Suchergebnisse

Objectives: To examine the association between maternal anaemia and adverse maternal and infant outcomes, and to assess the feasibility of conducting epidemiological studies through the Indian Obstetric Surveillance System–Assam (IndOSS-Assam) Design: Retrospective cohort study using anonymised hospital records. Exposure: maternal iron deficiency anaemia; outcomes: postpartum haemorrhage (PPH), low birthweight, small-for-gestational age, perinatal death. Setting: Five government medical colleges in Assam. Study population: 1007 pregnant women who delivered in the five medical colleges from January to June 2015. Main outcome measures: Odds ratios with 95% confidence intervals (CI) to estimate the association between maternal iron deficiency anaemia and the adverse maternal and infant outcomes. Potential interactive roles of infections and induction of labour on the adverse outcomes were explored. Results: 35% (n=351) pregnant women had moderate-severe anaemia. Women with severe anaemia had a higher odds of PPH (adjusted odds ratio (aOR)=9·45; 95%CI=2·62-34·05), giving birth to low birthweight (aOR=6·19; 95%CI=1·44-26·71) and small-for-gestational age babies (aOR=8·72; 95%CI=1·66-45·67), and perinatal death (aOR=16·42; 95%CI=4·38-61·55). Odds of PPH increased 17-fold among women with moderate-severe anaemia who underwent induction of labour and increased 19-fold among women who had infection and moderate-severe anaemia. Conclusion: Maternal iron deficiency anaemia is a major public health problem in Assam. Maternal anaemia was associated with increased risks of PPH, low birthweight, small-for-gestational age babies and perinatal death. While the best approach is prevention a large number of women present with severe anaemia late in pregnancy and there is no clear guidance on how these women should be managed during labour and delivery.

Antimicrobial resistance (AMR) is widely recognised as a global health threat, which is projected to account for more deaths than cancer by 2050. The Government of India has formulated a National Action Plan to tackle AMR (NAP-AMR), largely modelled on the World Health Organization's Global Action Plan on AMR. While the NAP-AMR successfully mirrors the Global Action Plan and lays out ambitious goals, we find that the lack of financial allocation across states, poor enforcement and inadequate multisectoral co-ordination have hampered progress. A broader focus on improving infrastructure for water and sanitation, linking the issue of AMR to existing vertical health programmes for human immunodeficiency virus (HIV) and tuberculosis (TB), prioritising infection prevention and control, strengthening the frontline healthcare workforce in rural and peri-urban settings to reduce reliance on antibiotics, leveraging pointof-care testing and mobile app-based health interventions for diagnosis and surveillance, and adopting a socioecological approach to health and development would help to create an enabling environment for concrete action on AMR in India. (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

This is the tenth edition of a classic work on child development by Ronald Illingworth (1909-1990), the renowned English paediatrician who was Professor of Child Health at the University of Sheffield. This book was first published in 1960, and Professor Illingworth revised it frequently. It was translated into several languages and is used throughout the world. Since the publication of the ninth edition of this book in 1987, a sea of changes has happened in the discipline of child development. To bridge this gap Dr. MKC Nair and Dr. Paul Russell have supported Professor Illingworth's extraord

Objectives Analyse the effect of the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), a wage-for-employment policy of the Indian Government, on infant malnutrition and delineate the pathways through which MGNREGA affects infant malnutrition. Hypothesis: MGNREGA could reduce infant malnutrition through positive effects on household food security and infant feeding. Method Mixed methods using cross-sectional study and focus group discussions conducted in Dungarpur district, Rajasthan, India. Participants: Infants aged 1 to <12 months and their mothers/caregivers. Final sample 528 households with 1056 participants, response rate 89.6%. Selected households were divided into MGNREGA-households and non-MGNREGA-households based on participation in MGNREGA between August-2010 and September-2011. Outcomes: Infant malnutrition measured using anthropometric indicators - underweight, stunting, and wasting (WHO criteria). Results We included 528 households with 1,056 participants. Out of 528, 281 households took part in MGNREGA between August'10, and September'11. Prevalence of wasting was 39%, stunting 24%, and underweight 50%. Households participating in MGNREGA were less likely to have wasted infants (OR 0·57, 95% CI 0·37–0·89, p = 0·014) and less likely to have underweight infants (OR 0·48, 95% CI 0·30–0·76, p = 0·002) than non-participating households. Stunting did not differ significantly between groups. We did 11 focus group discussions with 62 mothers. Although MGNREGA reduced starvation, it did not provide the desired benefits because of lower than standard wages and delayed payments. Results from path analysis did not support existence of an effect through household food security and infant feeding, but suggested a pathway of effect through low birth-weight. Conclusion Participation in MGNREGA was associated with reduced infant malnutrition possibly mediated indirectly via improved birth-weight rather than by improved infant feeding. Addressing factors such as lack of mothers' knowledge and ...