Micronutrient Deficiency in Pregnancy: Time to Think Beyond Iron and Folic Acid Supplementation

BACKGROUND

Micronutrients play an important role in influencing pregnancy outcomes. Anemia is common among pregnant women against which iron and folic acid supplementation programs are already in action. The study aimed to estimate the prevalence of anemic and selected micronutrient status among pregnant women.

MATERIALS AND METHODS

It is a community-based cross-sectional study. The study was carried out among pregnant women registered in Primary Health Center, Kallur, Tirunelveli district, Tamil Nadu, India, using a semi-structured data capture tool. The blood samples were collected following standard procedure.

RESULTS

The micronutrient status among 139 pregnant women were selenium <1%, copper <1%, zinc 11.5%, iodine 14.4%, Vitamin B12 41.7%, and ferritin 42.4%. Vitamin B12, zinc, and selenium levels showed a significant difference with reference values among the three trimesters. Iron and folic acid supplementation was followed by 58.7% of pregnant women. Multiple micronutrient deficiency with anemia was found among 54.6%.

CONCLUSION

Anemia and micronutrient deficiency are high among pregnant women in this region. Since iron and folic acid supplementation strategies are already being implemented by the government, it is high time that we extend our health policy beyond that and plan for micronutrient supplementation as well.

Studies on rapid assessment methods in leprosy

A study was undertaken in Pudukottai district, Tamilnadu, India to test rapid assessment methods: viz (i) sample surveys with lower coverages for clinical examination in estimating the disease problem in the community, (ii) utility of registered case prevalence for estimating the actual prevalence in a given area, (iii) leprosy in school-going children and its utility in estimating leprosy prevalence in the community, and (iv) information on disability and smear positivity in estimating leprosy prevalence; and develop correction factors for estimating leprosy situation. A sample of 23 clusters from 582 clusters of contiguous villages and hamlets was further divided into two random sub-samples for two surveys with differing coverages. One team covered nine clusters comprising 34 villages with a population of 17,562 and examined 15,596 with a population of 26,927 and examined 16,622 (62%) persons for leprosy. The results showed that: (i) leprosy sample surveys with lowered coverages would tend to miss valuable information, in terms of quality and quantity; (ii) from 'known case' registers, to estimate the true burden of leprosy disease and to monitor its trend over time is inadequate; (iii) school surveys are of limited value for estimating the disease burden in the community or to monitor its trend over time; (iv) the number of smear-positive cases is to small to serve as an indicator for the total case load in the community; and (v) the prevalence of active disease and that of grade 2 disability in the community are poorly correlated. Reliable methods other than those used here need to be developed for evaluation and monitoring of the disease burden particularly in the post-MDT era.

Clinical predictors of Japanese encephalitis

Over a 5-year period, virological investigations for Japanese encephalitis (JE) were conducted in children presenting with acute encephalopathic illness. Clinical features of JE-positive patients (n = 116) were compared with patients in whom the diagnosis could be excluded (n = 57). Multivariate analysis by logistic regression revealed that two clinical signs--central hyperpneic breathing pattern and extrapyramidal signs--were significant predictors of the diagnosis. Application of the model yielded a sensitivity of 41.3% and a specificity of 80.7% with positive and negative predictive values of 81.3 and 40.3%, respectively. This indicates that the model may be helpful in making the diagnosis but not in excluding it. The model should be further validated in different areas where the disease is prevalent.

Clinical sequelae of Japanese encephalitis in children

Over a five and a half year period, virological investigations for Japanese encephalitis (JE) were conducted in children admitted with acute encephalitis like illness to a large city hospital. The diagnosis of Japanese encephalitis was made by viral isolation from cerebrospinal fluid and/or a four-fold or higher rise in haemagglutination inhibiting antibodies in paired sera followed by demonstration of specific IgM antibodies by HI test after treatment with 2-mercapto ethanol. All children surviving the illness were contacted by post and followed up for sequelae. A total of 55 children could be followed up after 12-18 months and 22 of these even after 2 yr. A high rate of major sequelae (45.5%) in the form of frank motor deficits (32.7%), mental retardation (21.8%) and/or convulsions (18.2%) was observed. Neurological deficits were of diverse types and improved even after 2 yr of the illness. Fourteen patients (25.4%) had only minor deficits in the form of scholastic backwardness, behavioural problems and/or subtle neurological signs. Only 16 (29.2%) patients were completely normal on follow up. JE may therefore be an important cause of neurological handicap in this area. Sequelae of the disease were more severe if the initial illness was prolonged (P < 0.001, CI 2.45, 12.64), or associated with focal neurological deficits (P < 0.001, CI 1.97, 7.02).