Village Health Workers Improve Child Health: The Jamkhed, India Experience

OBJECTIVE: To assess the effect of the three-decade old Comprehensive Rural Health Project (CRHP) on morbidity, mortality, immunization rates, and health care utilization among children under 5 years of age in Jamkhed, Central India. METHODS: We conducted a cross-sectional survey of a stratified, cluster sample of 879 children (under-fives) in 15 Jamkhed villages served by CRHP. CRHP has a three-tiered primary health care model that comprises a tertiary care facility, a mobile health program supporting 30 subcenters, and community-based health workers. FINDINGS: We found a prevalence of diarrhea [6.4%, 95% CI: 4.0%-8.8%], measles [2.3%, 95% CI: 0%-5.6%], tuberculosis [0.3%, 95% CI: 0%-0.8%], bronchopneumonia [0.1%, 95% CI: 0-0.3%], and no cases of poliomyelitis, pertussis, diphtheria, and tetanus among under-fives. Malnutrition (using WHO criteria) was less evident in infants [mean Z-score: -0.8] compared to children aged 1-5 years [mean Z-scores: -1.6 to -1.8]. The child International Journal of Global Health and Health Disparities 41 mortality rate of 4.6 deaths per 1,000 live births [95% CI: 0 to 9 deaths per 1,000] was 10-20 fold lower than corresponding state (58.1) and national (103.7) figures. The infant diarrhea prevalence rate of 6.4% [95% CI 4.0% to 8.8%] was also substantially lower than state (25.4%) and national data (19.6%). There was ≥ 99% immunization coverage for DPT3/OPV3 and measles after the child\u27s first year. CONCLUSION: These data document the effectiveness of village health workers in improving child health. If confirmed by other studies, these findings call for even greater allocation of primary health care resources to train, supervise and use community health workers

Analytical method development and validation of olmutinib bulk drug as per ICH Q2 guidelines by using RP-HPLC Method

RP-HPLC is fast, simple, sensitive, precise, and reproducible (liquid chromatography) method, developed and validated to analyseolmutinib bulk dosage form. Using C-18 HPLC column separation was carried out. This was maintained at ambient temperature. During separation mobile phase consist of methanol (100 v/v) was delivered at a rate of 1mL/min. Using UV detector analysis was carried out at the wavelength 267.68 nm. RP-HPLC method was validated by using various parameters like, precision, limit of quantitation (LOQ), linearity and robustness. The RP-HPLC method was found to be linear over the concentration ranges from 50-100 μg/mL (r2 =0.999). Retention time for bulk olmutinib was found to be 9.349 min. LOQ of method was 5.8540 μg/mL and LOD 3.0536μg/mL. Thus, the developed RP-HPLC method was found to be robust and rugged which can be applied for the regular analysis of olmutinib in the bulk as well as pharmaceutical dosage form. Keywords: C18, RP-HPLC, Methanol, Olmutini

Spectrophotometric Determination of Olmutinib in Bulk by Area under Curve and First Order Derivative Methods and its Validation as per ICH guidelines

Abstract: A simple, precise and economical UV-spectrophotometric method has been developed for the estimation of Olmutinib from bulk. Two methods were developed First method (A) applied was area under curve (AUC) in which the area was integrated in wavelength from 262-272nm. Second method (B) was first order derivative spectrometric method. In this method absorbance at λmin=256.57nm, λmax=282.83nm and zero cross=267.68nm was measured. Calibration curves were plotted for the method by using instrumental response at selected wavelength and concentration of analyte in the solution. In both the methods, linearity was observed in the concentration range of 2-12µg/ml at the λmax=267.68nm. Accuracy and precision studies were carried out and results were satisfactorily obtained. The drug at each of the 80 %, 100 % and 120 % levels showed good recoveries that is in the range of 98.00 to 99.00% for both methods, hence it could be said that the method was accurate. Limit of detection (LOD) and limit of quantitation (LOQ) were determined for the method. The method was validated as per International Conference on Harmonization. All validation parameters were within the acceptable limit. The developed method was successfully applied to estimate the amount of Olmutinib in pharmaceutical formulation

HIV Transmission Potential Among Local and Migrant Factory Workers in Kolkata, India

Migrant workers in India play a key role in the spread of HIV. Kolkata is a common destination for workers, who may acquire infection and transmit it to their wives and/or other sexual partners. We investigated sexual relations and condom use by factory workers. Migrant and local factory workers were randomly selected from five wards of Kolkata. Information was collected about demographic and socio-economic characteristics, sexual relationships, condom usage, and perceptions and intent to use condoms. Condom use was very low in both groups of workers, particularly among migrants. Many married workers visited female sex workers but never used condoms. Few intended to use condoms, and if they did, it did not always translate into actual usage. There is great potential for transmission of HIV/sexually transmitted infections by these workers. Carefully designed intervention and education programs in the context of low literacy and cultural norms are urgently needed

Communities, birth attendants and health facilities: a continuum of emergency maternal and newborn care (the global network's EmONC trial)

<p>Abstract</p> <p>Background</p> <p>Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes.</p> <p><b>Methods/Design</b></p> <p>We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each) across 7 sites of the Global Network for Women's and Children's Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis) and 28-day neonatal mortality.</p> <p>Discussion</p> <p>In this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant women and newborns in low-income countries.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov NCT01073488</p

Empowerment of women and mental health promotion: a qualitative study in rural Maharashtra, India.

BACKGROUND: The global burden of mental illness is high and opportunities for promoting mental health are neglected in most parts of the world. Many people affected by mental illness live in developing countries, where treatment and care options are limited. In this context, primary health care (PHC) programs can indirectly promote mental health by addressing its determinants i.e. by enhancing social unity, minimising discrimination and generating income opportunities. The objectives of this study were to: 1. Describe concepts of mental health and beliefs about determinants of mental health and illness among women involved with a PHC project in rural Maharashtra, India; 2. Identify perceived mental health problems in this community, specifically depression, suicide and violence, their perceived causes, and existing and potential community strategies to respond to them and; 3. Investigate the impact of the PHC program on individual and community factors associated with mental health METHOD: We undertook qualitative in-depth interviews with 32 women associated with the PHC project regarding: their concepts of mental health and its determinants; suicide, depression and violence; and the perceived impact of the PHC project on the determinants of mental health. The interviews were taped, transcribed, translated and thematically analysed. RESULTS: Mental health and illness were understood by these women to be the product of cultural and socio-economic factors. Mental health was commonly conceptualised as an absence of stress and the commonest stressors were conflict with husbands and mother-in-laws, domestic violence and poverty. Links between empowerment of women through income generation and education, reduction of discrimination based on caste and sex, and promotion of individual and community mental health were recognised. However, mental health problems such as suicide and violence were well-described by participants. CONCLUSION: While it is essential that affordable, accessible, appropriate treatments and systems of referral and care are available for people with mental illness in developing country settings, the promotion of mental health by addressing its determinants is another potential strategy for reducing the burden of mental illness for individuals and communities in these settings