01) in ambient temperatures <20 degrees C (35.9+/-1.4 degrees C, n=225) compared to > or =20 degrees C (36.5+/-0.9 degrees C, n=1450). Among hypothermic newborns, 42% (331/787) of their mothers had a lower temperature (range -6.7 to 0.1 degrees C, mean difference 0.4+/-1.2 degrees C). Acceptance of STSC was nearly universal. No adverse events from STSC were reported. STSC was perceived to prevent newborn hypothermia, enhance mother's capability to protect her baby from evil spirits, and make the baby more content. CONCLUSION: STSC was highly acceptable in rural India when introduced through appropriate cultural paradigms. STSC may be of benefit for all newborns and for many mothers as well. New approaches are needed for introduction of STSC in the community compared to the hospital.

Effects of farmyard manure and fertilizers on yield, fibre quality and nutrient balance of rainfed cotton (Gossypium hirsutum).

Two-year field experiments were conducted to evaluate the effect of fertilizer with or without farmyard manure (FYM) application on cotton productivity and fibre quality. A partial nutrient balance was calculated by the difference method (nutrient applied--crop removal). Seed cotton yield was improved with addition of FYM (5 Mg ha(-1)). Application of both N and P resulted in significant improvements in seed cotton yield than the control and without N plots (PK). Uniformity ratio and ginning outturn (GOT) was greater in the FYM amended plots than the plots without FYM. Nitrogen and P balance was positive in the fertilizer-N and P applied plots whereas K balance was negative in spite of the addition of fertilizer-K. Potassium balance was positive only when FYM was applied. These studies suggest that it is advantageous to apply FYM as it improves fibre yield by way of improved GOT and maintains a positive nutrient balance.