A study to assess the factors associated with developmental delay and nutritional status among the children with cleft lip and/or cleft palate

Background: Cleft lip with or without cleft palate is one of the most common congenital anomalies. Development is often affected in these children. It may be due to other associated defects, syndromic status, or malnutrition. Objective: The objective of this study was to assess the factors associated with developmental delay and nutritional status among the children with cleft lip and/or cleft palate. Materials and Methods: A cross-sectional study was conducted at the Department of Pediatrics of a Medical College in Sawangi (Meghe), Wardha, for 2 years from August 2010 to March 2012. All children below 15 years with cleft lip and/or palate admitted in the pediatric ward, the neonatal intensive care unit, or postnatal ward were included in the study. A total of 200 children were included in the study and were analyzed for developmental delay and growth lag. Results: Cleft clip was seen in 51 (25.5%) of the children, 25 (12.5%) had cleft palate, and 124 (62%) had both cleft lip and palate. Developmental delay was more common in cleft palate category; however, it was not statistically significant (χ2=0.90, p=0.34). Unilateral form of defects had more number of delays as compared to bilateral defects, and it was statistically significant (χ2=7.32, p=0.006). Delay was more common when both the defects were present together as compared to isolated defects; however, it was not statistically significant. Gross motor and language delay were the most common type followed by global and personal social. 12.5% of children were syndromic. Most of the syndromic children (64%) had global developmental delay (χ2=7.84, significant). 69.6% of children below the age group of 5 years were malnourished (χ2=16, significant). Faulty feeding (73.5%), recurrent respiratory infections (21.4%), and repeated hospitalization (17.1%) were the statistically significant factors for poor growth. Conclusion: Global developmental delay was more common in syndromic children. Overall, delay was more commonly seen in children with unilateral defect. Factors, which contributed to growth lag, were faulty feeding, recurrent respiratory infections, and repeated hospitalization

Design, Development, and Testing of BEST4Baby, an mHealth Technology to Support Exclusive Breastfeeding in India: Pilot Study.

Background: Exclusive breastfeeding (EBF) at 6 months of age in most low- and middle-income countries, including India, is surprisingly low. There is a relative lack of mobile health apps that specifically focus on leveraging the use of peer counselors (PCs) to support mothers as a means of increasing EBF practices in low- and middle-income countries. Objective: This study aimed to design, develop, and test the usability of Breastfeeding Education Support Tool for Baby (BEST4Baby), a mobile health app specifically designed to support PCs in providing in-home breastfeeding counseling support to mothers in rural India on optimal breastfeeding practices. Methods: A user-centered design process with an agile development methodology was used. The approach involved stakeholders and mothers who were trained to serve as PCs to guide BEST4Baby\u27s design and development, including the app\u27s content and features. PCs were engaged through focus groups with interactive wireframes. During the 24-month pilot study period, we conducted a feasibility test of the BEST4Baby app with 22 PCs who supported home visits with mothers residing in rural India. The intervention protocol required PCs to provide education and follow mothers using the BEST4Baby app, with 9 scheduled home visits from the late prenatal stage to 6 months post partum. BEST4Baby\u27s usability from the PCs\u27 perspective was assessed using the translated System Usability Scale (SUS). Results: The findings of this study align with best practices in user-centered design (ie, understanding user experience, including context with iterative design with stakeholders) to address EBF barriers. This led to the cultural tailoring and contextual alignment of an evidence-based World Health Organization breastfeeding program with an iterative design and agile development of the BEST4Baby app. A total of 22 PCs tested and rated the BEST4Baby app as highly usable, with a mean SUS score of 85.3 (SD 9.1), placing it over the 95th percentile for SUS scores. The approach translated into a highly usable BEST4Baby app for use by PCs in breastfeeding counseling, which also statistically increased EBF practices. Conclusions: The findings suggest that BEST4Baby was highly usable and accepted by mothers serving as PCs to support other mothers in their EBF practices and led to positive outcomes in the intervention group\u27s EBF rates. The pilot study demonstrated that using the specially designed BEST4Baby app was an important support tool for mothers to serve as PCs during the 9 home visits. Trial registration: Clinicaltrials.gov NCT03533725; https://clinicaltrials.gov/ct2/show/NCT03533725

Awareness of gestational diabetes mellitus among pregnant women attending a tertiary health center

BACKGROUND AND OBJECTIVES: Awareness of gestational diabetes mellitus (GDM) among pregnant women is poor. However, increasing awareness may help in diagnosis and prevention of maternal and fetal complications. Hence, this study was aimed at evaluating the knowledge in diagnosed GDM pregnant women. METHODOLOGY: This cross-sectional study was conducted from October 2014 to March 2017. A total of 500 registered pregnant women diagnosed to have GDM residing within 5 km of the study area aged more than 18 years who were willing to participate in the study were enrolled in the study. The participants were provided with the questionnaire which was designed to assess their knowledge about GDM. RESULTS: The age of the women ranged from 22 to 44 years with mean age as 27.53 ± 2.42 years and median age as 27 years. The most common age group was 26–30 years which comprised 67.6% of the women. Maximum women had primary education (61%) and were Hindus (54.8%). Most of the women were working (54.8%), resided in slum areas (43.2%), and had body mass index (BMI) between 19.8 and 26 kg/m2 (67%). The mean BMI level was 28.07 ± 4.11 kg/m2. The mean blood sugar levels at diagnosis ranged between 88 and 300 mg/dL and the mean blood sugar level was 201.36 ± 38.67 mg/dL and the median blood sugar level was 190 mg/dL. Majority of the women, that is, 57.6% of the women, had an average knowledge about GDM while 21.8% of the women had good knowledge, 1.6% had excellent, and 19% had poor knowledge. The mean knowledge score was 6.51 ± 3.41. The mean percentage of the knowledge was 36.14% ± 18.94%. Statistically significant association was noted between knowledge about GDM with maternal age and educational status, religion, and occupation (P < 0.050), but the GDM knowledge was independent of that found between place of residence (P = 0.715) and family history of DM (P = 0.661). CONCLUSION: There is poor knowledge about GDM in the study area. Hence, there is need to create awareness of this condition through counseling and use of mass media

Immunogenicity and safety of 3-dose primary vaccination with combined DTPa-HBV-IPV/Hib in Indian infants

Multivalent combination vaccines have reduced the number of injections and therefore improved vaccine acceptance, timeliness of administration and global coverage. The hexavalent diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus/Haemophilus influenzae type b (DTPa-HBV-IPV/Hib; Infanrix hexa™) vaccine, administered according to various schedules, is widely used for the primary vaccination of infants worldwide. In the current publication, we are presenting the immunogenicity and safety of 3 doses of DTPa-HBV-IPV/Hib vaccine when administered to Indian infants. 224 healthy infants (mean age 6.8 weeks) were vaccinated at 6–10–14 weeks (W) of age (n = 112) or 2–4–6 months (M) of age (n = 112). One month after the third vaccine dose, the seroprotection/seropositivity status against diphtheria, pertussis, tetanus, polio, hepatitis B and Hib antigens ranged from 98.6% to 100% in both groups. The vaccine response rate to the pertussis antigens ranged from 97% to 100%. Pain (6–10–14W group: 25.2%; 2–4–6M group: 13.4%) and fever (15.3% and; 15.2%, respectively) were the most frequently reported solicited local and general symptoms. Unsolicited adverse events were reported for 35.7% (6–10–14W group) and 22.3% (2–4–6M group) of subjects. No vaccine related serious adverse events were reported. In conclusion, the hexavalent DTPa-HBV-IPV/Hib vaccine was immunogenic and well tolerated, irrespective of the dosing schedule