Implementing and sustaining a mobile medical clinic for prenatal care and sexually transmitted infection prevention in rural Mysore, India

Background In rural India, mobile medical clinics are useful models for delivering health promotion, education, and care. Mobile medical clinics use fewer providers for larger catchment areas compared to traditional clinic models in resource limited settings, which is especially useful in areas with shortages of healthcare providers and a wide geographical distribution of patients. Methods From 2008 to 2011, we built infrastructure to implement a mobile clinic system to educate rural communities about maternal child health, train community health workers in common safe birthing procedures, and provide comprehensive antenatal care, prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), and testing for specific infections in a large rural catchment area of pregnant women in rural Mysore. This was done using two mobile clinics and one walk-in clinic. Women were tested for HIV, hepatitis B, syphilis, and bacterial vaginosis along with random blood sugar, urine albumin, and anemia. Sociodemographic information, medical, and obstetric history were collected using interviewer-administered questionnaires in the local language, Kannada. Data were entered in Microsoft Excel and analyzed using Stata SE 14.1. Results During the program period, nearly 700 community workers and 100 health care providers were trained; educational sessions were delivered to over 15,000 men and women and integrated antenatal care and HIV/sexually transmitted infection testing was offered to 3545 pregnant women. There were 22 (0.6%) cases of HIV, 19 (0.5%) cases of hepatitis B, 2 (0.1%) cases of syphilis, and 250 (7.1%) cases of BV, which were identified and treated. Additionally, 1755 (49.5%) cases of moderate to severe anemia and 154 (4.3%) cases of hypertension were identified and treated among the pregnant women tested. Conclusions Patient-centered mobile medical clinics are feasible, successful, and acceptable models that can be used to provide quality healthcare to pregnant women in rural and hard-to-reach settings. The high numbers of pregnant women attending mobile medical clinics show that integrated antenatal care with PMTCT services were acceptable and utilized. The program also developed and trained health professionals who continue to remain in those communities

What's normal? Oligosaccharide concentrations and profiles in milk produced by healthy women vary geographically.

Background: Human milk is a complex fluid comprised of myriad substances, with one of the most abundant substances being a group of complex carbohydrates referred to as human milk oligosaccharides (HMOs). There has been some evidence that HMO profiles differ in populations, but few studies have rigorously explored this variability.Objectives: We tested the hypothesis that HMO profiles differ in diverse populations of healthy women. Next, we examined relations between HMO and maternal anthropometric and reproductive indexes and indirectly examined whether differences were likely related to genetic or environmental variations.Design: In this cross-sectional, observational study, milk was collected from a total of 410 healthy, breastfeeding women in 11 international cohorts and analyzed for HMOs by using high-performance liquid chromatography.Results: There was an effect of the cohort (P 4 times higher in milk collected in Sweden than in milk collected in rural Gambia (mean ± SEM: 473 ± 55 compared with 103 ± 16 nmol/mL, respectively; P < 0.05), and disialyllacto-N-tetraose (DSLNT) concentrations ranged from 216 ± 14 nmol/mL (in Sweden) to 870 ± 68 nmol/mL (in rural Gambia) (P < 0.05). Maternal age, time postpartum, weight, and body mass index were all correlated with several HMOs, and multiple differences in HMOs [e.g., lacto-N-neotetrose and DSLNT] were shown between ethnically similar (and likely genetically similar) populations who were living in different locations, which suggests that the environment may play a role in regulating the synthesis of HMOs.Conclusions: The results of this study support our hypothesis that normal HMO concentrations and profiles vary geographically, even in healthy women. Targeted genomic analyses are required to determine whether these differences are due at least in part to genetic variation. A careful examination of sociocultural, behavioral, and environmental factors is needed to determine their roles in this regard. This study was registered at clinicaltrials.gov as NCT02670278

Moralizing gods, impartiality and religious parochialism across 15 societies

The emergence of large-scale cooperation during the Holocene remains a central problem in the evolutionary literature. One hypothesis points to culturally evolved beliefs in punishing, interventionist gods that facilitate the extension of cooperative behaviour toward geographically distant co-religionists. Furthermore, another hypothesis points to such mechanisms being constrained to the religious ingroup, possibly at the expense of religious outgroups. To test these hypotheses, we administered two behavioural experiments and a set of interviews to a sample of 2228 participants from 15 diverse populations. These populations included foragers, pastoralists, horticulturalists, and wage labourers, practicing Buddhism, Christianity, and Hinduism, but also forms of animism and ancestor worship. Using the Random Allocation Game (RAG) and the Dictator Game (DG) in which individuals allocated money between themselves, local and geographically distant co-religionists, and religious outgroups, we found that higher ratings of gods as monitoring and punishing predicted decreased local favouritism (RAGs) and increased resource-sharing with distant co-religionists (DGs). The effects of punishing and monitoring gods on outgroup allocations revealed between-site variability, suggesting that in the absence of intergroup hostility, moralizing gods may be implicated in cooperative behaviour toward outgroups. These results provide support for the hypothesis that beliefs in monitoring and punitive gods help expand the circle of sustainable social interaction, and open questions about the treatment of religious outgroups

BEYOND PICKLES AND ICE CREAM A BIOCULTURAL INVESTIGATION OF PREGNANCY DIET IN SOUTH INDIA

Leading evolutionary theories of women’s diet in pregnancy postulate that unusual changes in diet occur as a response to increased risk of toxin and/or pathogen exposure (coined the “maternal-fetal protection” hypothesis). Women are therefore hypothesized to experience aversions to meat and vegetables, and experience cravings for nutrient-rich, high-calorie foods. Tests of these hypotheses, however, have been limited to industrialized societies with adequate food supply and low pathogen burden. The aim of this dissertation, therefore, was to test classic theories of the maternal-fetal protection hypothesis against others hypotheses of dietary shifts in pregnancy.Research was conducted with non-pregnant (n=54) and pregnant (n=197) women in two states located in South India: Tamil Nadu and Karnataka. Semi-structured interviews were conducted with non-pregnant women regarding the cultural norms of diet in pregnancy. Pregnant women completed structured interviews and were asked to provide anthropometric measures. The structured interviews included self-reported cravings, aversions, and social avoidances, as well as markers for pathogen and toxin avoidance, psychological distress, resource scarcity, and demographics.Findings revealed that cultural norms of diet in pregnancy, such as humoral theory, largely shaped the repertoire of dietary patterns among women and seemingly function to protect the woman and fetus from harm. Women in Tamil Nadu reported cravings and consumption of uncooked rice (amylophagy), which was strongly associated with indices of pathogen exposure; pica, which were linked to resource scarcity; cravings and aversions to humoral food items, which the latter were correlated with psychological distress; and meat aversions, which were correlated with pathogen exposure. Women reported “social learning” as the means by which they acquired most dietary preferences. In Karnataka, women reported aversions to staple food items and avoidances for high-quality items, such as fruits and nuts/seeds/legumes. This study revealed that aversions and avoidances are separate systems to protect the fetus and mother, and that the information was acquired by genetically-invested individuals (e.g. mothers, mothers-in-law, and grandmothers).Overall, findings from these studies show a more complex picture of dietary preferences in pregnancy and point to the importance of using an interdisciplinary perspective when assessing women’s dietary choices

Religion as an adaptive system the impact of religious participation on cooperation within a rural Caribbean community

The current study addresses the nature of cooperation among religious individuals in a rural community in the commonwealth of Dominica. Anthropological survey suggests that participation in religious ritual promotes cooperation among non-kins. This hypothesis is based on the cross-cultural religious characteristics of "supernatural monitoring" effects and participations for participation in rituals. The study took place over the course of two months, and lends empirical evidence to current anthropological theory by examining the relationship between religious ritual behavior and cooperation. Results support the notion that participation in religious activities increases cooperative behavior among Seventh Day Adventists and Anabaptists, but not Catholics. Post hoc analysis demonstrated that the assumed cooperative strategy of pne's opponent was a strong predicator for cooperative decisions among participants

Electronic Supplementary Material 2 from A test of four evolutionary hypotheses of pregnancy food cravings: evidence for the social bargaining model

Calories per serving of food ite

Tamil Data for Royal Society

These data include pregnancy diet cravings, anthropometrics, and predictors o

Electronic Supplementary Material 1 from A test of four evolutionary hypotheses of pregnancy food cravings: evidence for the social bargaining model

Summary statistics for individual Food Frequency Questionnaire item

tamils.xlsx

These data include pregnancy cravings and indicators of nutrition, psychological distress, and resource scarcity