Research priorities in Maternal, Newborn, & Child Health & Nutrition for India:An Indian Council of Medical Research-INCLEN Initiative

In India, research prioritization in Maternal, Newborn, and Child Health and Nutrition (MNCHN) themes has traditionally involved only a handful of experts mostly from major cities. The Indian Council of Medical Research (ICMR)-INCLEN collaboration undertook a nationwide exercise engaging faculty from 256 institutions to identify top research priorities in the MNCHN themes for 2016-2025. The Child Health and Nutrition Research Initiative method of priority setting was adapted. The context of the exercise was defined by a National Steering Group (NSG) and guided by four Thematic Research Subcommittees. Research ideas were pooled from 498 experts located in different parts of India, iteratively consolidated into research options, scored by 893 experts against five pre-defined criteria (answerability, relevance, equity, investment and innovation) and weighed by a larger reference group. Ranked lists of priorities were generated for each of the four themes at national and three subnational (regional) levels [Empowered Action Group & North-Eastern States, Southern and Western States, & Northern States (including West Bengal)]. Research priorities differed between regions and from overall national priorities. Delivery domain of research which included implementation research constituted about 70 per cent of the top ten research options under all four themes. The results were endorsed in the NSG meeting. There was unanimity that the research priorities should be considered by different governmental and non-governmental agencies for investment with prioritization on implementation research and issues cutting across themes

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions

Media news on vaccines and vaccination: The content profile, sentiment and trend of the online mass media during 2015–2020 in India

Background: The immunization coverage progress in India is relatively slower than anticipated. The rising internet and media penetration and online news contents are likely to shape the public vaccine sentiments and attitude. The measles-rubella immunization campaign in India experienced challenges in some states due to the social media and messaging. This study studied the profile and vaccine sentiments of the online media news in India. Methods: We retrieved the online news on immunization and vaccines published in English during November 2015 to May 2020. The news were analysed for contents and categorised as positive, negative and neutral sentiments. Results: Out of 2626 news retrieved, 1788 eligible ones were analysed. The news focused on immunization program in 59.1% and vaccine hesitancy in 7.7% items. While 42.5% news originated from national level, 33.2% were from six states. Measles-rubella was the leading vaccine in the news (23.2%) followed by coronavirus (12.8%), poliomyelitis (10.4%) and rotavirus (5.1%) vaccines. While 71.4% news conveyed positive sentiment, 23.8% and 4.7% had negative and neutral sentiments, respectively. The negative sentiments focused on adverse events, vaccine hesitancy and resistance. The news volume and negative sentiments were largely linked to the measles-rubella vaccination campaign phases in India. Conclusions: Negative vaccine news constitute a sizable proportion of the online news and can influence the public vaccine sentiment and attitude. The experiences of public response towards measles-rubella, pentavalent and human papillomavirus vaccines suggest necessity of comprehensive media mapping and tracking to guide appropriately to sustain the public vaccine confidence and improve coverage

Clinical correlation of renal vasculature variation

Background: The coupled renal arteries typically supply the kidneys, which are retroperitoneal organs. However, there are frequent changes in the way that the renal arteries and their perihilar branches are presented. Aim: The aim of the current research is to evaluate the occurrence of various renal arteries and give a medical association between them. Materials and Methods: The research material consisted of 30 formalin-fixed cadavers.&nbsp; While performing a regular abdominal dissection, the kidneys and their arteries were examined, and the morphological differences in&nbsp;the renal arteries were observed. Result: In 54.8% of the patients, numerous renal arteries were seen to arise from the abdominal aorta, including double hilar arteries (22.7%), triple hilar arteries (11.9%), superior polar and inferior polar arteries (13.2%), and numerous hilar and polar arteries (7.2%). Conclusion: For angiographic tests, kidney transplantation, and urological or radiological operations, understanding the renal vasculature, including its regular as well as variational structure, is essential. This information also makes embolization and angioplasties possible.clinica

Sacral hiatus anatomical variations and clinical relevance in caudal epidural block

Objective: For the management of perioperative pain control during procedures like genitourinary surgery and labor pain instances when the sacral epidural space technique is utilized for the application of analgesia, caudal epidural anesthesia (CEB) is frequently used. CEB is an anesthetic that is injected through the sacral hiatus (SH) into the sacral canal. Anatomical features of sacral hiatus that are in-depth are needed for the best possible access to the sacral epidural area. By employing the sacral bone as a point of reference to failure parameters for evaluating caudal epidural anesthesia and refining the success factors in practice, this study intends to explore the anatomical structures and variations of the Sacral hiatus. Material and methods:&nbsp; 85 sacral bones had their alignment points measured precisely morphometrically. Virtual calipers were used to take the readings were used to evaluate those utilizing photogrammetric techniques. Results: Inverted U was the most frequent sacral hiatus form reported (33.32%), although bifida and 6.8% 3.44% of cases frequently missing sacral hiatus were also seen. The mean Sacral hiatus length was 28.67.0 mm, the mean intracorneal distance was 13.472.68 mm, and the mean gap between the apex of the Sacral hiatus and S2 sacral foramen was 34.677.08 mm.&nbsp

Documentation of vaccine handling and service delivery at outreach immunization sessions across 27 districts of India

Background: Outreach sessions constitute a major share of routine immunization service under national program in India. Objective: To document the organisation, logistics, vaccine handling and services delivered during outreach sessions in India. Method: This cross-sectional study was undertaken at 136 outreach sessions across 27 districts in three states (Bihar-62, Gujarat-43 and Kerala-31). Data was collected on session organization, vaccine supply, handling, beneficiary interaction, documentation, and waste handling. Results: All essential items and vaccines were available at 52.2% and 59.7% of sessions. The overall beneficiary turnout was 72.6%. Matching diluents were available for 94.4% of lyophilised vaccine vials. All four messages were given to 58.8% beneficiaries and 40% were advised to wait for 30 minutes. Few sites received vaccine vials with unusable vaccine vial monitors and frozen free-sensitive vaccine vials. Conclusion: Program attention is needed to improve organisation, logistics and vaccine handling at the outreach sessions to ensure optimal service delivery and beneficiary experience. The supportive supervision and monitoring must be strengthened focusing on updated beneficiary list, vaccine handling, counselling and waste handling

Improvements in essential newborn care and newborn resuscitation services following a capacity building and quality improvement program in three districts of Uttar Pradesh, India

Background: Neonatal death remains a global challenge contributing to 45% of underfive deaths. With rising institutional delivery, to accelerate decline in neonatal mortality rate (NMR) improvement in the quality of perinatal care requires attention. Objectives: This implementation research targeted improving service delivery readiness for quality of newborn care at public health facilities in three districts of Uttar Pradesh, India, with high NMR. Materials and Methods: This before-after study assessed the facility readiness and quality of newborn services at 42 health facilities. The changes in 26 signal functions for routine and emergency obstetric and newborn care were tracked. Results: There was marked improvement in newborn service availability: skilled birth attendants (51%), resuscitation (30%), and kangaroo mother care (27%) at these facilities. A multifold rise in newborn resuscitation efforts and documentation (n = 4431 vs. n = 144 in preintervention period) with high success rate (98.6%) was observed. There was also improvement in obstetric care services including partograph use (31%) and active management of third stage of labor (46%). However, several infrastructural indicators (electricity, water supply, toilets, and sanitation) remained unchanged. Conclusion: Overall improvements were observed in the majority of the signal functions for perinatal care and newborn resuscitation efforts. There was a limited impact on the infrastructural and supervision components