Study to determine the distribution pattern of agglutinating antibodies to Salmonella enterica serotype: typhi, paratyphi A and paratyphi B antigens in normal healthy individuals and individuals with afebrile illness in pediatric population

Background: Enteric fever continues to be a major health problem in developing countries including India. The serological test, Widal test, is a well known test, used as an indirect test to detect the serological evidences of presence of Salmonella groups. The following study was undertaken to determine the baseline Widal titre (the titre of the antibodies to the O and the H antigens of S. typhi and to the H antigens of S. paratyphi A and B) in normal healthy individuals and individuals with afebrile illness in paediatric population coming to our hospital (both IPD and OPD). Materials & Methods: The Widal test was performed with serial serum dilutions: 1:20, 1:40, 1:80, 1:160 and 1:320 by using isotonic normal saline. 0.5ml of each of the antigen suspension was added to corresponding tubes, mixed well and incubated at 37C for 24 hours. The tubes were then examined visually for agglutination. A 50% agglutination is considered and recorded as the titre of antibodies present in the individual against Salmonella. Results: Positive agglutination in Widal test was observed to be lowest among under-fives as compared to older children (46% vs 62%), but the results were not significant (p=0.06). No significant association was observed between Positive agglutination in Widal test and gender (p=0.31). Conclusion: It is clear that Salmonella agglutinins are common among apparently healthy people and as endemicity of typhoid in an area may change over time, more studies should be carried out to determine Salmonella agglutinin titre in apparently healthy populations, so that a better judgment which is based on the prevailing agglutinin titres can be made. Keywords: Agglutination, Salmonellosis, Typhoid fever, Salmonella typhi, Paratyphi A,  Paratyphi

Determinants of Low Birth Weight in India: An Investigation from a Single Hospital Survey in Madhya Pradesh

Background: Birth weight is one of the most important criteria for determining the neonatal and infant survival. Low birth weight (LBW) is a major public health concern, especially in developing countries, and is frequently related to child morbidity and mortality. LBW is a major public health concern and one of the strongest single risk factors for early neonatal mortality and morbidity. Materials and Methods: About 1000 live newborns on the 1st day of birth and their mothers were studied from the department of obstetrics and gynecology and intensive neonatal care, department of pediatrics of a tertiary care teaching hospital between January 2016 and December 2019. Examinations of mother and newborns were carefully carried out in all cases recorded on a pretested and predesigned pro forma. Results: Mothers weighing <45 kg delivered significantly higher number of LBW babies than normal birth babies. This is statistically very highly significant. It appears that mothers with mid-arm circumference (MAC) 22 cm or less had given birth to much higher number of LBW babies (74.8%), while mothers with MAC >26 cm gave birth to higher number of LBW babies than normal BW babies. This is very highly significant (P < 0.001). Mothers who had taken iron plus folic acid tablets only for few days in any of the trimesters had given birth to higher number of LBW babies while mothers who have taken hematinics throughout pregnancy or taken irregularly had given birth to most of normal birth weight babies. The incidence of LBW was almost 2 ½ times more in joint family (72.6%) than nuclear family. Mothers with moderate to severe anemia have given birth to higher number of LBW babies. Mothers with Hb >10 g% gave birth to higher number of normal BW babies. Conclusion: LBW and premature babies were more prevalent in joint families, with low socioeconomic status, maternal illiteracy, and housewives. With increase in income, both LBW and prematurity decreased reflecting a better distribution of nutrition and care for pregnant and the newborn. Mothers educated till primary school and unskilled workers had higher prevalence of LBW babies

An epidemiological study to estimate the baseline titres of Widal test in apparently healthy children

Background: Enteric fever is one of the common infectious diseases of humans. It is a major health problem in developing countries and its diagnosis on clinical ground is difficult. Diagnosis in developing countries is still mostly done by Widal test. However, the value of the test has been debated. The following study was undertaken to determine the baseline Widal titre (the titre of the antibodies to the O and the H antigens of S. typhi and to the H antigens of S. paratyphi A and B) in normal healthy children.Materials & Methods: A total of 300 children satisfying the eligibility criteria were taken in the study after informed consent from their parents.  ­­­­­A detailed history was taken from each participant with special reference to source of water and method used for purification. Participants were classified into various socio-economic classes as per modified Kuppuswami classification. Widal titres were done with tube agglutination method for all the patients. A Widal antigen kit (antigen suspension of salmonella enterica serotype typhi, paratyphi A and B) was used. Venous blood sample was collected from each participant; left to clot for 15 minutes in the room temperature then sera was separated by using micropipette. The separated sera was properly labeled and stored in -20C for further study. Results: Most of the study subjects were between 6- 10 years of age with mean age of 7.8 +/- 3.2 years.  More males were observed among study subjects with male to female ratio of 2:1 (67% males vs 33% females).  Over half of the subjects (58.7%) were from middle socio-economic class as per modified kuppuswami classification. About one third were from lower class while only 7% were from upper class. Out of the total 300 subjects, 37% of the subjects were not using any purification method for water and were directly consuming water supplied from municipal sources.   Positive agglutination in Widal test i.e titre ≥ 1:20 was seen in 59% of the healthy subjects.  Positive agglutination in Widal test was observed to be lowest among under-fives as compared to older children (46% vs 62%), but the results were not significant (p-0.06). No significant association was observed between positive agglutination in Widal test and gender (p-0.31). Conclusion: It is clear that Salmonella agglutinins are common among apparently healthy people and as endemicity of typhoid in an area may change over time, more studies should be carried out to determine Salmonella agglutinin titre in apparently healthy populations, so that a better judgment which is based on the prevailing agglutinin titres can be made

Impact of maternal physical activities, rest, sleep, paternal education and addiction as determinants of low birth weight in India: a single hospital survey in Madhya Pradesh

Background: Birthweight continues to be the leading infant health indicator and the main focus of infant health policy. Low birthweight babies are at a higher risk of mortality and morbidity in most low-income countries. However, the physical activity level of pregnant women and its association with low birthweight is not well studied in India, especially Central India. Materials & Methods: About 1000 live newborns on 1st day of birth and their mothers were studied from Department of Obstetrics and Gynaecology and Intensive neonatal care, Department of Pediatrics of a tertiary care teaching hospital between January 2016 to December 2019. Examinations of mother and newborns were carefully carried out in all cases recorded on a pretested and predesigned proforma. Results: Mothers, who were advised bed rest for any of the cause, gave birth to more number of LBW babies. Among the women who were working outside beside the routine household work, the unskilled workers had more of LBW babies while skilled workers had less number of LBW babies. This was statistically very highly significant. About 503 mothers who took rest in the afternoon of 1-2 hrs, 377 of them (75%) gave birth to NBW babies. Rest more than 1-2 hrs, showed similar results. About 300 mothers who could not take post lunch rest in the afternoon 83% of them gave birth to LBW babies. This was statistically very highly significant. The number of LBW babes was more with paternal literacy of higher secondary or more than that. The difference was much marked in babies whose fathers were technically educated. This was statistically very highly significant. Conclusion: Mothers educated till Primary School and unskilled workers had higher prevalence of LBW babies. However after graduation in both parents, the LBW and prematurity increased after showing reduction with Higher Secondary education. Socioeconomic factors reflected on maternal health. Our study demonstrated that both maternal and paternal factors could affect birth weight. The assumption that antepartum bed-rest treatment is effective in preventing preterm birth and preventing fetal growth restriction or birth weight