Functioning of a Nutritional Rehabilitation Center against acceptable levels of care.

Background: Establishment of Nutritional Rehabilitation Centers (NRCs) is an initiative under National Rural Health Mission to provide institutional care for children with severe acute malnutrition (SAM). The aim of the study was to assess the effectiveness of nutritional interventional measures in improving the nutritional status of children admitted to an NRC. Methods: A retrospective health facility-based descriptive study was conducted in the NRC, Rural Health Training Center, All India Institute of Medical Sciences, Raipur. Results: A total of 765 children were enrolled in the NRC between March 2015 and November 2019, and majority (87.97%) were admitted as per weight for height/length (<-3SD) criteria. The total number of SAM children with complications were 428 (55.94%). Of the 724 total discharges, 498 (68.78%) were cured, 197 (27.2%) were nonresponders and 28 (3.87%) were defaulters. Conclusion: The findings suggest factors affecting nutritional rehabilitation that are complex and require a more integrated management in the health system and community. Regular review, supportive supervision and identification of nutrient-dense food from locally available low-cost ingredients is the need of the hour.

Need Assessment of Existing Mentorship Program Among Undergraduate Medical Students: Experience From a Medical College in Chhattisgarh, India.

Introduction While mentoring students during regular medical education has a long-standing tradition in many developed countries' medical schools, it has yet to become a standard practice in the majority of medical institutions, especially in the developing world, such as India. In institutions where mentoring programs are sparsely implemented, there is a lack of data regarding their assessment. Methodology This qualitative study involved two groups of students - nine undergraduate medical students (five male and four female) and 10 undergraduate medical students (six male and four female) who had at least three years of experience in the existing mentorship program at a tertiary care teaching hospital. We conducted two focused group discussions (FGDs) with these two groups of students using a guide, with FGDs lasting 45 and 50 minutes, respectively. We recorded the audio and it was transcripted to text. Thematic analysis of the transcripts from the 2 FGDs was conducted using Atlasti (Version 7.1.8) software to assess perceptions of the mentorship program. Results The content analysis of the discussions revealed two broad themes, namely "Current Functioning of the Programme" and "Suggestions for Improvement." These themes were further divided into multiple domains and subdomains, providing a comprehensive overview of the study's findings. Although there is a consensus among students that the mentorship program is essential, the current operational framework still has limited confidence due to biases, fears, and misinformation among the students. Conclusion The ongoing medical curriculum imparts a vast amount of scientific knowledge within a limited timeframe, with practical application occurring primarily in the last three years of the academic curriculum and minimal emphasis on ethical practice, professionalism, effective communication, handling urgent health situations, and interacting with family members, underscores the genuine need for a structured mentorship curriculum for undergraduate medical students. To enhance the program's effectiveness, the active involvement of undergraduate students must address their specific needs.

Performance Appraisal of Nutritional Rehabilitation Centers in Central India: A Retrospective Facility-Based Descriptive Study.

Background: Nutritional rehabilitation centers (NRCs) were established with the objective of providing institutional care to malnourished children and building the capacity of the primary caregivers of these children. Objectives and Methodology: The objective of this study was to assess the effect of nutritional interventional measures undertaken at NRCs in improving the nutritional status of admitted children; a retrospective facility-based descriptive study was conducted using the monthly performance reports (March 2015 to November 2019) of all NRCs in Dhamtari district, Chhattisgarh. Results: Of the 3171 children registered in the NRCs, the majority were 1-3 years of age (59.22%), female children (55.50%), and from Other Backward Class caste category (56.79%). The district records a cure rate of 56.12%, death rate of 0.03%, and defaulter rate of 4.71%, with an average length of stay being 16.5 days. NRCs of Dhamtari district had less than acceptable level of recovery/cure rate though death rate and defaulter rate were within acceptable standards. Conclusion: Lower cure rate along with lower defaulter rate and death rate with more than recommended length of stay reflects the below-average performance of the NRCs in the district.

Association Between Early Pregnancy Body Mass Index and Gestational Weight Gain in Relation to Neonatal Birth Weight.

INTRODUCTION: Maternal early pregnancy body mass index (BMI) and gestational weight gain (GWG) strongly correlate with pregnancy outcomes. Gestational hypertension and diabetes have been associated with overweight and obesity in pregnancy. A low pre-pregnancy BMI has been associated with low birth weight and preterm birth. METHOD: This observational study was carried out from November 2018 to July 2020 in a tertiary care hospital in South India with a sample size of 100. Pregnant women with uncomplicated singleton pregnancies booked for regular antenatal care by 10 weeks of gestation were included in the study. During the participants' antenatal check-ups, detailed history and examinations were made. The weight of the participants was recorded at every antenatal check-up. Information about the gestational age at delivery and the birth weight of the neonates were collected following delivery. RESULTS:  The mean age of women was 25.83 + 2.74 years. Of women who delivered low birth weight neonates (<2.5 kg), 86% had GWG below the Institute of Medicine (IOM) recommendation. A total of 57% of women with normal early pregnancy BMI and 67% of obese women had GWG within the IOM recommendation. Early pregnancy BMI had a positive correlation with neonatal birth weight (r (98) = 0.779, p = 0.001). Of the underweight pregnant women, 72% gave birth to small for gestational age (SGA) babies, and 97% percent of normal early pregnancy BMI women delivered neonates with normal weight for gestational age. A total of 33% of overweight and 50% of obese women had large for gestational age (LGA) babies. CONCLUSION: Results from this study suggest that maternal early pregnancy BMI is more strongly associated with neonatal birth weight than GWG. Therefore, early pregnancy BMI may be an important focus for counseling during pregnancy.

Prophylactic Medications Taken by Healthcare Workers for COVID-19; A Mixed Methods Study from South India.

BACKGROUND: COVID-19 is an unprecedented pandemic that has taken the modern world under seize. In spite of lack of solid evidence, certain federal governments had recommended the use of hydroxychloroquine (HCQ), chloroquine, and azithromycin as prophylactic medications either for contacts or for healthcare providers in particular. The objective of this study is to assess the issues related to intake of prophylactic medications in view of COVID-19 and the proportion and pattern of side effects. METHODS: A descriptive cross-sectional study was conducted using mixed methods approach among healthcare workers in Puducherry, India. RESULTS: HCQ was the prophylactic drug taken by all the participants (n = 26). Of the 26, 15.4% had a baseline ECG, 26.9% took HCQ based on the recommended Day 1 dose of 800 mg and 61.5% of the participants had the drug provided by the hospital where they work. Reasons for taking prophylaxis were sense of vulnerability (due to co-morbidities, lack of PPE kits) and peer practice. However, the participants did not recommend prophylactic medication to others due to lack of evidence, death claims related to prophylactic drugs in media, hospitals not taking responsibility of baseline monitoring and need for long follow-up. CONCLUSIONS: The data on assessment of HCQ prophylaxis indicates only minor side-effects, though limited by sample size. Evidence-based recommendations on prophylactic drugs for COVID-19, effective risk communication, peer education and support, accountability, ease of baseline, and follow-up investigations were the need of the hour to improve intake and adherence to prophylactic regime for COVID-19.

Retrospective analysis to identify the association of various determinants on birth weight.

OBJECTIVES: LBW is the strong determinant of neonatal morbidity and mortality with a global prevalence of nearly 15%. India's prevalence, though not yet established, ranges from 16-30% and influenced by maternal nutritional status, antenatal care and associated maternal morbidity. Hence, the study was aimed to determine the influencing parameters for occurrence of LBW. STUDY DESIGN: A retrospective observational study conducted for all live newborns delivered in a tertiary care centre during the study period of twenty four months. METHODS: Data from institutional medical record section was recorded on predesigned questionnaire from a total of 1216 newborns. RESULTS: The percentage of LBW was found to be 27.55% (335/1216) with a proportion of LBW to NBW babies was approximately 1:3. The occurrence of LBW was significantly higher in babies of anemic mothers (59.39%, P < 0.0001), young mothers (30.39%, P < 0.01), mothers with parity ≥ 3 (35.71%, P < 0.05), those with <3 ANC check-up (56.88%, P < 0.0001) and those with premature delivery (71.57%, P < 0.0001). Maternal anemia (OR 4.7, 95%CI 3.4-6.7, P < 0.001); ANC with <3 visits (OR 2.2, 95%CI 1.4-3.4, P < 0.01) and prematurity (OR 7.6, 95%CI 5.1-11.2, P < 0.0001) were considered as independent risk factor for LBW. Significant association of neonatal complications was found with LBW babies (OR 1.6, 95%CI 1.1-2.5, P < 0.05). CONCLUSIONS: Inadequate antenatal care, maternal anemia and other maternal illness causing premature delivery are considered critical determinants for LBW and thus associated with high neonatal mortality and morbidity. Continued focus for improving the overall maternal health status would lead to lowering burden of LBW.

A Review on Role of Yoga in the Management of Patients with Cardiac Arrhythmias.

Evidence suggests that yoga is safe and effective in improving various risk factors, quality of life (QoL), and psychological burden that is related to arrhythmia. However, this is the first-ever systematic review performed to report the role of yoga in arrhythmia. We have performed a literature search using Cochrane Library, Medline/PubMed, Web of Science Core Collection, and IndMED electronic databases up to 3, January 2018. Of 240 articles, 6 potentially eligible articles were identified and included in the review. Results showed that yoga could be considered an efficient adjuvant in reducing arrhythmia (paroxysmal atrial fibrillation, ventricular tachyarrhythmia, and palpitation) related health problems; blood pressure, heart rate, depression and anxiety scores; and in improving health-related QoL of arrhythmia patients. However, there is a lack of randomized controlled trials and a clear mechanism behind the effect of yoga; studies had relatively a small sample size and different yoga protocols.

Maternal near miss: reaching the last mile.

Maternal mortality misses the morbidity associated with pregnancy and delivery. Maternal Near Miss is an alternate measure that reflects maternal morbidity and in areas with low maternal mortality improves comparability. Maternal Near Miss is a proxy indicator of the quality of healthcare services and helps in understanding health system failures with relation to obstetric care and addressing them. But regional variations in availability of resources have led to a dozen different adapted versions of WHO Maternal Near Miss criteria. This creates confusion and reduces comparability, nationally and internationally. A review of articles defining maternal near miss was conducted using a PubMed search to compare and assess the various definitions of MNM. The present article summarises the available criteria and discusses the advantages and drawbacks of WHO MNM criteria as compared to others. The objective is to impress the need to have comprehensive criteria that can be applied in different settings and ensure comparability.Impact statementWhat is already known on this subject? Many different definitions and criteria to diagnose Maternal Near Miss are available. They are diverse, thereby reducing comparability both nationally and internationally.What do the results of this study add? This article summarises the differences in the available definitions and classifying criteria. It also highlights the difficulty in usage of the criteria in different settings.What are the implications of these findings for clinical practice and/or further research? This calls for researchers working in areas of maternal health to further simplify the definitions and criteria used for identification of Maternal Near Miss to improve comparability and uniformity.

Comparison between two different successful approaches to COVID-19 pandemic in India (Dharavi versus Kerala).

Various factors interplay when it comes to successful containment of pandemic. In last one year, we have witnessed various countries formulating and practicing their own unique ways to tackle coronavirus. We have seen the most developed countries failing terribly and unable to slow the COVID-19 spread, but at the same time also endorsed the comparatively less resourceful countries outperforming in terms of reduced disease morbidity and mortality. Current review is about two regions from India (Dharavi and Kerala) who were different in their approach as compared to rest of the country and were able to keep the COVID-19 cases to the minimum.

Cognitive and motor outcomes in children born low birth weight: a systematic review and meta-analysis of studies from South Asia.

BACKGROUND: South Asia contributes substantially to global low birth weight population (i.e. those with birth weight < 2500 g). Synthesized evidence is lacking on magnitude of cognitive and motor deficits in low birth weight (LBW) children compared to those with normal birth weight (NBW) (i.e. birth weight ≥ 2500 g). The meta-analysis aimed to generate this essential evidence. METHODS: Literature search was performed using PubMed and Google Scholar. Original research articles from south Asia that compared cognitive and/or motor scores among LBW and NBW individuals were included. Weighted mean differences (WMD) and pooled relative risks (RR) were calculated. All analyses were done using STATA 14 software. RESULTS: Nineteen articles (n = 5999) were included in the analysis. Children < 10 years of age born LBW had lower cognitive (WMD -4.56; 95% CI: -6.38, - 2.74) and motor scores (WMD -4.16; 95% CI: -5.42, - 2.89) compared to children with NBW. Within LBW children, those with birth weight < 2000 g had much lower cognitive (WMD -7.23, 95% CI; - 9.20, - 5.26) and motor scores (WMD -6.45, 95% CI; - 9.64, - 3.27). CONCLUSIONS: In south Asia, children born LBW, especially with < 2000 g birth weight, have substantial cognitive and motor impairment compared to children with NBW. Early child development interventions should lay emphasis to children born LBW.