Intestinal parasites prevalence and related factors among school children in the rural area of central India.

A cross sectional study was conducted to determine the prevalence of intestinal parasitic infections and its epidemiological correlates among rural Indian school going children and to find out the effect of hygiene education on personal hygiene of school children at village Karanji (Kaji) in Wardha district of central India. Out of 172, 87 (50.6%) boys and 85 (49.4%) girls were examined. The mean age of the school children was 10.37 +/- 2.71. The prevalence of intestinal parasite infection was 7.56%. The prevalence was significantly high among barefoot children (OR = 8.99; 95% CI: 2.14 - 43.49) followed by those having poor hand washing practices (OR = 4.90; 95% CI: 1.30 - 20.01), not using sanitary latrine (OR = 2.49; 95% CI: 0.6 - 11.91)) and dirty untrimmed nails (OR = 1.98; 95% CI: 0.56 - 7.04). One month after hygiene education, there was significant improvement in the key personal hygiene behavior (p < 0.05). The proportion of children having practice of hand washing with soap after defecation significantly improved. Health education on personal hygiene to the school children was effective for behavior change. A multisectoral control approach and hygiene education will help health authorities in strategy of control programs for intestinal parasites among school going children.

Validating the MUAC (Mid-upper arm circumference) Cut-off for Detection of Severe Acute Malnutrition in Children Aged 6-59 Months in Rural Maharashtra.

OBJECTIVE: To review the Mid-upper arm circumference (MUAC) cut-off currently being used to identify Severe Acute Malnutrition (SAM) as currently defined using Weight-for-Height. METHODS: Cross-sectional study conducted in 24 villages of a Primary Health Centre in Wardha district of Maharashtra among 2650 children between the ages of 6 to 59 months. RESULTS: For identifying SAM, sensitivity of MUAC was 23.5% and specificity was 99.7% for cut-off <11.5 cm. Using Youden index, best Mid-upper arm circumference cut-off point to identify SAM was <13 cm with sensitivity of 74.5% and specificity of 92.7%. Using Receiver operating characteristics curve, best MUAC cut-off point was 12.8 cm with 74.5% sensitivity and 92.7% specificity. Area under curve was 0.88 (95%CI: 0.85-0.91). CONCLUSION: The current MUAC cut-off of <11.5 cm for detecting SAM needs to be increased to ensure that children, who need referral for management of malnutrition, are not missed.

Molecular Genetic Study to Detect Prevalence of High-risk Human Papilloma Virus Strains (type 16 and 18) in Cervical Lesions and Asymptomatic Healthy Subjects of Rural Central India.

BACKGROUND: Carcinoma cervix of uterus (CaCx) is the most common malignancy affecting women worldwide. It is an established fact that infection of specific types of human papilloma virus (HPV) is essential for the development of cervical cancer. The present study reports the high-risk viruses (HPV 16 and 18) type distribution in rural central India, which has unique climatic condition. To our knowledge, no molecular study on HPV prevalence has been done in this region of rural population, this intended us do such study. MATERIALS AND METHODS: Sexually active women reporting to the Gynecology were divided in three groups, first being asymptomatic women with normal cervix (52 cases), second group with benign cervical lesion (52 cases), and third group of women with frank cervical malignancy (40 cases). Cervical swabs were collected for HPV DNA sampling. The incidence of HPV positivity was recorded in each group. RESULTS: Fifty-two women with asymptomatic normal cervix showed 44.23% positivity for HPV 16 and 5.76% positivity for HPV 18. Fifty-two women with benign cervical lesion showed 38.46% positivity for HPV 16 and 3.84% positivity for HPV 18. Forty women with frank cervical malignancy were with prevalence of 62.5% for HPV 16 and 22.5% for HPV 18. CONCLUSION: The results of the study are definitely helpful to know the prevalence of HPV in this region of rural population and will enrich the national epidemiological data related to HPV infection in cervical cancer.

Effectiveness of weekly supplementation of iron to control anaemia among adolescent girls of Nashik, Maharashtra, India.

A national nutritional anaemia-control programme in India, focusing on supplementation of iron to pregnant women after the first trimester of pregnancy, failed to make an impact. It is prudent to recommend the correction of iron stores before the woman becomes pregnant. 'Efficacy' of weekly supplementation of iron has been proved to improve iron stores in adolescence in many studies abroad and in India. The objective was to study the 'effectiveness' of a weekly iron-supplementation regimen among urban-slum, rural, and tribal girls of Nashik district, Maharashtra, India. A baseline and the mid-term assessments were done using the cluster-sampling techniques. In each stratum, 30 clusters were identified. Twelve and 10 adolescent girls from each cluster were identified in the baseline and mid-term surveys respectively. The haemoglobin estimation was done using the HemoCue system. Data were analyzed using the Epi Info software (version 6.04). The overall prevalence of anaemia came down significantly to 54.3% from 65.3%. The decline was statistically significant (p<0.001) in tribal girls (48.6% from 68.9%) and among rural girls (51.6% from 62.8%). But the decline was not statistically significant among urban slum girls. Similarly, a significant rise in the mean haemoglobin levels was seen among tribal and rural girls. However, it did not increase significantly among urban slum girls. The programme had performed poorly in urban-slum areas, as the mean number of tablets consumed in urban-slum areas was only 5.6+/-3.3, as against 6.7+/-2.6 tablets in tribal girls and 7.2+/-2.2 tablets in rural girls. Considering the biological and operational feasibility and the effectiveness of the intervention, weekly supplementation of iron to adolescent girls should be universally started to correct the iron stores of a woman before she becomes pregnant.

Relationship of anthropometric indicators with blood pressure levels in rural Wardha.

BACKGROUND AND OBJECTIVES: Overweight and obesity are important determinants of health leading to adverse metabolic changes, including increase in blood pressure. Being overweight is associated with two- to six-fold increase in the risk of developing hypertension. Studies in urban Indian population showed strong relationship between different anthropometric indicators and blood pressure levels. Surprisingly, little is known about these relationships in rural population of India. The present study was carried out to examine the relationship between different anthropometric indicators and blood pressure levels in rural population of Wardha district in central India. METHODS: This cross-sectional study was carried out in the areas of two Rural Health Training Centres (RHTC) of Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram; namely Bhidi and Anji through house-to-house visits. Two stage sampling method (30 cluster followed by systematic random) was used to reach the respondents' households. Partial correlation coefficients were used for continuous variables. Linear regression analysis was used to assess the influence of different anthropometric indicators on the systolic and diastolic blood pressure. ROC analysis was done to identify optimal cut-off values while likelihood ratios were calculated to identify the odds of having hypertension in comparison to those with lower values of anthropometric indicators. RESULTS: The mean systolic blood pressures were 120.2 and 118.4 mmHg while the mean diastolic blood pressures were 77.7 and 76.3 mmHg in men and women respectively. There was a significant positive correlation of obesity indicators with both systolic and diastolic blood pressure. For SBP, the correlation coefficient was 0.23 with BMI, 0.23 with waist circumference, 0.11 with WHR and 0.22 with WHtR. For DBP, it was 0.13 with BMI, 0.12 with WC, 0.04 with WHR and 0.11 with WHtR. Step-wise linear regression suggested that BMI and WC were important predictors of hypertension. The suggested cut-off values for BMI were 21.7 for men and 21.2 for women; for waist circumference, the cut-offs were 72.5 for men and 65.5 for women. INTERPRETATION AND CONCLUSION: BMI and WC had strong correlation with systolic and diastolic blood pressure. The suggested lower cut-off values of the anthropometric indicators will cover maximum of the population with higher odds of having hypertension and may help in reducing the mean population blood pressure levels.

Effect of microinjections of 5-hydroxytryptamine and adrenaline in central grey on pain responsiveness during acute food deprivation in conscious rats.

To study the effects of microinjections of 5 hydroxytryptamine and adrenaline in central grey on pain responsiveness during acute food deprivation, experiments were conducted in nine male rats. Microinjections of 5 HT (10 micrograms/microliter) and adrenaline (10 micrograms/microliter) were given in central grey before and at the end of 6, 12, 18 and 24 hr food deprivation and the effects on pain threshold, cardiorespiratory parameters and body temperature were noted. Observations showed that 5 HT increased the pain threshold (antinociception) significantly (P < 0.05) with no change in cardiorespiratory response and body temperature, adrenaline did not alter pain threshold with no change in cardiorespiratory response and body temperature. The observations suggest the possible existence of two types of monoaminergic receptors or pathways in the central grey.

Left ventricular mass by M-mode echocardiography.

A comparison of various M-mode echocardiographic methods for assessment of left ventricular mass (LVM) was done in 21 subjects. The anatomical LVM was taken as Standard; it varied from 64.55 to 341.82 g. Of the six different M-mode echo methods compared, the method of Devereux and Reichek (1977) was found to correlate best with anatomical LVM (r = 0.99; SD = 49.54). By this method LVM = 1.4 [(LVIDd + LVPWTd + IVSTd)3 - (LVIDd)3] - 14 g.

Left ventricular M-mode echocardiographic measurements of Indian population.

The left ventricular dimensions of 506 normal healthy subjects (men = 317, women = 189) in the age group of 17 to 80 years were measured echocardiographically. The measurements were found to differ significantly from the western data. A separate limit for left ventricular echocardiographic parameter for the normal Indian population was established.

Reliability of perception of fever by touch.

OBJECTIVE: To assess the reliability of touch to predict fever in children. METHODS: 200 children who reported with fever formed the study material. Group I consisted of 100 children between 0-1 year of age and Group II consisted of 100 children between 6-12 years of age. Preterm, neonates under warming device, tachypnoeic and hypothermic were excluded from the study. The caregiver (CG) and the medical staffs (MS) response regarding presence or absence of fever by touch was noted in each child. Both were blinded to each other's response. Immediately temperature was recorded by calibrated rectal thermometer in Group I and calibrated axillary thermometer in Group II. RESULTS: The CG's touch had a sensitivity of 70.5% specificity of 40.9%, PPV of 38% NPV of 72.9%, PLR was 1.16 and NLR was 0.75. The MS's touch had a sensitivity of 78.0%, specificity of 63.6%, PPV of 38.0% NPV 84.8%, PLR of 2.08 and NLR of 0.36. There is over and under diagnosis of fever by both, the former being more by the CG reflecting the parental anxiety. The MS's touch is better to affirm or negative fever as compared to CG. The best site to palpate for presence of fever was abdomen, neck and forehead. CONCLUSION: Touch is not a valid screening test for fever. It is recommended that a thermometer must always be used by the MS to record fever and CG must be motivated for the same.

Vaccine preventable diseases in eastern Maharashtra--a hospital based analysis.

A retrospective study of hospital admissions of six vaccine preventable diseases from 1982-86 was carried out to save as a baseline data for future evaluation of vaccination programmes. Children between 1-4 years predominated the admissions in all diseases except whooping cough. The frequency of admissions of tuberculosis showed no change. Measles showed classical cyclical trend. Male female ratio was 1.8: 1.0. The mortality rate in meningeal tuberculosis was not influenced by the immunization status. Relatively small number of admissions of diphtheria and whooping cough indicates a decline due to natural causes or due to intervention programmes.

Dental caries and periodontal diseases among urban, rural and tribal school children.

The oral health status in school children of Wardha was studied to find out the geographical differences in oral health status and to relate it with the teeth cleaning habit and nutritional status. A cluster sample of 778 children studying in 2 urban, 4 rural and 2 tribal primary schools was selected. Majority (60.8%) of children were habituated to clean their teeth with Manjan. The prevalence of periodontal diseases was significantly high in children habituated to ash, Manjan and coal. The tribal children showed a better oral health status than urban counterparts. Nutritional status has played no role in dental decay. The school oral health education campaigns should be addressed to dental caries, periodontal diseases and the harmful teeth cleaning materials.

PIP: During 1990-1991, in Wardha district, India, dental workers conducted an oral health examination of 778 children attending two urban, four rural, and two tribal primary schools to determine oral health status and the association between oral health and sex, location of school, brushing behavior, and nutritional status. 59.2% of boys and 62% of girls cleaned their teeth once a day with Manjan, a locally available red and black granular powder. 5.7% of boys and 13.6% of girls brushed their teeth with tooth paste. 3.1% of all children only used their finger and plain water. 21.1% used ash and coal, which may damage gums and teeth enamel. 16.5% of all children had dental caries. About 40% of children who used tobacco powder and a small twig to clean their teeth had dental caries compared to 15-18% for those who used coal, ash, Manjan, and tooth paste (p 0.005). 13% had deposits of calcium phosphate and carbonate with organic matter on their teeth (i.e., calculus). 24.5% had stains on their teeth. The DM index (total number of decayed and missing teeth in each group divided by the total number of children in that group) at 12 years was 0.52 for boys and 0.8 for girls. The overall prevalence of periodontal diseases (abscess/bleeding and calculus) stood at 17.8%. Periodontal diseases tended to be limited to children using ash, coal, and Manjan. Rural children were more likely than urban and tribal children to suffer from periodontal diseases (22.6% vs. 10.5% and 15%, respectively; p 0.05). Dental caries were more prevalent among urban children than rural and tribal children (22.8% vs. 15.5% and 15%, respectively). Stains were more common among tribal children than urban and rural children (30% vs. 18.7% and 22.4%, respectively). Overall, the oral health status of tribal children was better than that of urban children. No association between dental caries and nutritional status existed. In conclusion, school oral health education should address dental caries, periodontal diseases, and the materials that harm teeth.

Comparison of axillary temperature with rectal or oral temperature and determination of optimum placement time in children.

The present study was done to compare axillary temperature (AT) with rectal temperature (RT) in 100 infants and with oral temperature (OT) in 100 children agd 6 to 12 years and also to find out the optimum placement time of the mercury thermometer at the above sites. Simultaneous AT and RT recording was done in infants while sequential AT and OT recording was done in older children by different investigators using calibrated Hick thermometers. The placement time recorded was when 3 consecutive readings at one minute interval remained unchanged. Significant correlation was observed between RT and AT (r=0.95, p <0.01) and between OT & AT (r = 0.97, p 0 <0.01). Equations were derived to calculate RT & AT from AT. The mean placement time for RT, AT and OT was 2.3 minutes, 4.8 minutes and 3.1 minutes respectively. The study showed a high degree of correlation between OT or RT and AT.

Electro neuro physiological studies in early tuberculoid leprosy.

Electro physiological studies were carried out in early tuberculoid type of leprosy in order to study their utility in detecting nerve damage before the onset of obvious functional deficit. Fifty-three cases showing one mixed nerve thickening in one limb were selected. Nerve conduction studies (both motor and sensory) were done using single blind technique. There was no statistically significant difference between the findings obtained from clinically thickened and non-thickened nerves. There was also no direct relationship between clinical sensory deficit and electro physiological abnormality. Clinical motor power loss was well correlated with electro physiological abnormalities.

Nutritional status of adolescents in rural Wardha.

OBJECTIVE: The objective of the study was to study the nutritional status of adolescents in rural area of Wardha. METHODS: The cross-sectional study was carried out in two PHC areas of Wardha district with two stage sampling method. In the first stage, cluster-sampling method was used to identify 30-clusters in each Rural Health Training Centre (RHTC) area separately. In the second stage, systematic random sampling method was used to identify 10 households per cluster. All adolescents in the household thus selected were included in the study. The mean body mass index (BMI) for age was used for classifying the nutritional status with CDC 2000 reference. Data thus generated was entered and analyzed using epi_info 2000. RESULTS: Overall, 53.8% of the adolescents were thin, 44% were normal and 2.2% were overweight. The mean body mass index (BMI) for boys and girls was 16.88 and 15.54 respectively. The difference was statistically significant (p<0.05). The prevalence of thinness was significantly (p<0.05) higher in early adolescence, girls, lower education (<8th standard) and lower economic status. CONCLUSION: Majority (53.8%) of the adolescents in this study area are thin and only 2.2% were overweight.

Epidemiology of early neonatal mortality.

PIP: During 1981-1991 at a rural teaching hospital (Kasturba Hospital) of Mahatma Gandhi Institute of Medical Sciences in Sevagram, Wardha, India, 454 of 13,939 newborns died during the early neonatal period for an early neonatal mortality rate (ENMR) of 33.7/1000 live births. The ENMR for boys was not significantly different from that for girls (36.1 vs. 28.6). Community medicine specialists analyzed data on these early neonatal deaths to examine distribution of early neonatal mortality, especially its relationship with prematurity, low birth weight, birth order, and by sex. They calculated average percent deaths (APD) per hour to examine the dynamics in early neonatal mortality. The mean age at death was lower among newborns of birth order greater than 2 than those of birth order less than 2 (23.47 vs. 26.85 hours; p 0.001). ENMR was higher for newborns of birth order greater than 2 than those of birth order less than 2 (41.74% vs. 27.35%; P 0.001). The mean age at death increased as gestation increased (10.34 for 28 weeks; 24.27 for 28-33 weeks, 31.53 for 33-37 weeks, and 34.43 for 37 weeks; p 0.001). ENMR decreased as gestation increased (850 for 28 weeks; 375 for 28-33 weeks, 147.02 for 33-37 weeks, and 8.77 for 37 weeks; p 0.001). The mean age at death increased as birth weight increased for newborns weighing less than 1500 gms through 2000-2500 gms (23.36-37.13 hours; p 0.001). It was lowest among those weighing more 3000 gms (11.55 gms). ENMR fell as birth weight increased (614.33 for 1500 gms, 116.19 for 1500-2000 gms, 19.38 for 2000-2500 gms, 10.99 for 2500-3000 gms, and 5.41 for 3000 gms; p 0.001). The APD/hour for the first hour of life was 3.74% for a relative risk of 12.9. It decreased steadily as the hours of life increased (3.08% for 1-6 hours, 1.19% for 6-24 hours, 0.67% for 24-72 hours, and 0.29% for 72-168 hours). Knowledge of time of likely death can help providers know where they need to focus their attention to prevent early neonatal deaths.^ieng