Stunting and its determinants among adolescents in four schools of Bangalore city: Height for age- a vital metric for nutritional assessment

Background: National Family Health Surveys in India have not included nutritional status of the crucial age group of 10-14 years, when pubertal growth spurt typically occurs. BMI-for-age is commonly used to assess adolescent nutritional status which may misclassify stunted adolescents as normal or overweight. Objectives: To estimate prevalence and determinants of stunting among adolescents (10 to 19 years) in Bangalore city and to estimate the proportion of adolescents who are stunted, but otherwise assessed as normal or overweight using BMI-for-age. Methods: Cross sectional study conducted in four schools of Bangalore city using a self-administered questionnaire to capture socio-demographic details, dietary patterns and physical activity. WHO Anthroplus software was used to classify nutritional status based on height-for-age and BMI-for-age. Multiple logistic regression analysis was done to calculate adjusted odds ratios of independent co-variates associated with stunting. Results: Overall prevalence of stunting was 14% (95%CI:11.5-16.5%); 14.3% among females (95%CI:10.7-17.9%) and 13.6% among males (95%CI: 10.2-17.0%). Determinants of stunting were late adolescence [AOR=1.90(1.24-2.90),P=0.03], lower socio-economic class [AOR=2.75(1.39-5.41),P=0.03] and not taking weekly iron and folic acid supplements [AOR=2.78(1.48-5.21),P=0.001] Four of every five stunted children (81%) were classified as normal/ overweight/ obese using BMI-for-age. Conclusion: Stunting is a problem among urban adolescents in Bangalore. Height-for-age is a vital metric for assessing nutritional status of adolescents along with other metrics. We recommend strengthening of weekly iron and folic acid supplementation in schools and culturally specific targeted nutritional interventions for adolescents from economically weaker sections of society using a multi-sectoral and participatory approach

Pre-travel Preparedness of International Students Undertaking Electives in a Medical College in Bengaluru City, South India

Introduction: The number of foreign travelers arriving in India has shown an exponential increase from 1.2 million in 1981 to 8.03 million in the year 2015, with an annual growth rate of 4.5%. With the influx of internationally mobile students to developing countries such as India comes the responsibility of having to cater to the health needs of these visitors. The current study was undertaken with the objective of assessing how travel prepared the international student travelers were, what gaps existed, and how better to address this issue in the future. Methods: A cross-sectional study was conducted at a medical college in Bengaluru city of South India during the 6-month period from March to August, 2015. International students doing an elective rotation at the medical college were approached to participate in the study. Written informed consent was obtained from participants, and a 23-item, self-administered questionnaire was distributed to them. Data was entered in EpiData software v3.1 and analyzed using Statistical Package for Social Science v 21.0. Results: The current study comprised 43 elective students. The mean age of the participants was 24 ± 2 years with age ranging from 19-29 years. Females made up the majority (79.1%). A majority of the students (69.8%) had purchased travel insurance, 62.8% had consulted a doctor prior to their travel, and 74.4% had carried a first aid kit during their travel. Conclusion: The current study highlights the variability in the uptake of pre-travel health consultation, vaccination, and other precautions taken by student travelers. Determining the most appropriate strategies for increasing pre-travel health preparation is the next step in advancing travel medicine research

How involved are husbands in antenatal care? the perspective of women availing antenatal services at a maternity hospital in rural South Karnataka, India

Background: Male involvement in maternal health is associated with significant positive health outcomes in the mother. We aimed to assess the antenatal womens’ perception of their husbands’ involvement in antenatal care in a maternity hospital in rural Karnataka, India.Methods: 200 pregnant women in a maternity hospital in Karnataka were interviewed using a semi-structured pilot tested questionnaire on their perception about their husbands’ participation in antenatal care.Results: The mean score of women’s perception of husband’s awareness of antenatal care was 10.1±2.2 out of a maximum of 12, while that of husband’s attitude to antenatal care was 7.7±1.4 out of a maximum of 9 and of husband’s participation was 21.7±5.4 out of a maximum of 30. The score of perception of husband’s awareness was significantly higher among multigravidae and among women who had a planned pregnancy. The score of perception of husband’s attitude was significantly higher among women from nuclear families, multigravidae, those with a living child and those with no complications in the current pregnancy. The score of perception of husband’s participation was significantly higher among women with no complications in the current pregnancy.Conclusions: Husbands play a vital role in the antenatal care of their wives. This should be harnessed by health care workers by providing health education to them, encouraging husbands to accompany their wives to antenatal checkups and labour and promptly communicating clinical findings to them

Awareness of cervical cancer and practice of Papanicolou smears among adult women availing health services or visiting a rural maternity hospital, Ramnagara District, Karnataka, India

Background: Cervical cancer is a leading cause of cancer-related deaths among women worldwide. Almost 87% of cervical cancer deaths occur in low and middle-income countries. The study was conducted to assess the awareness of cervical cancer and practice of Papanicolou (Pap) smears among women availing health services or visiting a rural maternity hospital, Karnataka.Methods: A hospital-based cross-sectional study was conducted using a 50-item interview schedule. The interview was administered to women >18 years of age who availed services at the hospital and their caretakers.Results: Mean age of the 158 women interviewed was 32.68±13.7 years. Only 21% of women had heard about cervical cancer. Only 11.4% knew at least one symptom and 1.9% knew one risk factor of cervical cancer. Most of the women (99%) were not aware about prevention of cervical cancer. Only 4% of the women had heard about Pap smears and 3% of the women had undergone a Pap smear test.Conclusions: Women in our study had very poor awareness of cervical cancer and practice of Pap smears. Gainfully employed women (OR=32; 8.8-111.2) and women who reported cervical cancer among family members or friends (OR=116; 20.2-665.4).  were more likely to have heard about cervical cancer. This study indicates a need to increase the awareness on cervical cancer and its prevention especially regarding Pap smears among rural women in Karnataka

Perceptions about caesarean section among women and health care providers: a qualitative study in a rural maternity hospital in Karnataka, India

Background: Caesarean section is life-saving, but rising rates are a cause for concern. Perceptions surrounding caesarean delivery may play a significant role in the shared-decision making process. Objective of this study was to explore the perceptions of caesarean section among antenatal, postnatal women and healthcare providers in a rural maternity hospital in Ramanagara district, Karnataka.Methods: Qualitative research methodology was adopted to explore perceptions regarding preferred birthing mode, caesarean and its perceived complications. Focus group discussions and in-depth interviews were conducted with antenatal and postnatal women, their caregivers and health care providers. Inductive coding approach and thematic framework analysis was done.Results: Five major themes emerged regarding perceptions of caesarean section among women in a rural area of Karnataka: understanding, fears, decision making, after-care and prevention. Women had a strong preference for normal vaginal birth, but willing to accept doctor’s decision for caesarean as they believed that it would protect the life of unborn child. Women perceived that caesarean was profitable to the hospital. Common mentioned side effects following caesarean were backache and pain at the surgical site.Conclusions: The understanding regarding caesarean section was adequate. Women had fears linked to caesarean such as pain, inability to work, weight gain, prolonged recovery and caesarean deliveries in subsequent pregnancies. Husbands and other family members as well as the doctors were the important decision makers, while the women themselves had little say in the matter. Obstetricians need to focus on alleviating concerns among pregnant women and their family members regarding caesarean section

Maternal and Perinatal Complications from a Hospital-based Intra-partum Complications Registry Established in Remote Referral Hospitals of a Desert District of India

Background: Despite increase in institutional deliveries, maternal and neonatal mortality has reduced slower than expected. It is important to know the reasons of maternal and perinatal deaths for doing focused efforts for reducing them. Objective: The objective of this study was to establish a system to improve estimation of maternal and perinatal complications among deliveries. Methods: The study was designed as a descriptive study. An Intrapartum Complications Registry was set up in eleven government hospitals of Bikaner. In each facility, a “champion” nurse ensured the complete documentation in case sheets and delivery register, and entered all maternal and perinatal complications into an Intrapartum Complications Register which was digitized into a registry database. The data for a six-month period in 2014 was analysed. Results: Out of 3675 women admitted to the labour rooms of the study facilities, 295 women were referred out with complications before delivery, and 3380 mothers delivered 3386 new-borns (including 6 twins). The registry documented 828 cases (22.5%) (512 mothers and 363 new-borns, 47 cases having both mother and new-born complications) with 1014 complications (535 maternal and 479 perinatal complications). The commonest maternal complications were haemorrhage (47.1%), prolonged or obstructed labour (28.4%) and hypertensive disorders (15.3%). The commonest perinatal complications were low birth weight (33.6%), birth asphyxia (18.6%) and neonatal sepsis (16.2%). No maternal or neonatal deaths occurred up to the first 48 hours. Conclusion: Intrapartum Complications Registry improved the documentation of and revealed the profile of maternal and perinatal complications in the study area

Use of mobile phones and television for essential obstetric care among women availing maternal and child health services at a rural maternity hospital in South Karnataka

Background: To improve on Maternal and Neonatal Mortality Rates, newer technologies need to be explored to achieve Sustainable Development Goals of 2030. Objectives: To assess the use of mobile phones for essential obstetric care and associated factors among women availing obstetric services at a rural maternity hospital in South Karnataka. Material & Methods: A cross sectional study was done among the women availing obstetric services in Snehalaya Hospital, Solur in Ramnagara District. Results: There were 236 women included in the study, with a mean age 23.3 (3.22) and 11.78 (2.87) mean years of completed education. 99.15% had mobile phones but only 65% among them had their own phone. None of the women received text messages from MCTS (Government MCH Texts). Of the 53.4% women who had smartphone at home, only 42.4% used the smartphone to search for general health information and none of them used their mobile phone to access essential obstetric care. 48.2% watched health related advertisements and promotions on TV. Antenatal care was adequate among the women, but birth preparedness was found to be poor. Conclusion: The rural women in this study had poor utilization of mobile phones in obstetric care despite the presence of smartphones at home

Awareness and Experience of Kangaroo Mother Care for full term newborns: An interventional study at a rural maternity hospital in south Karnataka

Background: Kangaroo Mother Care (KMC) is early, continuous and prolonged skin-to-skin contact between mother and baby, with exclusive breastfeeding.  Besides preterm and low birth weight babies, even full-term healthy newborns benefit from KMC. Objective: to assess awareness and experience of KMC for full-term newborns among newly delivered mothers in a rural maternity hospital. Methods: Interventional study with interview schedule to capture awareness of KMC (25 scored items). After one hour of practicing KMC, post-intervention assessment of KMC experience (23 scored items) was done. Bivariate analysis performed to associate awareness and experience of KMC with socio-demographic and obstetric variables. Results: The 100 mothers in our study had low median KMC awareness score of 4(IQR=2,8) and were unaware of benefits of KMC.  Median KMC experience score was 21(IQR=19,22), indicating highly positive experience. Mothers reported feeling happy or relaxed, found it easier to breastfeed, easy to practice KMC, and wanted to continue KMC at home. Mothers with caesarean section were more likely to experience abdominal or back pain during KMC (P=0.037) and mothers with previous abortion/stillbirth were more likely to have fear of suffocating the baby during KMC (P=0.005). Conclusion: Though awareness of KMC was found to be low, overall experience of KMC was very positive. Mothers should be educated about benefits of KMC and given an opportunity to practice KMC in hospital. Full-term healthy newborns and their mothers should not be denied the numerous advantages of KMC. There is need to create KMC-friendly hospital culture and promote KMC for all newborns

Postpartum and Newborn Care - A Qualitative study

Community-based postpartum care of mothers and newborns is vital to achieve mortality reduction. This qualitative study explored cultural beliefs and practices regarding postpartum care of mothers and newborns in rural Karnataka. Focus group discussions with newly delivered mothers and their caregivers in a rural maternity hospital, and in-depth interviews with community level health workers revealed cessation of the practice of withholding colostrum and the barbaric practice of branding, but found persisting harmful cultural beliefs and practices like withholding nutritious foods considered “hot” or “cold”, inadequate postpartum ambulation, separating husband and wife for up to a year or more after the birth, application of various substances to the umbilical stump and eyes of the newborn and giving pre-lacteal feeds. Antenatal and postpartum mothers, their caregivers, including elders in the family should be targeted by community level health workers for counseling and behavior change

What motivates an ASHA? Narratives from Ramanagara district, Karnataka

Background: The National Rural Health Mission (NRHM) aimed to bridge the gap in rural health care with the introduction of the Accredited Social Health Activist (ASHA) in 2005. It is essential to identify the motivators and barriers to work performance by the ASHAs in order to facilitate better health care in the community. Objective: To identify the motivators and barriers to the work performance of ASHAs in the Solur PHC area, Ramanagara district, Karnataka. Material & Methods: A qualitative study was conducted in one PHC area of Ramanagara District, Karnataka. Four KIIs with government health functionaries and one FGD with nine ASHAs were conducted. A thematic frame-work approach was used for data analysis. Results: The main personal motivators were altruism and intrinsic satisfaction, while social support and team-work were important environmental motivators. De-motivating factors were financial problems such as insufficient pay and irregular financial incentives, as well as logistic difficulties, including transportation and safety. Conclusion: Personal, cultural, financial considerations and working conditions affect the performance of an ASHA. It is essential to address relevant issues faced by these health workers in order to improve their work satisfaction and efficiency