Risk of developing adulthood obesity among females born with low birth weight: Results from a non-concurrent study from rural Southern India.

OBJECTIVE: To determine the relationship between birth weight and the evolution of obesity in adult life in women from a rural developmental block in southern India. DESIGN: Non-concurrent cohort. SETTING: General community- a rural developmental block in southern India. PARTICIPANTS: Two hundred and seventy one young healthy females were recruited from a birth cohort. The study subjects were 98 women in the age group of 19-23 years who had been born with low birth weight (LBW) and 173 women in the same age group who had been born with normal birth weight (NBW). MATERIALS AND METHODS: Data collection involved interview using a structured questionnaire and anthropometric measurements. ANALYSIS: Chi-square test to assess significance of association, independent sample t test to assess the difference between means, odds ratios for measuring magnitude of association, stratified analysis to identify various interactions and confounders, and multiple logistic regression models to identify the relationship between birth weight and young adult obesity (BMI > 25). RESULTS: A crude odds ratio of 0.564 (95% CI 0.262 - 1.214) was obtained for the association between LBW and development of obesity later in life. In the final logistic regression model, it was found that a young adult female with low birth weight who belonged to a higher socio-economic group had a higher risk of developing obesity (Adjusted odds for the interaction term between LBW and high SES 6.251; 95% CI 1.236 - 31.611). CONCLUSION: The study could not find any significant association between LBW and development of obesity later in life, but it found a higher probability of developing obesity later in life among low birth weight female children born in high socio-economic status families.

Birthweight centile charts from rural community-based data from southern India.

OBJECTIVE: The objectives of the study were to estimate gestational age specific birthweight centiles from healthy pregnancies in a defined rural block and compare the under-two month mortality rates in those belonging to the lowest and highest centile groups. DESIGN: Retrospective chart review. SETTING: Routine data collected regarding all pregnancies, births and deaths occurring in Kaniyambadi, a rural block in Southern India, between 2003 to 2012. SUBJECTS: All singleton live newborns of women without known major antenatal risk factors. MAIN OUTCOME MEASURES: Gestational age- and sex-specific birthweight centile curves were created using the LMS method. Mortality rates for the first two months of life were calculated for those in various centile groups. RESULTS: The median birthweight at term was lower for the study subjects as compared to the median birth weights in the WHO child growth standards 2006, the US and the UK standards. Mortality rates for those with birthweights both below the 3rd centile as well as above the 97th centile higher than for those between 3rd and 97th centiles. CONCLUSIONS: While absolute values of birthweights were lower than the WHO 2006 child growth standards there was a J shaped curve of birthweight and mortality. This suggests that in a given population, mortality increases at extremes of birthweights, even if some of these birthweights may be considered normal by other standards.

Evaluation of a programme for prevention of vertical transmission of hepatitis B in a rural block in southern India.

BACKGROUND & OBJECTIVES: This study was undertaken to evaluate a community based programme of antenatal screening for hepatitis B surface antigen (HBsAg) and selective immunization of children commencing at birth, at a secondary care hospital in south India. The primary objective was to assess immunization coverage among children born to HBsAg positive women; secondary objectives were to study the prevalence of HBsAg among antenatal women, prevalence of HBsAg among immunized children (to estimate vaccine efficacy), seroconversion rate and relationship of maternal hepatitis B e antigen (HBeAg) to hepatitis infection. METHODS: The prevalence of hepatitis B antigen among antenatal women and immunization coverage achieved with hepatitis B vaccine in a rural block in Vellore, Tamil Nadu were assessed through examination of records. Children born between May 2002 and December 2007 to hepatitis B positive women were followed up for a serological evaluation, based on which vaccine efficacy and the effect of maternal hepatitis B e antigen (HBeAg) on breakthrough infection was estimated. RESULTS: The prevalence of hepatitis B surface antigen among antenatal women was 1.58 % (95% CI: 1.35-1.81%). Vaccine coverage for three doses as per a recommended schedule (including a birth dose) was 70 per cent, while 82.4 per cent eventually received three doses (including a birth dose). Estimated vaccine efficacy was 68 per cent and seroconversion 92.4 per cent in children aged 6-24 months. Maternal HBeAg was significantly associated with either anti-HBc or HBsAg in immunized children, RR=5.89 (95% CI: 1.21-28.52%). INTERPRETATION & CONCLUSIONS: The prevalence of hepatitis B among antenatal women in this region was low and a programme of selective immunization was found to be feasible, achieving a high coverage for three doses of the vaccine including a birth dose.

Economic implications of three strategies for the control of taeniasis.

OBJECTIVE: To evaluate the cost-effectiveness of three strategies for the control of taeniasis in a community, in terms of cost per case treated. METHODS: A study was conducted in South India to determine the prevalence of taeniasis by screening stool samples from 653 randomly chosen subjects, for coproantigens. The costs incurred in the project were used to estimate the cost per case screened and treated. A one-way sensitivity analysis was carried out for varying rates of taeniasis, different screening strategies and mass therapy. Further sensitivity analysis was carried out with different manpower and test costs. RESULTS: The rate of taeniasis as detected by ELISA for coproantigen was 3 per 1000 (2 of 653 samples). Our study showed that mass therapy without screening for taeniasis would be the most economical strategy in terms of cost per case treated if field workers are employed exclusively for either mass therapy or screening. For each strategy, costs per case treated are higher at low prevalence of taeniasis, with a sharp rise below 15%. CONCLUSIONS: In places that are endemic for taeniasis and neurocysticercosis, mass therapy or screening for taeniasis should be considered. Screening by stool microscopy is not cost-effective in terms of cost per case of taeniasis treated owing to its low sensitivity. Although the cost per case of taeniasis treated is high at low prevalence of taeniasis for all options, incorporating mass therapy into existing mass drug distribution programmes might prove to be the most cost-effective control strategy.