An overview of multicentric training workshops for public health professionals on reproductive and child health programme in India

The major emphasis of Reproductive and Child Health (RCH) programme in India is delivery of client-oriented, demand driven and broader ranges of high quality, safe and effective services for children, adolescents, mothers and reproductive age group population at large. Increased client satisfaction is considered as main determinant for improved acceptance of the services. Thus, well trained and motivated health personnel are necessary to deal with highly sensitive, personal health issues of the clients, like contraception, abortion, infertility services etc. The Indian Public Health Association organized total 10 workshops in several places of India (A total 322 members, composed of Medical Administrators (54.7%), Faculty members of Medical Colleges (24.5%), Sociologist and Nutritionists (13.9%) and also public health personnel (6.9%) participated in the workshop). Learning objectives and lesson plans etc. were formulated. Accordingly the contents were incorporated in a module, validated and pretested. The training sessions were conducted by briefing, discussion, group exercise and VIPP method and were evaluated by semi structured. The pre/post assessment schedule and scored scale of feedback from participantsAE were used for evaluation. The pre-post assessment scores revealed wide variations of mean score among the participants of several places. Significant post workshop improvement of knowledge was quite evident, with few exceptions. The group variants of pre and post score of results was considered to be due to heterogeneous groups of participants. Review of objectivity and quality of the questionnaire were felt as necessary.

Metastability of amorphous silicon from silicon network rebonding

We propose a network rebonding model for light-induced metastability in amorphous silicon, involving bonding rearrangements of silicon and hydrogen atoms. Nonradiative recombination breaks weak silicon bonds and generates dangling bond-floating bond pairs, with very low activation energies. The transient floating bonds annihilate, generating local hydrogen motion. Charged defects are also found. Support for these processes is found with tight-binding molecular dynamics simulations. The model accounts for major experimental features of the Staebler-Wronski effect including electron-spin resonance data, the t(1/3) kinetics of defect formation, two types of metastable dangling bonds, and hysteretic annealing.

All-metallic three-dimensional photonic crystals with a large infrared bandgap

Three-dimensional (3D) metallic crystals are promising photonic bandgap structures: they can possess a large bandgap, new electromagnetic phenomena can be explored, and high-temperature (above 1,000 degrees C) applications may be possible. However, investigation of their photonic bandgap properties is challenging, especially in the infrared and visible spectrum, as metals are dispersive and absorbing in these regions. Studies of metallic photonic crystals have therefore mainly concentrated on microwave and millimetre wavelengths. Difficulties in fabricating 3D metallic crystals present another challenge, although emerging techniques such as self-assembly may help to resolve these problems. Here we report measurements and simulations of a 3D tungsten crystal that has a large photonic bandgap at infrared wavelengths (from about 8 to 20 microm). A very strong attenuation exists in the bandgap, approximately 30 dB per unit cell at 12 microm. These structures also possess other interesting optical properties; a sharp absorption peak is present at the photonic band edge, and a surprisingly large transmission is observed in the allowed band, below 6 microm. We propose that these 3D metallic photonic crystals can be used to integrate various photonic transport phenomena, allowing applications in thermophotovoltaics and blackbody emission.

Tetracycline in the treatment of severe cholera due to Vibrio cholerae O139 Bengal

Vibrio cholerae O139 synonym Bengal, recognized in 1993, is the second member in the list of about 200 serogroups of V. cholerae with epidemic and pandemic potential. Although replacement of fluids and electrolytes remains the cornerstone in the management of cholera, antimicrobial therapy can significantly shorten the duration of diarrhoea, and reduce stool volume and requirements ofrehydration fluids. The role of antimicrobial therapy on the natural course of the disease caused by this relatively new pathogen has not been systematically assessed. A randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the efficacy of tetracycline in the treatment of adults with severe cholera due to V. cholerae O139 Bengal. Forty-three adult males with severe cholera were randomly allocated to receive either 500 mg of tetracycline (n=21) or placebo (n=22) for three consecutive days. Demographic and clinical characteristics of these patients on admission were comparable. Tetracycline therapy was associated with significantly reduced total median (inter-quartile range) stool volume [216.48 (90.18-325.22) mL/kg vs 334.25 (215.12-537.64) mL/kg; p=0.001], higher rates of clinical cure (81% vs 27%; p<0.001), and shorter median (inter-quartile range) duration of diarrhoea [32 (24-48) hours vs 80 (48-104) hours; p<0.001]. The mean +/- (SD) requirement of intravenous fluid was not significantly different between the two groups [146.42 +/- 42.12 mL/kg vs 150.44 +/- 27.21 mL/kg; p=0.70]. The median (inter-quartile range) duration of faecal excretion of V. cholerae O139 was significantly shorter in the tetracycline group than the placebo group [1(1-2) day vs 5 (3-6) days; p<0.001]. The results of the study indicate that tetracycline therapy is clinically useful in the treatment of severe cholera due to V. cholerae O139 Bengal.

HIV in Nepal: is it rare or the tip of an iceberg?

Acquired immunodeficiency syndrome (AIDS) has reached alarming proportions in SE Asia. The magnitude of the epidemic is projected to exceed that of sub-Saharan Africa as we enter the 21st century. Nepal has much in common with India geopolitically and socially and the prevalence of HIV is expected to be no different from the rest of SE Asia. However, evidence thus far paints a different picture altogether--a very low prevalence of HlV even in high-risk population groups. This is surprising, particularly since high-risk behaviour is evidenced by a high rate of drug abuse. In addition, other communicable diseases commonly associated with HIV infection, such as tuberculosis and HBV/HCV infection, are common in Nepal and yet still the prevalence of HIV infection in these patients and in the general population is reported to be low. This paper identifies some of these anomalies and attempts to analyse the reasons for this discrepancy. We emphasize the need for extended survey and strict surveillance to avoid an explosion of this dreaded infection.

Risk factors of diarrhoea among flood victims: a controlled epidemiological study

The concept and practice of 'disaster preparedness and response', instead of traditional casualty relief, is relatively new. Vulnerability analysis and health risks assessment of disaster prone communities are important prerequisites of meaningful preparedness and effective response against any calamity. In this community based study, the risk of diarrhoeal disease and its related epidemiological factors were analysed by collecting data from two selected flood prone block of Midnapur district of West Bengal. The information was compared with that of another population living in two non-flood prone blocks of the same district. The study showed that diarrhoeal disease was the commonest morbidity in flood prone population. Some behaviours, like use of pond water for utensil wash and kitchen purpose, hand washing after defecation without soap, improper hand washing before eating, open field defecation, storage of drinking water in wide mouth vessels etc. were found to be associated with high attack rate of diarrhoea, in both study and control population during flood season compared to pre-flood season. Attack rates were also significantly higher in flood prone population than that of population in non-flood prone area during the same season. Necessity of both community education for proper water use behaviour and personal hygiene along with ensuring safe water and sanitation facilities of flood affected communities were emphasized.

Monitoring and continuing education system of ICDS Programme in Hooghly District, West Bengal

The functioning of "Monitoring and Continuing Education System" of ICDS Programme in Hooghly District was studied through record analysis and individual interviews of Anganwadi Workers (AWW). No Sector Adviser was entrusted the task of monitoring and continuing education activities in 15 out of 17 sectors, supervisors and Health Workers were present in 88.0% and 29.4% sector meetings respectively. The sector meetings were not usually held on fixed dates. Visits of Anganwadi centres (AWC) by Health Workers, Supervisors and Child Development Project Officers (CDPO) were very infrequent and no joint visit was made. Only 11.8% Anganwadi Workers were exposed to continuing education sessions. There was gross under reporting of pregnant mothers and live births. Need of all-round improvement of functioning of 'Monitoring and Continuing Education System' of ICDS Programme is well felt.

Effectiveness of training on infant feeding practices among community influencers in a rural area of west Bengal

Total 34 Influencers were trained in a subcentre area of South 24-parganas district of West Bengal. Knowledge was imparted to community influencers on infant feeding practices through lecture, group discussion, question-answer session and hand-on-training by trained health workers. Pre-assessment was done before initiation of training. Repeat training was conducted at frequent intervals within a period of 3 months. Mean score of knowledge of influencers during pre-training assessment was 13.3 and improved thereafter-following training to 20.8 (1st assessment), 20.6 (2nd assessment), 23.7 (3rd assessment) and 25.2 (final-assessment). Repeat training had also desired impact.

An unusual paratyphoid fever

Salmonella typhi is known to produce acalculous cholecystitis and related gall bladder perforation. Following is a documentation of a patient of sub-phrenic abscess and gall bladder perforation which was possibly a result of Salmonella paratyphi A.

Reproductive health needs and care seeking behaviour of pavement dwellers of Calcutta

An unabated growth of street dwellers in the city of Calcutta is reported to be due to twin reasons like, migration of rural poor people as well as uncontrolled fertility among these poor settlers of the city. A community-based study on reproductive health, fertility and related care seeking behaviour was studied among a sample of women of child bearing age living on streets of Calcutta. Besides, the quite common conditions like leucorrhoea (28.5%), menstrual irregularities (12.3%), infertility (2.5%) and STDs (1.3%) were also reported. But most of these illnesses (three-fourth) were uncared for, and the remaining one-fourth sought treatment from govemment institutions, private agencies or even from untrained practitioners (quacks). The reproductive behaviour of street dwelling women was characterised by early marriage, teenage pregnancies, and scarce use of contraceptives (32%) as well as frequent abortions (2.8%). Very few pregnant women received adequate antenatal care (3.8%). Coverage of tetanus toxoid immunisation (68.5%) and proper iron and folic acid supplementation (16.7%) were also poor. Whereas, antenatal care was received mostly from government health institutions (71%), home delivery (ie, on street) was a common practice and conducted mostly by untrained birth attendants (51.8%).

Maternal mortality associated with eclampsia and severe preeclampsia of pregnancy

OBJECTIVE

To analyse factors associated with maternal mortality in eclampsia and preeclampsia.

METHOD

Retrospective analysis of 69 maternal deaths due to (eclampsia-61; severe preeclampsia-8) was carried out during a period of 17 years (1982-1998). Maternal condition on admission, associated complications and principal cause of death was analysed in each case.

RESULTS

Mean time interval between hospitalization and maternal death was 49.56 +/- 62.01 hrs (1-240 hrs). Twenty (28.9%) women died undelivered. Twenty-three (37.7%) women were in grade IV coma and 52.4% of eclampsia patients had recurrent convulsions (> 10) prior to admission. Associated complications in form of hemorrhage, cerebrovascular accidents, acute renal failure, jaundice, aspiration pneumonia and pulmonary oedema were 30.4, 31.8, 34.8, 18.8, 17.8, and 5.8%, respectively. Maternal mortality in eclampsia was significantly low in time period B (4.1%) when magnesium sulphate was used as an anticonvulsant.

CONCLUSIONS

Maternal condition on admission and associated complications are the major determinant of maternal outcome. Use of magnesium sulphate is associated with significant reduction of maternal mortality.

Vibrio cholerae O139 Bengal: a descriptive study

A prospective study was conducted to determine the clinical and laboratory characteristics and the clinical course of cholera due to Vibrio cholerae O139 Bengal. The study subjects included 22 adult males with stool culture-proven V. cholerae O139. On enrollment, mean +/- SD concentrations (mmol/L) of serum sodium, potassium, chloride, and bicarbonate were 134 +/- 3, 4 +/- 1, 102 +/- 4, and 13 +/- 4 respectively, and stool sodium, potassium, chloride, and bicarbonate concentrations were 120 +/- 24, 18 +/- 6, 93 +/- 16, and 37 +/- 9 respectively. Seventeen patients (7.8%) had faecal leukocytes ranging from 11 to 50 per high-power field. All V. cholerae O139 isolates (100%) were susceptible to tetracycline, erythromycin, and ciprofloxacin, 92% to furazolidine, and only 5% to trimethoprim-sulphamethaxazole. The median (interquartile) volume of liquid stool during the first 24 hours was 9 (5-12) litre. The median (interquartile) volume of liquid stool and the amounts of intravenous and oral rehydration fluids required during the entire study period were 16 (9-24) litre, 9 (6-18) litre, and 14 (9-20) litre respectively. The median (interquartile) duration of diarrhoea was 80 (48-104) hours. The median (interquartile) duration of excretion of V. cholerae O139 in stool was 5 (3-6) days. Clinical and laboratory features, and case management of cholera due to V. cholerae O139 are very similar to conventional cholera due to V. cholerae O1.

The crystal structure of the octamer [r(guauaca)dC]2 with six Watson-Crick base-pairs and two 3' overhang residues

The crystal structure of an alternating RNA octamer, r(guauaca)dC (RNA bases are in lower case while the only DNA base is in upper case), with two 3' overhang residues one of them a terminal deoxycytosine and the other a ribose adenine, has been determined at 2.2 A resolution. The refined structure has an Rwork 18.6% and Rfree 26.8%. There are two independent duplexes (molecules I and II) in the asymmetric unit cell, a = 24.95, b = 45.25 and c = 73.67 A, with space group P2(1)2(1)2(1). Instead of forming a blunt end duplex with two a+.c mispairs and six Watson-Crick base-pairs, the strands in the duplex slide towards the 3' direction forming a two-base overhang (radC) and a six Watson-Crick base-paired duplex. The duplexes are bent (molecule I, 20 degrees; molecule II, 25 degrees) and stack head-to-head to form a right-handed superhelix. The overhang residues are looped out and the penultimate adenines of the two residues at the top end (A15) are anti and at the bottom (A7) end are syn. The syn adenine bases form minor groove A*(G.C) base triples with C8-H...N2 hydrogen bonds. The anti adenine in molecule II also forms a triple and a different C2-H...N3 hydrogen bond, while the other anti adenine in molecule I does not, it stacks on the looped out overhang base dC. The 3' terminal deoxycytosines form two stacked hemiprotonated trans d(C.C)+ base-pairs and the pseudo dyad related molecules form four consecutive deoxyribose and ribose zipper hydrogen bonds in the minor groove.

Mapping RNA-protein interactions in ribonuclease P from Escherichia coli using disulfide-linked EDTA-Fe

The protein subunit of Escherichia coli ribonuclease P (which has a cysteine residue at position 113) and its single cysteine-substituted mutant derivatives (S16C/C113S, K54C/C113S and K66C/C113S) have been modified using a sulfhydryl-specific iron complex of EDTA-2- aminoethyl 2-pyridyl disulfide (EPD-Fe). This reaction converts C5 protein, or its single cysteine-substituted mutant derivatives, into chemical nucleases which are capable of cleaving the cognate RNA ligand, M1 RNA, the catalytic RNA subunit of E. coli RNase P, in the presence of ascorbate and hydrogen peroxide. Cleavages in M1 RNA are expected to occur at positions proximal to the site of contact between the modified residue (in C5 protein) and the ribose units in M1 RNA. When EPD-Fe was used to modify residue Cys16 in C5 protein, hydroxyl radical-mediated cleavages occurred predominantly in the P3 helix of M1 RNA present in the reconstituted holoenzyme. C5 Cys54-EDTA-Fe produced cleavages on the 5' strand of the P4 pseudoknot of M1 RNA, while the cleavages promoted by C5 Cys66-EDTA-Fe were in the loop connecting helices P18 and P2 (J18/2) and the loop (J2/4) preceding the 3' strand of the P4 pseudoknot. However, hydroxyl radical-mediated cleavages in M1 RNA were not evident with Cys113-EDTA-Fe, perhaps indicative of Cys113 being distal from the RNA-protein interface in the RNase P holoenzyme. Our directed hydroxyl radical-mediated footprinting experiments indicate that conserved residues in the RNA and protein subunit of the RNase-P holoenzyme are adjacent to each other and provide structural information essential for understanding the assembly of RNase P.

A study of intersectoral co-ordination in disaster management in flood prone districts of West Bengal

Disaster management is essentially a multi-sectoral and multidisciplinary endeavor. The status of disaster preparedness, coordination among different sectors and its impact on disaster management performance were studied and compared in two flood prone comparable districts viz. Midnapore and Murshidabad of West Bengal. The perception of state level officers about important job responsibilities of other departments in relation to disaster management and its intersectoral co-ordination was found mostly satisfactory; but this desired status did not prevail at district level. Lack of co-ordination among some sectors at district levels persisted in Murshidabad district, indicating comparatively better intersectoral co-ordination in Midnapore district. Thus, 'early response following flood' the most important indicator of adequacy of pre-disaster preparedness was found significantly better in Midnapore district. On the contrary, due to liberal use of Radio transmission set for flood warning, a significantly higher proportion of affected families in Murshidabad district received early flood warning compared to Midnapore. Organisational aspects of disaster management need to be improvised with role clarity of different departments in relation to other sectors involved in this endeavor.

A community based study on health impact of flood in a vulnerable district of West Bengal

In order to ascertain the disaster vulnerability and health risks of flood in Hooghly district of West Bengal, this community based study was conducted through record analysis, interview of concerned authorities and household survey of morbidities before and after flood. Two blocks, with most of its population, were found to be the worst affected among all the disaster vulnerable blocks of the district. Incidence of diarrhoea, other enteric diseases and respiratory infections were significantly higher (P < 0.05) among the population in flood affected blocks, compared to the unaffected. The attack rate of diarrhoea in the flood affected population had increased significantly following flood (P < 0.05).

Risk factors of acute respiratory infections in underfives of urban slum community

To ascertain the risk factors of Acute Respiratory Infections (ARI) in children, a prospective study was conducted for a period of one year among 112 underfives in urban slum community of Calcutta. Incidence of ARI was found significantly higher in undernourished children of poor socio-economic class. Parental smoking habit and solid fuel use for cooking were recognised as important risk factors of ARI.