Ferric carboxymaltose: A game changer in the management of iron deficiency anaemia in pregnancy.

Anaemia is a well-known global health concern in the South Asian countries, and it is estimated that India has the utmost prevalence of anaemia and maternal deaths due to iron deficiency anaemia. This study aims to assess the efficacy and safety of intravenous ferric carboxymaltose (FCM) in antenatal women with anaemia in the second and third trimesters of pregnancy. Methods: A single-arm prospective cohort (before-after) study among 60 antenatal women with moderate to severe anaemia in the second and third trimesters was conducted from December 2020 to December 2022, and the eligible women were given 1000 mg of intravenous FCM injection. Efficacy was assessed by rate of improvement in haemoglobin and ferritin at 2 weeks post infusion. Safety analysis was done by assessing adverse drug reactions and foetal heart monitoring during the infusion. Results: A total 60 antenatal women with a median gestational age of 32.5 weeks at presentation received 1000 mg of intravenous FCM. There was a rise in mean haemoglobin from 8.05 gm% pre-infusion to 10.93 gm% 2 weeks post infusion, showing a mean rise of 2.88 gm%. Similar improvement was noted in mean serum ferritin levels from 25.92 pre-infusion to 253.96 post FCM infusion. There were no reports of drug-related major adverse effects in the mother or the foetus. Conclusions: FCM is found to be safe and effective treatment with rapid replenishment of haemoglobin and ferritin levels in a single dose, which makes it suitable and compels consideration as the first choice for treatment of iron-deficiency anaemia.

Undernutrition and its determinants among under-five children in a tribal community of Meghalaya.

Background and Objectives: Malnutrition among under-five children is a rampant and major public health problem in developing countries. The paucity of studies on undernutrition among tribals made it imperative to determine the prevalence and the factors associated with undernutrition among the tribal under-five children. Materials and Methods: A community-based cross-sectional analytical study was conducted among 196 under-five children residing in the village under the rural field practice area of North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Meghalaya. Sociodemographic and clinical data were collected using a pretested semi-structured questionnaire, and burden of food insecurity was collected using the Food Insecurity Experience Scale Survey Module (FIES-SM). Anthropometric measurements, such as height, weight, and mid-upper arm circumference, were measured for all the children, and Z-scores were calculated for weight for age, height for age, and weight for height. Results: Of the 196 children, the mean age of the children was 36.7 (15.3) months. The prevalence of underweight, stunting, and wasting was 9.2% (95% confidence interval (CI): 5.7%-14.3%), 28.6% (95% CI: 22.5%-35.5%), and 6.1% (95% CI: 3.3%-10.7%), respectively. There was a significant association for girls, birth weight, and age of the mother during first childbirth and immunization status with underweight. Similarly, there was a significant association for girls with wasting and education of the mother and birth weight with stunting. Conclusion and Recommendations: The prevalence of underweight wasting and stunting was lesser with an observable enhancement in the nutritional status of the children; however, the undernutrition status is still alarming, which warrants health and nutritional education along with behavioral change communication.

Vaccine Hesitancy and Factors Related to Vaccine Hesitancy in COVID-19 Vaccination among a Tribal Community of Meghalaya: A Mixed Methods Study.

Vaccine hesitancy should be dealt as an important issue as it carries both individual- and community-level risks; however, it lacks proper assessment in particular among the indigenous tribal population. A community-based sequential explanatory mixed methods study was conducted among 238 eligible individuals in Ri-Bhoi district, Meghalaya. The quantitative part involved a cross-sectional study to determine the proportion of vaccine hesitancy and the qualitative part comprised in-depth interviews among the eligible residents and key informant interviews among the health workers providing the vaccination services, to explore the facilitators and barriers of vaccine uptake. A total of 113 [47.5% (95% confidence interval [CI]: 41.0%-54.0%)] participants were found to be hesitant to vaccination, among which 16.8% (95% CI: 12.4%-22.3%) were initially hesitant and 30.7% (95% CI: 24.9%-37.0%) had vaccine refusal. The themes generated through qualitative interviews were individual-related, disease-related, vaccine-related, healthcare system and provider related and socio-cultural and religious. The main barriers for the likelihood of action were perceived susceptibility and perceived severity under the individual perception along with ambiguity aversion, scepticism about the efficacy, mistrust, concerns on side effects, rumors, and socio-cultural and religious misbeliefs. Vaccine hesitancy is found to be considerably higher and it depends on complacency toward the vaccine, confidence in its safety, perceived susceptibility to the disease and perceived severity to the disease coupled with modifying factors for cues for action. Healthcare workers should better communicate to improve the uptake of vaccines by reducing the barriers to the vaccine acceptance.

Vaccination and COVID-19 infection among adults aged 45 years and above in a North-Eastern state of India.

Background: In response to this coronavirus disease 2019 (COVID-19) pandemic, vaccines reaching the predetermined levels of safety and efficacy were rolled out for use under emergency use approval/listing (EUA/EUL). The government of India has introduced three vaccines for emergency use as of today. Aim: The study was conducted to evaluate the association between the Covishield vaccine and COVID-19 infection among adults (≥45 years) who undergo reverse transcription-polymerase chain reaction (RT-PCR) COVID-19 testing. Methods: The study was conducted in a dedicated COVID-19 hospital in a north-eastern state of India among adults aged 45 years and above, who underwent RT-PCR testing. Cases were those who tested positive for RT-PCR and controls were those who were RT-PCR negative during the same period. A structured questionnaire was used to collect relevant data pertaining to socio-demographic profile, symptoms of COVID-19, vaccination status, co-morbidities, etc. Multiple logistic regression was used to calculate the odds ratio (OR) to find the association between vaccination and COVID-19 infection. Results: A total of 116 participants, 45 years and above were interviewed in the study. It was found that cases were more likely to have symptoms (48% vs. 6.9%, P value = <0.005) and have history of positive family member (89.7% vs. 72.4%, P value = 0.018) than controls. The odds of having COVID-19 infection were OR 12.60 (95% confidence interval (CI) 4.03-39.34) for those that have symptoms and OR 6.07 (95% CI 1.90-19.34) for unvaccinated individuals. Conclusions: Covishield vaccine protected individuals against COVID-19 infection with the risk of getting the infection being significantly lower in vaccinated individuals. Relevance for Patients: COVID-19 vaccination prevents the infection and addresses misconceptions about the vaccine.