Manas Pratim Roy

Determinants of utilization of antenatal care services in rural Lucknow, India

Background: Antenatal care services are the first steps towards ensuring the health of mothers and the newborn. This is the key component for achieving Millennium Development Goals by 2015. But Indias performance continues to be poor in providing antenatal care services to its huge population, particularly in the rural areas. Objective: To assess the determinants of utilization of antenatal services by rural beneficiaries in Lucknow, a district of north India. Materials and Methods: The study, cross-sectional in design, was conducted from August 2009 to July 2010. Multistage random sampling was used for selecting villages. A total of 352 recently delivered women were selected following systematic random sampling. Logistic regression was used to find out the determinants of three antenatal care services. Results: Overall, 85.5% of the beneficiaries surveyed were found to receive at least three antenatal care services from any health facility. Community health centre was the most common source for such care. Significant difference was found between beneficiaries who took three antenatal care visits and who did not in terms of age, socio economic status, and timing of registration. On multiple regression, only age (OR = 2.107, 95% CI = 1.132 – 3.923) and timing of registration (OR = 2.817, 95% CI = 1.487 – 5.338) were found to be the predictors for three antenatal care visits. Conclusion: Intervention should be focused on young and late registered women for ensuring sufficient care during pregnancy.

Contraceptive behaviour in North India

The article by Choudhary et al. is a real eye opener [1]. It reemphasizes the fact that even at national capital and its surroundings, the practice of family planning method is far from satisfactory, particularly when we are chasing the target of bringing down net reproductive rate to one. The article found literacy as a factor responsible for reproductive behaviour. As depicted earlier by Prusti, availability and policy taken by local health service providers also play pivotal role for the same outcome [2]. While interpreting the finding, caution must be taken in this regard. Number of living children and socio-economic status (SES) also play role in determining contraceptive uptake [2,3]. A comparison between respondents belonging to low SES and others (all classes merging together) would have given extra edge to the study. Pattern of gender preference is another issue deserves mention. Preference for son is undoubtedly a vital factor in determining contraceptive practice in this part of the country [2].

Mortality in newborns referred to tertiary hospital: An introspection.

Background: India is one of the largest contributors in the pool of neonatal death in the world. However, there are inadequate data on newborns referred to tertiary care centers. The present study aimed to find out predictors of mortality among newborns delivered elsewhere and admitted in a tertiary hospital in New Delhi between February and September 2014. Materials and Methods: Hospital data for were retrieved and analyzed for determining predictors for mortality of the newborns. Time of admission, referral and presenting clinical features were considered. Results: Out of 1496 newborns included in the study, there were 300 deaths. About 43% deaths took place in first 24 hours of life. Asphyxia and low birth weight were the main causes of death in early neonatal period, whereas sepsis had maximum contribution in deaths during late neonatal period. Severe hypothermia, severe respiratory distress, admission within first 24 hours of life, absence of health personnel during transport and referral from any hospital had significant correlation with mortality. Conclusions: There is need for ensure thermoregulation, respiratory sufficiency and presence of health personnel during transport.

Correlation of Childhood Obesity and Related Insulin Resistance with Leptin and Retinol Binding Protein 4: Correspondence

To the Editor: I read with interest the article on childhood obesity [1]. Current epidemic of obesity, change in blood parameters across all the age groups and rise of over-nutrition as new face of childhood morbidity make the study well-timed. Although a nice read, certain hiccoughs cannot be avoided while going through the article. For example, p value for cholesterol has been marked as significant (in Table 3) which, in fact, is not. Again, for C-reactive protein (CRP), the meaning of borderline significance, as mentioned in discussion, is not clear (p 0.075). Secondly, inclusion of plasminogen activator inhibitor, resistin, IL 6 and TNF alpha in discussion does not fit as the present study did not deal with them. Thirdly, as mentioned in conclusion, a ‘rise’ has never been documented in the study. In fact, it is beyond the purview of a cross sectional study. If such a comment deemed necessary for the article at all, the source needs to be mentioned. A time when we are striving to be more accurate and authentic in documenting scientific data and write-ups, we need to be more cautious about what we write in scientific journals.

Seasonal Variation and Dengue Burden in Paediatric Patients in New Delhi

Objective We conducted a study to find a relationship between main weather parameters with admission of positive dengue cases in a tertiary hospital. Methods Retrospective analysis was undertaken to identify epidemiological trend of dengue in 2016 from paediatric wards of a tertiary hospital in New Delhi. Data were collected on patient particulars and daily weather from January to December 2016. Results A total of 266 confirmed cases of dengue were considered. Relative humidity (RH) was associated with burden of positive dengue cases. On week-wise analysis, each surge of dengue admission was preceded by heavy rain 4-6 weeks earlier. Monthly averaged daily temperature range and RH were noted to have strong correlations with dengue burden, keeping an interval of 2 months in between. Conclusions Weather parameters seem to influence magnitude of dengue epidemic, particularly in dengue season. There is need to have an in-depth study about developing a prediction model for dengue epidemic.

Discrimination in Seeking Medical Care for Female Child from Birth to Adolescence – A Retrospective Study: Correspondence

To the Editor: The article on discrimination to girl child is timely and thought provoking [1]. The authors tried to correlate hospital attendance to neglected female children. However, being a tertiary care centre, the study hospital mostly caters to referred and critical cases and may not be a good reflector of the health seeking behavior of the community. Infact, Immunization Clinic may act as a proxy for general population (similar to antenatal clinic in annual HIV sentinel surveillance) but other ratios are not good indicator for gender discrimination, especially if we consider higher vulnerability of male children to diseases and mortality. To be precise about sex ratio at birth, most of the countries in the world experience a higher female birth today [2]. India is no exception. According to Census, sex ratio at birth was 908 in India while sex ratio for child (0–4 y) was 912 in 2010–12 [3]. Still, in a country with a population of 1.25 billion, for bringing down sex ratio at birth to 908, prenatal sex determination and feticides are not enough, particularly when they are considered illegal (Pre-Conception & Pre-Natal Diagnostic Techniques Act, 1994). Add 21.9 % population living below poverty line to that and the possible cost for conducting an illegal medical procedure like prenatal sex determination, the poor sex ratio have to have some other explanations [4]. To summarize, the problem of prenatal sex determination is there in our country but the prevalence is yet to be determined. Without taking other facts in consideration, the blame for poor sex ratio at birth should not be solely attributed to prenatal sex determination. There is a clear need for conducting further study to explore the skewed ratio and its biological correlates.

Mitigating the stillbirth challenge in India

www.thelancet.com Vol 387 May 14, 2016 1995 2 Lawn JE, Blencowe H, Waiswa P, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet 2016; 387: 587–603. 3 UNAIDS. UNAIDS global factsheets 2014. 2014. http://www.unaids.org/sites/default/ fi les/en/media/unaids/contentassets/ documents/factsheet/2014/20140716_ FactSheet_en.pdf (accessed March 17, 2016). 4 Wedi CO, Kirtley S, Hopewell S, Corrigan R, Kennedy SH, Hemelaar J. Perinatal outcomes associated with maternal HIV infection: a systematic review and meta-analysis. Lancet HIV 2016; 3: e33–48. 5 Chen JY, Ribaudo HJ, Souda S, et al. Highly active antiretroviral therapy and adverse birth outcomes among HIV-infected women in Botswana. J Infect Dis 2012; 206: 1695–705.

Neonatal transport in India: From public health perspective

Transport of sick newborns is undergoing massive changes in India. Over past few years, specialized transport has been activated in most of the states although out of pocket expenditure and absence of health personnel in the ambulance are still posing hurdles. With gradual expansion of all-weather roads to the furthest corner of the country and introduction of free transport for all neonates, it brings opportunities for us to reach all the sick newborns to the nearest equipped hospital at the earliest. Telecommunication and presence of health personnel during transport and training on life support are other initiatives boosting health care of the neonates during transport. Thus, improved transport could be a solution for reduction of stagnant neonatal mortality in India.

Vitamin D for infants.

Vitamin D, sometimes referred to as “the sunshine vitamin,” has long been recognized in helping build strong bones and preventing rickets, a softening or weakening of bones in children. New research is suggesting Vitamin D may have other important roles in heart health, regulating the immune system, and even in cancer prevention. Unfortunately, many adults and children often have low levels of Vitamin D and must rely on supplements to achieve the appropriate amounts of Vitamin D on a regular basis.

Knowledge on sexually transmitted diseases: Different view

1. Mou SZ, Bhuiya FA, Islam SM. Knowledge and perceptions of sexually transmitted diseases, HIV/AIDS, and reproductive health among female students in Dhaka, Bangladesh. Int J Adv Med Health Res 2015;2:9-15. Sir, I read with interest the article on sexually transmitted diseases (STDs) by Mou et al.[1] The authors deserve complement for undertaking such effort among the student community. However, certain points need elaboration. 1. About the transmission of STDs, it is not clear how does sexual transmission differ from bacteria/virus. For example, if we consider gonorrhea, a bacterium is transmitted by sexual intercourse. How did the authors classify it? Bacteria or sexual intercourse? In case it was an open-ended question, there are possibilities that such nonspecific answers may come up. Similar confusion arises about causation of AIDS as HIV and virus are kept as different options. It should have been clarified by the authors for bringing clarity in their article. 2. About 79% students knew about STDs, but 85% is expressing their views about building awareness among common people. Those 19% who did not know about STDs had supposedly not come in contact with advertisement, textbook, or campaign about STDs and yet they are suggesting these media! This is, again, a point where further explanation would have cleared doubt among the readers. 3. It is not clear how authors defined the Western culture aggression. If someone wants to repeat the study at a different location, he/she would require such details. 4. How did they expect nonmedical students to know about Kaposi sarcoma or lymphoid intestinal pneumonia and how did they explain the diseases to them? The same could be asked about combination therapy for AIDS treatment. 5. The study found that 38% of the students knew about sexual intercourse as the route of transmission of AIDS, but 65% suggested safe sex for prevention. Moreover, denominator is the same for both the proportions. In a questionnaire-based study on knowledge, this type of discrepancy between Access this article online