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PubMed2001

Safe motherhood--a long way to achieve.

Maternal mortality ratio (MMR) is the most important index for monitoring the progress of safe motherhood programmes. A retrospective analysis of all maternal deaths at RG Kar Medical College and Hospital, Calcutta from 1st January, 1995 to 31st December, 1997 was carried out. There were 29,563 live births and 203 maternal deaths giving cumulative MMR of 686.67 per 100,000 live births. Among the victims 25.6% were < or = 20 years of age, majority (73.4%) were unbooked, mostly from rural (59.6%) or urban slum (20.2%) and from low socio-economic status (59.6%). Most (60.10%) were multiparous and 50.74% patients died within 24 hours of hospital admission. Direct causes were responsible for 83.25%, indirect causes for 14.78% and unrelated causes for 1.97% of maternal deaths. Toxaemia was the leading cause (53.20%) of maternal mortality. Other important causes were haemorrhage (16.75%), sepsis (12.31%), severe anaemia (6.4%), infective hepatitis (1.47%) and heart disease (3.44%). In comparison to previous years no significant changes in MMR had been found though there were temporary decline in some years. The contribution of toxaemia in maternal deaths is significantly high and is on the rise. The other national and global pictures were reviewed. India is among the countries of high MMR and far away from achieving safe motherhood. Majority of deaths are preventable. The medical causes of maternal deaths are in fact, the end point of a longer chain of many underlying factors like low socio-economic status, poverty, illiteracy, high parity and inadequate or no health care. An active community-based health care system accessible to every mother with strong referral system is the most effective approach to achieve safe motherhood.

Cause of Death↗
PubMed2001

Nutritional status of pre-school children in an integrated child development service (ICDS) block of Chandigarh.

Nutritional status of 1286 pre-school children selected by a stratified random sampling and residing in urban, rural and slum areas of Chandigarh was assessed by weight for age criteria by making domicilliary visits. The overall prevalence of protein energy mulnutrition (PEM) was found to be 51.6% while 65.4%, 26.3%, 5.3% and 3% of children had grades I, II, II and IV PEM, respectively. The prevalence of malnutrition significantly increased with increase in age till 3rd year, then started declining (P<0.001). The prevalence of PEMwas significantly higher among Integrated Child Development Service (ICDS) beneficiaries (53.8%) than non-ICDS beneficiaries (46.9%); P<0.05. More attention and better impetus are required to be given to improve the nutritional status of pre-school children in Chandigarh.

Child Health Services↗
PubMed2002

Basic amenities and health in urban India.

We have examined the findings from various studies and corroborated other evidence that the large and continuous increase in India's urban population, and the concomitant growth of the population residing in slums and shanty towns, has resulted in over-straining of infrastructure and a deterioration in public health. Inadequate civic amenities, lack of purchasing power, and lack of knowledge and awareness among the urban poor have resulted in urban poverty which is very different from its rural counterpart. While a few policies have specifically targeted the urban poor, these have been neither sufficient nor effective. Also, the deteriorating health status of urban people needs urgent attention because many of the recent health problems can take an epidemic form if neglected. A resurgence of malaria, dengue and tuberculosis indicates that much of the poor health emanates from a lack of basic amenities such as sanitation, clean water and housing, coupled with a lack of awareness about the need to take precautionary measures against preventable and infectious diseases. To tackle these problems effectively, it is important for policy-makers to recognize that certain groups are more susceptible to ill health than others; they are vulnerable to the severe impact of illnesses and also the likely sources of infection for the population at large. There is an urgent need for research on the factors that prevent the urban poor from availing the services provided to them. It is possible that this is due to the lack of awareness-generating policies which should accompany any supply-side policies such as the provision of basic facilities (e.g. Sulabh Sauchalaya). To reduce the private costs as well as the negative externalities of ill health, it may be necessary to target such populations by cost-effective strategies based on holistic research on all the factors that determine well-being.

Health Status↗
PubMed1996

[Population and underdevelopment--thoughts on the Cairo International Conference on Population and Development].

The continuing rapid growth of world population, particularly in the developing countries, is described. "The backward social and economic environment is not able to keep pace with the growing population. The result is an increasing population pressure which finds its expression in unemployment, hunger, the depletion of...nature, deforestation as well as migration, uncontrolled expansion of the cities and slum-building. These problems [already have] global dimensions and their aggravation is expected in the next 30 years. Our civilisation is exposed to these global risks. And we have no practicable conception for solving them." (SUMMARY IN ENG)

Conservation of Natural Resources↗
PubMed2002

[Community based intervention and reduction of women's vulnerability to STD/AIDS in Brazil].

OBJECTIVES: Despite the growing number of AIDS cases in women reported, community-based interventions, which are essential in this context, are scarce and rarely evaluated. The aim of this study was to carry out a community-based research intervention, to develop and evaluate a set of STD/ AIDS prevention actions targeting the vulnerability of low income women population. METHODS: The study was carried out in Monte Azul slum in the city of São Paulo, SP, Brazil, in the period 1998-1999. The following actions were put in place: training of health professionals from the local outpatient clinic, availability of prevention resources (male and female condoms), educational groups, educational materials and community radio programs. For evaluating intervention, data from four different research instruments were assessed: pre and post training testing of health professionals, monitoring of condom supply, direct observation of community activities, and record of health professionals and target population's voluntary statements during activities. RESULTS: It was observed an increase in demand for male condom and an interest in female condoms. There were relevant gender and age differences in adhering to proposed activities. Although there were good results regarding sensitization and training of health professionals, their involvement in prevention activities was limited. CONCLUSIONS: Strategies relating to codes, demands and specific interests of the local society, especially those related to gender roles, have successfully performed as preventive actions. Health professionals' overwork at the local outpatient clinic proved to be an important limitation for maintaining preventive actions.

Acquired Immunodeficiency Syndrome↗
PubMed1976

[Relationship between the veterinarian and animals, their rights and duties (author's transl)].

The vulnerable position of the human organism with in kingdom of organisms entitles man to subsist as a species. Far-reaching specialization towards animality, resulting in high degree of differentiation, has rendered man extremely vulnerable and thus compelled him to search for possibilities to utilize his environment. However, the fact that he is inherently bound up with this environment imposes limitations on this right to manipulate within it. This right of man is not exclusive but analogously includes the rights of animals. This implies that man should accept the intrinsic value of animals. An animal is a value, not a person, and therefore only has rights analogously. Animals are constantly under the direct influence of man who influences or even destroys their biotopes. The only basic principle to be stressed in this regard is the right of animals to remain in their oecological niche wherever possible, taking into account the effects of selection and mutation which have eventually resulted from their association with man. In view of the above, the following code of conduct is suggested for veterinarians: (1) When man takes animals into his home as pets, he should at least see to it that these animals will be able to develop a natural behaviour in order to safeguard the intrinsic value of the animals wherever possible. (Keeping sporting dogs and greyhounds in flats is not permitted.) (2) Veterinarians should not tolerate symptom-suppressive forms of treatment. (Declawing a domestic cat is not permitted for the simple reason that the owner will usually have caused the abnormal behaviour of the animal.) (3) As an educator, the veterinarian will have to expose any tendency to humanize animals as a devaluation of man. (Laying out animal graveyards and fattening small animals.) (4) On an interdisciplinary basis and from the point of view of the subsistence of mankind, the veterinarian should raise the question of the responsibility of man as a social creature for the kingdom of organisms, not only his fellow-men but the entire environment. (5) The question can be asked to which extent the veterinarian is under an obligation to direct studies and research towards the selection of organisms still capable of establishing a relationship with man in this slum-dwelling called earth.

Animals↗
PubMed2002

Field survey on water supply, sanitation and associated health impacts in urban poor communities--a case from Mumbai City, India.

A field survey was conducted on four slum, squatter and pavement dweller communities of Mumbai City, India with a total sample size of 1,070 households. Study revealed extremely low water consumption pattern averaging merely 30 l/c x d, no sewerage and safe excreta disposal facilities manifested by high occurrence of water-borne diseases. The annual diarrhoeal, typhoid and malaria cases were estimated to 614, 68 and 126 per thousand populations respectively. At point prevalence scale, at least 30% of all morbidity can be accounted for by water-related infections. In addition to the impacts of neighborhood water pollution and sanitation, such diseases were also found positively correlated with low water consumption and poverty related factors as, poor housing and family income. Analysis of variance also revealed intra-poor gradient both in living standards and health conditions on which the pavement dwellers were observed to be the greatest sufferers of all.

Diarrhea↗
PubMed2002

Comparative study between tubotympanic and atticoantral types of chronic suppurative otitis media.

This prospective study was done to compare the different aspects of tubotympanic (group I) and atticoantral types (group II) of chronic suppurative otitis media. The study included 200 patients of chronic suppurative otitis media, of them 100 were of tubotympanic type and 100 were with atticoantral disease. The age (mean +/- SD) of group I and II were 17 +/- 2.7 years and 12 +/- 2.3 years respectively (P < 0.05). The majority of the patients having poor socio-economic condition 69% in group I and 87% in-group II. In both groups, slum dwellers with bathing habit in pond or river and illiterate were more sufferer (P < 0.05). There was central perforation in all patients in-group I, and in-group II, 67% were with attic and 33% were with marginal perforations. In group I, aural discharge was mucoid or mucopurulent in majority of cases 80% and in-group II foul smelling scanty ear discharge was from 88% of subjects. In atticoantral type, hearing impairment was more than tubotympanic disease. Complications were more in atticoantral type of disease. In-group II, post auricular sinus 25% was the commonest extracranial complication followed by subperiosteal abscess 18%, and meningitis 10% was the commonest intracranial complication followed by brain abscess 8%. In tubotympanic type conservative treatment with reconstructive surgery were the treatment of choice, whereas radical or some modifications of radical surgery (with or without reconstruction) were the treatment plan for atticoantral disease. Among the groups the mortality rate was only 4% in-group II and was due to intracranial complications. The study recommends early detection and effective surgical treatment of the disease to improve the situation.

Adolescent↗
PubMed2002

Effect of vitamin A supplementation on childhood morbidity and mortality.

In a double blind design, 1520 children aged < 10 years were individually randomised in vitamin A and placebo group in slums of Chandigarh. Children > 12, 6-12 and < 6 months of age received 200,000, 100,000, 500,000 I.U. of vitamin A respectively every 4 to 6 months during 15 months trial period. The prevalence of vitamin A deficiency was significantly reduced in vitamin A compared to placebo group during the follow-up period. In vitamin A group, incidence of diarrhoea and measles was significantly reduced but incidence of acute respiratory infections was not significantly different compared to control group. Risk of death was also significantly less in vitamin A group. Therefore, promotion of vitamin A rich diet or supplementation with synthetic vitamin A at 4-6 month interval should be a priority in populations where risk of vitamin A deficiency is high.

Case-Control Studies↗
PubMed2002

[Anticholera vaccines and vaccination].

Cholera is still an important diarrhoeal disease in developing countries. The impact of cholera out-break is tremendous for a country at human and economic level. WHO estimates that diarrhoeal diseases cause about 2.8 million deaths per year in developing countries. Officially, cholera is causing around 120,000 deaths per year. The poorest population (from slums and refugee camps) are the most vulnerable target for cholera infection. Development of simple cheap and effective vaccine is highly recommended. This article aims at giving an update on the currently available and future vaccines for the prevention of diarrhoea due to Vibrio cholerae O1 and O139.

Cause of Death↗
PubMed2000

Prevalence of malnutrition using Z-scores and absolute values in children under five years of age in Utan village, Jos, Plateau State, Nigeria.

OBJECTIVE: To compare the use of Z scores and absolute measurements in determining the prevalence of malnutrition among under-five children in the Plateau State, Nigeria. DESIGN: A community based, cross sectional study of under-five children. SETTING: An urban slum, Utan village, Jos, Plateau State, Nigeria. POPULATION: The village has a projected population of 3,000 people; 15% of whom are under-fives. STUDY POPULATION: Four hundred and twenty six under-five children. MAIN OUTCOME MEASURES: Absolute measures of weight for age, weight for height and height for age; and Z scores for the same indicators. INTERVENTION: Mass chemotherapy (antihelminths) and nutrition education were carried out after the study was done in 1993. RESULTS: Based on absolute measurements, 23.7% of the children had low weight for age; 34.9% of the under-fives were stunted (height for age), while 11.1% had low weight for height. Using Z-scores, 25.3% of the under-fives were malnourished based on weight for age, 37% were stunted (height for age), while 8.7% had low weight for height. CONCLUSION: Stunting is still prevalent in the under-five children surveyed in spite of the siting of the PHC clinic which offers promotive, preventive and curative services. Small scale industry could be set up to empower the women economically so that they can provide enough food for their households. A credit/loan scheme would also be beneficial. Emphasis should be placed on growth monitoring to help the women discover when the weight of their children is faltering. The use of oral rehydration therapy against diarrhoeal diseases and immunisation against the common childhood diseases that also affect the nutritional status of the children is important. Nutrition education and family planning programmes should be effectively organised for mothers.

Anthropometry↗
PubMedDate not supplied

Childhood stunting in relation to adolescent living environment and resilience: a follow up study in Lahore, Pakistan.

BACKGROUND: Stunting, as a manifestation of deprivation in early childhood, is a common problem among young Pakistani children. Poverty and lack of resources may predispose a child to maladjustment in the grown-up society. Resilience has been studied in young children to ascertain how the children cope with the challenges in life. The aim of the investigation was to study differences in growth, socio-economic situation and resilience between adolescent boys who had been stunted or normal in height at the age of five years. METHODS: Using both quantitative and qualitative study designs, the study areas were an urban slum area and a village outside Lahore, Pakistan. All boys (n = 36) had been followed from birth to 5 years of age in an earlier epidemiological study conducted at the Dept of Social and Preventive Paediatrics, King Edward Medical College, Lahore and were identified for follow up at 12-15 years of age. RESULTS: Those who were stunted at 5 years were also shorter as adolescents than those who were normal in height at 5 years of age. Resilience, i.e., the combination of the adolescent's emotional abilities, his access to emotional and family support and view of himself was interestingly not heavily influenced by earlier malnutrition. CONCLUSIONS: Despite the hardships faced by the young adolescent boys, living in poor socio-economic situations, are capable of displaying resilience despite being stunted.

Adaptation, Psychological↗
PubMed1992

Childhood diarrhoea due to rotavirus in a community.

The etiologic role of rotavirus in acute diarrhoeal illness in children under five years of age was studied over a period of one year in an urban slum community. Rotavirus was detected in 17.7 per cent of 376 children with diarrhoea and 4 per cent of 299 healthy children with maximum prevalence at 19-24 months of age with statistically comparable detection in 0-6 months of age. The overall prevalence was significantly higher in children below 2 yr as compared to those between 2-5 yr of age. Girls (24.1%) were more susceptible amongst the diarrhoeal group in comparison to boys (13.8%). Diarrhoea due to rotavirus was more prevalent during the cooler months (November-February) of the year and no correlation was observed with rainfall and relative humidity. Rotavirus as the sole pathogen was observed in 9 per cent children with diarrhoea and in the rest, association of Cryptosporidium (3%) was observed for the first time with this virus along with other known enteropathogenic bacteria and parasites, enterotoxigenic Escherichia coli being the commonest organism.

Age Factors↗
PubMed1992

Antibody response of children immunized with poliovaccines: an evaluation using two strains of poliovirus type 1.

Neutralizing antibody response of children immunized with either OPV (3 doses), or IPV (2 doses) was evaluated against poliovirus type 1 Sabin vaccine strain and a local neurovirulent isolate. Both vaccines elicited significantly better antibody response against the vaccine strain than against the neurovirulent isolate. Moreover, approximately 35 per cent of sera contained very low levels of antibody against the virulent virus in spite of good antibody titre against the vaccine strain. The observed difference in antibody response to the wild and the vaccine strains was significant. The differential immune response could be one of the reasons of paralytic disease observed even after administration of OPV (3), in some children if infecting virus dose is high, as in case of urban slums in endemic areas.

Antibodies, Viral↗
PubMed1992

The output and outcome of two types of formal health structures--health post and creche--for nutritional interventions for preschool children in two urban, low-income communities of Belo Horizonte, Brazil (1986).

In order to observe the nutritional and health status of pre-school children, the output and outcome of two formal health services -health post and creche- for this vulnerable group in two urban slum areas of Belo Horizonte, Brazil were studied in 1986. A total of 420 children were surveyed, 254 children randomly selected from the communities and 156 from three creches. Growth monitoring was not undertaken systematically, and mothers did not have growth control charts. When a child had diarrhea, mothers preferred to apply home remedies or to buy proprietary drugs rather than to consult medical personnel. 72% of mothers reported using ORT, and 11% suspending feeding completely. After three month of life, 50% of infants were receiving some breast milk. 75% of children were immunized completely. The prevalence of health and nutrition indicators such as anemia (50% vs. 30%), parasitosis (87% vs. 70%), and stunting (28% vs. 20%) was worse in the creches than in the communities.

Anemia↗
PubMed1992

Nutrition situation in metropolitan Jakarta.

Jakarta is the capital and biggest city of Indonesia with a total population of 10 million. The National Census Office revealed a rapid increase in population through 1985 to 1990. This rapid increase has brought many devastating effects on various aspects of life such as housing, food stock and food production, health and environmental conditions, education, socio-economic and cultural life and political stability. All of these factors contribute to malnutrition in the city as well as in the country as a whole. Data obtained from the Municipal Health Offices showed an unsatisfactory health status having a crude birth rate (CBR) of 2.80%; crude death rate (CDR) of 0.68%; and family size of 5.5. Undernutrition among under-five children still is alarming with a prevalence of 27.91%. Anemia also afflicts a great number of pregnant mothers (70%) and preschool children (38.6%). Nutrition problems are worst in urban areas with their high population density; moderate and severe PEM is 5.63% in urban areas compared with 3.7% moderate PEM and no PEM in rural areas. Jakarta is experiencing rapid urbanization. The presence of slums, air and water pollution in city is a paramount factor leading to poor environmental conditions. The existing health system cannot keep pace with the increasing occurrence of infectious diseases brought about by these unfavorable conditions. Unemployment and underemployment as well as rising costs of foodstuffs cause inadequate food availability at the household level. Due to the grinding poverty experienced by the low socio-economic groups, female workers occupy almost one-third of Indonesia's labor force, hence inadequate care is given to children. All these are factors aggravating the nutritional problems in the country.

Adolescent↗
PubMed2003

Immunization divide: who do get vaccinated in Bangladesh?

This paper examines inequalities in the use of, and access to, vaccination service in Bangladesh by analyzing national and small area-based datasets. The analysis showed that female children had a lower immunization coverage than male children--the difference persists for all antigens and widens against girls for higher doses. The immunization coverage was higher for children whose mothers were more educated. Children whose fathers had a higher-status occupation (salaried employment) were two-and-a-half times more likely to be immunized than children whose fathers held a lower-status job, e.g. day-labourer. The coverage for the poorest quintile was 70% of the well-to-do. Children residing in urban areas were more likely to be fully immunized than their rural counterparts (70% vs 59% for children aged 12-23 months). Within urban areas, the situation in slums was worse. Large differences existed among the various administrative regions of the country. Ethnic minorities in the Chittagong Hill Tracts had a lower immunization coverage than the Bangalees. In Sylhet, children of non-local workers in Bangladesh-owned tea estates had a lower coverage than their counterparts in foreign-owned tea estates. The study identifies children of various disadvantaged groups as having a lower coverage. Managers of immunization programmes must realize that only through removal of such disparities among groups will overall coverage be increased. Affirmative actions in targeting could be effective in reaching such groups.

Bangladesh↗
PubMed2003

Effectiveness of nutrition education, iron supplementation or both on iron status in children.

OBJECTIVE: A community-based, randomized trial was designed to compare the effect of nutrition education and/or iron supplementation (weekly) on iron status of children in an urban slum in Delhi. METHODS: Four hundred and fifty one children, 9-36 months of age and their caretakers (mothers), assigned to one of the following groups were included in the cohort. Group 1, nutrition education. Group 2, supplementation (with 20 mg elemental iron). Group 3, nutrition education with supplementation (with 20 mg elemental iron) and Group 4, control given placebo. The intervention program was of four months duration, with a treatment phase of 8 wk followed by 8 wk of no treatment. RESULTS: Post intervention, at 8 wk and at 16 wk, the hemoglobin change in the nutrition education, supplementation, nutrition education with supplementation and control groups was 2.9, 1.9, 3.8 and -5.9%, respectively and 2.1, -1.9, 0 and -9.3%, respectively (as compared to initial values). There was no significant effect of any of the intervention at 8 weeks. At 16 wk, there was significant positive effect of nutrition education group (p less than 0.05). The percent change in serum ferritin value at 16 wk in the nutrition education, supplementation, nutrition education with supplementation and control groups was 5.7, -2.3, -3.4 and -40%, respectively. Serum ferritin values were significantly higher for the nutrition education group (p < 0.001) as compared to the control. At 16 wk, the nutrition education group mothers showed significantly higher nutrition knowledge and the dietary iron intake of children was significantly higher than their control group counterparts (p < 0.0001). CONCLUSION: The study suggests that nutrition education did have a positive effect on the iron status possibly by improving the dietary iron intake.

Analysis of Variance↗