Concerning public health situation of under-nutrition in children and anemia in women in Indian Sundarbans delta: a community based cross-sectional investigation

BACKGROUND: The National Family Health Survey-Round 3 in India during 2005–2006 recorded more children and women as anaemic compared to the prevailing situation eight years ago; more children also had wasting. Analysis of this dataset further linked adversity, rather than intrauterine biological processes, with under-nutrition running across generations. Against this background we conducted the present situation assessment in the Sundarbans area of India. The Sundarbans is world’s largest delta with mangrove forest and prone to natural disasters. METHODS: The current community based investigation was undertaken in five villages under Patharpratima block of the Sundarbans. Participants were selected randomly from the lists of eligible children (aged ≤5 year) and married women (≤49 year) prepared for each of the villages. Interviewer administered questionnaire, tools for anthropometry and hematologic auto-analyzer were used. Data from 561 children and 1145 married women (of which 55 were pregnant) were analysed. RESULTS: Underweight and stunting were recorded in 40 and 51 % of the children respectively. Of the 561 children, 47 (8 %), had severe acute malnutrition. Weight for height z-score reflecting acute and chronic state of nutritional deprivation revealed that four of the five villages were in critical stage. One fourth of the women had low body-mass-index (BMI). Hygienic practices of women were also poor; 41 % reportedly used water, mud/ash and not soap to wash hands after defecation. Anaemia prevalence in women of all the villages was >40 % underscoring a sever public health situation. Factors independently associated with anaemia in non-pregnant women (698/1090; 64 %) were residential-village, low (<18.5 kg/m2) BMI of women (Adjusted Odds Ratio; AOR = 1.39; 95 % CI of AOR 1.02–1.89), non-adoption of family planning method (AOR 1.86; 95 % CI of AOR 1.36–2.54; p < 0.001) and adopting contraceptive practices other than oral pills (AOR 1.84; 95 % CI of AOR 1.32–2.56; p < 0.001). CONCLUSIONS: Sundarbans poses its unique public health challenge due to geographical-vulnerability. Securing nutritional support emerges as an immediate need for the study population residing in this natural-disaster prone area of islands and estuaries. The existing situation of anaemia in women requires innovative intervention development and would require addressing health seeking practices. Behavioural intervention appears to be the key

Adherence to anti-retroviral therapy & factors associated with it: A community based cross-sectional study from West Bengal, India

Background & objectives: Failure to adhere to anti-retroviral therapy (ART) can lead to a range of unfavourable consequences impacting upon people living with HIV (PLH) and society. It is, therefore, paramount that ART adherence is measured in a reliable manner and factors associated with adherence are identified. Lack of such data from West Bengal necessitated undertaking the current study. Methods: Participants were included during August-October, 2011 from three Drop-In-Centres (DICs) from the three districts of West Bengal, India. ART-adherence was calculated by using formula based on pill-count and records collected from ART-card in possession of each of the 128 consenting adult PLH. Information on self-reported adherence, socio-demography, and adherence influencing issues was also collected through interviewer-administered questionnaire. Results: Of the 128 PLH, 99 (77%) and 93 (73%) PLH had ≥90 per cent and ≥95 per cent adherence, respectively to ART. Conversely, subjective reporting captured much higher proportion of PLH as ′well adherent′; a finding having implications for ongoing ART programme. Factors, independently associated with poor adherence (<90%), were ′7 th to 12 th month period of ART intake′ (adjusted OR=9.5; 90% CI 1.9 - 47.3; p0 =0.02) and ′non-disclosure of HIV status to family members′ (adjusted OR=4; 90% CI 1.3 - 13; P=0.05. Results at 95 per cent adherence cut-off were similar. Interpretation & conclusions: Enabling environment, which would encourage people to disclose their HIV status and in turn seek adherence partners from families and beyond and ongoing adherence-counselling appear to be important issues in the programme. Relevance of these study findings in wider context is conceivable

Rapid situation & response assessment of diarrhoea outbreak in a coastal district following tropical cyclone AILA in India

Background &amp; objectives : Cyclone AILA hit Indian States on eastern coast on May 25, 2009. An investigation was conducted to examine if AILA was responsible for increased reporting of diarrhoea cases from the district of East-Medinipur in West Bengal. Identifying causative organisms for diarrhoea and assessing their antibiotic susceptibility profile were other objectives. Methods: Rapid situation and response assessment technique was employed to triangulate primary and secondary data collected through field visits. Prescription audit was also conducted. Results: Significantly increased occurrence of diarrhoea was observed in June 2009 in two subdivisions namely Haldia and Egra (OR 1.6 and 1.3 respectively; 95% CI 1.52-1.65 and 1.21-1.32 P&lt;0.001) considering 2007 as baseline. Vibrio cholerae grew from 54 per cent of the stool samples (21/39; 17 V. cholerae O1-Ogawa and 4 non-O1-non-O139), confirming a community outbreak of cholera. Shigella flexneri 3a was isolated from 5 per cent stool specimens. Increased rate of admission in treatment centres due to diarrhoea in the whole district coincided with the formation of cyclone and showed over two-fold rise compared to the admission recorded 6 days ago. Haldia subdivision had the highest attack rate of 9 per 1000 in the month of June, 2009 whereas for the whole district it was 5 per 1000 in the same month. All the isolates of V. cholerae were resistant to ampicillin and furazolidone and sensitive to norfloxacin and azithromycin. Interpretation &amp; conclusions : Pre-AILA changes in the environment, AILA and seasonality of diarrhoea in the study district interplayed towards increased occurrence of diarrhoea. Continuous tracking of 'seasonality of diarrhoea in the community with vulnerability assessment of potential hosts', 'antibiotic sensitivity profile of the causative microorganisms', and 'prescription practice of physicians' would help appropriate disaster management