Implementation of Delayed Cord Clamping in public health facilities: a case study from India.

BACKGROUND: Global and country specific recommendations on Delayed umbilical cord clamping (DCC) are available, though guidance on their implementation in program settings is lacking. In India, DCC (clamping not earlier than 1 min after birth) is a component in the package of services delivered as part of the India Newborn Action Plan (INAP) supported by Nutrition International (NI) in two states. The objective of this case study was to document the learnings from implementation of DCC in these two states and to understand the health system factors that affected its operationalization. METHODS: Mixed methods were followed. Using the World Health Organization (WHO) Health Systems building blocks as a framework, 20 Key-Informant Interviews were conducted to explore facilitators and barriers to routine implementation of DCC in public health settings. Existing quantitative program data and secondary data from labour-room registers from eight NI- supported districts were analysed to assess the prevalence of DCC implementation in public health systems settings. RESULTS: A demonstrated commitment from the government to implement DCC at all delivery points in NI supported districts was observed. Funds were sufficient, trainings were optimal, knowledge of the health workforce was adequate and a recording mechanism was in place. According to record reviews, DCC was more likely to happen in facilities that provide Basic Emergency Obstetric services and among normal deliveries. It was less likely to be followed in babies delivered by Caesarean section (OR 0.03; 95%CI 0.02,0.05), birthweight < 2000 g (OR 0.22; 95%CI 0.12,0.47), multiple pregnancies (OR 0.17, 95%CI 0.05,0.63), birth asphyxia requiring resuscitation (0.37; 95%CI 0.26,0.52), and those delivered during day shift (OR 0.59, 95%CI 0.40, 0.83). CONCLUSIONS: Wide coverage of DCC in public health settings in the two states was observed. Good governance, adequate funding, commitment of health workforce has likely contributed to its success in these contexts. These are critical elements to guide DCC implementation in India and for consideration in other settings.

Treatment of class II and class III maloccolusion by using churro jumper: an efficient, inexpensive and uncomplicated fixed flexible functional technique

Functional orthopedic treatment seeks to improve skeletal and dental relationship of the jaws. The challenging task is to correctly position jaws antero-posteriorly and vertically with correct overbite, overjet and Centric relation. The Churro Jumper is an efficient, inexpensive and uncomplicated fixed flexible functional appliance. It is used to evaluate the efficacy of the Churro Jumper appliance in treatment of skeletal Class II malocclusion with retrognathic mandible. Churro Jumper contributes in correction of Class II molar relationship by dento-alveolar effects on both jaws. There was up-righting of maxillary incisors and proclination of mandibular incisors. Churro Jumper is clinically efficient as well as effective appliance to correct skeletal class II malocclusion. The only problem with this appliance is its frequent breakage and oral hygiene maintenance causing inconvenience to both patient as well as operator.