Aarti Kumar

Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial

BACKGROUND In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management, with a focus on prevention of hypothermia, aimed at modifying practices and reducing neonatal mortality. METHODS We did a cluster-randomised controlled efficacy trial in Shivgarh, a rural area in Uttar Pradesh. 39 village administrative units (population 104,123) were allocated to one of three groups: a control group, which received the usual services of governmental and non-governmental organisations in the area; an intervention group, which received a preventive package of interventions for essential newborn care (birth preparedness, clean delivery and cord care, thermal care [including skin-to-skin care], breastfeeding promotion, and danger sign recognition); or another intervention group, which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator (ThermoSpot). In the intervention clusters, community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations. Outcome measures included changes in newborn-care practices and neonatal mortality rate compared with the control group. Analysis was by intention to treat. This study is registered as International Standard Randomised Control Trial, number NCT00198653. FINDINGS Improvements in birth preparedness, hygienic delivery, thermal care (including skin-to-skin care), umbilical cord care, skin care, and breastfeeding were seen in intervention arms. There was little change in care-seeking. Compared with controls, neonatal mortality rate was reduced by 54% in the essential newborn-care intervention (rate ratio 0.46 [95% CI 0.35-0.60], p<0.0001) and by 52% in the essential newborn care plus ThermoSpot arm (0.48 [95% CI 0.35-0.66], p<0.0001). INTERPRETATION A socioculturally contextualised, community-based intervention, targeted at high-risk newborn-care practices, can lead to substantial behavioural modification and reduction in neonatal mortality. This approach can be applied to behaviour change along the continuum of care, harmonise vertical interventions, and build community capacity for sustained development. FUNDING USAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation.

Population Health Metrics Research Consortium gold standard verbal autopsy validation study: design, implementation, and development of analysis datasets

BackgroundVerbal autopsy methods are critically important for evaluating the leading causes of death in populations without adequate vital registration systems. With a myriad of analytical and data collection approaches, it is essential to create a high quality validation dataset from different populations to evaluate comparative method performance and make recommendations for future verbal autopsy implementation. This study was undertaken to compile a set of strictly defined gold standard deaths for which verbal autopsies were collected to validate the accuracy of different methods of verbal autopsy cause of death assignment.MethodsData collection was implemented in six sites in four countries: Andhra Pradesh, India; Bohol, Philippines; Dar es Salaam, Tanzania; Mexico City, Mexico; Pemba Island, Tanzania; and Uttar Pradesh, India. The Population Health Metrics Research Consortium (PHMRC) developed stringent diagnostic criteria including laboratory, pathology, and medical imaging findings to identify gold standard deaths in health facilities as well as an enhanced verbal autopsy instrument based on World Health Organization (WHO) standards. A cause list was constructed based on the WHO Global Burden of Disease estimates of the leading causes of death, potential to identify unique signs and symptoms, and the likely existence of sufficient medical technology to ascertain gold standard cases. Blinded verbal autopsies were collected on all gold standard deaths.ResultsOver 12,000 verbal autopsies on deaths with gold standard diagnoses were collected (7,836 adults, 2,075 children, 1,629 neonates, and 1,002 stillbirths). Difficulties in finding sufficient cases to meet gold standard criteria as well as problems with misclassification for certain causes meant that the target list of causes for analysis was reduced to 34 for adults, 21 for children, and 10 for neonates, excluding stillbirths. To ensure strict independence for the validation of methods and assessment of comparative performance, 500 test-train datasets were created from the universe of cases, covering a range of cause-specific compositions.ConclusionsThis unique, robust validation dataset will allow scholars to evaluate the performance of different verbal autopsy analytic methods as well as instrument design. This dataset can be used to inform the implementation of verbal autopsies to more reliably ascertain cause of death in national health information systems.

Using verbal autopsy to measure causes of death: the comparative performance of existing methods

BackgroundMonitoring progress with disease and injury reduction in many populations will require widespread use of verbal autopsy (VA). Multiple methods have been developed for assigning cause of death from a VA but their application is restricted by uncertainty about their reliability.MethodsWe investigated the validity of five automated VA methods for assigning cause of death: InterVA-4, Random Forest (RF), Simplified Symptom Pattern (SSP), Tariff method (Tariff), and King-Lu (KL), in addition to physician review of VA forms (PCVA), based on 12,535 cases from diverse populations for which the true cause of death had been reliably established. For adults, children, neonates and stillbirths, performance was assessed separately for individuals using sensitivity, specificity, Kappa, and chance-corrected concordance (CCC) and for populations using cause specific mortality fraction (CSMF) accuracy, with and without additional diagnostic information from prior contact with health services. A total of 500 train-test splits were used to ensure that results are robust to variation in the underlying cause of death distribution.ResultsThree automated diagnostic methods, Tariff, SSP, and RF, but not InterVA-4, performed better than physician review in all age groups, study sites, and for the majority of causes of death studied. For adults, CSMF accuracy ranged from 0.764 to 0.770, compared with 0.680 for PCVA and 0.625 for InterVA; CCC varied from 49.2% to 54.1%, compared with 42.2% for PCVA, and 23.8% for InterVA. For children, CSMF accuracy was 0.783 for Tariff, 0.678 for PCVA, and 0.520 for InterVA; CCC was 52.5% for Tariff, 44.5% for PCVA, and 30.3% for InterVA. For neonates, CSMF accuracy was 0.817 for Tariff, 0.719 for PCVA, and 0.629 for InterVA; CCC varied from 47.3% to 50.3% for the three automated methods, 29.3% for PCVA, and 19.4% for InterVA. The method with the highest sensitivity for a specific cause varied by cause.ConclusionsPhysician review of verbal autopsy questionnaires is less accurate than automated methods in determining both individual and population causes of death. Overall, Tariff performs as well or better than other methods and should be widely applied in routine mortality surveillance systems with poor cause of death certification practices.

Electrochemical synthesis and characterization of chloride doped polyaniline

Chloride doped polyaniline conducting polymer films have been prepared in a protic acid medium (HCl) by potentiodynamic method in an electrochemical cell and studied by cyclic voltammetry and FTIR techniques. The FTIR spectra confirmed Cl- ion doping in the polymers. The polymerization rate was found to increase with increasing concentration of aniline monomer. But the films obtained at high monomer concentration were rough having a nonuniform flaky polyaniline distribution. Results showed that the polymerization rate did not increase beyond a critical HCl concentration. Cyclic voltammetry suggested that, the oxidation-reduction current increased with an increase in scan rate and that the undoped polyaniline films were not hygroscopic whereas chloride doped polyaniline films were found to be highly hygroscopic.

Behavior change for newborn survival in resource-poor community settings: bridging the gap between evidence and impact.

Despite an established evidence base of simple, affordable, and low-cost interventions to avert neonatal deaths, global progress in reducing neonatal mortality has stagnated in recent years. Under-recognition of the critical role played by behavior change in ensuring adoption and dissemination of innovations is a major reason for this gap between evidence and impact. A general lack of understanding of the mechanisms underlying behavior change at a population level coupled with an under-appreciation of the sociocultural context of newborn care behaviors has underscored ill-informed approaches towards behavior change that have met with limited success. This article draws upon available evidence from prevention-oriented, community-based newborn survival trials to derive insights into the role of behavior change in neonatal mortality reduction. We propose a simple model, the intervention-causation pathway, to explain the pathway through which behavior change interventions may lead to reductions in mortality. Further, we explore the unique nature of newborn care behaviors and their underlying sociocultural context, along with state-of-the-art advances in social, behavioral, and management sciences. These principles form the basis of the behavior change management framework that has successfully guided intervention design and implementation, leading to high impact on neonatal mortality reduction, in Uttar Pradesh, India. We describe how the behavior change management framework can be applied to inform the design of theoretically and empirically sound behavior change interventions with greater precision, predictability and pace towards reduction in neonatal mortality. We finally touch upon key overarching principles that should guide intervention execution for maximal impact.

Community-driven impact of a newborn-focused behavioral intervention on maternal health in Shivgarh, India.

To assess the effect on maternal health outcomes of a community‐based behavior change management intervention for essential newborn care leading to a reduction in neonatal mortality.

Doping level dependent space charge limited conduction in polyaniline nanoparticles

Spherical shaped polyaniline nanoparticles of average diameter ∼4 nm were doped with different concentration of hydrochloric acid. The x-ray diffraction studies reveal an increase in crystallinity with doping. Temperature dependent current-voltage measurements on the different nanoparticle samples indicate the prevalence of bulk-controlled space charge limited conduction (SCLC) mechanism in the high voltage (>1 V) region while the ohmic conduction dominates at the lower voltage (<1 V) region. With increasing doping the nature of SCLC changes from trap-free SCLC to Child-Langmuir type SCLC via exponential trap-limited SCLC. Moreover, the field and temperature dependence of mobility exhibits the universal Poole-Frenkel behavior. The energetic disorder parameter, spatial disorder parameter, inter-site distance, and localization length have been extracted employing the uncorrelated and the correlated Gaussian disorder model.

Electrical and optical studies in polyaniline nanofibre–SnO2 nanocomposites

Polyaniline nanofibre–tin oxide (PAni-SnO2) nanocomposites are synthesized and mixed with polyvinyl alcohol (PVA) as stabilizer to cast free-standing films. Composite films are characterized by X-ray diffraction studies (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), photoluminescence spectroscopy (PL) and UV-visible spectroscopy. XRD confirms the formation of PAni nanofibre–SnO2 nanocomposite. From TEM images, diameter of the polyaniline nanofibre and SnO2 nanoparticles in the PAni-SnO2 nanocomposite are found to be 20–60 nm. SEM results show fibrous morphology of the PAni nanofibre and spherical morphology of polyaniline-SnO2 composites. The nanocomposites exhibit high relative photoluminescence intensity in violet as well as green–yellow region of visible spectrum. From electrical conductivity measurement, it is confirmed that PAni nanofibre–SnO2 nanocomposite follows Mott’s one-dimensional variable range hopping (VRH) model.

Effect of temperature and magnetic field on the electrical transport of polyaniline nanofibers

The detailed nature of conduction in polyaniline nanofibers has been studied as a function of temperature as well as magnetic field. Three batches of nanofibers doped with different levels of hydrochloric acid are synthesized by interfacial polymerization technique with an average diameter of 7.5 nm. The structural studies show an increase in crystallinity with doping while the Raman spectroscopy reveals polaron as the major charge carrier. All the samples show a metal-insulator transition around 16 K. At low temperature, the metallic conduction has been ascribed to electron-electron interaction effects while in the high temperature insulating regime, the conduction mainly occurs by variable range hopping mechanism among superlocalized states. All the materials exhibit a sizable amount of magnetoresistance at all temperatures. It is, however, intriguing that the nature of magnetoresistance changes from positive to negative with temperature, and the magnitude of magnetoresistance itself modifies with the d...

Heat conduction in conducting polyaniline nanofibers

Thermal conductivity and specific heat of conducting polyaniline nanofibers are measured to identify the nature of heat carrying modes combined with their inhomogeneous structure. The low temperature thermal conductivity results reveal crystalline nature while the high temperature data confirm the amorphous nature of the material suggesting heterogeneous model for conducting polyaniline. Extended acoustic phonons dominate the low temperature ( 100 K) heat conduction.