Trends in caesarean section rates in a rural block of southern India

Background: Over the last decade many programmes have been implemented to improve the health of pregnant women and neonates. This study aims to look at the changes in modes of delivery and perinatal mortality rates in a rural block of Tamil Nadu between 2006 and 2015.Methods: Data on all the births that have occurred in this rural block of Tamil Nadu that has been prospectively collected between 2006 and 2015 was analysed. A longitudinal analysis was done to calculate the primary and overall caesarean section rate and the average annual rate of increase. The perinatal mortality rate was also calculated.Results: The primary LSCS rate has increased from 9.08% in 2005 to 16.1% in 2015. The overall caesarean section rate has increased from 11.7% to 19.2% in the same time with an average annual rate of increase of 5.1%. During this period the perinatal mortality has decreased from 33 per 1000 live births to 17 per 1000 live births.Conclusions: Though the overall caesarean section rate is higher than the 15% prescribed by WHO the rates are lower than the rest of the country and rural Tamil Nadu

Diagnostic pathways and direct medical costs incurred by new adult pulmonary tuberculosis patients prior to anti-tuberculosis treatment - Tamil Nadu, India.

BACKGROUND: Tuberculosis (TB) patients face substantial delays prior to treatment initiation, and out of pocket (OOP) expenditures often surpass the economic productivity of the household. We evaluated the pre-diagnostic cost and health seeking behaviour of new adult pulmonary TB patients registered at Primary Health Centres (PHCs) in Vellore district, Tamil Nadu, India. METHODS: This descriptive study, part of a randomised controlled trial conducted in three rural Tuberculosis Units from Dec 2012 to Dec 2015, collected data on number of health facilities, dates of visits prior to the initiation of anti-tuberculosis treatment, and direct OOP medical costs associated with TB diagnosis. Logistic regression analysis examined the factors associated with delays in treatment initiation and OOP expenditures. RESULTS: Of 880 TB patients interviewed, 34.7% presented to public health facilities and 65% patients sought private health facilities as their first point of care. The average monthly individual income was $77.79 (SD 57.14). About 69$39.74. Overall, patients experienced a median of 6 days (3-11 IQR) of time to treatment initiation and 21 days (10-30 IQR) of health systems delay. Age ≤ 40 years (aOR: 1.73; CI: 1.22-2.44), diabetes (aOR: 1.63; CI: 1.08-2.44) and first visit to a private health facility (aOR: 17.2; CI: 11.1-26.4) were associated with higher direct OOP medical costs, while age ≤ 40 years (aOR: 0.64; CI: 0.48-0.85) and first visit to private health facility (aOR: 1.79, CI: 1.34-2.39) were associated with health systems delay. CONCLUSION: The majority of rural TB patients registering at PHCs visited private health facilities first and incurred substantial direct OOP medical costs and delays prior to diagnosis and anti-tuberculosis treatment initiation. This study highlights the need for PHCs to be made as the preferred choice for first point of contact, to combat TB more efficiently.Eunice Kennedy Shriver National Institute of Child Health and Human Developmen

Perinatal outcomes in a South Asian setting with high rates of low birth weight

<p>Abstract</p> <p>Background</p> <p>It is unclear whether the high rates of low birth weight in South Asia are due to poor fetal growth or short pregnancy duration. Also, it is not known whether the traditional focus on preventing low birth weight has been successful. We addressed these and related issues by studying births in Kaniyambadi, South India, with births from Nova Scotia, Canada serving as a reference.</p> <p>Methods</p> <p>Population-based data for 1986 to 2005 were obtained from the birth database of the Community Health and Development program in Kaniyambadi and from the Nova Scotia Atlee Perinatal Database. Menstrual dates were used to obtain comparable information on gestational age. Small-for-gestational age (SGA) live births were identified using both a recent Canadian and an older Indian fetal growth standard.</p> <p>Results</p> <p>The low birth weight and preterm birth rates were 17.0% versus 5.5% and 12.3% versus 6.9% in Kaniyambadi and Nova Scotia, respectively. SGA rates were 46.9% in Kaniyambadi and 7.5% in Nova Scotia when the Canadian fetal growth standard was used to define SGA and 6.7% in Kaniyambadi and < 1% in Nova Scotia when the Indian standard was used. In Kaniyambadi, low birth weight, preterm birth and perinatal mortality rates did not decrease between 1990 and 2005. SGA rates in Kaniyambadi declined significantly when SGA was based on the Indian standard but not when it was based on the Canadian standard. Maternal mortality rates fell by 85% (95% confidence interval 57% to 95%) in Kaniyambadi between 1986–90 and 2001–05. Perinatal mortality rates were 11.7 and 2.6 per 1,000 total births and cesarean delivery rates were 6.0% and 20.9% among live births ≥ 2,500 g in Kaniyambadi and Nova Scotia, respectively.</p> <p>Conclusion</p> <p>High rates of fetal growth restriction and relatively high rates of preterm birth are responsible for the high rates of low birth weight in South Asia. Increased emphasis is required on health services that address the morbidity and mortality in all birth weight categories.</p

Mechanisms of Transcription Elongation on Chromatin and Gene Silecing

In the nucleus, the genomes of eukaryotes are packaged with histone proteins to form nucleosomes. Nucleosomes are the biological substrate for all of the processes that require access to the genomic DNA sequence. The first half of my research sought to address questions related to how one of these processes, transcription by RNA pol II, occurs on chromatin and how this process affects chromatin structure. The second half of my research focused on yeast silent chromatin and how it is affected by histone modifications and other chromatin factors. Chapter 1 of this dissertation is a general introduction to transcription and chromatin biology. This chapter should give the reader a general introduction to the importance of these topics, how the two intersect, and the key concepts required to understand the fields today. Chapter 2 of the dissertation describes published work demonstrating the cooperation between the histone chaperone NAP1 and the chromatin remodeling complex RSC. The data shows, in a reconstituted biochemical system, that these enzymes coordinate to evict one H2A-H2B dimer from the nucleosome and allow elongation through a nucleosome template. Chapter 3 of the dissertation describes work involving the function of a core module of the Rpd3 histone deacetylase complex in stabilizing chromatin structure independent of histone deacetylase activity. This core complex has both chromatin assembly activity and the capability to block nucleosome eviction by the RSC complex. Chapter 4 is a study of telomere position effect variegation and heterochromatin in yeast. A key result from the study is that methylation of H3K79 blocks the ability of the Sir complex to silence chromatin in vivo and in vitro without disrupting the ability of the complex to bind to nucleosomes. Chapter 5, the final chapter, is a study that started with a proteomic screen to identify proteins that interact with yeast heterochromatin. This screen identified the Ino80 complex as an interactor with heterochromatin. This interaction was confirmed in a reconstituted system and subsequent in vivo analysis showed that key subunits of the complex are important for silencing the hidden mating locus HML

Mechanisms of Transcription Elongation on Chromatin and Gene Silecing

In the nucleus, the genomes of eukaryotes are packaged with histone proteins to form nucleosomes. Nucleosomes are the biological substrate for all of the processes that require access to the genomic DNA sequence. The first half of my research sought to address questions related to how one of these processes, transcription by RNA pol II, occurs on chromatin and how this process affects chromatin structure. The second half of my research focused on yeast silent chromatin and how it is affected by histone modifications and other chromatin factors. Chapter 1 of this dissertation is a general introduction to transcription and chromatin biology. This chapter should give the reader a general introduction to the importance of these topics, how the two intersect, and the key concepts required to understand the fields today. Chapter 2 of the dissertation describes published work demonstrating the cooperation between the histone chaperone NAP1 and the chromatin remodeling complex RSC. The data shows, in a reconstituted biochemical system, that these enzymes coordinate to evict one H2A-H2B dimer from the nucleosome and allow elongation through a nucleosome template. Chapter 3 of the dissertation describes work involving the function of a core module of the Rpd3 histone deacetylase complex in stabilizing chromatin structure independent of histone deacetylase activity. This core complex has both chromatin assembly activity and the capability to block nucleosome eviction by the RSC complex. Chapter 4 is a study of telomere position effect variegation and heterochromatin in yeast. A key result from the study is that methylation of H3K79 blocks the ability of the Sir complex to silence chromatin in vivo and in vitro without disrupting the ability of the complex to bind to nucleosomes. Chapter 5, the final chapter, is a study that started with a proteomic screen to identify proteins that interact with yeast heterochromatin. This screen identified the Ino80 complex as an interactor with heterochromatin. This interaction was confirmed in a reconstituted system and subsequent in vivo analysis showed that key subunits of the complex are important for silencing the hidden mating locus HML

Perception of unintentional childhood injuries among mothers in rural South India

Parental perception of safe and risk-free environment is critical in the prevention of unintentional childhood injury. In this cross-sectional study, hundred mothers from 13 clusters were interviewed to assess the perception of mothers regarding the risks and hazards leading to unintentional childhood injuries from March to April 2013. A tool developed by Glik et al. was used. Mothers' perception of likelihood of injury from hazards such as household door and drawers, small toys, plastic bags, and cribs was poor. Mothers had a poor perception of injury by entrapment in refrigerators, choking, and strangulation by a rope. Age, education, and literacy (P < 0.05) were found to be significant predictors of perception of risk and hazard. Very few mothers (9%) believed injuries can be completely prevented and illiteracy (P < 0.05) was associated with poor perception on prevention. Health education should focus on improving maternal perception which may bring positive impact on prevention

Prevalence of risk factors for non-communicable diseases in rural & urban Tamil Nadu

Background & objectives: Surveillance of risk factors is important to plan suitable control measures for non-communicable diseases (NCDs). The objective of this study was to assess the behavioural, physical and biochemical risk factors for NCDs in Vellore Corporation and Kaniyambadi, a rural block in Vellore district, Tamil Nadu, India. Methods: This cross-sectional study was carried out among 6196 adults aged 30-64 yr, with 3799 participants from rural and 2397 from urban areas. The World Health Organization-STEPS method was used to record behavioural risk factors, anthropometry, blood pressure, fasting blood glucose and lipid profile. Multiple logistic regression was used to assess associations between risk factors. Results: The proportion of tobacco users (current smoking or daily use of smokeless tobacco) was 23 per cent in the rural sample and 18 per cent in the urban, with rates of smoking being similar. Ever consumption of alcohol was 62 per cent among rural men and 42 per cent among urban men. Low physical activity was seen among 63 per cent of the urban and 43 per cent of the rural sample. Consumption of fruits and vegetables was equally poor in both. In the urban sample, 54 per cent were overweight, 29 per cent had hypertension and 24 per cent diabetes as compared to 31, 17 and 11 per cent, respectively, in the rural sample. Physical inactivity was associated with hypertension, body mass index (BMI) ≥25 kg/m[2], central obesity and dyslipidaemia after adjusting for other factors. Increasing age, male sex, BMI ≥25 kg/m[2] and central obesity were independently associated with both hypertension and diabetes. Interpretation & conclusions: Diabetes, hypertension, dyslipidaemia, physical inactivity and overweight were higher in the urban area as compared to the rural area which had higher rates of smokeless tobacco use and alcohol consumption. Smoking and inadequate consumption of fruits and vegetables were equally prevalent in both the urban and rural samples. There is an urgent need to address behavioural risk factors such as smoking, alcohol consumption, physical inactivity and inadequate intake of fruits and vegetables through primary prevention

Prevalence of coronary heart disease in rural and urban Vellore: A repeat cross-sectional survey

Background: With the increase of cardiovascular risk factors in India, the prevalence of coronary heart disease (CHD) is also expected to rise. A cross-sectional study in 2010–2012 assessed the prevalence and risk factors for CHD in urban and rural Vellore, Tamil Nadu. The secondary objectives were to compare the current prevalence with the prevalence of CHD in the same areas in 1991–1994. Methods: A cross-sectional survey was carried out among adults aged 30–64 years to determine the prevalence of CHD (previously diagnosed disease, symptoms detected using Rose angina questionnaire, or ischemic changes on electrocardiography). The study used the WHO STEPS method in addition to the Rose angina questionnaire and resting electrocardiography and was conducted in nine clusters of a rural block in Vellore district and 48 wards of Vellore town. The results were compared with a similar study in the same area in 1991–1994. Results: The prevalence of CHD was 3.4% (95% CI: 1.6–5.2%) among rural men, 7.4% (95% CI: 4.7–10.1%) among rural women, 7.3% (95% CI: 5.7–8.9%) among urban men, and 13.4% (95% CI: 11.2–15.6%) among urban women in 2010–2012. The age-adjusted prevalence in rural women tripled and in urban women doubled, with only a slight increase among males, between 1991–1994 and 2010–2012. Conclusions: The large increase in prevalence of CHD, among both pre- and post-menopausal females, suggests the need for further confirmatory studies and interventions for prevention in both rural and urban areas

Rising trend of cardiovascular risk factors between 1991–1994 and 2010–2012: A repeat cross sectional survey in urban and rural Vellore

Background: Repeat cross sectional surveys document the trend of prevalence rates for non-communicable diseases and their risk factors. In this study, we compare the prevalence rates for risk factors for cardiovascular disease in urban and rural Vellore between 1991–1994 and 2010–2012. Methods: Cross sectional survey was carried out in 1991–1994 in a rural block in Vellore district and in Vellore town, to study the prevalence of cardiovascular risk factors among adults aged 30–60 years. A repeat survey was done in 2010–2012 using the WHO STEPS method. In both surveys, socio-demographic and behavioral history, physical measurements, biochemical measurements, and medical history were obtained. Age adjusted rates were used to compare the rates in the two surveys. Results: In the rural areas, there was a three times increase in diabetes and body mass index (BMI) ≥25 kg/m2 (overweight/obese) with a doubling of the prevalence of hypertension. In urban areas there was a tripling of diabetes, doubling of proportion with BMI ≥ 25 kg/m2 and 50% increase in prevalence of hypertension. While the proportion of male current smokers reduced by 50% in both rural and urban Vellore, lifetime abstainers to alcohol decreased in the rural area from 46.8% to 37.5% (p < 0.001). Conclusions: There has been an alarming rise in diabetes, hypertension, and overweight/obese with an even greater increase in rural areas. Alcohol use is increasing while smoking is on the decline. Primary prevention programs are required urgently to stem the rising incidence of non-communicable diseases in India