A cohort study on risk factors for preterm births in rural Gujarat.

BACKGROUND: Prematurity is one of the leading causes of neonatal and under-five mortalities globally and also in India. It is an important determinant of short- and long-term morbidities in infants and children. Unfortunately, risk factors of majority of preterm births (PTBs) remain unexplained which calls for appropriate action. There is a dearth of community-based research on PTB and its risk factors, especially in high burden countries like India. OBJECTIVES: The objective of the study was to explore different risk factors for PTB. METHODS:: A cohort of 1977 antenatal mothers was enrolled at household level by trained field investigators and was followed up in four districts of Gujarat, India, to document the outcome of pregnancy. Pretested and structured questionnaires were used to collect information. A hierarchical regression model was used to analyze the risk factors for PTB. RESULTS: Proportion of PTB was 9% among the enrolled cohort. Risk factors which were found to be significant on applying the hierarchical model were periodontal disease, long sleep duration, and sex during any trimester. CONCLUSIONS: The study suggests an urgent need for strengthening of existing guidelines for effective, evidence-based, and culturally appropriate interventions for prevention of PTB. Maintenance of good oral hygiene should find a place in routine recommendations for pregnant women, and antenatal examinations should include screening for oral hygiene also.

Improving Adolescent Health: Learnings from an Interventional Study in Gujarat, India.

BACKGROUND: There are multiple risk factors during adolescence, which become precursors of various diseases and injuries inflicting high morbidity, mortality, and disability. There are several gaps in adolescent health research in India; one among them is that programs targeting adolescent health are constrained by the absence of rigorous interventional research informing interventions for improving adolescent health. This study aims to document the effectiveness of intervention on adolescent health and knowledge change on the risk factors among adolescents in one of the selected districts in Gujarat, India. METHODS: This was an interventional study with quasi-experimental design executed in one of the blocks of Gujarat. Baseline was conducted in 2013-2014 followed by intervention and the end line during 2016-2017. A structured validated questionnaire after pilot testing was executed to collect information on sociodemographic profile, nutrition status, menstrual hygiene practices, reproductive and sexual health, substance abuse, program awareness and utilization, and empowerment through life skills of adolescents in baseline and end line survey. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp). RESULTS: This study documented increased awareness regarding anemia, knowledge about STD and HIV/AIDS, reduced addiction to tobacco, improved practices during menstrual hygiene and engagement with adolescent services/schemes in the intervention site. CONCLUSION: This study concludes that evidence-based interventions lead to increase in knowledge and practices; however, some improvements have also been documented in the nonintervention site. Therefore, changes due to interventions could not be attributed completely for improving adolescent health. Further long term interventional studies are required to develop a robust evidence on improving health of adolescents in India.

Convergence and Outreach for Successful Implementation of Rashtriya Kishor Swasthya Karyakram.

BACKGROUND: Adolescents (10-19 years of age) constitute about one-fifth of India's population. The Ministry of Health and Family Welfare, Government of India, has launched Rashtriya Kishor Swasthya Karyakram (RKSK) in 2014 to improve health of adolescents. Adolescent Health Day (AHD) is an important intervention of RKSK for outreach and to secure convergence among relevant departments. OBJECTIVES: The objective of this study is to design and document methodology for effective implementation of AHD. MATERIALS AND METHODS: This study was conducted in Talod block of Sabarkantha district of Gujarat. The methodology was developed using ABCDE approach - assess, build, create, deliver, and evaluate. RESULTS: During assess phase, experts identified convergence an important component for successful implementation of RKSK. Formative research reaffirm that convergence played an important role in effective implementation of RKSK. Findings from these two phases led to the creation of a methodology which was used to deliver AHDs. This was further evaluated using interviews with key stakeholders in health and education department. It is now being used to organize AHDs in the district. CONCLUSION: ABCDE approach can be used to develop a better health interventions for National Health Programs.

Noncommunicable Diseases among School-going Adolescents: A Case Study on Prevalence of Risk Factors from Sabarkantha District of Gujarat, India.

BACKGROUND: The increasing burden of noncommunicable diseases (NCDs) and large proportion of adolescent population in India; crafts the dynamics of NCD risk factors. Most of the NCD risk factors are behaviorally acquired which are due to change in lifestyle during adolescent age groups. OBJECTIVE: This study aims to determine the prevalence of risk factors among school-going adolescents in one of district of Gujarat state, India. SUBJECTS AND METHODS: This is a cross-sectional study conducted among sampled schools of Sabarkantha district of Gujarat, India, during September-December 2016. A total of 484 school-going adolescents were screened for body weight, height, blood pressure, and some information of sociodemographic, lifestyle habits, and family history were collected through a structured questionnaire in vernacular language. Data were managed with SPSS version 20. RESULTS: This study documents that not having fruits and not doing physical activities daily are the major risk factors of NCDs among school-going adolescents of Sabarkantha district, Gujarat. In addition to this, also it has been documented that there are differential standards for body mass index (BMI) available for adolescents and have been used extensively in various studies. This study provides an insight to these three major BMI standards and their differences in measurement for the school-going adolescents. CONCLUSIONS: This study recommends promoting healthier practices for prevention of NCD lifestyle risk factors among school-going adolescents and it also recommends standardizing the BMI measurements for adolescents for India.