Whole-genome characterization of common rotavirus strains circulating in Vellore, India from 2002 to 2017: emergence of non-classical genomic constellations.

Rotaviruses (RVs) are the most common etiological agent of acute gastroenteritis among young children, even after vaccine introduction in low-income countries. A whole-genome classification representing the 11 RV genes, was introduced for surveillance and characterization of RVs. This study characterized the common circulating strains in Vellore, India from 2002 to 2017 to understand rotavirus strain diversity and evolution using Whole genome sequencing (WGS) carried out on Illumina MiSeq. The 89% (92% of Wa-like, 86% of DS-1-like) of strains had classical constellations, while reassortant constellations were seen in 11% (8% of Wa-like, 14% of DS-1-like) of the strains. The rare E6-NSP4 in combination with DS-1 like G1P[8] and the emergence of the OP-354 subtype of P[8] were identified. Phylogenetics of RV strains revealed multiple subtypes circulating in the past 15 years, with strong evidence of animal to human gene transmission among several strains.

Prevalence and determinants of hypertension among urban tribal communities in Nagaland, India-A community-based study.

Background: There is a paucity of data on the burden and factors associated with hypertension among the Nagas (collective term for tribal ethnic groups predominantly residing in Nagaland) living in an urban environment. Insights from this study will aid in mapping focused community-based and primary care interventions for hypertension. Objectives: To determine the prevalence and risk factors associated with hypertension among Nagas aged 30-50 years residing in urban Dimapur, Nagaland. Methods: A community-based cross-sectional study was conducted between January and July 2019. This study screened 660 participants for hypertension using a digital blood pressure apparatus. A semi-structured questionnaire was used to assess the risk factors, and anthropometric measurements were recorded using standard guidelines. Results: The prevalence of hypertension and pre-hypertension was 25.9% and 44.5%, respectively. Non-modifiable risk factors such as male gender (adjusted odds ratio [AOR]: 2.02; 95% confidence interval [CI]: 1.32-3.09), age > 40 years (AOR: 2.32; 95% CI: 1.57-3.41), family history of hypertension (AOR, 1.87, 95% CI: 1.19-2.92) and modifiable risk factors such as current alcohol consumption (AOR: 2.05; 95% CI: 1.27-3.31), high/very high perceived stress (AOR: 2.15; 95% CI: 1.28-3.62), lack of participation in stress relief activities (AOR: 2.08; 95% CI: 1.17-3.71) and overweight/obesity (AOR: 2.26; 95% CI: 1.55-3.30) were independently associated with hypertension in this study. Conclusion: To avert an impending health crisis in this community, a multipronged approach involving primary-care/family physicians, culturally appropriate awareness, and targeted community-based screening programs with an adept referral system must be implemented to curtail this emerging threat.

Pulmonary tuberculosis and diabetes mellitus: Clinical profile and outcomes.

Background: India is endemic for Tuberculosis (TB), contributing to the world's highest number of active cases. Diabetes (DM), with its increasing burden in India, could contribute to adverse outcomes among patients with TB. Methods: Consecutive patients with sputum smear positive pulmonary tuberculosis were included in the study. We defined cases as those patients with diabetes at recruitment. Controls were non diabetics (NDM). Sputum samples for AFB smears, AFB culture and Xpert PCR along with blood samples for glycosylated Haemoglobin and glucose levels were collected at recruitment and at 6 months from patients with sputum positive pulmonary TB. Blood glucose levels and sputum smears were repeated at 2 months and monthly till they tested negative. The primary outcome studied was mortality at 6 month follow-up. The secondary outcomes included the time to conversion of sputum smears and cure rates between cases and controls. Results: We recruited 124 patients of which 68 were cases. Mortality after therapy was 15% in cases and 7% in controls, however, the difference was not statistically significant. Equal proportions in each group (Diabetics: 9% vs. NDM 9%) had persistent smear positivity at 2 months. There was no association between delayed sputum conversion and uncontrolled diabetes. Only about 57% of cases and 50% of controls were documented to have completed treatment or been cured. A significant reduction in HbA1c after 6 months of Antituberculous therapy was noted among the cases. [Mean difference - 1.76, P-value - 0.001, 95% CI of difference - (1.01 - 2.52)]. Conclusions: Diabetes did not have adverse outcomes in the form of increased mortality or delayed sputum conversion rates. The high proportion of loss to follow-up seems to be a trend of concern, which should be addressed emergently.

Effect of lock down due to COVID-19 pandemic on the alcohol use and abuse among a tribal community in South India.

Background: Alcohol consumption in the tribal communities is found to be rising, as Indian-made foreign liquor (IMFL) is easily accessible through state-run outlets. During the first coronavirus disease (COVID-19) lockdown, despite IMFL being non-available, there were not any reports of alcohol withdrawal among the tribal men who were enrolled in our substance abuse clinic. Methodology: This is a community-based, mixed-method study to document the changes during the lockdown in the drinking pattern and behavior of families and communities of men who consume alcohol. The quantitative part of the study was done by interviewing 45 alcohol-dependent men and documenting their alcohol use disorders identification test (AUDIT) scores during the lockdown. The qualitative part captured the changes in familial and social behavior. Focused group discussions (FGDs) were conducted among community members and leaders. In-depth interviews (IDs) were done among men with harmful drinking patterns and their spouses. Results: There was a significant reduction in the consumption of IMFL among the men interviewed as depicted by the low mean AUDIT score (16.42, P < 0.001). Trivial withdrawal symptoms were found among them (67%). Around 73.3% could access arrack. The community perceived that arrack was brewed and sold at a higher cost within days of lockdown. Familial conflicts reduced. Certain community leaders and members could proactively curb the brewing and selling of arrack. Conclusion: The study uniquely brought out in depth the information at the individual, familial, and community contexts. It is imperative to develop policies to protect indigenous populations by different rules governing the sales of alcohol.

Predicting antitubercular drug-induced liver injury and its outcome and introducing a novel scoring system.

Background: Tuberculosis (TB) is a major global health problem, mainly in developing countries. Despite the availability of highly effective first-line antitubercular (ATT) drugs, ATT drug-induced liver injury (ATT DILI) leads to treatment interruption and consequently loss of therapeutic efficacy. Methods: In this prospective cohort study from India, all consecutive patients who met inclusion criteria and started on ATT were included. The incidence, risk factors, and outcome of ATT DILI were determined. A clinical prediction score for ATT DILI was derived. Results: A total of 393 patients were included. The incidence of ATT DILI was 9.7% (95% confidence interval 7%-13.2%). HIV infection, daily regimen, disseminated disease, and chronic liver disease were identified as significant risk factors (P < 0.05) for developing DILI. A prediction score derived from the risk factors showed that a score of >5 could predict DILI with a sensitivity of 74% and a specificity of 67%. All-cause mortality in DILI was 4.7%. Conclusion: The incidence of ATT DILI was 9.7% in our cohort with higher incidence among the patients on daily regimen. The study suggests that the combination of risk factors of extensive TB disease, HIV infection, chronic liver disease, and under nutrition increases the vulnerability to DILI, particularly with daily treatment regimen, emphasizing the role of acquired risk factors in the development of DILI.

Evidence of dysregulated iron homeostasis in newly diagnosed diabetics, but not in pre-diabetics.

AIM: Diabetes mellitus has been reported to be associated with increased serum levels of ferritin. The basis of this association is unclear. It is also not precisely known whether other iron-related parameters, including hepcidin (the central regulator of systemic iron homeostasis), are affected under these circumstances. This study attempted to determine this. METHODS: Adult men (normoglycemic or newly diagnosed with diabetes or pre-diabetes) were recruited. Anthropometric, metabolic, and hematological and iron-related parameters in blood were measured. Indices of insulin resistance (HOMA-IR) and pancreatic beta cell function (HOMA-ß) were calculated. RESULTS: Subjects in the 3 groups were similar in age, and anthropometric and hematological parameters. Serum ferritin and hepcidin levels were higher in diabetics, than in pre-diabetics and in control subjects. These elevations seen were not linked to the presence of inflammation. HOMA-IR was higher in diabetics, and HOMA-ß lower in diabetics and pre-diabetics, than in control subjects. HOMA-IR and serum ferritin were positively correlated with one another. CONCLUSION: Elevated levels of serum ferritin and hepcidin in newly diagnosed diabetics (but not pre-diabetics) indicate dysregulated iron homeostasis, with the former positively associated with insulin resistance in these patients.

Hazardous use of alcohol among men in the tribal population of Jawadhi Hills, Tamil Nadu: Nature, prevalence, and risk factors.

BACKGROUND: Worldwide, hazardous use of alcohol is common among many cultures and societies and adversely impacts families and communities, with significant morbidity and mortality. Scheduled Tribes (STs) who are socially deprived and marginalised have higher rates of alcohol use. AIM: We attempted to determine the nature, prevalence, and risk factors associated with hazardous consumption of alcohol in the tribal community. METHODOLOGY: A cross-sectional study was conducted among adult male and permanent residents of Jawadhi hills. A total of 1200 men were interviewed. Study participants were chosen by Probability Proportionate to Size (PPS) sampling method. The questionnaire that documented socio-demographic characteristics and patterns of alcohol use was used. AUDIT tool was used to assess the hazardous use of Alcohol. Data were analysed using SPSS. RESULTS: Majority of the men were middle-aged, married, and were from lower socio-economic strata. A large proportion of men (65%) had a history of alcohol consumption in the last one year using one-year, of whom a quarter showed hazardous use (29%) and another quarter exhibited alcohol dependency (24%). Tobacco use, higher income and local alcohol production were found to be significant risk factors for Hazardous alcohol use. CONCLUSION: Alcohol consumption needs to be treated as a social problem and has to be tackled at the policy level. Population-based interventions, legislation, taxation, policies regarding the manufacture and sale of alcohol, are some of the ways to address this problem.

Feasibility, uptake and real-life challenges of a rural cervical and breast cancer screening program in Vellore, Tamil Nadu, South India.

BACKGROUND: Early detection of breast and cervical cancer by organized screening has been found to reduce mortality rates in trials, but documentation of programme results and challenges is rarely done from non-trial settings. This study reports results of a population-based cancer control programme in a rural block in Vellore, Tamil Nadu, population size (116,085), targeting a population of 18,490 women aged 25-60 years, between November 2014 and March 2018. METHODS: Village-based health education sessions were conducted by social workers, using trained volunteers and health workers to motivate eligible women. Screening was done at a secondary level hospital, by trained general physicians using visual inspection with acetic acid and clinical breast examination, followed by colposcopy, radiological imaging (breast) and biopsy as required. RESULTS: A total of 8 volunteers and 17 health workers motivated women for 93 health education and screening sessions, in 46 out of 82 villages. While 1,890/18,490 (10.2 per cent) were screened for breast cancer, 1,783 (9.6 per cent) were screened for cervical cancer, with a yield of 3.4/1,000 for cervical pre-cancer/cancer. The main challenges were creating time for screening activities in a busy secondary hospital and difficulty in ensuring treatment completion of screen-detected cases. CONCLUSIONS: Population-based cancer screening programs can be offered by secondary hospitals that also run primary care services, to increase screening rates. Clear referral systems need to be established, bearing in mind that social factors, especially poor family support, may pose a threat to treatment, in spite of easy availability of cure.

Risk factors for severe acute malnutrition among children aged 6-59 months: A community-based case-control study from Vellore, Southern India.

BACKGROUND: Malnutrition plays an important role in the economic burden of society as well as the country. This study aimed to identify the various risk factors and determinants of severe acute malnutrition (SAM) as defined by WHO growth reference standards in children aged 6 months to 59 months living in Vellore. METHODS: A community-based case-control study matched for age (±2months), gender and location was done among the children of the age group 6- 59 months residing in both rural and urban Vellore. Children of age group 6-59 months with SAM according to WHO definition, i.e., weight for height of less than -3SD with or without nutritional oedema were classified as cases. Children with weight-for-height z-score more than -1 SD and MUAC ≥13.5cms were classified as controls. With 2 controls per case, the required sample size was 54 cases and 108 controls. A questionnaire used to identify the risk factors including dietary intake. Uni-variate and multivariate analysis was done to generate an odds ratio and 95% confidence interval for the risk factors. RESULTS: Majority of the cases 64.8% and 50% of the controls belonged to low SES. After adjusting all confounders, Severe Acute Malnutrition was significantly associated with birth weight <2.499kg [AOR- 8.95 (95% CI: 2.98-26.85)], not exclusively breastfed for 6 months [AOR 4.67 (95% CI: 1.72-12.65)], inadequate calorie intake [AOR 8.09 (95% CI: 3.15-20.82)] and mother being underweight [AOR 6.87 (95% CI: 1.92-24.55)]. CONCLUSION: Programs should be implemented to reduce the poor nutritional status of young girls and women in the reproductive age group. The importance of exclusive breastfeeding for the first six months, the time of weaning and appropriate feeding practice for the child should be emphasized to postnatal mothers during their hospital visits.

Treatment outcomes with daily self-administered treatment and thrice-weekly directly-observed treatment in two cohorts of newly-diagnosed, sputum-positive adults with pulmonary tuberculosis.

BACKGROUND: The Revised National Tuberculosis Control Program (RNTCP) envisages shifting from thrice-weekly to a daily anti-tuberculosis treatment (ATT) regimen. The potential merits and demerits of both regimens continue to be debated. METHODS: This retrospective study compared treatment outcomes in 191 HIV-negative, newly diagnosed, sputum-positive adults with pulmonary tuberculosis from Vellore district of Tamil Nadu who were treated at a private medical college during 2009 to 2012 with intermittent Directly Observed Treatment Short Course (intermittent DOTS cohort, n=132) or who opted for daily Self-Administered Treatment (daily SAT cohort, n=59). Treatment outcomes obtained from medical records were supplemented by interviews with consenting, traceable patients. RESULTS: The rates for the RNTCP-recommended sputum smear examinations were suboptimal (42% for daily SAT and 72% for intermittent DOTS). However, treatment success with daily SAT and intermittent DOTS (76.2% vs. 70.4%); default (11.9% vs. 18.2%); death (6.8% vs. 5.3%); treatment failure (5.1% vs. 4.6%); and relapse (0% vs. 1.5%) did not significantly differ. CONCLUSIONS: While evaluable treatment outcomes were not significantly different with daily SAT and intermittent DOTS, rates for timely smear examinations and for treatment success were lower, and for default higher, in both cohorts than comparable RNTCP data from Vellore district. Further strengthening of RNTCP facilities within private medical colleges and regular, real-time audits of performance and outcomes are needed if daily ATT regimen under the RNTCP is to succeed.

The insulin sharps disposal study: Evaluation of a structured patient education initiative in an urban community health centre in India.

CONTEXT: India has witnessed an increase in people suffering from diabetes mellitus and also those on insulin. The issue of handling used sharps in the community is an area of concern. AIMS: Our study aimed to assess the change in knowledge and practise concerning the disposal of used insulin sharps in patients with diabetes, pre- and post-evaluation, a structured, health provider-initiated, patient-centred insulin-use health education (PIHE). SETTINGS AND DESIGN: A pre- and post-evaluation study of PIHE set in an urban health centre in south India. METHODS AND MATERIALS: A pre-evaluation study was done on a cross-sectional sample of type II diabetes patients, who visited the urban health centre and were on insulin for at least 1 year. A semi-structured pilot-tested questionnaire was used for the study. For 18 months, PIHE was provided to all insulin users at outpatient contact, after which a post-evaluation study among another cross-sectional sample of patients in the same centre, was done to assess change in knowledge and practise. STATISTICAL ANALYSIS USED: Univariate analysis followed by logistic regression. RESULTS: The participants in the pre- and post-evaluation studies had a mean (SD) age of 54.9 (11.33) years and 57.2 (11.01) years, respectively. The baseline characteristics of gender, socioeconomic status and diabetes duration were similar. There was a statistically significant (P < 0.001) difference in knowledge (19 [19%] to 81 [81%]) and practise (7 [7%] to 73 [73%]) of participants regarding the correct disposal method of used insulin syringes and sharps before and after PIHE. CONCLUSIONS: PIHE over an 18-month period for diabetic patients on insulin significantly improved knowledge and practises relating to insulin use and correct disposal of syringes and sharps.

Prevalence and Factors Associated with Gestational Diabetes Mellitus among Antenatal Women at a Rural Health Center in Vellore.

BACKGROUND AND OBJECTIVES: Gestational Diabetes Mellitus (GDM) has been well documented to be associated with significant mortality and morbidity among both mother and their offspring. Prevalence of GDM in India varies between regions and has been documented to be on the rise over the last two decades which is a public health concern and reflects an increase in the frequency of type 2 diabetes mellitus in these populations. This study aimed at estimating the prevalence of GDM among antenatal women attending a rural secondary care hospital in southern India and attempts to study associations between anthropometry, parental history, physical activity of pregnant women and GDM. METHODS: A hospital based cross sectional study was done among 630 pregnant women who were screened with oral glucose tolerance test between 24 and 28 weeks of gestation based on IADPSG criteria. Risk factors for developing GDM were assessed by conducting home visits to 75 women diagnosed to have GDM and 150 randomly selected women without GDM. RESULTS: Hospital based prevalence of GDM was 14% (95 % CI: 11.3% to 16.7%) and a significant rise in prevalence levels was noted with age. Women with family history of diabetes mellitus, women with body fat of more than 23% had 2.65 and 2.89 times significantly higher odds of developing GDM. Interpretation and conclusion: Family history of diabetes and excess body fat are risk factors associated with GDM. Among them excess body fat could be an independent risk factor without the influence of foetal weight and preventive measures could be directed towards it.

Prevalence of oral diseases and risks to oral health in an urban community aged above 14 years.

INTRODUCTION: Oral health is a requisite to general health and quality of life. The public health problems associated with oral diseases are a serious burden in every nation around the globe. AIMS: The aim of this study is to assess the prevalence of dental problems and the oral health seeking behavior of an urban south Indian population aged >14 years. MATERIALS AND METHODS: In this population-based cross-sectional study, 101 households were selected through systematic random sampling. About 419 participants were interviewed and information on sociodemographic characteristics, personal, and dental history was obtained and a complete oral cavity examination was performed. RESULTS: The prevalence of dental caries, periodontal problems, and tooth wear were 78.75%, 74.7%, and 72.3%, respectively. The mean number of overall affected teeth in the population by one dental problem is 16 ± 8.13. The mean Decayed, Missing and Filled Teeth (DMFT) score was 4.5. The risk factors that were significantly associated with the poor oral health status were age >31 years (Odds Ratio (OR), 2.88), education less than eighth grade (OR, 2.35), inadequate oral hygiene practices (OR, 1.61), use of any form of tobacco (OR, 2.08), and alcohol consumption (OR, 2.02). Only 185 (44.1%) participants perceived that they had a dental problem at the point of the survey and only 20 of them (10.81%) visited a dentist. CONCLUSION: This study showed a high prevalence of dental caries, periodontal problem, and tooth wear. This emphasizes the need for community-based awareness program on dental health and recommends periodic dental health screening program at the community level for early diagnosis and better treatment.

Nutritional status and intellectual development in children: A community-based study from rural Southern India.

BACKGROUND: There is a dearth of recent data on the relationship between nutritional status and intellectual development among children in India. To determine whether such a relationship exists, we studied children in a rural area of Tamil Nadu. METHODS: We stratified villages in Kaniyambadi block, Tamil Nadu, and recruited consecutive children who satisfied the study criteria. We assessed nutritional status by measuring height and weight and recording chronological age, and calculated indices weight-for-age, height-for-age, weight-forheight and their Z scores. We assessed intellectual development using the Indian adaptation of the Vineland Social Maturity Scale. We used a case-control framework to determine the relationship and logistic regression to adjust for common confounders. RESULTS: We recruited 114 children between the ages of 12 and 72 months. Z score means (weight-for-age -1.36; height-for-age -1.42; weight-for-height -0.78) were much less than 0 and indicate undernutrition. Z score standard deviations (weight-for-age 1.04; height-for-age 1.18; weightfor- height 1.06) were within the WHO recommended range for good quality of nutrition data suggesting reduced measurement errors and incorrect reporting of age. The frequency distributions of population Z scores suggest high undernutrition, wasting and medium stunting. A tenth of the population (9.6%) had values to suggest borderline/below average intelligence (social quotient <89). Lower height-forage, height-for-age Z score and weight-for-height Z score were significantly associated with a lower social quotient. These relationships remained statistically significant after adjusting for sex and socioeconomic status using logistic regression. CONCLUSION: Chronic undernutrition, wasting and stunting and their association with lower intellectual development demand an urgent re-assessment of national food policies and programmes.

Challenges in Implementation of ANISA Protocol at the Vellore Site, India.

BACKGROUND: The Aetiology of Neonatal Infection in South Asia (ANISA) study aims to determine the population-based incidence, etiology, risk factors and antibiotic resistance profiles of community-acquired young infant infections in Bangladesh, India and Pakistan using community-based surveillance and standard newer diagnostic tests. The data generated will help plan preventive and treatment strategies to reduce neonatal and infant mortality in this region. The aim of this article is to describe the site-specific characteristics, challenges and solutions in implementing the ANISA protocol at the Vellore site, India. CHALLENGES: Vellore joined the ANISA study 2 years after the sites in Bangladesh and Pakistan, and some challenges relate to the need for rapid implementation. The Vellore site differs primarily in the high rate of institutional deliveries, actively promoted by the Government of India's conditional cash transfer program. The Vellore site hospitals are regular care providers for the study population, which leads to very high rates of consent for enrollment and collection of samples. Keeping blood culture contamination rates low was a challenge the site team overcame by adhering strictly to the protocol. Issues related to incorporation of a large study into a busy clinical services laboratory were overcome by meticulously setting up algorithms related to receipt, processing and storage of samples. CONCLUSION: ANISA is a complex study, but the challenges in implementation have been largely resolved and documented.

Prevalence of Adult Celiac Disease in India: Regional Variations and Associations.

OBJECTIVES: Although celiac disease (CeD) affects 1% of people in the northern part of India, it is believed to be uncommon in the southern and northeastern parts because of significant differences in dietary pattern and ethnicity. We estimated the prevalence of CeD in these three populations. In a subset, we also investigated differences in the prevalence of HLA-DQ 2/8 allelotype and dietary grain consumption. METHODS: A total of 23,331 healthy adults were sampled from three regions of India-northern (n=6207), northeastern (n=8149), and southern (n=8973)-and screened for CeD using IgA anti-tissue transglutaminase antibody. Positive tests were reconfirmed using a second ELISA. CeD was diagnosed if the second test was positive and these participants were further investigated. A subsample of participants was tested for HLA-DQ2/-DQ8 and underwent detailed dietary evaluation. RESULTS: Age-adjusted prevalence of celiac autoantibodies was 1.23% in northern, 0.87% in northeastern, and 0.10% in southern India (P<0.0001). Prevalence of CeD and latent CeD, respectively, was 8.53/1,000 and 3.70/1,000 in northern, 4.66/1,000 and 3.92/1,000 in northeastern, and 0.11/1,000 and 1.22/1,000 in the southern part. The population prevalence of genes determining HLA-DQ2 and/or -DQ8 expression was 38.1% in northern, 31.4% in northeastern, and 36.4% in southern India. Mean daily wheat intake was highest in northern (455 g) compared with northeastern (37 g) or southern part (25 g), whereas daily rice intake showed an inverse pattern. CONCLUSIONS: CeD and latent CeD were most prevalent in northern India and were the least in southern India. The prevalence correlated with wheat intake and did not reflect differences in the genetic background.

Drug prescribing pattern in pregnancy in a secondary care hospital in south India: a retrospective study.

BACKGROUND: In pregnancy drug treatment presents a special concern due potential teratogenic effects and physiologic alterations in mother. This retrospective study was performed to evaluate the drug prescribing pattern in pregnancy among pregnant women in a secondary care hospital in India. MATERIALS AND METHODS: This cross-sectional retrospective study was done for 3 months using pre-formatted forms and patient's records. RESULTS: A total of 326 drugs, including 46 different types of drugs, were prescribed to 606 gravid women. Eight different types of medications were started before being seen at the antenatal clinic. Most of these drugs fall under US FDA pregnancy categories B and C and few under categories A, X and N. CONCLUSION: This study reflects a good, safe and rational medication practice during pregnancy in various common disorders in a secondary care hospital and can be cited as an example to similar primary and secondary care hospitals.

A community based case control study on determinants of perinatal mortality in a tribal population of southern India.

INTRODUCTION: Perinatal mortality rate has been regarded as an indicator of the quality of prenatal, obstetric and neonatal care in an area, which also reflects the maternal health and socioeconomic environment. The objective of the current study was to identify causes and risk factors for perinatal deaths among the tribal population in Jawadhi Hills, Tamil Nadu, southern India. METHODS: A community-based case control study design was used, where a case was a perinatal death and controls were from a sampling frame of all children who were born alive in the same area ±7 days from the day of birth of the case. The WHO Standard International Verbal Autopsy form was used to arrive at the cause of death. Univariate and multivariate analyses for factors associated with perinatal deaths were done. RESULTS: A total of 40 cases, including 22 early neonatal deaths and 18 stillbirths, and 110 controls were included in the study. Among the perinatal deaths, 40% were born prematurely. Sepsis (17.5%) and birth asphyxias (12.5%) were the major causes of deaths. In the final logistic regression model, parity ≥4 (odds ratio [OR] 5.75 [95% confidence interval (CI) 1.88-17.54]), preterm births (OR 5.62 [95% CI 2.12-16.68]) and time to reach the nearest health facility more than two hours (OR 2.51 [95% CI 1.086.73]) were significantly associated with the perinatal deaths. CONCLUSIONS: Prematurity, poor accessibility and a high parity were significantly associated with perinatal deaths in the tribal population of Jawadhi Hills.

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.

Determinants of postpartum anemia among women from a rural population in southern India.

BACKGROUND: Even though the problem of anemia during pregnancy has been adequately emphasized, very little attention has been paid to postpartum anemia. The objective of the current study was to estimate the mean change in maternal hemoglobin from 36 weeks' gestation to 6 weeks postpartum and to identify the factors associated with anemia during the postpartum period among women in a rural development block in Tamil Nadu, India. METHODS: Ninety-three pregnant women were interviewed using a structured questionnaire at 36 weeks' gestation and then at 2 and 6 weeks postpartum. Blood samples were collected from the participants at 36 weeks' gestation and at 6 weeks postpartum. Paired t-tests assessing the difference in mean hemoglobin prepartum and postpartum, univariate analysis, and multiple logistic regression to identify factors associated with postpartum anemia were done using Statistical Package for the Social Sciences version 12 for Microsoft Windows software. RESULTS: The proportion of study subjects who were anemic (hemoglobin <11 g/dL) at 36 weeks' gestation was 26.8% and at 6 weeks postpartum was 47.3% (hemoglobin <12 g/dL). The mean hemoglobin at 36-38 weeks' gestation was 11.70±1.43 g/dL and at 6 weeks postpartum was 12.10±1.27 g/dL. Anemia at 36 weeks' gestation (odds ratio [OR] 10.47, 95% confidence interval [CI] 2.37-42.34), heavy blood loss perceived by the mother during delivery (OR 12.91, 95% CI 2.01-61.25), younger maternal age (<21 years, OR 2.45, 95% CI 1.28-23.86), and inadequate iron supplementation during the postpartum period (OR 3.53, 95% CI 1.18-11.37) were identified as significant factors associated with anemia at 6 weeks postpartum. CONCLUSION: Anemia during the third trimester of pregnancy, heavy bleeding perceived by the mother during delivery, younger maternal age, and inadequate iron supplementation during the postpartum period were associated with postpartum anemia.