Food security among preschool children.

A cross-sectional study of preschool children from 450 families from a residential colony of 'D' class hospital employees was undertaken to study food security & associated variables. Food security was established from (a) 24 hours recall method with 1 day weighment and (b) monthly food purchase inventory for cereals and pulses. Relationship between food secure status and variables of interest was studied from Chi-square value and odds ratio. Only 42.6% households and 54% preschool children from these households were calorically secure. Insecurity was the highest in 48-59 months age group. Per capital income, increasing birth order, family size, household size, less years of schooling of the mother, less than 4 meals per day and pulse insufficiency at home were associated with food insecurity. Per capita income ensures food availability at home. Family size and household size probably ensure distribution. Mother's education, frequent feeds more than four, ensure that it reaches the preschool children.

Anganwadi worker's participation in rural newborn care.

Anganwadi worker was involved in rural newborn care as a link between a dai and a health worker. She was trained to ensure that, (i) borderline LBW/preterm baby was kept warm at home and (ii) a very small baby was referred to hospital. The training was conducted during routine monthly meetings and cost of equipping each anganwadi worked out to be Rs 110. Newborn survival, infant survivals and overall MCH performance improved. Thus, newborn care formed an ideal entry point into MCH activities.

PIP: The Rural Neonatal Care Program was initiated in January 1988 in Ganjad Primary Health Center, Dahanu, India, with the training of dais in care of the newborn. Later in the year training was conducted for anganwadi workers, who would follow-up newborn care until the child was 6 years of age. The anganwadi worker was a link between the dai and health worker and the health center. Home visits were made on the day of birth. The infant was measured and an health assessment made. If the infant was preterm or low birth weight and with a foot length of between 6.5 and 7 cm, repeat home visits were made to assess the breast feeding progress, the infant activity level, and general signs of health, as reflected in warm and pink feet. Training was conducted at monthly meetings at the block level, at the primary health care level, and during field visits to show how to care for hypothermic babies. A training manual and record book were developed and used. Footprints were made, and referrals were made to the hospital for those with feet under 6.5 to 7 cm. General observations were that birth registration improved, and infants were more easily identified for immunization. Newborn referral improved, and infant mortality declined. There was an important role for the anganwadi worker in providing continuity of care, identification of referrals, and training in the home for how to keep a baby warm. The number of referrals averaged 1-2 per month and 1-2 with special home attention. The training of the anganwadi worker in newborn care was included in the normal course of training and cost about Rs. 110 per worker.

Rural neonatal care: Dahanu experience.

The Rural Neonatal Care Project, started by the Government of Maharashtra in the Ganjad Primary Health Centre, Dahanu block in Maharashtra, had the TBA as the sheet anchor for delivery of neonatal care. Maintenance of "warm chain" and resuscitation of an asphyxiated baby were recognized as the most important interventions besides detection of a very low birth weight/preterm baby and safe transportation of such a baby. Foot length measurement from foot print was used as a surrogate to birth weight as an indicator for referral. Neonatal and perinatal mortality rates dropped appreciably over 3 years and the antenatal registration went up by 30%. The cost of this programme is affordable and the programme itself was acceptable to the community and the TBAs because of its simplicity.

Training of traditional birth attendants in newborn care.

PIP: Appropriate training of traditional birth attendants (TBAs) can both increase the proportion of births attended by trained persons and enhance linkages between rural communities and modern health services. Described is a TBA training program in newborn care developed by the Rural Neonatal Care Project in Maharashtra State, India. To improve attendance, a sub-center was established for TBAs from the northern part of the primary health care area. In addition, an effort was made to train women who assist the TBAs (usually a close relative). Two training sessions per month were held for 6 months, then the frequency was reduced to once a month. TBAs received 5 rupees for attending a training session and an additional 5 rupees for each registered birth. The training, delivered by lady health visitors and auxiliary nurse midwives, used photographs and dolls to communicate information about keeping the newborn warm, resuscitating a depressed baby, identifying very small infants, and safely transporting at-risk infants to the primary health care center. Also addressed were immunization, management of diarrhea, and referral of acute respiratory infection cases. Program evaluation highlighted the importance of brief, task-oriented sessions that use demonstrations, case histories, oral questioning, and reviews of material presented in earlier sessions. Since TBAs have extensive experience in deliveries in village conditions, they should be regarded by trainers as equal partners.^ieng

Orogastric versus nasogastric feeding of newborn babies.

Oxygen saturations were compared, 10 min before and 10, 20 and 30 min after orogastric and nasogastric feeds, in 10 stable newborns. The mean saturations were significantly lower with mere passage of nasogastric tube and continued to be so during feeds. There was no difficulty in securing the orogastric tube and no baby aspirated milk.

Occupation of women and maternal and child health.

PIP: This study was carried out in Dahanu taluka of Thane district in the state of Maharashtra, India, in October 1987 using cluster sampling. 10 clusters from 9 primary health centers were selected, which yielded 1954 families and a representative population of 7800. The distribution of various occupations among the women indicated that 1127 were housewives, 594 were agricultural laborers, 19 were skilled workers, 118 were unskilled workers, and 96 were engaged in other work. Regarding family income, 304 housewives earned 1000 rupees or more vs. 63 working mothers; 423 housewives earned 500-999 rupees vs. 451 working mothers; and 393 housewives earned 250-4999 rupees vs. 214 working mothers. As far as prenatal care was concerned, among housewives, 861 did not get any care, 190 had fewer than 3 visits, and 14 had over 3 visits. Among agricultural laborers, 533 did not get any care, 14 had fewer than 3 visits, and 2 had 3 or more visits. Among skilled workers, the respective figures were 10, 7, and 0. Among housewives, prenatal problems consisted of edema (18), anemia (7), and bleeding (36). The respective figures for agricultural laborers were 8, 21, and 26. Among housewives, 270 were attended by trained health workers at birth and 794 were attended by untrained health workers. The respective figures for agricultural laborers were 251 and 298; for unskilled workers, 20 and 94; and for skilled workers, 10 and 7. Among housewives, prolonged labor and malposition occurred in 4 cases, but these were absent in 1062 cases. The respective figures for working mothers were 9 and 673. Similarly, excessive bleeding or fever occurred in 9 housewives but were absent in 1059. The respective figures for working women were 2 and 679. Pregnancy outcome among housewives included 867 FTND, 2 very low birth weight, 3 safe birth?, 3 abortions, and 8 neonatal deaths. Among working women, the respective figures were 548, 3, 2, 1, and 6. Socioeconomic factors are linked to the level of health, and hard physical labor can adversely affect it.^ieng

Health information for primary neonatal care.

A baseline health survey was carried out in tribal area of Dahanu taluka in Maharashtra as a part of Rural Neonatal Care Project of the Government of Maharashtra. A population of 9684 was surveyed following the technique of cluster-sampling. High perinatal, neonatal, and maternal mortality rates were noted. Unfavourable maternal characteristics, obstetric factors, and infrastructural facilities contributed to high mortality rates.

Epidemiology of perinatal loss in rural Maharashtra.

This study was carried out in a tribal block in Maharashtra in 1987. Socio-economic and obstetric factors commonly known to be associated with unfavourable perinatal outcome were assessed by studying odds ratio, attributable risk, and stepwise multiple regression. Preference for traditional health care, long distance from health post, teenage pregnancy, inadequate schooling, hard physical work, first or fifth and subsequent pregnancy, certain antenatal, intranatal, and postnatal factors emerged as important causes associated with perinatal loss.

Risk assessment in birth asphyxia.

In developing countries the need for a risk approach in neonatology is obvious because of a high birth rate, high neonatal mortality rate, and limited availability of resources. Quantification of risk, with selected antepartum, intrapartum factors, clinical, and post-mortem findings was done by calculating odds ratio, attributable risk, and 95 per cent confidence limits in 1811 babies, 541 of which were asphyxiated. Primigravidity, history of perinatal death, pregnancy induced hypertension, and antepartum haemorrhage carried higher risk. Abnormal fetal heart rate and meconium passage in amniotic fluid correctly predicted high risk of birth asphyxia. Decreasing risk in premature/low birth weight babies without increase in abdominal deliveries suggested that caesarean sections were unnecessary in preterm deliveries. Clinical monitoring of asphyxiated newborns was adequate enough.

Quality of survivals on conservative neonatal care.

Quantity as well as quality of survivals determine the performance of a neonatal centre. Our centre has succeeded in improving survival with low cost technology without compromising the quality. Neurodevelopmental handicap was low on a 1-year follow-up. No baby had retinopathy of prematurity or hearing deficit. Dropout rate has been high although comprising of mainly full-term or near-term babies with mild perinatal asphyxia or mild respiratory distress or requiring instrumentation during delivery. Longer follow-up is desirable.

Determinants of death among admissions to intensive care unit for newborns.

Determinants of death in newborns admitted to the Intensive Care Unit were studied taking into consideration antenatal history, intrapartum events, and clinical findings. Over 3 years (1984, 1985 and 1986) 1747 admissions were the subjects of this study. Of these, 424 deaths formed the study group and 1323 survivors form the control group. Odds ratio, attributable risk, univariate analysis, multiple stepwise regression, and analysis of variance were obtained. Clinical features associated with respiratory distress, birth asphyxia, admission to nursery after 6 hours of birth, and hypothermia on admission were found to be important factors related to death among nursery admissions.