Najam Khalique

Poor perinatal care practices in urban slums: possible role of social mobilization networks.

Background: Making perinatal care accessible to women in marginalized periurban areas poses a public health problem. Many women do not utilize institutional care in spite of physical accessibility. Home-based care by traditional birth attendants (TBA) is hazardous. Inappropriate early neonatal feeding practices are common. Many barriers to perinatal care can be overcome by social mobilization and capacity building at the community level. Objectives: To determine the existing perinatal practices in an urban slum and to identify barriers to utilization of health services by mothers. Study Design: This is a cross-sectional descriptive study. Setting and Participants: The high-risk periurban areas of Nabi Nagar, Aligarh has a population of 40,000 living in 5,480 households. Mothers delivering babies in September 2007 were identified from records of social mobilization workers (Community Mobilization Coordinators or CMCs) already working in an NGO in the area. A total of 92 mothers were interviewed at home. Current perinatal practices and reasons for utilizing or not utilizing health services were the topics of inquiry. Statistical Analysis: Data was tabulated and analyzed using SPSS 12. Results: Analyses revealed that 80.4% of mothers had received antenatal care. However, this did not translate into safe delivery practices as more than 60% of the women had home deliveries conducted by traditional untrained or trained birth attendants. Reasons for preferring home deliveries were mostly tradition (41.9%) or related to economics (30.7%). A total of 56% of the deliveries were conducted in the squatting position and in 25% of the cases, the umbilical cord was cut using the edge of a broken cup. Although breast-feeding was universal, inappropriate early neonatal feeding practices were common. Prelacteal feeds were given to nearly 50% of the babies and feeding was delayed beyond 24 hours in 8% of the cases. Several mothers had breastfeeding problems. Conclusion: Barriers to utilization of available services leads to hazardous perinatal practices in urban slums.

Lifestyle and gallstone disease: scope for primary prevention.

Objective: To study the antecedent risk factors in the causation of gallstone disease in a hospital-based case control study. Materials and Methods: Cases (n = 150) from all age groups and both sexes with sonographically proven gallstones were recruited over a duration of 3 months from the surgical wards of a tertiary care teaching hospital. Modes of presentation were also noted among cases. Age- and sex-matched controls (n = 150) were chosen from among ward inmates admitted for other reasons. Univariate and multivariate logistic regression analyses were performed for selected sociodemographic, dietary, and lifestyle-related variables. Results: Females had a higher prevalence of gallstone disease than males (P < 0.01). Among males, the geriatric age group (<60 years) was relatively more susceptible (28%). Prepubertal age group was least afflicted (3.3%). Univariate analysis revealed multiparity, high fat, refined sugar, and low fiber intakes to be significantly associated with gallstones. Sedentary habits, recent stress, and hypertension were also among the significant lifestyle-related factors. High body mass index and waist hip ratios, again representing unhealthy lifestyles, were the significant anthropometric covariates. However, only three of these, viz., physical inactivity, high saturated fats, and high waist hip ratio emerged as significant predictors on stepwise logistic regression analysis (P < 0.05). Conclusion: Gallstone disease is frequent among females and elderly males. Significant predictor variables are abdominal adiposity, inadequate physical activity, and high intake of saturated fats; thus representing high risk lifestyles and yet amenable to primary prevention.

Potentially modifiable micro-environmental and co-morbid factors associated with severe wasting and stunting in children below 3 years of age in Aligarh District.

Undernutrition among children is a major public health problem in developing countries like India. The most commonly cited causative factors are food availability and dietary intake, breastfeeding, prevalence of infectious and parasitic diseases, access to health care, immunization against major childhood diseases, vitamin A supplementation, maternal care during pregnancy, water supply and sanitation, socio-economic status, and health-seeking behavior.(1) Children, especially the infants and toddlers, constitute the most disadvantaged group. The present study attempts to investigate the potentially modifiable distal and proximal factors that cause severe malnutrition in children under three years of age and suggests ways to mould them to their advantage.

Breakfast skipping and proposed effects of breakfast on obesity: A school based study in adolescents in Aligarh, India

Background: Breakfast is one of the most integral components of an individual’s diet, despite that breakfast skipping is widely prevalent. Proposed effects of breakfast on obesity (PEBO) have corroborative evidences from different countries, especially, regarding the effects of breakfast skipping on obesity. Habits and lifestyle factors like breakfast skipping maybe formed, changed or strengthened in the tender age of adolescence and can also serve as an early warning system of threats that may engulf larger populations. The study objectives were to ϐind out the frequency of breakfast skipping in adolesc ents and PEBO, including associations with body mass index (BMI) status. Materials and Methods: This was a cross sectional study conducted in all the 13-15 years students who fulϐilled the inclusion criteria in the scho ols afϐiliated to Aligarh Muslim University. The study was based on a pretested and validated questionnaire and the nutritional status/anthropometric records were measured by the now recommended World Health Organization multicentric growth reference standards 2007. Result and Conclusion: A total of 1416 students were studied, out of which frequency of breakfast consumption was found to be <2 times/week in 6. 21% of the study population, 3-5 times/week in 27.54% and 6-7 times/week in 66.24%. As far as PEBO is concerned, a decreased frequency of breakfast was found to have an association with obesity and overweight as well. Further, an association of breakfast skipping on the BMI Z scores was also found to be signiϐicant on analysis of va riance and post-hoc tests. The high prevalence of breakfast skipping in India and PEBO is a big cause of concern for multiple reasons, and an intervention is urged.

Cultural determinants: Addressing barriers to holistic diabetes care

Background: Cultural beliefs and traditional practices nearly affect all aspects of diabetes care. Therefore, understanding its broader cultural context can serve as important background information for effective care for diabetes. Materials and Methods: We conducted this study to explore the cultural determinants in diabetes care and to propose a broad theoretical framework for cultural assessment in persons with diabetes. Explanatory Model Interview Catalog interviews of 25 diabetes persons were conducted. Results: We found that perception about diabetes is influenced by tradition, customs and ethos. Diabetes does not show early signs and therefore symptoms are usually ignored until they interfere with their day-to-day living. Following dietary advice was the most difficult part of diabetes care due to varied cultural barriers. Due to cultural reasons, diabetes is still not assigned due priority by the family. Health illiteracy and cost of care were important barriers for seeking care. Diabetics taking conventional treatment often used complementary treatment, which may be hazardous. Language was also considered a barrier for effective diabetes care. Females struggle more for receiving appropriate care for their diabetes due to social and cultural factors. Conclusion: Cultural assessment needs to be done at various stages - initial assessment, identification of cultural issues in care, planning for culturally relevant intervention and evaluation. This calls for focused elements relevant to the presenting problem, necessary intervention, and participatory evaluation. Cultural values, beliefs, customs, and family patterns may be used as clues for planning diabetes care. Such interventions are likely to bear significant impact on diabetes care in times to come.

Dietary diversity and stunting among infants and young children: A cross-sectional study in Aligarh

Context: Child undernutrition is a public health problem in a developing country like India. Dietary diversity is an important immediate determinant of undernutrition. Aims: The aim of this study is to find the prevalence of stunting among infants and young children aged 6–23 months and its association with dietary diversity. Settings and Design: This study was community-based cross-sectional study. It was carried out in the registered families of the Urban Health Training Centre and Rural Health Training Centre, Department of Community Medicine, Jawaharlal Nehru Medical College, AMU, Aligarh. Methods: A total of 326 children aged 6–23 months were included in the study. Study tools were predesigned and pretested questionnaire, modified infant and young child feeding practices questionnaire, and infantometer. Systematic random sampling with probability proportionate to size technique was utilized to drawn necessary sample size. Statistical analysis: Walds statistics, Z-scores, and bivariate and multivariate logistic regression (LR) (stepwise backward LR) were used. Results: The prevalence of stunting in study population was 45.7% (95% CI - 40.1%, 51.1%); moderate stunting was 33.7% (95% CI - 28.8%, 39%); and severe stunting was 12% (95% CI - 8.8%, 16%). The prevalence of stunting was significantly associated with dietary diversity (OR - 0.17, 95% CI - 0.10–0.29) Conclusions: The study concludes that dietary diversity is a significant predictor of stunting. Therefore, interventions aimed at improving dietary diversity should be taken to reduce the burden of stunting among infants and young children.

Role models and occupational ambitions of in-school male adolescents.

Background: A role model is perceived as worthy of imitation, their selection can indicate significant elements of psychosocial health and self-projection in adolescents. Patterns of behavior and lifestyle choices established during adolescence can have immediate and lasting effects on health. Materials and Methods: Cross-sectional study was undertaken in the schools of Aligarh, Uttar Pradesh, India. The sample frame was 2347, out of which a sample of 390 students was studied. Data collected were entered and analyzed by SPSS for Windows version 10%). Results: Majority (62.7%) of adolescents revealed that their role models were Film Star (34.8%) and their Teachers (27.9%), Parents (14.3%), Sportsman (12.0%). Politicians as the role models were opted by least proportion (1.2%). Desire of future occupation was Businessmen (27.9%), Doctor (18.6), and Engineer (14.4%). Conclusion: Nearly all adolescents had a role model. There is greater impact of cinema on the minds of adolescents, which resulted in choosing film actors as their role model. Aspiration of future occupation was not related to the characteristics of the role model.

Adverse eating behavior and its association with obesity in Indian adolescents: Evidence from a nonmetropolitan city in India

Introduction: With the so-called modernization, the epidemiological and sociocultural context of adolescents in developing countries is rapidly changing and is affecting their eating behavior and dietary choices. The objective of our study is twofold. First, our study seeks to find whether there is a prevalence of the adverse eating behaviors among the adolescents. Second, our study seeks to examine whether the prevalence of the adverse eating behavior is related to obesity and quantifies their association of with body mass index (BMI) status. Materials and Methods: A cross-sectional school-based study was conducted in 13–15-year-old adolescents from schools of Aligarh, India, with prevalidated study tools and standardized anthropometric measures. The Z-scores were found by the WHO recommended AnthroPlus. Results: The results indicate a high prevalence of different adverse eating behaviors. The dietary behavior was found to be poor in 19.3%, fair in 54.4%, and good in only 26.3% of the study population. The mean BMI for age Z-score was found to be 0.87 and 0.02 in poor and fair dietary behavior. The odds of being overweight and obese were high (1.82 [1.20–2.78]) in those with poor dietary behavior. Conclusions: Our findings suggest that more research and timely intervention in adverse eating behaviors are much needed in India before this widely neglected problem acquires even more alarming and gigantic proportions.

A community based study of neonatal mortality in Aligarh by using verbal autopsy

Globally, 2.6 million children died in the first month of life in 2016, most of which occurred in the first week, with about 1 million dying on the first day and close to 1 million dying within the next six days. The first 28 days are the most vulnerable time for a child’s survival. Children face the highest risk of dying in their first month of life. Most newborn deaths occurred in two regions: Southern Asia (39%) and sub-Saharan Africa (38%). Five countries accounted for half of all new-born deaths: India (24%), Pakistan (10%), Nigeria (9%), the Democratic Republic of the Congo (4%) and Ethiopia (3%). About a quarter of global neonatal deaths occur in India. Neonatal mortality is an important indicator of quality of healthcare of a country. Neonatal mortality is becoming increasingly important because the proportion of underfive deaths that occur during the neonatal period is increasing. However, the neonatal deaths have declined from 4.7 million in 1990 to 2.8 million in 2013.. ABSTRACT

Improvements in essential newborn care and newborn resuscitation services following a capacity building and quality improvement program in three districts of Uttar Pradesh, India

Background: Neonatal death remains a global challenge contributing to 45% of underfive deaths. With rising institutional delivery, to accelerate decline in neonatal mortality rate (NMR) improvement in the quality of perinatal care requires attention. Objectives: This implementation research targeted improving service delivery readiness for quality of newborn care at public health facilities in three districts of Uttar Pradesh, India, with high NMR. Materials and Methods: This before-after study assessed the facility readiness and quality of newborn services at 42 health facilities. The changes in 26 signal functions for routine and emergency obstetric and newborn care were tracked. Results: There was marked improvement in newborn service availability: skilled birth attendants (51%), resuscitation (30%), and kangaroo mother care (27%) at these facilities. A multifold rise in newborn resuscitation efforts and documentation (n = 4431 vs. n = 144 in preintervention period) with high success rate (98.6%) was observed. There was also improvement in obstetric care services including partograph use (31%) and active management of third stage of labor (46%). However, several infrastructural indicators (electricity, water supply, toilets, and sanitation) remained unchanged. Conclusion: Overall improvements were observed in the majority of the signal functions for perinatal care and newborn resuscitation efforts. There was a limited impact on the infrastructural and supervision components.