Role of probiotics VSL#3 in prevention of suspected sepsis in low birthweight infants in India: a randomised controlled trial

OBJECTIVES

To assess the effect of the probiotic VSL#3 in prevention of neonatal sepsis in low birthweight (LBW) infants.

DESIGN

Randomised, double-blind, placebo-controlled trial.

SETTING

Community setting in rural India.

PARTICIPANTS

LBW infants aged 3-7 days.

INTERVENTIONS

Infants were randomised to receive probiotic (VSL#3, 10 billion colony-forming units (cfu)) or placebo for 30 days, and were followed up for 2 months.

MAIN OUTCOME MEASURE

Possible serious bacterial infection (PSBI) as per the Integrated Management of Neonatal Childhood Illnesses algorithm, as diagnosed by fieldworkers/physicians.

RESULTS

668 infants were randomised to VSL#3 and 672 to placebo. By intention-to-treat analysis, the risk of PSBI among infants in the overall population of LBW infants was not statistically significant (RR 0.79 (95% CI 0.56 to 1.03)). Probiotics reduced median days of hospitalisation (6 days vs 3 days in probiotics) (p=0.018) but not the risk of hospitalisation (RR 0.66 (95% CI 0.42 to 1.04). The onset of PSBI in 10% of infants occurred on the 40th day in the probiotics arm versus the 25th day in the control arm (p=0.063).

CONCLUSIONS

Daily supplementation of LBW infants with probiotics VSL#3 (10 billion cfu) for 30 days led to a non-significant 21% reduction in risk of neonatal sepsis. A larger study with sufficient power and a more specific primary end point is warranted to confirm the preventive effect of VSL#3 on neonatal sepsis in LBW infants.

TRIAL REGISTRATION NUMBER

The study is registered at the Clinical Trial Registry of India (CTRI/2008/091/000049).

Study of infant and childhood mortality in an ICDS block of eastern U.P

Information on births and deaths was collected in 11 randomly selected AWW areas of Barhaj Mahen ICDS project area in Eastern U.P. by an independent survey team in 1988-89. The findings revealed that the births and deaths were under-reported to the tune of 36.6 and 13.9 percent respectively, by AWWs. The different demographic indicators generated from the data were as follows, CBR and CDR were 30.3 and 7.1 per 1000 population. Neonatal mortality rate, IMR, and MMR were 58.3, 74.7 and 6.5 per 1000 live births. 0-6 yr mortality was 16.3 per 1000 children and constituted 37.5% of the total deaths. ARI, diarrhoea and fever were the major causes of mortality in 0-6 yr old children accounting for 25.9, 22.3 and 14.8% respectively. The findings indicated that there was underreporting in adult mortalities despite the independent investigation, and a reduction in infant and childhood mortality possibly due to the beneficial effect of ICDS services.

Epidemiological correlates between consumption of Indian chewing tobacco and oral cancer

The problem of cancer is universal; the only variation occurs in the type, site or other clinicoepidemiological parameters. Peculiarly enough, oral cancers caused by chewing tobacco are common in India and some parts of the Indian sub-continent. Oral cancers caused by other carcinogens are not common in these areas. The present study shows a significant association (P less than 0.001) between the use of Indian chewing tobacco and oral cancer. Number of quids, mean quantity of tobacco and mean duration of keeping the quids in the mouth had direct dose and effect relationships in causation of oral cancer. A dose of 10 gms of chewing tobacco for about 26 years was observed to have produced cancerous lesions in the buccal cavity.

Epidemiology of gastro-intestinal and respiratory tract diseases in rural areas of Varanasi (India)

The pattern of gastro-intestinal (GIT) and Respiratory tract (RTI) diseases in rural areas of the Varanasi district, U.P. (India) was studied from the outpatient (OPD) attendance between July 1985 to June 1986. Out of a total of new patients, 19.71% had respiratory diseases in contrast to 27.9% with GIT disease. A decreasing trend was observed in attendance rates as age advanced. The difference in age distribution of males and females was statistically significant. The attendance rates for GIT diseases were higher in female (29.16%) than in males (25.16%) whereas in RTI, the rates were higher in males (19.39%) than in females (18.77%). The attendance rate was found to be higher in rainy season (23.59%) followed by summer (14.50%). Diarrhoea (15.44%) and upper (URTI) respiratory tract infection (19.93%) occupied the major recorded episodes.

Prevalence of ascariasis and ancylostomiasis in families: a collaborative inquiry

A collaborative survey was carried out to estimate the prevalence of ascariasis and ancylostomiasis in random samples of 200 families in each of 3 different communities: a city slum (CS), an industrial township (IT), a farming village community (FVC). Stool examination was done by Kato's qualitative thick smear method. Ascariasis was prevalent in all the three communities; the percentage of families with multiple members infected varied from 50 to 91 per cent; the percentage of members infected within such a family varied from 48 to 74 per cent; the infection was highly prevalent (41-78%) in all age groups excepts adults in the IT. From 8 to 11 per cent of persons with ascariasis were negative on stool examination but passed worms after medication. Ancylostomiasis was arevelent mainly in the FVC and to a less extent in the IT; the percentage of families with multiple members infected was 83 per cent in the FVC and 17 per cent in the IT; the percentage of members infected within such a family was 54 per cent in the FVC and 58 per cent in the IT. All the persons surveyed received a single 10 mg/kg dose of pyrantel pamoate (Combantrin*, Pfizer) which was well tolerated.