Congenital superior vena cava (SVC) stenosis and obstructed supracardiac total anomalous pulmonary venous connection (TAPVC)-A surgical perspective.

Congenital superior vena cava (SVC) stenosis is a very rare anomaly, especially in pediatric population. Coexistence with obstructed supracardiac total anomalous pulmonary venous connection (TAPVC) has never been reported. Clinical examination should prompt detailed and focused evaluation for this treatable etiology. Pericardial patch augmentation can cure SVC stenosis, and may allow for growth potential as well. We describe a case of congenital SVC stenosis in a case of obstructed supracardiac TAPVC in a 3-month-old infant, managed successfully.

Adolescent girls' Anaemia Control Programme, Gujarat, India.

BACKGROUND & OBJECTIVE: In June 2000, Adolescent Anaemia Control Programme was initiated as a pilot programme in Vadodara district of Gujarat covering over 69000 girls in over 426 schools. Programme strategy was to provide once weekly fixed day (Wednesday) supervised iron folic acid (IFA) supplements to all adolescent girls in Grade 8-12. Currently, programme covers 10 lakh schoolgirls and 2.6 lakh out of school girls with a compliance rate of over 90 per cent as reported by education department. This study was undertaken to institutionalize once a week IFA supplementation in the schools for adolescent girls with built in compliance monitoring in one district and scale up the programme from its learning to all the districts as feasible. METHODS: Baseline survey for three areas of Vadodara district, tribal, rural and urban from 10 schools each was conducted to collect data for anaemia prevalence. Education Inspectors were assigned responsibility to supervise and motivate teachers to try out innovative ideas to promote the programme. Simultaneously anganwadi workers of urban Vadodara were motivated to initiate IFA supplementation for out of schoolgirls on similar strategy. After approximately 17 months of intervention, impact study was conducted in the same 30 schools in November 2001 to obtain levels of anaemia and some of the paired data from the students who were part of the baseline study. Study also included knowledge and practices of the adolescent girls with reference to their dietary habits and package of intervention included nutrition education through schools by providing information and education material prepared by the government. RESULTS: Baseline study had shown around 75 per cent anaemia prevalence, which was similar in all the three areas. Level of serum ferritin was also low. Impact evaluation showed reduction in anaemia prevalence by 21.5 per cent that is, from 74.7 per cent to 53.2 per cent (P

Emergency obstetric care: measuring availability and monitoring progress.

To reduce maternal deaths substantially, the facilities for Emergency Obstetric Care (EOC) must exist, be accessible, be utilized by complicated cases and be successful. Accordingly, a new set of indicators, viz., number of functional EOC facilities, geographic bed distribution within a district, proportion of expected births and expected complications managed at these units, and case fatality rate for complicated cases, were assessed in ten districts drawn from ten major states of India. The paper discusses the findings and some of the problems of data collection and interpretation. In general, maldistribution of beds within the district, low levels of cesarean section rates and, sometimes, high case fatality point to a need for an improvement in availability, distribution and quality of EOC. Similarly, low institutional birth rate and much lower than expected number of complications reaching the facilities point to the need for encouraging families to use them. Changes in these indicators over time will help gauge improvements in provision and utilization of EOC. The study findings and methodology are serving as an important element for developing a monitoring system for EOC under Safe Motherhood in India.

AIDS awareness amongst school teachers in a rural area of India.

One hundred and eighty-two teachers from a random selection of 15 schools in a rural area of Lucknow district of northern India were interviewed to assess their awareness and knowledge about AIDS using a pretested CARC proposed questionnaire. Observations revealed that only 79.7% of the teachers had heard about AIDS, newspapers being the main source of information. Awareness amongst graduate teachers was significantly higher than non-graduates. Many believed AIDS to be mosquito-borne and less than 2% knew that condom usage make sex safer. The study reveals the need to undertake intensive health education efforts as school teachers are an important source of health-related information for rural populations.

A survey of missed opportunity for immunization in Lucknow.

An exit interview of the women accompanying the children of 0-2 years visiting the three large urban hospitals and three randomly selected rural primary health centres of Lucknow district was undertaken to assess the magnitude of problem of missed opportunity for immunization at health facilities. The WHO suggested protocol for the study was followed. Observations reveal that in 59.1% children, the opportunity to vaccinate was missed. Only 3% children had a true contraindication for vaccination. Also 44.6% of women accompanying the children and in the reproductive age group could have been immunized against tetanus. A high level of acceptability of immunization in those with missed opportunity was noted.

Impact of Urban Basic Services on immunization coverage in a slum area of northern India.

The Urban Basic Services (UBS) programme was launched in some of the urban slums in the major cities of India in the year 1986. The main objective of the Urban Basic Services (UBS) Program is to improve and upgrade the quality of life of the urban poor, particularly the women and children. The major thrust area under the UBS programme includes child survival and development, learning opportunities for women and children, water and sanitation, and community organization. The present study attempts to find out the impact of the UBS Program in terms of the immunization coverage carried out in slums covered by UBS and comparing it with non-UBS slums using the 30-cluster sampling technique as suggested by WHO. The percentage of fully immunized children was higher (16.2%) in the UBS slums compared to 10.9% in non-UBS slums. The immunization coverage of children was slightly better in the UBS slums for BCG, DPT and Oral Polio Vaccines, while for measles it was 18.6% in UBS slums and 11.9% in non-UBS slums. The dropout rates for I to III doses of DPT was much higher (36.4%) in non-UBS slums as compared to 28% in UBS slums. The availability of immunization cards was found to be higher in both mothers (16.7%) and children (22.4%) in UBS slums compared to the non-UBS ones (5.2% and 8.6% respectively). The slums thus covered under the UBS program have done marginally better in immunization but it appears that to assess the overall impact of UBS, all the components of services and not merely immunization should be assessed.

Sex bias in immunization coverage in an urban area of U.P.

Two hundred and ten female and two hundred and ten male children aged 1-2 years were identified using 30 cluster random sampling technique in the Nagar Palika of Sitapur. The immunization status was determined to assess differences, if any, in the coverage in accordance with the sex of the child. Except for measles, a significantly higher vaccination coverage was observed for male children as compared to females for every vaccine, this being 65.2 and 60.9%, respectively for DPT III and OPV III for males as compared to 51.9 and 49.5%, respectively for girls. The drop out rates for DPT and OPV were also found to be higher (p greater than 0.05) in female children. However, no difference was observed in the reasons for non-immunization between the female and male children.