Community Based Monitoring under National Rural Health Mission (NRHM) at Village Level in the State of Maharashtra, India.

Background: Government of India, under National Rural Health Mission has established Village Health Sanitation Nutrition Committees (VHSNCs) and appointed Accredited Social Health Activists (ASHAs) in all the villages. Government of India also started Community Based Monitoring (CBM) project through Non-Governmental Organizations (NGOs). State of Maharashtra was one of the nine states selected for implementation of the pilot project. Objectives: To assess the effect of training and implementation of CBM on Knowledge, Attitude and Practices of VHSNC members including ASHAs. Design: It is a descriptive study using comparison group. Settings: The study was carried out in 90 villages, 45 each from study and comparison group, in the State of Maharashtra, India. Interventions: The study was conducted with the help of the Community Medicine Departments from nearby Medical Colleges. From each village one ASHA and three members of VHSNC were interviewed. An assessment instrument was developed having some parameters. Based upon responses to each parameter, a scoring system was also developed. Then comprehensive score was calculated for each respondent. Main Variable: Comprehensive score obtained by the interviewed individual was studied. Results: Only 41% ASHAs and 28% VHSNC members were trained in CBM by the concerned NGOs. The Mean score of ASHAs’ was 7.52. The mean score was 6.55 for trained members of VHSNC and 5.00 for un-trained members. Discussion: The interviewed members were lacking in core areas. The members are not ready to take ownership and to monitor services. Conclusions: The training and implementation of CBM did not have any difference in awareness and active participation of ASHAs. This may be due to improper coverage of training. The training helped VHSNC members in improving score but actual implementation of project did not improve the score.

Hsp90 mediates activation of the heme regulated eIF-2 kinase during oxidative stress.

The heme-regulated inhibitor (HRI), a member of the eIF-2 kinase family is crucial for regulating protein synthesis during stress. In addition to heme, stress proteins Hsp90 and Hsp70 are known to regulate HRI. The present study aims to determine the physical association of these Hsps in the regulation of HRI activation during oxidative stress using human K562 cells as a model. Extracts from the stress-induced cells were used for determining HRI kinase activity by measuring eIF-2 phosphorylation, and Hsp-HRI interaction by immunoprecipitation and immunoblot analyses. The results indicate a significant increase in both Hsp70 and Hsp90 expression during AAPH (2, 2’-azobis (2-amidinopropane) dihydrochloride)-induced oxidative stress. Further, their interaction with HRI, which correlates well with its increased HRI kinase activity leads to inhibition of protein synthesis. Thus, we demonstrate that Hsps play an important role in the regulation of initiation of protein synthesis during oxidative stress.

Birth weight and anthropometry of newborns.

OBJECTIVE: To determine the relationship between birth weight and the anthropometric measurements of newborn to screen for low birth weight. METHODS: 1,252 newborns have been enrolled in the study. The birth weight, mid-arm, head and chest circumferences were measured by standard techniques. RESULT: The highest correlation of birth weight was found with chest circumference (r = 0.70). The maximum sensitivity of detecting low birth weight was seen with chest circumference (94.26%). CONCLUSION: Measurement of chest circumference being simple, easy, cheap and reliable method for identification of low birth weight in the community.

Awareness of urban slum mothers regarding home management of diarrhoea and symptoms of pneumonia.

A total of 635 mothers of under five children from urban slum area of Nanded city were assessed to know their awareness about home management of diarrhoea and symptoms of pneumonia. 48.5% of the mothers were unaware of any method of rehydrating the child with diarrhoea at home level followed by 36.2% mothers who were knowing home available fluids for rehydrating the child. 50.4% of the mothers were not knowing a single symptom of pneumonia followed by 35.1% mothers who were aware rapid abdominal movements (Pet Udna) as a symptom of pneumonia.

Epidemiological investigation of an outbreak of enteric fever in a village in Maharashtra.

Four hundred fifteen fever cases occurred in village Katkalamba, in Nanded district, Maharashtra during November-December, 1995. Explosive nature of the outbreak, non involvement of infants, significantly higher incidence rate in the age group 1-14 years and clustering of almost all cases in the users of a particular well indicated it to be a water borne outbreak. Laboratory investigations in selected cases confirmed it to be an outbreak of enteric fever. Chemical and microbiological examination of water samples from the suspected wells gave evidence of faecal contamination of water. Circumstances under which the contamination occurred and the outbreak spread are discussed.

Immune response to hepatitis B viral antigens in chronic infection & its relationship with liver necrosis.

Markers of hepatitis B virus (HBV) and immune response against them were studied in 18 chronic asymptomatic carriers, 8 patients of the virus induced chronic liver disease (CLD), and 7 patients of chronic alcoholic liver cirrhosis, who were also chronic HBV carriers (CALC). The LMI responses to HBeAg were elevated in HBeAg and/or HBV-DNA positive chronic asymptomatic carriers, (median response 31.5%), along with elevation of serum alanine aminotransferase (sALT) levels (59-150 IU/l). On the other hand the LMI responses to this antigen, in HBeAg and HBV-DNA negative chronic carriers were in the normal range (median response 12%) and their sALT levels were also normal (7-50 IU/l). The CLD and CALC patients did not show any relation between their LMI to HBeAg and sALT levels. In contrast no relation between LMI to HBsAg and sALT levels was observed in any group. The LMI responses to HBsAg in CLD patients were elevated (median response 38%) and the responses of chronic asymptomatic carriers and CALC patients were either in the normal range or poor (median responses, 18 and 7% respectively), irrespective of their sALT levels. These results suggest that T cell responses to both the antigens may be involved in liver cell damage.