Correlates of maternal health care utilization in rohilkhand region, India

Background:

Until date, the importance of maternal health care services in reducing maternal mortality and morbidity has received a significant recognition. Most of the maternal deaths can be prevented if women have access to basic antenatal, natal and postnatal care. However, uptake of maternal health care services is far from universal even in settings where they are extensively available.

Aim:

The aim of this study is to assess the pattern and identify underlying factors on maternal health care utilization in rural areas of Bareilly.

Subjects and Methods:

This was a cross-sectional study was conducted during June-December 2011. Six villages were selected by convenience out of 99 villages in Bhojipura Block of Bareilly district, Uttar Pradesh to cover maximum number of women. All currently married women aged between 15 and 49 years who had delivered a child within last 1 year were interviewed by house-to-house survey and comprised the study unit. Their socioeconomic and demographic characteristics, reproductive history and knowledge of specific obstetric complications were taken. The information was gathered on various aspects of maternal-care utilization. In analyzing data, both bivariate and multivariate analyses were employed, using the Microsoft Excel and SPSS for Windows, Version 15.0 (SPSS Inc., Chicago, Illinois,USA).

Results:

Most (88.6%; 343/387) of pregnancies had registration for antenatal care (ANC). Majority (69.7%; 239/343) of them were registered between 16 and 24 weeks. Only 28.5% (110/343) of women received ANC from a private doctor. Maternal health care service utilization from health personnel was significantly associated with age at marriage ≥18 years, family size ≤3, birth order ≤2, nuclear family and higher socio-economic status. Most of the pregnancy related complications were found among women aged >30 years, with birth order ≥3, having birth interval <24 months, among Muslims, working mothers and among those belonging to joint family. Mother's education and husband's occupation were found to be strong predictors for the utilization of maternal health care using the logistic regression.

Conclusion:

Utilization of maternal health care services is high. However this can be improved by community based education program.

Prevalence of celiac disease in nutritional anemia at a tertiary care center

BACKGROUND

While anemia occurs in 80 % to 90 % of patients with celiac disease (CD), it may be the sole manifestation of CD. The prevalence of CD in Indian patients with nutritional anemia is not known.

PATIENTS AND METHODS

Adolescent and adult patients presenting with nutritional anemia were prospectively screened for CD using IgA anti-tissue transglutaminase antibody (anti-tTG Ab) followed, if positive, by upper gastrointestinal endoscopy and duodenal biopsy.

RESULTS

Ninety-six patients [mean ± SD age 32.1 ± 13.1 years and median duration of anemia 11 months (range 1 to 144 months)] were screened. Of these patients, 80 had iron deficiency anemia, 11 had megaloblastic anemia, and 5 had dimorphic anemia. Seventy-three patients were on hematinics and 36.4 % had received blood transfusions. Nineteen had a history of chronic diarrhea and the mean ± SD duration of diarrhea in them was 9.7 ± 35.8 months. IgA anti-tTG Ab was positive in 13 patients, of whom 12 agreed to undergo duodenal biopsy. Ten patients had villous atrophy (Marsh grade 3a in three, 3b in one, and 3c in six) and two did not. Thus, 10 patients with nutritional anemia (iron deficiency 9, vitamin B12 deficiency 1) were diagnosed to have CD. On multivariate logistic regression, age, duration of symptoms, and presence of diarrhea were found to be the predictors of CD. All the patients with CD were put on gluten-free diet and with iron and vitamin supplementations and showed a significant improvement in hemoglobin concentration.

CONCLUSIONS

CD screening should be included in the work up of otherwise unexplained nutritional anemia.

Synthesis and evaluation of flavanones as anticancer agents

A few flavanones were synthesised by cyclisation of corresponding 3-(heteroaryl)-1(2-hydroxyphenyl) prop-2-en-1-one with sodium acetate in alcohol-water and evaluated for activity. Synthesised compounds were assayed for their in vitro anticancer activity against three human cancer cell lines, mammary adenocarcinoma (MCF7), human colon adenocarcinoma (HT29) and human kidney adenocarcinoma (A498) using sulforhodamine B dye. Results indicated that most of the compounds exhibited significant in vitro anticancer potential. Among them, compound having furan ring showed most potent activity against all the tested cell lines.

Palm top plasma focus device as a portable pulsed neutron source

Development of a palm top plasma focus device generating (5.2 ± 0.8) × 10(4) neutrons∕pulse into 4π steradians with a pulse width of 15 ± 3 ns is reported for the first time. The weight of the system is less than 1.5 kg. The system comprises a compact capacitor bank, a triggered open air spark gap switch, and a sealed type miniature plasma focus tube. The setup is around 14 cm in diameter and 12.5 cm in length. The energy driver for the unit is a capacitor bank of four cylindrical commercially available electrolytic capacitors. Each capacitor is of 2 μF capacity, 4.5 cm in diameter, and 9.8 cm in length. The cost of each capacitor is less than US$ 10. The internal diameter and the effective length of the plasma focus unit are 2.9 cm and 5 cm, respectively. A DC to DC converter power supply powered by two rechargeable batteries charges the capacitor bank to the desired voltage and also provides a trigger pulse of -15 kV to the spark gap. The maximum energy of operation of the device is 100 J (8 μF, 5 kV, 59 kA) with deuterium gas filling pressure of 3 mbar. The neutrons have also been produced at energy as low as 36 J (3 kV) of operation. The neutron diagnostics are carried out with a bank of (3)He detectors and with a plastic scintillator detector. The device is portable, reusable, and can be operated for multiple shots with a single gas filling.

Appropriateness of Antibiotic Use in Enteric fever inpatients in Tertiary Care Hospitals in Western Nepal: A Cross-Sectional Study

Background: Enteric fever, also known as typhoid fever, is a commonly diagnosed disease in Nepal. Globally, enteric fever affects 21.6 million people and causes 216500 deaths annually. Appropriate use of antibiotics is a key element in the successful treatment of enteric fever. Objective: The study was aimed to study antibiotic use and their appropriateness in the patient with Enteric Fever. Methods: A cross-sectional study was carried out in two tertiary-care hospitals viz. Manipal Teaching Hospital (MTH) and Western Regional Hospital (WRH) in western Nepal between Aug- September 2010. Appropriateness in this study was assessed using Medication Appropriateness Index (MAI) criteria which include indication, effectiveness, dosage, correct directions, practical directions, drug-drug interactions, drug-disease interactions, duplication, duration and expense.  Results: Mean use of antibiotics in WRH (2.18±0.87) was not significantly different (P = 0.015) from MTH (2.13±1.11). The Cephalosporin group of antibiotics was used widely to treat enteric fever in both hospitals. On average 1.12 Cephalosporin per patient in MTH and 0.93 Cephalosporin per patient in WRH were used. On average, we found that 31.7% in MTH and 39.5% in WRH of patient’s treatments with antibiotics were inappropriate. Other common types of inappropriateness are expensive drugs [90% (MTH), 92% (WRH)] duplication of antibiotics [53% (MTH), 822% (WRH)], prescribing high generation antibiotics [80% (MTH), 89% (WRH)], and practical direction [17% (MTH), 33% (WRH)]. Conclusion: Conclusively, more than thirty percent of patients in both of hospitals treated for enteric fever received inappropriate antibiotics. Hence we recommend future education or managerial intervention to improve appropriateness. DOI: http://dx.doi.org/10.3126/nje.v3i1.8289   Nepal Journal of Epidemiology 2013;3 (1): 236-242