Association of socioeconomic status with sex ratio at live birth in individuals living in the slums of Sholapur city, India

Background: The existence of female feticide in India is well known. However, limited data are available on the association of socioeconomic status (SES) on sex ratio at live birth in disadvantaged populations, despite the fact that 33% of the population of India live on less than $1.25 per day. Objective: To study the association of SES with sex ratio at live birth in individuals living in the slums of Sholapur city, India. Materials and Methods: We used the data collected as a part of a social work intervention in the slums of Sholapur city, Maharashtra, from January 2007 to August 2011. Two measures of SES were used, location of birth (government hospital compared to private hospital) and eligibility for means-tested financial support after delivery. Results: Data were available for 1391 infants. The infants born in government hospitals were more likely to be male compared to those born in private hospitals (sex ratio of 1.45 compared to 1.14, respectively, p = 0.03). Similarly, infants whose parents were eligible for post-delivery financial support had a trend to a higher sex ratio (1.47 compared to 1.18, p = 0.057). Maternal age was independently and inversely associated with sex ratio at live birth with a linear relation (OR per year increase in maternal age 0.96, 95% CI 0.93–1.00, p = 0.03). Conclusion: In this particular population, two measures of less affluent SES were associated with higher sex ratio at live birth. However, care should be taken while generalizing these observations to other disadvantaged groups living in India, but this represents an area of research where more epidemiological work is required, as these differences perpetuated over generations may have substantial demographic consequences

Weight, height and midupper arm circumference are associated with haemoglobin levels in adolescent girls living in rural India: A cross-sectional study

Objective:We aimed to explore the association of physical parameters with haemoglobin (Hb) levels to test the hypothesis that impaired physical development is associated with anaemia.Methods:A cross-sectional survey study recruited adolescent girls (13 to 17 years) living in rural areas of Maharashtra state of India. Data were collected on physical parameters include height, weight and mid upper arm circumference (MUAC). Haemoglobin (Hb) levels were measured using Sahli's haemometer. Linear regression was conducted to test the hypothesis. Results:Data were collected from 1,010 girls on physical parameter and Hb levels. The majority of the adolescent girls were diagnosed with anaemia (87%). The regression analysis adjusted for age gave a significant association of Hb levels with all three variables (MUAC, weight, height). Hb increased by 0.11 g/dl with an each centimetre of increase in MUAC (95% CI: 0.08 to 0.15,

Assessment of a non-invasive haemoglobin sensor NBM 200 among pregnant women in rural India

Objective: This study aimed to assess a non-invasive haemoglobin sensor NBM 200 in pregnant women in a rural Indian setting. Methods: The study population consisted of women between 3 to 5 months of pregnancy, from 33 villages in Tuljapur and Lohara blocks of Osmanabad district, Maharashtra between April 2014 and June 2015. Haemoglobin (Hb) measurements obtained from the non-invasive sensor NBM 200 were compared with measurements obtained from an automated haematology analyser Sysmex XP-100, using the Bland Altman method and Spearman’s Rank correlation coefficient. Interclass correlation coefficient (ICC), sensitivity and specificity values were used to assess the anaemia diagnostic accuracy of NBM 200 against the gold standard (Sysmex XP-100). Results: Data were obtained from 269 pregnant women (median age: 21 years, Interquartile range: 19 to 23 years). Haemoglobin levels estimated by the Sysmex XP-100 analyser ranged from 5.5 g/dL to 14.1 g/dL (mean: 10.0 g/dL, standard deviation (SD): 1.28), while measurements obtained from NBM 200 ranged from 9.5 g/dL to 14.6 g/dL (mean: 11.9 g/dL, SD: 1.43). The Spearman’s test found a significant, moderately positive correlation between the two methods (rs= 0.4, p<0.001), ICC was 0.22, and the Bland-Altman analysis showed a mean difference of -1.8 g/dL (95% Confidence interval (CI): -2.06 to -1.71) indicating a systematic overestimation of Hb using the NBM 200. The NBM 200 showed low sensitivity (33.7%; 95% CI: 27.3 - 40.5) but high specificity (91.8%; 95% CI: 81.9 - 97.3) for the diagnosis of anaemia. Conclusion: Haemoglobin measurements obtained from the NBM 200 were higher with consequent underestimation of anaemia as compared with the gold standard reference method. This limits the use of the NBM 200 as an anaemia diagnostic test in our study population consisting of women during pregnancy

Weight, height, and midupper arm circumference are associated with haemoglobin levels in adolescent girls living in rural India: A cross‐sectional study

We aimed to explore the association of physical parameters with haemoglobin (Hb) levels to test the hypothesis that impaired physical development is associated with anaemia. A cross‐sectional survey study recruited adolescent girls (13 to 17 years) living in rural areas of Maharashtra state of India. Data were collected on physical parameters include height, weight, and midupper arm circumference (MUAC). Hb levels were measured using Sahli's haemometer. Linear regression was conducted to test the hypothesis. Data were collected from 1,010 girls on physical parameter and Hb levels. The majority of the adolescent girls were diagnosed with anaemia (87%). The regression analysis adjusted for age gave a significant association of Hb levels with all three variables (MUAC, weight, and height). Hb increased by 0.11 g/dl with an each centimetre of increase in MUAC (95% confidence interval, CI, [0.08, 0.15], P < .001). Each kilogram of increase in the body weight showed an increase in Hb levels (0.02 g dl, 95% CI [0.01, 0.03], P = .001). With an each centimetre of increase in height, Hb increased by 0.01 g dl (95% CI [0.00, 0.02], P = .022). There was a consistent association between three measures of somatic growth and anaemia in the study population. It is likely that life‐course exposures from conception onwards contribute to this, and the public health implications are that preventing anaemia is a challenge that requires a multifaceted interventional approach. Understanding the importance of the timing of these life exposures will help design interventions that can achieve optimal results

Risk factors for maternal anaemia and low birth weight in pregnant women living in rural India: a prospective cohort study

Objective: The aim of this prospective study was to estimate the prevalence and risk factors for maternal anaemia and low birth weight in pregnant women living in Maharashtra state, India. Study design: Prospective study Methods: Women between 3 to 5 months of pregnancy were recruited from 34 villages based in Maharashtra state. Baseline data collection, anthropometric measurements and blood investigations were performed. Participants were followed-up to record birth weight. Results: In total, 303 women were eligible, and 287 (95%) provided data. 77% were anaemic defined as haemoglobin less than 11.0 g/dL at the time of recruitment, with a mean corpuscular volume (MCV) of 80.5 fl/cell, (standard deviation: 7.22, range: 53.4 to 93.8). Increased risk of anaemia was seen in women with consanguineous marriages (odds ratio (OR): 2.41, 95% Confidence Interval (CI): 1.16 to 5.01, p=0.01) after adjustment for potential confounding factors. Post-delivery data from full-term singleton live births demonstrated a 7% prevalence of low birth weight. Consanguineous marriage was a major risk for low birth weight (OR: 4.10, 95% CI: 1.25 to 13.41, p=0.02). The presence of maternal anaemia during 3 to 5 months of pregnancy was associated with lower risk of low birth weight (unadjusted OR: 0.34, 95% CI: 0.13 to 0.92, p= 0.03). Conclusion: About 30% of our study participants were in a consanguineous marriage, which was identified as a potentially avoidable risk factor for both anaemia and low birth weight

Proceedings of the inaugural International Summit for Medical Nutrition Education and Research

© 2016 The Royal Society for Public Health Medical Nutrition Education (MNE) has been identified as an area with potential public health impact. Despite countries having distinctive education systems, barriers and facilitators to effective MNE are consistent across borders, demanding a common platform to initiate global programmes. A shared approach to supporting greater MNE is ideal to support countries to work together. In an effort to initiate this process, the Need for Nutrition Education/Innovation Programme group, in association with their strategic partners, hosted the inaugural International Summit on Medical Nutrition Education and Research on August 8, 2015 in Cambridge, UK. Speakers from the UK, the USA, Canada, Australia, New Zealand, Italy, and India provided insights into their respective countries including their education systems, inherent challenges, and potential solutions across two main themes: (1) Medical Nutrition Education, focused on best practice examples in competencies and assessment; and (2) Medical Nutrition Research, discussing how to translate nutrition research into education opportunities. The Summit identified shared needs across regions, showcased examples of transferrable strategies and identified opportunities for collaboration in nutrition education for healthcare (including medical) professionals. These proceedings highlight the key messages presented at the Summit and showcase opportunities for working together towards a common goal of improvement in MNE to improve public health at large

Maternal smoking and the risk of still birth: systematic review and meta-analysis

BACKGROUND: Smoking in pregnancy is known to be associated with a range of adverse pregnancy outcomes, yet there is a high prevalence of smoking among pregnant women in many countries, and it remains a major public health concern. We have conducted a systematic review and meta-analysis to provide contemporary estimates of the association between maternal smoking in pregnancy and the risk of stillbirth.METHODS: We searched four databases namely MEDLINE, EMBASE, Psych Info and Web of Science for all relevant original studies published until 31(st) December 2012. We included observational studies that measured the association between maternal smoking during pregnancy and the risk of stillbirth. RESULTS: 1766 studies were screened for title analysis, of which 34 papers (21 cohorts, 8 case controls and 5 cross sectional studies) met the inclusion criteria. In meta-analysis smoking during pregnancy was significantly associated with a 47% increase in the odds of stillbirth (OR 1.47, 95% CI 1.37, 1.57, p

Factors associated with preterm delivery and low birth weight: a study from rural Maharashtra, India

Background: Although preterm delivery and low birth weight (LBW) have been studied in India, findings may not be generalisable to rural areas such as the Marathwada region of Maharashtra state. There is limited information available on maternal and child health indicators from this region. We aimed to present some local estimates of preterm delivery and LBW in the Osmanabad district of Marathwada and assess available maternal risk factors. Methods: The study used routinely collected data on all in-hospital births in the maternity department of Halo Medical Foundation’s hospital from 1 (st )January 2008 to 31 (st )December 2014. Multivariable logistic regression analysis provided odds ratios (OR) with 95% confidence intervals (CI) for preterm delivery and LBW according to each maternal risk factor. Results: We analysed 655 live births, of which 6.1% were preterm deliveries. Of the full term births (N=615), 13.8% were LBW (<2.5 kilograms at birth). The odds of preterm delivery were three times higher (OR=3.23, 95% CI 1.36 to 7.65) and the odds of LBW were double (OR=2.03, 95% CI 1.14 to 3.60) among women <22 years of age compared with older women. The odds of both preterm delivery and LBW were reduced in multigravida compared with primigravida women regardless of age. Anaemia (Hb<11g/dl), which was prevalent in 91% of women tested, was not significantly related to these birth outcomes. Conclusions: The odds of preterm delivery and LBW were much higher in mothers under 22 years of age in this rural Indian population. Future studies should explore other related risk factors and the reasons for poor birth outcomes in younger mothers in this population, to inform the design of appropriate public health policies that address this issue

A qualitative study exploring factors influencing clinical decision-making for influenza-like illness in Solapur city, Maharashtra, India

The co-existence of different types of medical systems (medical pluralism) is a typical feature of India's healthcare system. For conditions such as influenza-like illness (ILI), where non-specific disease signs/symptoms exist, clinical reasoning in the context of medical pluralism becomes crucial. Recognising this need, we undertook a qualitative study, which explored factors underpinning clinical decisions on diagnosis and management of ILI. The study involved semi-structured interviews including clinical vignettes with 20 healthcare practitioners (working within allopathy, homeopathy and Ayurveda) working in the private healthcare sector in Solapur city, India. An inquiry was conducted into criteria influencing the diagnosis, treatment, referral to specialist care and role of treatment guidelines for ILI. Thematic analysis was used to identify aspects relating to ILI diagnosis, treatment and referral. The diagnosis of influenza was based largely on clinical symptoms suggestive of influenza in the absence of other diagnoses. Referral for laboratory tests was only initiated if illness did not resolve, generally after 2-3 consultations. Antibiotics were often prescribed for persistent illness, with antivirals rarely considered. Some differences between practitioners from different medical systems were observed in relation to treatment and referral in case of persistent illness. A combination of analytical and intuitive clinical reasoning was used by the participants and clinical decisions were based on both social and clinical factors. Clinical decision-making was rarely a linear process and respondents felt that broad guidelines on influenza that allowed doctors to account for the sociocultural context within which they practised medicine would be helpful

aDolescents gEnder surVey, rEsponsible coupLes evaluatiOn, and capacity building Project in India (DEVELOP): a study protocol [version 2; peer review: 2 approved]

Domestic violence and assault (DVA) against women is a serious concern in India. This affects the health and wellbeing of victims and their dependents. Published evidence has documented a variety of reasons for such violence in Indian societies, paving a pathway to design, implement, and evaluate intervention models to address this issue. DEVELOP is a research study designed by UK and Indian research teams to plan future projects to address gender-based discrimination and DVA against women and girls in India. This study protocol provides detailed information on the objectives, research methods, data collection, storage, analysis, and dissemination plans of the DEVELOP phase 1 work (2018-19). The first component is a survey of adolescent boys and girls from rural areas of the Maharashtra state of India to understand their gender equality related knowledge and beliefs. The insight gathered will be used to design interventions targeted at adolescent populations through future research and development programmes. Secondly, an evaluation of the ‘Responsible Couples’ project will be conducted to assess its success and challenges, and to inform future programme activities and strategy. The ‘Responsible Couples’ project is implemented in 40 villages of Maharashtra state to improve relationships in married couples, prevent violence against women, intervene during violence, and to provide support services for women and their family members. Research findings will be disseminated though public engagement events in India, international conferences, and peer reviewed publications. Secondly, our two key partners (SWISSAID and HMF) will benefit from such evidence to inform their on-going as well as forthcoming projects on gender equality in India. Research findings will be also useful for local government authorities and non-government agencies striving to advance gender equality