Community based kangaroo mother care for low birth weight babies: A pilot study.

BACKGROUND & OBJECTIVES: Kangaroo mother care (KMC - early continuous skin-to-skin contact between mother and infants) has been recommended as an alternative care for low birth weight infants. There is limited evidence in our country on KMC initiated at home. The present study was undertaken to study acceptability of KMC in different community settings. METHODS: A community-based pilot study was carried out at three sites in the States of Odisha, Gujarat and Maharashtra covering rural, urban and rural tribal population, respectively. Trained health workers provided IEC (information, education and communication) on KMC during antenatal period along with essential newborn care messages. These messages were reinforced during the postnatal period. Outcome measures were the proportion of women accepting KMC, duration of KMC/day and total number of days continuing KMC. Focus group discussions and in-depth interviews were also carried out. RESULTS: KMC was provided to 101 infants weighing 1500-2000 g; 57.4 per cent were preterm. Overall, 80.2 per cent mothers received health education on KMC during antenatal period, family members (68.3%) also attended KMC sessions along with pregnant women and 55.4 per cent of the women initiated KMC within 72 h of birth. KMC was provided on an average for five hours per day. Qualitative survey data indicated that the method was acceptable to mothers and family members; living in nuclear family, household work, twin pregnancy, hot weather, etc., were cited as reasons for not being able to practice KMC for a longer duration. INTERPRETATION & CONCLUSIONS: It was feasible to provide KMC using existing infrastructure, and the method was acceptable to most mothers of low birth infants.

Neonatal sepsis due to vertical transmission from maternal genital tract.

High vaginal swabs (HVS) of 1792 expectant mothers were sent for culture at the time of delivery, prior to first vaginal examination. The newborns were followed-up for development of superficial or deep infections. Appropriate cultures of the babies who developed infections were sent. Bacterial growth of predominantly gram-ve organisms was obtained in 1026 (57%) HVS. Infection developed in 48 (27%) babies in 1st 72 hours of life, of which 28 had deep infection while the rest had superficial infection. Vertical transmission of organisms was documented in 24 (1.3%) mother-baby dyads and the same was 72% in newborns who were at risk of developing sepsis by septicemia scoring, showing a significantly higher incidence of vertical transmission and subsequent sepsis in high risk newborns.

Cardiomyopathy in children in Ahmedabad.

A clinical study and follow up of 20 children with cardiomyopathies upto age of 16 years are presented. The DCM was most common variety followed by RCM and HCM in pediatric age group. SHMD presenting with cardiomyopathy were common in infancy and early childhood. Cardiomyopathies presented most frequently between 2-5 years and 10-16 years age group with DCM having almost equal distribution. Clinical presentation of various types is described, despite of vigorous decongestive and vasodilator treatment in advanced cases, course was rapidly downhill and prognosis is poor in general.

Footlength measurement in the neonate.

In 353 neonates, foot length were recorded along with birth weight, crown heel length and head circumference. Foot length correlated well with all three indices (p less than .01). Highest correlation in preterm babies was with crown heel length and weight, and in term babies with head circumference. The formula, length = footlength x 6.5 +/- 20 mm could be correctly used in 95% of babies. When it is difficult to weigh or measure the length accurately, foot length can serve as a useful measurement to assess a baby quickly.

Urolithiasis in childhood.

Clinical and laboratory findings in 41 cases of urolithiasis in children are presented. Males were more than females (9.25:1). Five patients had family history of urolithiasis. Clinical presentation was highly variable. Most of the stones were of mixed variety composed of calcium, phosphates and oxalates.

Knowledge, attitude and practice of immunization in an urban educated population.

A KAP evaluation of urban educated parents revealed suboptimal, superficial transfer of immunization knowledge. Poorer dose-related knowledge as compared to vaccine awareness contributed to partial immunization. Non-availability of vaccine contributed to 18.7% unprotected children, and therefore all logistics must be overcome to remedy service default. The unacceptable level of knowledge found in final year nursing and medical students, points out the need to restructure immunization related teaching in our hospitals. Incorporation of immunization based knowledge in high school curriculum is also recommended. It is important that areas of relevant information and education must be delineated time to time with increasing vaccination coverage.

A study of serum zinc levels in cord blood of neonates and their mothers.

Serum zinc was estimated in the cord blood of 60 neonates of different gestational age and birth weight, and their mothers. Mean serum zinc levels in neonates FTGA, PTAGA and term SGA were 128.88 +/- 14.37, 94.32 +/- 17.79 and 111.8 +/- 9.2 ug/dl respectively. The maternal serum zinc levels in corresponding groups was 96.28 +/- 19.48, 115.44 +/- 15.41 and 93.8 +/- 7.62 ug/dl. Thus mean serum zinc level in cord blood of FT AGA newborns was significantly higher than that in PT AGA and FT SGA. Mean serum zinc level in mothers of FT AGA was significantly lower than that in mothers of PT AGA. However, there was no significant difference between the maternal serum zinc levels of FT AGA and FT SGAs. There was positive correlation between gestational age and serum zinc level in cord blood of AGAs while correlation was negative in case of their mothers. There was positive correlation between weight (keeping gestational age constant) and serum zinc level in case of neonates while corresponding maternal zinc levels did not vary. (FT AGA and FT SGA).

Appropriate technologies for mother and child health care in developing countries.

PIP: Perinatal (PNMR) and neonatal (NMR) mortality rates are very high in India amounting to 40%-60% of infant mortality rates (IMR). Perinatal and antenatal care aids include pictorial cards for registering pregnancy for the use of illiterate traditional birth assistants (TBAs), adult weighing scales for mothers with red (40 kg), yellow (40-45 kg), and green (45 kg) relating to pregnancy weight. Tricolored mid arm strips can be useful to assess the degree of undernutrition in pregnant women. short women can be measured with the help of sticks painted red up to 140 cm and white above 140 cm. Educated workers can be trained to measure fundal height and abdominal girth. Graphs for weight gain patterns during pregnancy and teaching slides to train the community workers to detect high risk mothers have been developed. Pregnant women are supplied with a simple sterile cord care kit containing a half blade, 2 threads, and gauze pieces as well as with an illustrated list of articles to be kept ready in case of home delivery. Some birth attendants have been trained in proper detection and counting of fetal heart rate. Care during delivery is facilitated by pictorial cards for labor monitoring, delivery kits for trained birth attendants, safe cord care kits, resuscitation kits containing presterilized mucus aspirators, and birth record cards. Low birth weight and pre-term babies can be identified by portable weighing scales and by examination of certain physical features. The goals of care during infancy are to promote overall child health including physical, mental and social well-being. Health charts register weights taken at regular monthly intervals and details of feeding, weaning and diet. These child health records also serve the detection of malnutrition and undernutrition. Other techniques include pictorial symbols for different grades of respiratory distress, immunization record cards, proper sterilization of syringes and needles, the popularization of the symbol for Mother and Child Health (MCH) Care Services. The goal of "Health for All by 2000 A.D." can be achieved by improving the status of women through education, by proper utilization of mass media, and by allocating additional resources, rather than by imitating Western patterns.^ieng