Effect of Differences in Month and Location of Measurement in Estimating Prevalence and Trend of Wasting and Stunting in India in 2005-2006 and 2015-2016

Background: Child undernutrition in India remains widespread. Data from the National Family Health Survey 3 and 4 (NFHS-3 and NFHS-4) suggest that wasting prevalence has increased while stunting prevalence has declined. Objective: The objectives of this study were to do the following: ) describe wasting and stunting by month of measurement in India in children surveys, and ) test whether differences in the timing of anthropometric data collection and in states between survey years introduced bias in the comparison of estimates of wasting and stunting between NFHS-3 and NFHS-4. Methods: Data on wasting and stunting for 42,608 and 232,744 children aged \u3e5 y in the NFHS-3 and NFHS-4 survey rounds were analyzed. Differences in the prevalence of wasting and stunting by month of year and by state of residence were examined descriptively. Regression analyses were conducted to test the sensitivity of the estimate of differences in wasting and stunting prevalence across survey years to both state differences and seasonality. Results: Examination of the patterns of wasting and stunting by month of measurement and by state across survey years reveal marked variability. When both state and month were adjusted, regardless of the method used to account for sample size, there was a small negative difference from 2005-2006 to 2015-2016 in the prevalence of wasting (-0.8 ± 0.6 percentage points; = 0.2) and a negative difference in stunting prevalence (-8.3 ± 0.7 percentage points; \u3c 0.001), indicating a small bias for wasting but not for stunting in unadjusted analyses. Conclusions: State and seasonal differences may have introduced bias to the estimated difference in prevalence of wasting between the survey years but did not do so for stunting. Future data collection should be designed to maximize consistency in coverage of both time and place

Effect of temperature and time delay in centrifugation on stability of select biomarkers of nutrition and non-communicable diseases in blood samples

Introduction: Preanalytical conditions are critical for blood sample integrity and poses challenge in surveys involving biochemical measurements. A cross sectional study was conducted to assess the stability of select biomarkers at conditions that mimic field situations in surveys. Material and methods: Blood from 420 volunteers was exposed to 2 – 8 °C, room temperature (RT), 22 – 30 °C and > 30 °C for 30 min, 6 hours, 12 hours and 24 hours prior to centrifugation. After different exposures, whole blood (N = 35) was used to assess stability of haemoglobin, HbA1c and erythrocyte folate; serum (N = 35) for assessing stability of ferritin, C-reactive protein (CRP), vitamins B12, A and D, zinc, soluble transferrin receptor (sTfR), total cholesterol, high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), tryglicerides, albumin, total protein and creatinine; and plasma (N = 35) was used for glucose. The mean % deviation of the analytes was compared with the total change limit (TCL), computed from analytical and intra-individual imprecision. Values that were within the TCL were deemed to be stable. Result: Creatinine (mean % deviation 14.6, TCL 5.9), haemoglobin (16.4%, TCL 4.4) and folate (33.6%, TCL 22.6) were unstable after 12 hours at 22- 30°C, a temperature at which other analytes were stable. Creatinine was unstable even at RT for 12 hours (mean % deviation: 10.4). Albumin, CRP, glucose, cholesterol, LDL, triglycerides, vitamins B12 and A, sTfR and HbA1c were stable at all studied conditions. Conclusion: All analytes other than creatinine, folate and haemoglobin can be reliably estimated in blood samples exposed to 22-30°C for 12 hours in community-based studies

A Community Based Study On The Prevalence Of Risk Factors OF Cancer Cervix In Married Women Of A Rural Area Of West Bengal

Research question: What is the prevalence of the established risk factors associated with cancer cervix? Objective: To assess the presence of some determinants of cancer cervix among married, rural women of reproductive age group. Study design: Community based, cross â€" sectional, observational study. Setting: Rural: Village East Gobindopur is Singur block in Hooghly district of West Bengal. Study population : All the married women of reproductive age group (103) of the village were included in the study. Results: More than two â€" third (72.8%) of the study population belonged to the vulnerable age group (25-45 years) for this disease while 59.3% were married before they attained 18 years of age. Again 50% (approx) of the married women gave birth to their first child before they were 18 years of age. One â€" third of the study population had parity higher than three. Two â€" third of the women studied were using one or more methods of family planning and one â€" third of the same population were permanently sterilized, 20% were using oral contraceptive pills and only 7.7% were using barrier methods of contraception. Only 31% of the women had satisfactory genital hygiene practice and 36.9% had symptoms of reproductive tract infection. Conclusion: There was a high prevalence of some important risk factors associated with cancer cervix like age, age of marriage, age of first child birth, parity ,family planning practices, genital hygiene and reproductive tract infections in the study population. Therefore screening and early detection efforts can be directed specifically to the group at risk

Characterisation of the types of anaemia prevalent among children and adolescents aged 1–19 years in India: A population-based study

Background: Anaemia is a serious public health concern in India. However, national estimates for its prevalence are not available for the 5–14 years age group, nor are estimates available for the types of anaemia among children and adolescents (1–19 years). We aimed to assess the prevalence of anaemia among children and adolescents in India and to categorise types of anaemia on the basis of micronutrient deficiencies. Methods: We assessed the prevalence of anaemia among children (1–4 years and 5–9 years) and adolescents (10–19 years) using nationally representative data from the Comprehensive National Nutrition Survey. Anaemia was classified on the basis of age and sex-specific WHO cutoffs and serum ferritin, soluble transferrin receptor, folate, cyanocobalamin, and C-reactive protein concentrations as iron deficiency anaemia, folate or vitamin B12 deficiency anaemia, dimorphic anaemia (iron deficiency anaemia and folate or vitamin B12 deficiency anaemia), anaemia of other causes (anaemia not classified as iron deficiency anaemia and folate or vitamin B12 deficiency anaemia), and anaemia of inflammation. Findings: We included 26 765 children (11 624 aged 1–4 years and 15 141 aged 5–9 years) and 14 669 adolescents. In the weighted sample, anaemia prevalence was 40·5% (4553 of 11 233) among 1–4 year-olds, 23·4% (3439 of 14 664) among 5–9 year-olds, and 28·4% (4064 of 14 300) among adolescents. Among 2862 children aged 1–4 years, iron deficiency anaemia (1045 [36·5%]) was the most prevalent type, followed by anaemia of other causes (702 [24·5%]), folate or vitamin B12 deficiency anaemia (542 [18·9%]), dimorphic anaemia (387 [13·5%]), and anaemia of inflammation (186 [6·5%]). Among 2261 children aged 5–9 years, anaemia of other causes was the most common (986 [43·6%]), followed by folate or vitamin B12 deficiency anaemia (558 [24·6%]), iron deficiency anaemia (353 [15·6%]), dimorphic anaemia (242 [10·7%]), and anaemia of inflammation (122 [5·4%]). 861 (31·4%) of 2740 adolescents had anaemia of other causes, 703 (25·6%) had folate or vitamin B12 deficiency anaemia, 584 (21·3%) had iron deficiency anaemia, 498 (18·2%) and dimorphic anaemia, and 94 (3·4%) had anaemia of inflammation. Interpretation: Iron deficiency anaemia is the most common form of anaemia among younger children and anaemia of other causes among 5–9-year-old children and adolescents. Folate or vitamin B12 deficiency anaemia accounts for more than a third of anaemia prevalence. Anaemia prevention efforts should focus on strengthening the existing iron and folate supplementation programmes and prevention of folate or vitamin B12 deficiency anaemia

Population estimates, consequences, and risk factors of obesity among pregnant and postpartum women in India: Results from a national survey and policy recommendations

Objective To examine prevalence, risk factors, and consequences of maternal obesity; and provide evidence on current policies and programs to manage maternal obesity in India. Methods This is a mixed‐methods study. We analyzed the National Family Health Survey (NFHS)‐4 data (2015–16) to estimate the prevalence and risk factors of obesity, followed by a desk review of literature and stakeholder mapping with interviews to develop policy guidance. Results National prevalence of obesity (defined by WHO as body mass index ≥25) was comparable among pregnant (12%) and postpartum women (13%) ≥20 years of age. A high prevalence of obesity (>40%) was observed in over 30 districts in multiple states. Older maternal age, urban residence, increasing wealth quintile, and secondary education were associated with increased odds of obesity among pregnant and postpartum women; higher education increased odds among postpartum women only (OR 1.90; 95% CI, 1.44–2.52). Dietary variables were not associated with obesity. Several implementation challenges across healthcare system blocks were observed at policy level. Conclusion Overall prevalence of obesity in India during and after pregnancy is high, with huge variation across districts. Policy and programs must be state‐specific focusing on prevention, screening, and management of obesity among pregnant and postpartum women

Prevalence of low serum zinc concentrations in Indian children and adolescents: Findings from the Comprehensive National Nutrition Survey 2016–18

Background: It is thought that there is a high risk of zinc deficiency in India, but there are no representative national estimates. Objectives: We aimed to evaluate the national and state-level prevalence of low serum zinc concentrations (SZCs) in Indian children from the nationally representative Comprehensive National Nutrition Survey. Methods: Prevalence of low SZC, adjusted for C-reactive protein, was estimated among preschool (1–4 y; n = 7874) and school-age children (5–9 y; n = 10,430) and adolescents (10–19 y; n = 10,140), using SZC cutoffs defined by the International Zinc Nutrition Consultative Group. Results: Prevalence of low SZC was high among adolescents (31.1%; 95% CI: 29.8%, 32.4%), compared with school-age (15.8%; 95% CI: 15.3%, 16.3%) or preschool children (17.4%; 95% CI: 16.7%, 18.0%). However, stratification of prevalence by fasting status or using an alternative lower SZC cutoff independent of fasting status led to a reduction in prevalence by 3.7% or 7.8% in children \u3c 10 y, respectively. The prevalence of low SZC was higher among rural preschool children, those belonging to households with poor socioeconomic status, and those with severe stunting or underweight. Preschool children with diarrhea (22.6%; 95% CI: 20.8%, 24.4%), productive cough (22.7%; 95% CI: 18.5%, 27.5%), or malaria/dengue (38.5%; 95% CI: 29.4%, 48.2%) in the 2 wk preceding the survey had a higher prevalence of low SZC than those without morbidity (16.5%; 95% CI: 15.9%, 17.2%; 17.6%; 95% CI: 16.9%, 18.2%; and 17.5%; 95% CI: 16.8%, 18.1%, respectively). Conclusions: The national prevalence of low SZC among preschool (17%) or school-age children (16%) was \u3c 20%, which is considered the cutoff indicating a problem of public health significance; but there were variations by state and socioeconomic status. In adolescents, however, the prevalence of low SZC was 31%, which warrants further investigation. The association of low SZC with diarrhea in preschool children necessitates better coverage of Zn administration in the management of diarrhea