Prevalence and risk factors of diarrhea morbidity among under-five children in India: A systematic review and meta-analysis

Background: Acute diarrhea accounts for a huge burden of infectious diseases in under-five children. Objective: This systematicreview was carried out to study the prevalence and associated risk factors of diarrhea among Indian children aged <5 years.Methods: Papers were identified by a comprehensive electronic search of relevant medical subject heading (MeSH) terms inPubMed. Identified articles were independently reviewed against inclusion/exclusion criteria and rated for quality. 15 articles wereabstracted and reviewed to identify the reported prevalence and risk factors for childhood diarrhea. Meta-analysis was done forcalculating the pooled prevalence of diarrhea and point estimates of risk factors using random effects model with use of appropriatepopulation weights, and depicted using forest plot. Results: The overall prevalence of diarrhea between 2002 and 2013 was 21.70%(95% confidence interval [CI]: 11.24-34.46). The significantly associated risk factors were malnutrition (odds ratio [OR]: 1.73,95% CI: 1.53-1.96) and anemia (OR: 1.71, 95% CI: 1.29-2.28) in child, and low socioeconomic status (OR: 7.14, 95% CI: 2.19-23.32). Age of the child <24 months, not breastfeeding, mothers’ low literacy status and untreated drinking water did not showa significant association. Sex of the child, religion, higher education of mothers, and seasonality were found to be inconsistentlyassociated in single studies. Conclusion: It was concluded that there is sufficient evidence on the association of childhood diarrheawith socio-demographic factors, but evidence on other contributory factors including breastfeeding and vaccination is inconclusive.There is need to conduct more analytical studies on lesser known risk factors of diarrhea to establish their risk factors in Indianchildren

Burden of acute infections (except respiratory and diarrheal) and its risk factors among under-five children in India: A systematic review and meta-analysis

Context: Acute infections of eyes, ears, skin, and others are a common cause of morbidity in under-five children. The overall burdenof other infections and their risk factors is not known. Evidence Acquisition: Available literature was searched comprehensivelyusing PubMed for acute infections (except acute respiratory and diarrheal diseases) using the relevant medical subject heading terms.Extracted articles were independently reviewed against inclusion/exclusion criteria and rated for quality. 10 articles were abstractedand reviewed to identify the reported prevalence and risk factors for acute infections among children. Results: The pooled prevalenceof infections (not including acute respiratory and diarrhea) between 2002 and 2013 was 18.42 (95% confidence interval: 9.30-30.62),with reported range of 3.7-50.8%. The significantly positively associated factors reported in single studies were young age of the child,malnutrition, poor breastfeeding, low socio-economic status, animal rearing near household and mothers’ illiteracy for independentmorbidities. Conclusion: The evidence on risk factors including breastfeeding, vaccination, age, and sex that predispose under-fiveIndian children to different infections is inconclusive. There is a need to conduct more studies on acute infections other than acuterespiratory and diarrhea, to establish their determinants in Indian children

Burden and Correlates of Falls among Rural Elders of South India: Mobility and Independent Living in Elders Study

Aim. Falls are an important contributor to loss of function, morbidity, and mortality in elders. Little is known about falls in Indian populations. The objective of this cross-sectional report was to identify the prevalence and correlates of falls in a cohort of 562 rural southern Indian men and women. Methods. Risk factors included demographics, anthropometrics, self-reported health, medical history, physical function, vision, depression, and lifestyle. Odds ratios were calculated using logistic regression. Results. 71 (13%) subjects reported at least 1 fall in the past year. Prevalence was higher among women (17%) than men (8%), P=0.003. Sex and age showed significant interaction (P=0.04) whereby falls prevalence increased with age among women but decreased among men. Correlates of falls among men included a history of osteoarthritis (OA) (odds ratio (OR): 6.91; 95% CI: 1.4–33.1), depression (OR:9.6; 3.1–30.1), and greater height (OR per 1 standard deviation increase: 2.33; 1.1–5.1). Among women, poor physical performance (OR: 3.33; 1.13–9.86) and history of cardiovascular disease (CVD) (OR: 2.42; 1.01–5.80) were independently associated with falls. Implications. Prevalence of falls in elderly South Indians was lower than published reports from western countries and likely reflects low exposure to fall risks. Patterns with age differed in men and women and may reflect sex differences in the accuracy of age recall. Presence of comorbidities specifically OA, CVD, and depression was independent correlate of falling

Factors affecting the functioning of Rogi Kalyan Samitis in Uttarakhand state of India

Introduction: The Rogi Kalyan Samitis (RKSs) in Uttarakhand were formed at community health centers (CHCs) to monitor and improve the quality of services offered. Methodology: An independent study was taken up to study the progress made by RKSs in two districts of the state. This article presents the different factors affecting the functioning of RKSs. Data were collected from all member secretaries and at least 20% sampled members in all RKSs in eight CHCs. Results: RKS is not functioning properly in both the districts because of a number of inhibitory factors such as poor interest of the members and lack of awareness among members and the general community. Conclusion: Educational activities about spreading awareness regarding the existence and activities of RKS should be undertaken in those areas where the RKS is not performing well

Quality of Health Assistants in primary Health centres in Rural Maharashtra, India

Introduction Health assistants are important functionaries of the primary health care system in India. Their role is supervision of field-based services among other things. A quality assurance mechanism for these health assistants is lacking. The present study was undertaken with the objectives of developing a tool to assess the quality of health assistants in primary health centres (PHCs) and to assess their quality using this tool. Methodology Health assistants from three PHCs in the Wardha district of India were observed for a year using a tool developed from primary health care management Aavancement program modules. Data was collected by direct observation, interview, and review of records for quality of activities. Results Staff strength of health assistants was 87.5%. None of the health assistants were clear about their job descriptions. A supervisory schedule for providing supportive supervision to auxiliary nurse midwives (ANMs) was absent; most field activities pertaining to maternal and child health received poor focus. Monthly meetings lacked a clear agenda, and comments on quality improvement of services provided by the ANMs were missing. Conclusion Continuous training with sensitization on quality issues is required to improve the unsatisfactory quality

Quality assessment of private practitioners in rural Wardha, Maharashtra

<b>Objective:</b> To assess the quality of care provided by private practitioners in rural areas of Wardha district. <b> Methodology:</b> The study was carried out in three primary health centres of Wardha district. 20&#x0025; of the 44 registered private practitioners were selected randomly for the study. The data was collected using checklist through direct observation for the infrastructure. Assessment of quality of services delivered, 10 consecutive patients were observed and also the medical practitioner was interviewed. Supplies and logistics were assessed through observation.<b> Results:</b> All the facilities were sheltered from weather conditions and 90&#x0025; had adequate waiting space. But, drinking water and adequate IEC material was available in only 20&#x0025; facilities. Complete history taking and relevant physical examination was done in only 20&#x0025; cases. Only 20&#x0025; practitioners recorded blood pressure and 30&#x0025; recorded temperature in cases with fever. Provisional diagnosis was not written in any of the case and only 20&#x0025; explained prescription to the patients. <b> Conclusion:</b> There is considerable scope to improve the quality of services of private practitioners. To achieve this quality assurance programs may be initiated along with the training of private medical practitioners

Gender identity in urban poor mobilizations: evidence from Bengaluru

This paper draws on field research conducted among a group of resettled slum(1) dwellers in the west of Bengaluru, and analyzes women's collective engagement to improve the provision of urban services in low-income neighbourhoods. The paper argues the need to deepen the focus on urban poor mobilizations below the level of the urban poor as a group - to look at the various groups, and the differences, divergences and contradictions within. Using gender as a differential, the paper focuses on women who dominate local neighbourhood level initiatives within low-income settlements, and analyzes their specific opportunities and constraints as actors within the larger domain of urban poor mobilizations. It proposes that these seemingly insignificant day-to-day negotiations diverge from more individual forms of "leadership", creating a political space at the lowest level of the neighbourhood where the projects of material improvement and emancipation take place simultaneously

Increasing Full Child Immunization Rates by Government Using an Innovative Computerized Immunization Due List in Rural India

Increasing child vaccination coverage to 85% or more in rural India from the current level of 50% holds great promise for reducing infant and child mortality and improving health of children. We have tested a novel strategy called Rural Effective Affordable Comprehensive Health Care (REACH) in a rural population of more than 300 000 in Rajasthan and succeeded in achieving full immunization coverage of 88.7% among children aged 12 to 23 months in a short span of less than 2 years. The REACH strategy was first developed and successfully implemented in a demonstration project by SHARE INDIA in Medchal region of Andhra Pradesh, and was then replicated in Rajgarh block of Rajasthan in cooperation with Bhoruka Charitable Trust (private partners of Integrated Child Development Services and National Rural Health Mission health workers in Rajgarh). The success of the REACH strategy in both Andhra Pradesh and Rajasthan suggests that it could be successfully adopted as a model to enhance vaccination coverage dramatically in other areas of rural India

Dengue serotype-specific seroprevalence among 5- to 10-year-old children in India: a community-based cross-sectional study

Background: Dengue surveillance data in India are limited and probably substantially underestimate the burden of disease. A community-based study was undertaken to assess the prevalence of dengue-specific immunoglobulin G (IgG) antibodies in children across India and to examine historical dengue exposure rates. Potential associations between socio-economic factors and dengue seroprevalence were also assessed (registered at ctri.nic.in: CTRI/2011/12/002243). Methods: A convenience sample of 2609 healthy children aged 5–10 years was enrolled; these children were registered at or were living in the vicinity of eight centres located at six geographically distinct sites across India. Blood samples were drawn to test for the presence of dengue IgG antibodies using ELISA. Serotype-specific neutralizing antibody titres were measured in dengue IgG-positive children using dengue plaque reduction neutralization tests. Socio-demographic and household information was collected using a questionnaire. Results: Overall, 2558/2609 children had viable samples with laboratory results for dengue IgG. Dengue IgG seroprevalence across all sites was 59.6% (95% confidence interval 57.7–61.5%): the lowest (23.2%) was in Kalyani, West Bengal, and the highest (80.1%) was in Mumbai. Seroprevalence increased with age. Multivariate analysis suggested associations with household water storage/supply and type of housing. Half of the subjects with positive IgG results presented a multitypic profile, indicating previous exposure to more than one serotype. Conclusions: The overall dengue seroprevalence suggests that dengue endemicity in India is comparable to that in highly endemic countries of Southeast Asia. Additional prospective studies are required to fully quantify the disease burden, in order to support evidence-based policies for dengue prevention and control in India