Social determinants of morbidity during infancy: Results from a cross-sectional study in rural areas of Assam, India

Background: Assam, one of the seven North Eastern states of India has achieved the highest decline in maternal and child mortality compared to other states, still neonatal mortality and infant mortality rates are very high. Apart from other causes, certain social factors unique to Indian subcontinent are also responsible for high mortality and morbidity among children here. Objectives: To know the prevailing morbidity conditions among the infants and to assess the social determinants of morbidity of infants in rural areas of Assam. Materials and Methods: It was a cross-sectional study conducted among 250 rural families having an infant in each family. The primary caregiver was interviewed using pre-tested semi-structured interview schedules and investigators also clinically evaluate the index child for any morbidity. Data collected regarding various sociodemographic variables of the family, morbidity status of the infant and also the environmental variables relevant to the study were analyzed tabulated and percentages, and proportions were calculated. Chi-square test was done to see the relationship between the factors. Results: The study observed that prevalence of teenage mothers was high (32.4%). Most of the mothers were primipara (41.2%), and were belonging to nuclear families of lower socioeconomic strata (57%). In our study, acute respiratory infections (33.3%), fever (24.6%), and diarrhea (21.7%) were found to be the most common morbidities among infants. Statistically significant association was also found between morbidity of infants and male gender (p=0.003) and numbers of siblings (p=0.005), use of sanitary water source (p=0.001), and excreta disposal (p=0.001). Conclusion: This study observed that social factors which influence infant morbidity included male gender and numbers of siblings, use of sanitary water source and excreta disposal, less education of mothers, less family income, and lower social class of the family

Morbidity status of low birth weight babies in rural areas of Assam: A prospective longitudinal study

Introduction: Low birth weight (LBW) infants suffer more episodes of common childhood diseases and the spells of illness are more prolonged and serious. Longitudinal studies are useful to observe the health and disease pattern of LBW babies over time. Aims: This study was carried out in rural areas of Assam to assess the morbidity pattern of LBW babies during their first 6 months of life and to compare them with normal birth weight (NBW) counterparts. Materials and Methods: Total 30 LBW babies (0-2 months) and equal numbers of NBW babies from three subcenters under Boko Primary Health Centre of Assam were followed up in monthly intervals till 6 months of age in a prospective fashion. Results: More than two thirds of LBW babies (77%) were suffering from moderate or severe under-nutrition during the follow up. Acute respiratory tract infection (ARI) was the predominant morbidity suffered by LBW infants. The other illnesses suffered by the LBW infants during the follow up were diarrhea, skin disorders, fever and ear disorders. LBW infants had more episodes of hospitalization (65%) than the NBW infants (35%). Incidence rate of episodes of morbidity was found to be higher among those LBW infants who remained underweight at 6 months of age (Incidence rate of 49.3 per 100 infant months) and those who were not exclusively breast fed till 6 months of age (Incidence rate of 66.7 per 100 infant months). Conclusion: The study revealed that during the follow up, incidence of morbidities were higher among the LBW babies compared to NBW babies. It was also observed that ARI was the predominant morbidity in the LBW infants during first 6 months of age

A cross sectional study on health status of infants in rural areas of Kamrup, Assam

Introduction:  Infancy is the period of growth and development of a child. Inadequate care, malnutrition and infections in this crucial period lead to high neonatal and infant deaths and also high prevalence of morbidities. But data on childhood and infant mortality and morbidities are still not adequate in North Eastern part of India, so this cross sectional study was initiated. Objectives: To assess the nutritional status and morbidity profile of infants and to study the associated socio-economic factors. Material and methods: Total 450 singleton infants under 1 year of age in 30 cluster villages were selected for the study. Data collected about socioeconomic condition of the family, infants’ nutrition and morbidity status and anthropometric measurements were done. Results: Out of 450 infants 24% were found to be underweight while 13.3% were stunted and 7.1% were wasted. Female infants were found to be more malnourished. A statistically significant association was found between gender and nutritional status. ARI (20%) and Diarrhoea (14%) were the most common morbidities among the study population and 6 to 8 months age group was the most vulnerable for these common morbidities. Conclusion: the study revealed that high percentages of the infants were suffering from malnutrition with female predominance and respiratory diseases, diarrhoea and malnutrition were the major causes of morbidity during the first year of life

A comparative study on gender disparity in nutritional status in children under five years in rural and urban communities of Assam, India

Introduction: Under nutrition is a serious public health problem among children in the developing countries. Though the importance of girl child has been stressed time and again, yet a wide level of disparity still exists, whether implicit or explicit, in nutrition and child care both in the rural and urban areas.  Different underlying factors are responsible for this disparity. Rationale: Girls face discrimination from the moment she is born. The UNICEF intergenerational cycle of malnutrition stresses on the fact that the problem of malnutrition spans generation and is a vicious cycle. Though the importance of girl child has been stressed time and again, yet a wide level of disparity still exists. Therefore this study is conducted to document the gender disparity in nutritional status and compare rural and urban differences. Objective: 1.To compare the gender disparity in nutritional status in children aged 0-5 years in rural and urban areas.2.To assess the different socio-demographic factors influencing the gender disparity. Materials and Methods: A community based cross-sectional study was conducted in Kamrup Rural and Kamrup Urban using a pre-tested schedule from August 2013-July 2014.A total of 400 children were examined and their mother’s interviewed. Data was entered into MS-Excel spread sheets for analysis. The statistical analyses were done using SPSS version 16 software. Percentages and Chi square tests were used to analyze epidemiological variables. Results: The prevalence of underweight, stunting and wasting in rural area was 31%, 29%, 15.5% respectively whereas in urban it was 39.5%, 36% and 24.5% respectively. In rural area, male child were 32% underweight, 28% stunted and 19% wasted compared to female who were 30% underweight, 30% stunted and 12% wasted. In urban area 48% of female child were underweight, 39% stunted and 27% wasted compared to 31%, 33% and 22% in male child respectively. A significant higher proportion of underweight was found in girls belonging to Muslim religion, OBC category, nuclear family, illiterate unemployed mother and low income. Conclusion: The girl child suffers from malnutrition more in the urban areas than rural are

Application of growth monitoring charts by health care providers in Village Health and Nutrition Day (VHND) setting in rural Kamrup

Background: Growth monitoring attempts to promote optimal growth through effective education to caregivers; detection of ‘early growth faltering’, ‘underweight’ and initiation of relevant action. Objectives: (i) To observe application of the growth monitoring charts provided in the Mother and Child Protection (MCP) Card by health care providers in Village Health and Nutrition Day (VHND) setting in rural Kamrup. (ii) To assess whether their applied methods and interpretations are appropriate. (iii) To identify gaps in relation to growth monitoring. Materials and Methods: A cross-sectional study was conducted during January-July 2014 in VHND sessions covering 44 villages selected through multistage sampling in Kamrup district in Assam. 88 Auxiliary Nurses and Midwives (ANM) and 34 Anganwadi Workers (AWW) present in the sessions were closely observed during their activities and then interviewed regarding their interpretations of the growth chart. Results: 77% of the AWWs present were involved in growth assessment and weight plotting in growth charts of all the 0-36 months aged children brought to a session.  Correct plotting of weight and interpretations of the growth charts were known to 94% of the AWWs and only 69% of the ANMs. Conclusion: Growth monitoring charts provided in the MCP card were not found to be optimally applied for community based growth monitoring in rural Kamrup. Deficiency was found in the ANMs regarding their applied methods and interpretations of the growth charts in comparison to the AWWs. AWWs were inadequately involved in growth assessment and monitoring of children in the vulnerable age group of 0-36 months in the VHND sessions.

Factors influencing substance use among adolescent slum dwellers of Guwahati City, Assam

Introduction: Humans have been using substances in one form or the other for centuries. Adolescents seem to be the most vulnerable group, and the slum dwellers are particularly at risk because of the prevailing environment. Objectives: The objective of this study is to study the prevalence of substance use among adolescents of slums of Guwahati city and to find out various factors influencing substance use among them. Materials and Methods: A cross-sectional study was conducted among the adolescents living in slums of Guwahati, Assam, from February to May 2014. Using cluster sampling method, 23 slums were selected, and desired clusters were obtained by applying probability proportionate to size method. From each slum, equal number of boys and girls were interviewed to get a total of 414 study subjects. Statistical Analysis: Proportions, Chi-square test, and binary logistic regression were used. Results: The prevalence of ever users was 37.68% and 35.02% were current users. Gutkha was the most common substance used. The mean age of initiation of abusive substances was around 12 years for both boys and girls. Age, sex, religion, caste, schooling status, occupation, living status of parents and respondents, peer usage, and relationship with the family members showed significant association with substance use. Binary logistic regression concluded that age group, sex, and peer usage were the most significant factors influencing substance use behavior. Conclusion: As increasing age and peer usage influenced the substance usage, peer group counseling, recreational activities, and skill development programs in the early years hold promising in curbing the problem

Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015–2020

Objectives We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.Design A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data.Setting National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status.Participants Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district.Outcome measures We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015.Results The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra.Conclusion TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020