Effect of home-based childcare on childhood mortality in rural Maharashtra, India: a cluster randomised controlled trial

Under-five child mortality and associated factors among tribal populations from a South Indian district

This paper reports child mortality and associated factors among tribal (indigenous) populations from a South Indian district. In India, 104 million people belonged to 705 tribal groups, constituting 8.6% of India's population. Of the 705 tribal groups, 75 were classified as particularly vulnerable tribal groups (PVTG). The present study aims to report the under-five child mortality among the tribal (both PVTG and non-PVTG) population in Visakhapatnam district, a district with a higher concentration of tribes in the Indian state of Andhra Pradesh. Four sub-districts were selected to conduct a cross-sectional study to understand health and health-seeking behavior, including maternal and child health. Socio-demographic details and obstetric history were collected through a pre-tested, interviewer-administered questionnaire from mothers with a child aged up to one year. These 277 mothers gave birth to 632 liveborn children, out of which 56 children died within 12 months. Multiple logistic regression revealed that living in villages with no health facility, woman-headed households, younger age at first childbirth and mother' aged 30 years or above were significantly associated with mothers experiencing child death. Implementation of home-based neonatal care is crucial in the vulnerability context of the tribes due to socioeconomic conditions and remote habitation. Health educational interventions to address early marriages leading to teenage pregnancies are needed immediately. This disaggregated analysis of under-five mortality and associated factors among the tribes highlights the need for population-specific interventions and improving infrastructural facilities like all-weather roads and improved access to quality healthcare services in addition to the overall socio-economic development.

Ocular morbidity among children (aged 6-18 yr) of the tribal area of Melghat, India: A community-based study

BACKGROUND OBJECTIVES

Most of the ocular morbidities among school children are preventable or treatable. Melghat, a difficult to access, hilly, forest, tribal area with poorly developed infrastructure in the Amravati district of Maharashtra. Scarcity of ophthalmologists and low health-seeking behaviour of tribal people contributes to the high burden of ocular morbidity. Given the lack of published studies on the ocular morbidity among children in Melghat, outreach programmes are essential to diagnose and treat visual impairments promptly. The objective was to determine the prevalence of ocular morbidity among children in the tribal area of Melghat.

METHODS

A community-based observational study was carried out in the Chikhaldara and Dharni blocks of Melghat. Children from 15 tribal villages were screened for eye disorders by trained paramedics. Most of the children were examined by an ophthalmologist. We used Chi-square test for categorical variables.

RESULTS

A total of 4357 children aged between 6 and 18 yr were examined. Of these 2336 (53.6%) were females and 2021 (46.4%) were males. Out of 4357 children, 507 (11.63%) had an ocular morbidity. The prevalence of ocular morbidity and refractive error increased in the age group of 8-10 yr (P<0.05 and <0.001, respectively). Refractive error was the most common ocular morbidity (n=339; 7.8%), followed by vitamin A deficiency (VAD) (n=120; 2.8%).

INTERPRETATION CONCLUSIONS

The prevalence of refractive error and VAD in this study was significantly higher than the rest of India and the world. For the prevention of childhood blindness, immediate intervention programme, including eye screening by trained paramedics, treatment by an ophthalmologist and prophylaxis, is crucial.

Randomised controlled trials in child and adolescent health in 2023

In the year July 2022 to June 2023 there were 501 publications from randomised controlled trials (RCTs) in child and adolescent health in developing countries identified through a standardised search strategy that has been going for 20 years. This year, trials addressed the widest range of diseases and conditions that affect the health, development and well-being of children, newborns, adolescents and mothers. RCTs reflected old, neglected and new problems, the changing epidemiology of child health, social and economic circumstances in many countries, local and global priorities of low-income and middle-income countries, environmental causes of poor child health, and inequities. The RCTs tested new and refined treatments, diagnostics, vaccines, holistic management, and prevention approaches, and explored many outcomes, including mortality, nutrition, psychosocial measures, and neurodevelopment. The studies were conducted in numerous hospitals and healthcare clinics, schools, and communities, including among some of the world's most disadvantaged populations in humanitarian and refugee emergencies. Some studies are of the highest quality, and others fall short. Many RCTs will influence guidelines, practice and policies for years to come.

Verbal autopsy to assess causes of mortality among the economically productive age group in the tribal region of Melghat, central India

Background & Objectives

Verbal autopsy (VA) is the systematic and retrospective inquiry (from relatives) about the symptoms of an illness prior to death. In tribal India, 67-75 per cent of deaths occur at home with an unknown cause of death (CoD). Hence, the aim of this study was to determine the CoD in the 16-60 yr age group utilizing VA.

Methods

A prospective, community based longitudinal study was conducted in 32 tribal villages in the Melghat region of Maharashtra, between 2004 and 2020. Number of deaths and VAs in 16-60 yr age group were collected by village health workers (VHWs) and supervisors, verified by five different persons (internal-external) and cross-checked by three VA interpretation trained physicians. A modified version of WHO VA was used. Cause-specific mortality fractions were calculated.

Results

Of the 1011 deaths recorded, mortality in males was significantly higher than females (P<0.001). A total of 763 VAs were conducted which revealed that tuberculosis was the leading CoD, followed by jaundice, heart diseases, diarrhoea, central nervous system infections and suicide. Suicides were significantly more common among males than in females (P=0.046). Significantly, more deaths occurred during the monsoon (P=0.002), especially diarrhoeal deaths (P=0.024).

Interpretation & conclusions

The findings of this study suggest that, in Indian tribal areas, infectious diseases are the leading causes of morbidity and one of the major causes of deaths in economically productive age group. Intensified VHW-mediated interventions are required to reduce the premature deaths.

Community-Minimal Invasive Tissue Sampling (cMITS) using a modified ambulance for ascertaining the cause of death: A novel approach piloted in a remote inaccessible rural area in India

BACKGROUND

Melghat in India is a hilly, forested, difficult to access, impoverished rural area in northeast part of Maharashtra (Central India) with difficult healthcare access. Melghat has very high Mortality rates, because of grossly inadequate medical facilities. (1) Home deaths contribute to 67% of deaths,(2) which are difficult to track and where cause of death is mostly unknown.

METHODS

A feasibility study was carried out in 93 rural villages and 5 hospitals to assess feasibility of tracking real-time community mortality and to ascertain cause of death in 0-60 months and 16-60 years age group using Minimal Invasive Tissue Sampling (MITS) in purpose-modified ambulance. We used the network of village health workers (VHW)s, to establish real-time community mortality tracking. Upon receipt of reports of home death, we performed MITS within 4 h of death in the vicinity of the village.

RESULTS

We conducted 16 MITS. Nine, in MITS ambulance in community and seven at MAHAN hospital. The acceptance rate of MITS was 59.26%. Standard operating procedure (SOP) of conducting community MITS in an ambulance, is established. Major challenges were, Covid19 lockdown, reluctance of tribal parents for consent for MITS due to illiteracy, superstitions and fear of organ removal. Ambulance was an easy to reach transport means in remote area, provided a well-designed and discrete facility to perform MITS in community, winning the confidence of bereaved family. This has reduced time interval between time of death and performing MITS.

CONCLUSIONS

MITS in purpose-modified Ambulance can be used worldwide for community MITS especially in areas which are remote and lack healthcare access. This solution needs to be assessed in different cultural settings to document culture specific issues.