Estimation of the Parasitic Burden of Soil-Transmitted Helminths Among Pregnant Women in the Maharashtra State of India Using qPCR: A Community-Based Study.

Background: Soil-transmitted helminth (STH) infections are widespread in developing countries with inadequate sanitation facilities. These infections can lead to malnutrition, anemia, and other complications that can negatively impact both the mother's and fetus's health during pregnancy. This study aimed to estimate the burden of STH by Kato-Katz microscopy and quantitative polymerase chain reaction (qPCR) in pregnant women from rural India. The diagnostic accuracy of these two methods was also compared. Material and Methods: A community-based cross-sectional study was conducted in rural areas of Wardha district of Maharashtra state. We randomly selected and interviewed 688 pregnant women. A total of 534 (77.61%) participants gave stool samples. Two containers (60 mL) labeled with a unique identification number were given to pregnant women to collect stool samples for Kato-Katz microscopy and qPCR. Stool specimens were transported to an accredited lab and examined within 24 hours. Suitable examinations were conducted to compare sensitivity between two tests. Results: The results are presented for 534 participants who gave stool samples. The prevalence of any STH by Kato-Katz stool microscopy was 6.55% (95%CI 4.46-12.19), and that by qPCR was 20.41 (95%CI 17.53-29.40). The sensitivity of Kato-Katz microscopy was 29.17% compared to sensitivity of 90.83% by qPCR (P = 0.001). Pregnant women with STH infection have a significantly lower weight gain during pregnancy, and the majority were either mild or moderate anemic compared to those without STH. Conclusion: The study highlighted significant differences in prevalence of STH among pregnant women by Kato-Katz microscopy and qPCR. The sensitivity of qPCR for detecting STH was higher than that of Kato-Katz microscopy.

Teacher's Perspectives About Tobacco Consumption and Its Prevention Among Students From Western Maharashtra, India: A Qualitative Study.

Background Teachers are role models for students and influential members of society. They are capable of influencing social norms related to tobacco control among students. This background study was planned to understand teachers' opinions and views about factors influencing tobacco use and prevention strategies being used. Methodology We conducted qualitative research on teacher's opinions about tobacco use among students. We chose focus group discussion as our data collection method, as we wanted to observe their personal views on social norms. We involved 70 high school teachers in our study from the Akola district. The data collected from the teachers were organized into various themes interrelated to the objectives. Results The majority of teachers mentioned that the reason for tobacco consumption among children was peer pressure, from observations of older individuals in society, and from TV serials. Some teachers suggested that proper counseling and telling them about the harmful effects of tobacco are useful for prevention. Tobacco's harmful effects and its prevention strategies were not included in the standard curricula of students, which is one of the key barriers. Conclusions There is a need to implement school-based tobacco prevention education programs to reduce the early onset of smoking among students. School authorities must implement the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act, 2003 effectively with the help of the police to prohibit tobacco use among teachers and students.

Interventions for promoting and optimizing breastfeeding practices: An overview of systematic review.

Background: Optimal breastfeeding (BF) practices are essential for child survival and proper growth and development. The purpose of this overview is to evaluate the effectiveness of different interventions for promoting and optimizing breastfeeding. Methods: We included systematic reviews (SRs) [including trials from Low-Income (LICs) and Low Middle-Income countries (LMICs)] that have evaluated the effect of various interventions for promoting and optimizing breastfeeding and excluded non-systematic reviews, and SRs based on observational studies. We searched various electronic databases. We followed the standard methodology as suggested by the Cochrane Handbook for Systematic Reviews of Interventions. Two sets of reviewers undertook screening followed by data extraction and assessment of the methodological quality of included SRs. Result: We identified and screened 1,002 Cochrane SRs and included six SRs in this overview. Included SRs reported only two of the primary outcomes, early initiation of breastfeeding (EIBF) and/or exclusive breastfeeding (EBF). None of the included SR reported continued BF up to 2 years of age. The results were evaluated using two major comparisons groups: BF intervention against routine care and one type of BF intervention vs. other types of BF intervention. Overall results from included SRs showed that there were improvements in the rates of EIBF and EBF among women who received BF intervention such as BF education sessions and support compared to those women who received only standard care. However, BF intervention via mobile devices showed no improvements. In Target Client Communication (TCC) via mobile devices intervention group, no significant improvements were reported in BF practices, and also the reported evidence was of very low certainty. Conclusion: Community Based Intervention Packages (CBIP) delivered to pregnant and reproductive-age women during their Antenatal care (ANC) and/or Postnatal care (PNC) periods by Ancillary Nurse-Midwives reported the highest improvement in EIBF compared to women who received standard care. However, insufficient evidence was reported to suggest that BF intervention showed improvements in EBF in both the comparison groups. This overview highlighted the gaps in primary research regarding the uncertainty about the settings such as LICs or LMICs, lack of evidence from LMICs, and also identified gaps in the availability of reliable up-to-date SRs on the effects of several BF interventions to promote and optimize practices. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020174998, PROSPERO [CRD42020174998].

Design-redesign, implementation, and evaluation of effectiveness of maternal nutrition and responsive parenting program on child development at 2 years of age from rural India: a cluster RCT.

Background: To promote early childhood development (ECD), we require information not only on what needs to be addressed and on what effects can be achieved but also on effective delivery methods that can be adapted to local context. We describe design, implementation, and evaluation of a complex intervention to strengthen nurturing environment for young children. Methods: Study participants were pregnant women and their children from birth to 2 years. We used design and redesign, implementation, and evaluation approaches for the study. We co-created curriculum and delivery plan with stakeholders, based on the theoretical framework, findings from formative research, and our preliminary work. We recruited 656 pregnant women and newborns, 326 (49.69%) from intervention and 330 (50.30%) from the control group. We conducted a cluster randomized controlled trial to evaluate the program's effectiveness. The outcomes of children were assessed at 12 and 24 months. Findings: At recruitment, study participants from both the study arms were similar in sociodemographic characteristics. We conducted 6,665 home visits, 25 toy-making workshops, and 65 caregiver-meetings. The initial examination of program data revealed gaps in quality and coverage of interventions. The intervention was redesigned based on feedback from stakeholders in community meetings. At recruitment, participants in both study groups had similar socio-demographics. We conducted 6,665 home visits, 25 toy workshops, and 65 caregiver meetings. Initial program data showed intervention quality and coverage gaps, leading to a redesign program based on community and stakeholder feedback. Post-re-designing, session quality improved, with program coverage rising from 32 to 98%. Male participation in home visits increased from 4.3 to 32.65%, and data errors reduced from 270 to 140 per month on average. At 24 months, program showed moderate-mild impact on ECD - cognitive (0.31, 95%CI: 0.13-0.48), language (0.2, 95%CI: 0.01-0.39), and socioemotional-development (0.19, 95%CI: 0.01-0.37), moderate effect on home-environment and mother-child interaction. 96% of women initiated breastfeed within one-hour of delivery, and exclusive-breastfeeding rate of 89.80%. Interpretations: The study provides an evidence-based community centered ECD curriculum and implementation strategies to enhance service providers, and caregivers' knowledge and skills for promoting ECD in low-resource settings with the potential to scale within existing Government Program. Funding: The trial was funded by the Saving Brains Round 5 Initiative of Grand Challenges Canada (Grant no. SB-1707-05084), and we are grateful for their ongoing support through online sessions and orientation workshops. The trial was also supported by the Indian Council of Medical Research (File No: 5/7/1693/CH/Adhoc/RBMCH-2020).

Rapid-cycle evaluation and learning for the effective delivery of integrated interventions in early childhood in rural India.

Background: Effective and real-time data analytics plays an essential role in understanding gaps and improving the quality and coverage of complex public health interventions. Studies of public health information systems identify problems with data quality, such as incomplete records and untimely reporting. Effective data collection and real-time analysis systems for rapid-cycle learning are necessary to monitor public health programs and take timely evidence-based decisions. Early childhood development (ECD) programs are very diverse. Rapid-cycle evaluation and learning (REAL) guides the implementation process of such complex interventions in real time. Stepping stones was one such early childhood development program implemented in Central India. Objective: The objective was to improve the delivery of complex, integrated public health interventions for early childhood development in remote areas of rural India. Methodology: The program was developed according to the principles of inclusion and community-centeredness, which can be tested quickly and iteratively. To enhance the decision-making process and improve delivery and coverage, the core team implemented an information system for rapid-cycle learning. We developed performance indicators and a performance measurement matrix after defining the specific needs. Following that, we trained staff to collect complete data using electronic data collection tools and transfer it the same day to the server for quality review and further analysis. A variety of data/information was triangulated to address the gaps in intervention delivery, and those decisions were subsequently implemented. Results: We observed that the quality of data collection improved, and errors were reduced by 50% in the third quarter. The quality of the narrative was also enhanced; it became more elaborate and reflective. Sharing their field output in meetings and improving the quality of the narrative enhanced the self-reflection skills of field staff and consequently improved the quality of the intervention delivery. Refresher training and mentoring by supervisors helped to improve the data quality over time. Conclusion: Rapid-cycle evaluation and learning (REAL) can be implemented in resource-limited settings to improve the quality and coverage of integrated intervention in early childhood. It nurtures a reinforcing ecosystem that integrates providers, community, and family perspectives and guides interactions among stakeholders by integrating data from all available sources.

Effectiveness of family-centered program for enhancing competencies of responsive parenting among caregivers for early childhood development in rural India.

BACKGROUND: Responsive parenting constitutes an essential part of the context in which children live and has shown a positive effect on child development in the early years of life. AIMS: This study aimed to assess the effectiveness of family parenting programs for enhancing competencies of responsive parenting among caregivers. STUDY DESIGN: Cluster-RCT in 50 Anganwadi center areas. Twenty-five intervention clusters received responsive parenting intervention. Anganwadi workers delivered sessions after support and training. SUBJECTS: We enrolled 530 mother-child dyads; 264 (49.9 %) from the intervention arm and 266 (50.1 %) from the control arm. OUTCOME MEASURES: We assessed caregivers' knowledge and skills about child development using a parenting quiz. We evaluated the effect of an intervention on the home environment, mother-child interaction, and development outcomes at the endpoint. RESULTS: We conducted 200 parenting sessions in 25 intervention clusters. Caregivers attended, on average, five sessions out of the nine scheduled. Caregivers with improved knowledge and skills about nutrition, shelter & care, play & stimulation for responsive parenting were significantly more in the intervention than in the control arm (p < 0.05). Mean difference in scores of home environment (1.24; SE-0.75 & ICC-0.088) and mother to child interaction (2.36; SE-0.87 & ICC-0.023) motor development (1.71; SE-0.61 & ICC-0.002), language development (2.97; SE-0.85 & ICC-0.002) and socioemotional development (1.45; SE-0.56 & ICC-0.066) between intervention and control arm was statistically significant (p < 0.05). CONCLUSIONS: A locally adapted, family parenting curriculum was a practical approach for enhancing parents' competencies and confidence to promote early child development.

The burden of soil-transmitted helminths infections among pregnant women in Maharashtra and Rajasthan states of India.

Context: Soil-transmitted helminths (STH) infections are among the most common and widespread infections in developing countries where sanitation facilities are inadequate. Aims: This study aimed to estimate the prevalence of STH infections in prenatal mothers in two states in India. Settings and Design: A cross-sectional survey was conducted in Maharashtra and Rajasthan state of India. We randomly selected one municipal corporation and one rural block from a selected district in each state. Methods and Material: Out of 2400 contacted, 2206 pregnant women gave stool samples for microscopy for parasitological study. The response rate was 89.91%. Stool specimens were transported to an accredited lab and examined microscopically within 24 hrs. Results: Prevalence of STH was 8.34 (95%CI 7.22-9.57). The prevalence in rural and urban areas was 10.01% (95%CI 8.51-11.74) and 5.76% (95%CI 4.39-7.52), respectively. Ascaris lumbricoides (34.7%) were the most common, followed by Entamoeba histolytica (30.43%), and 20.1% were mixed infections. Higher age, walking barefoot, weight gain during pregnancy were significantly associated with STH (p < 0.05). The mean hemoglobin value in women with STH was significantly less (8.75 gm%; SD 4.04) compared to those without STH (10.23 gm%; SD 1.23) (p < 0.05), and average weight gain during pregnancy was significantly less among women with STH (3.80 kg; 4.11) compared to women without STH (8.45 kg; 2.83); (p = 0.000). Conclusion: The study provides valuable insights into the burden and intensity of STH in pregnant women that may support the policy recommendation for deworming during pregnancy.

Photostory-A "Stepping Stone" Approach to Community Engagement in Early Child Development.

Background: Capturing real-life practices through photographs provides an opportunity to create awareness and focus discussions on relevant issues in community. Photographs and narratives also engage decision makers, inspiring changes in policy and practice. Objective: Paper describes development and adaptation of an integrated photostory approach documenting actions and stimulating positive change in Early Child Development (ECD). Methodology: The Photostory method was built through a cyclical process to describe and explore early-childhood practices in central-India through photographs and stories. A systematic format to capture, archive and evaluate photographic material was developed. A standardized rating system was established to monitor levels of, and change in, community practices. We integrated Photostory process into routine visits undertaken during implementation of Stepping-Stones, an ECD intervention program. This paper utilized collected data to explore utility of rating framework to describe and measure behavior and to track change. We explored role of Photostory approach in engaging community in process of stimulating positive ECD experiences. Results: We developed a systematic framework to support data capture, analysis, and data utilization using multistep iterative mixed method process. A total of 161 Photostories were collected (72 at baseline and 89 at endpoint). Using a rating system which measured both the structure of the tasks, and the emotional engagement of the child and parent, many activities and practices observed were evaluated as providing at least an adequate learning space. In exploring change over the implementation process, at endpoint children were more likely to be observed as more engaged in their play activities (p < 0.05). Parental engagement levels remained stable, toward being less actively engaged. At endpoint we observed a trend toward activities being provided for children at a level of difficulty higher than child's level of developmental. The data provided the intervention team with local examples through which to engage parents in discussions on activities that stimulate effective child exploration and learning. We were also able to demonstrate the added value of photographs in stimulating detailed discussion amongst community members on early child development. Conclusion: Photostories can provide a systematic and rigorous methodology to stimulate engagement, monitor and measure change in community-based parenting interventions.