Assessment of utilization of child health services (under RCH program) and incorrect practices related to perinatal events in Jamnagar district, Gujarat, India

Background: India contributes to 25% of the over 6.9 million under-five deaths occurring worldwide every year with nearly half of them in neonatal period .This study is related indirectly with the causes of U5MR (e.g. Neonatal sepsis, prematurity-LBW) through focusing on service utilization related to perinatal events & incorrect practices of essential Newborn care (e.g. initiation of breast feeding and exclusive breastfeeding). Objectives: (1) Assess utilization of child health services related to perinatal events (2) Assess incorrect practices related to perinatal events (3) Assess effect of demographic variables on service utilization and association of these variables with practices.Methods: A cross-sectional study of 400 children (12 to 59 months) was done using multistage sampling technique in Jamnagar district. 120 children were selected from urban and 280 from rural areas as urban: rural ratio is 3:7 in India.Results: 93.55% children having umbilical infection. Birth weights were taken in majority of children (95.75%), 15.83% of those weighed were having low birth weight (LBW). Application on umbilical cord after birth was seen in 10.25% & prelacteal feed in about 1/3rd children. Breastfeeding immediately or within 4 hours after birth was seen in 3/4th, exclusive breastfeeding in 2/3rd children.Conclusions: Children having umbilical infection were treated indicating better utilization of curative services. Taking of birth weights in majority of children indicating good functioning of healthcare professionals but some of those weighed were having low birth weight (LBW) indicating underutilization of preventive-antenatal services indirectly affecting child health. Incorrect practices like application on umbilical cord after birth and prelacteal feed were seen in children. Recommended practices like breastfeeding immediately or within 4 hours after birth, exclusive breastfeeding were seen in children. Colostrum giving was more prevalent and low birth weight was less prevalent in rural areas compared to urban areas which indicated better health care utilization in rural areas.

Immunization Status of 12-23 Months Children of Urban Jamnagar

Background: Immunization is one of most cost effective public health intervention. Aims: (1) To assess immunization status among children of 12-23 months age group (2) To find out left out/dropout rate (3) To check association of socio demographic factors with immunization status. Material & Methods: A cross sectional study of sample 240 children aged between 12 to 23 months (using 30 cluster sampling technique) from Jamnagar municipal corporation area. Immunization of child was assessed through immunization card, presence of BCG scar & interview. Results: Out of 240 children, Coverage of BCG-99.58%, OPV0-94.58%, DPT1-98.33%, DPT2-96.67%, DPT3-95.42%, OPV1-96.67%, OPV2-95.83%, OPV3-4.58%. Coverage of HepB1, HepB2, and HepB3 were 73.33%, 70.42%, 68.75% respectively. Coverage of measles was 87.75%. Fully immunized children were 65%. Vaccine dropout of BCG-Measles was highest 11.34%, followed by DPT1-measles 10.58%. For BCG-DPT3 4.17%, DPT1-DPT3 2.96% & for HEP1-HEP3 6.25%. Fully immunized status was higher among male child as compare to female child which was statistically significant. Fully immunized children were more in Hindu religion compared to others which was statistically significant. No association found between educations of mother & immunization status of child. Socioeconomic class had no association with immunization status. Conclusion: Vaccination coverage shows gradual improvement in last decade (Fully immunized 65%) but at the same time reflects incomplete utilization (dropout rate is around 11%). Coverage was higher among male children as compared to female children which indicate the existence of gender difference in utilization of immunization services in our study areas. Utilization of immunization services was higher in Hindu community as compared to other community

Assessment of Ear Nose and Throat morbidities prevalent in the school going children aged 5-14 years in rural area of Jamnagar

Background: India is home to more than 400 million children forming about 35% of its total population. Upper respiratory tract infections predispose a child to complications such as otitis media, tonsillitis, and sinusitis that further contribute to morbidity leading to hearing impairment and learning disability & even RHD. Unfortunately these morbidities are either not detected or remain untreated making situation worse. Aims and objectives:1. To assess the prevalence of common Ear Nose and Throat symptoms among children aged 5-14 years and to study its relationship with socio-demographic factors 2. To know regarding health seeking behavior in relations to Ear Nose and Throat morbidities. Materials and method: A cross-sectional study was done over a period of 2 months among 300 school children aged 5-14 years of six government schools of Jamnagar district. Assessment was done through clinical examination and oral questioners. Results: Prevalence of Ear Nose and Throat morbidity was 46.66%; Ear (14.33%), Nose(28.66%) and Throat(10%).Common Ear Nose and Throat problems were– common cold(23%), cough(9.67%), sore throat(8.34%) and ear ache(8.67%). Associations of Ear Nose and Throat morbidity with age and religion were statistically significant. Only 31.40% of children had taken treatment for the problems. Mother’s education had statistically significant association on health seeking behavior of school children. Conclusion: Prevalence of Ear Nose and Throat morbidity was very high among school children, only 1/3 children had taken treatment, indicating negligence towards problems on the part of parents as well as teachers suggesting strong need for sensitization of parents and teachers

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million 95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% 95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

A study on prevalence of risk factors of non-communicable diseases and to assess awareness regarding non-communicable diseases and its risk factors among adolescents

Background: The major and potentially preventable risk factors of NCDs are associated with lifestyle and behaviour pattern which are largely due to practices adopted in younger age. Knowledge of adolescents about non-communicable diseases and their risk factors are an important part of population-based prevention strategy. Objectives: To assess prevalence of NCDs risk factors among adolescents and to study awareness regarding NCDs and their risk factors. Material &amp; Methods: It was a cross sectional study. 400 students of adolescent age from private school were interviewed over a period of four months. Data was entered and analysed statistically using Excel 2010 and Epi info software. Results: Majority of participants were from age 15-17 years. 7.25% were overweight and only 1% were Obese. Physical inactivity prevalent in 76.75%, Family history in 41.25%, Inadequate sleep in 43.50% and tobacco habit in 21%, Frequent junk food consumption in 75.75%, Lack of yoga meditation in 79.75%. Awareness was excellent for Diabetes and Hypertension. Regarding risk factors, 87% were aware about tobacco consumption, 94% about alcohol consumption, 69.50% about passive smoking, 91.50% about fast food consumption, 82% about excess salt intake, 79.50% about physical inactivity and 73.25% aware about obesity. Conclusions: Awareness was excellent regarding NCDs and their risk factors, but the prevalence of risk factors was high among adolescent. Fair numbers adolescents were following high risk practices. These results have highlighted the fact that there is an urgent need to take effective steps, to prevent this problem

A community based cross sectional study on menstrual hygiene awareness and practices among females of reproductive age group

Background: Good menstrual hygiene is essential for the health and dignity of women. Discussions on menstrual hygiene are important for women to clarify existing myths and misconceptions around menstruation. In developing countries it is reported that many women/girls do not follow healthy measures for maintaining the menstrual hygiene. Objectives: To study awareness regarding menstrual hygiene among the women of reproductive age and find out practice related to maintenance of menstrual hygiene. Material &amp; Methods: It was a community based cross sectional study; 200 women of reproductive age were interviewed over a period of four months (March to June 2019). Data obtained was entered and analyzed statistically using Excel Windows 2007 and Epi info version6. Results: 162(81%) had regular menstrual cycle pattern, 14(7%) participant mostly from rural area, believe that menstruation is a disease, 140(70%) get the information regarding menstruation from mother. 188(94%) were aware about sanitary pads but 150(75%) uses sanitary pads. 86.5% participants change sanitary pads 2-3 times a day. All participants were taking regular about bath. 197(98.5%) were regularly cleaned their external genitals. 153(76.5%) study participants throwing the sanitary material in dustbin. Conclusion: Majority of the participants use sanitary pads and were aware about menstrual hygiene, but in rural area majority of participants still use clothes instead of sanitary material and they had lack awareness about hygiene practice and majority of them didn’t follow menstrual hygiene practices. Menstrual hygiene can be promoted in community and in schools particularly in Rural area

Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health : all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million [95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% [95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Summary Background Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. Methods We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. Findings From an estimated 13·7 million (95% UI 10·9–17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7–10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2–18·1) of all global deaths and 56·2% (52·1–60·1) of all sepsis-related deaths in 2019. Five leading pathogens—Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa—were responsible for 54·9% (52·9–56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185–285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4–71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. Interpretation The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development

Age–sex differences in the global burden of lower respiratory infections and risk factors, 1990–2019: results from the Global Burden of Disease Study 2019

Summary Background The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. Methods In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466–469, 470.0, 480–482.8, 483.0–483.9, 484.1–484.2, 484.6–484.7, and 487–489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4–B97.6, J09–J15.8, J16–J16.9, J20–J21.9, J91.0, P23.0–P23.4, and U04–U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age–sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age–sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. Findings Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240–275) LRI incident episodes in males and 232 million (217–248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18–1·42) male deaths and 1·20 million (1·07–1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16–1·18) and 1·31 times (95% UI 1·23–1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4–131·1]) and deaths (100·0% [83·4–115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (–70·7% [–77·2 to –61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7–61·8] in males and 56·4% [40·7–65·1] in females), and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6–35·5] for males and PAF 25·8% [16·3–35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4–25·2) in those aged 15–49 years, 30·5% (24·1–36·9) in those aged 50–69 years, and 21·9% (16·8–27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5–27·9) in those aged 15–49 years and 18·2% (12·5–24·5) in those aged 50–69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2–15·8) of LRI deaths. Interpretation The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities