Preference in place of delivery among rural Indian women

<div><p>India accounts for the highest number of maternal and child deaths globally. A large body of empirical research suggests that improvement in the coverage of institutional delivery is essential to reduce the burden of maternal and child death. However the dynamics of choice of place of delivery is poorly understood. Using qualitative survey data consisting of twelve focus group discussions, conducted in a rural setting of West Bengal, India, this study aims to understand the reasons behind preferring home or institution for delivery. Findings reveal that some women who underwent an institutional delivery preferred to deliver their baby at home. On the other hand, of women who delivered their baby at home, 60% wanted to deliver their babies in institutions but could not do so, primarily due to the unwillingness of family members and misreporting of the onset of true labour pain. With the help of Accredited Social Health Activists, the village level health workers, there is need for an intervention that focuses on educating household members (essentially targeting husbands and mother-in-laws) about birth preparedness, and identification of true labour pain.</p></div

Socio-demographic characteristics of women selected for focus group discussion, stratified by the place of delivery.

<p>Socio-demographic characteristics of women selected for focus group discussion, stratified by the place of delivery.</p

Over all analysis regarding the colonization of multiple <i>H. pylori</i> strains in same host in this study population.

<p>Over all analysis regarding the colonization of multiple <i>H. pylori</i> strains in same host in this study population.</p

Gut Microbiomes of Indian Children of Varying Nutritional Status

<div><p>Background</p><p>Malnutrition is a global health problem affecting more than 300 million pre-school children worldwide. It is one of the major health concerns in India since around 50% of children below the age of two suffer from various forms of malnutrition. The gut microbiome plays an important role in nutrient pre-processing, assimilation and energy harvest from food. Consequently, dysbiosis of the gut microbiota has been implicated in malnutrition.</p><p>Methodology/Principal Findings</p><p>Metagenomics approach was adopted to investigate the gut microbiome sampled from 20 rural Indian children with varying nutritional status. The changes in the abundances of various taxonomic and functional groups were investigated across these gut microbiomes. A core set of 23 genera were observed across samples, with some showing differential abundances with varying nutritional status. One of the findings of the current study is the positive/negative associations of specific taxonomic and functional groups with the nutritional status of the children. Notable alterations in the architecture of the inter-microbial co-occurrence networks were also observed with changes in nutritional status. A key example is the clustering of potentially pathogenic groups into a distinct hub in severely malnourished gut. Our data does not demonstrate causality with the microbiome patterns that we observed, rather a description of some interesting patterns, whose underlying mechanism remains to be uncovered.</p><p>Conclusions</p><p>The present study envisioned interrelationships between the pattern of gut microbiome and the nutritional status of children. The cause of this pattern needs to be explored. However, insights obtained from the present study form the basis for further metagenomic investigations on larger population of children. Results of such studies will be useful in identifying the key microbial groups that can be utilized for targeted therapeutic interventions for managing severe acute malnutrition.</p></div

PG207 showed evidence of mixed infections on the basis of obtaining either <i>iceA1</i> or <i>iceA2</i> alleles.

<p>M, 100 bp marker; lanes 1–10, single colonies isolated from PG207; C, positive control; N, Negative control (<i>E. coli</i> DNA). (a) All the single colonies were negative for <i>iceA1</i> except for lane 8. (b) All these single colonies were positive for <i>iceA2</i> except for lane 8. Three different amplicon sizes were obtained in this <i>iceA2</i> PCR (lanes 1, 9; lanes 2, 3, 6, 7, 10 and lanes 4, 5).</p

RAPD patterns obtained with primer 1281 and 1283 in two representative cases.

<p>M, 1 kb molecular marker (New England Biolabs); lanes 1–10, single colonies isolated from respective patients and “P” denotes pooled DNA sample (a) Multiple <i>H. pylori</i> colonies and pooled culture isolated from PG207 showed different RAPD patterns with primers 1281. (b) The same <i>H. pylori</i> colonies (PG207) gave different RAPD patterns with primer 1283 also. (c) Showing difference in RAPD patterns among single colonies obtained with primer 1281 for PG158 though, (d) almost identical RAPD patterns were obtained for these colonies with primer 1283.</p

Combination of genotype and RAPD analysis for PG157 indicated multiple infections and microdiversity in a single host.

<p>M, 100 bp marker; lanes 1–10, single colonies isolated from PG157; P, pooled DNA. (a) RAPD patterns using primer 1281 showed two distinct patterns (lanes 1–8 and lanes 9–10) (b) RAPD patterns using primer 1283 also yielded two distinct patterns (lanes 1–8 and lanes 9–10) (c) Multiplex PCR for <i>vacA</i> alleles and <i>cagA</i> showed existence of s1m1<i>cagA</i>⁺ strains in lanes 1–8 and s2m2<i>cagA</i>⁻ strains in lanes 9–10. (d) Variant <i>cagA</i> subtypes detected on the basis of PCR for 3′ end of <i>cagA</i> using primers CAG1 and CAG2. This PCR assay showed existence of type A strains in lanes 4, 6–8 and existence of type B/D strains in lanes 1–3 and 5. Lanes 9–10, which were detected as <i>cagA</i>⁻, did not produce any amplicon and the pooled sample yielded amplicons for type A and type B/D strains.</p

Multiplex PCR for <i>vacA</i> subtypes, <i>cagA</i> and <i>cag</i> PAI empty site for the absence of <i>cag</i> PAI.

<p>M, 100 bp marker (New England Biolabs); lanes 1–10, single colonies isolated from PG207; C, 26695 for the first set (a) and AM1 (<i>cag</i> PAI negative strain) for the second set (b); N, Negative control (<i>E. coli</i> DNA). (a) Multiplex PCR showed this particular patient was infected by at least three different strains. Lanes 1–6 and lanes 9–10 showed existence of s2m2<i>cagA</i>⁻ strains, lane 7 showed existence of s1m1<i>cagA</i>⁻ strain and lane 8 showed existence of s1m1<i>cagA</i>⁺ strain. (b) All the single colonies, which failed to give amplicon for <i>cagA</i> gene, yielded ∼550 bp product for <i>cag</i> PAI empty site. The colony (Lane 8) that produced amplicon for <i>cagA</i> did not show any amplicon with primers for <i>cag</i> PAI empty site.</p

Mixed infections detected on the basis of <i>iceA</i> genetic locus.

<p>M, 100 bp marker; lanes 1–10, single colonies isolated from the patients, “P” denotes pooled DNA sample and N, Negative control (<i>E. coli</i> DNA). (a) PG98 showed evidence of mixed infections on the basis of obtaining amplicons of different sizes with primers specific for <i>iceA2</i>. (b) PG156 showed evidence of mixed infections on the basis of obtaining amplicons specific for <i>iceA2</i> and <i>iceA</i> negative genotype.</p

Multiple strain colonization detected on the basis of HP0527 gene in <i>cag</i> PAI.

<p>Lanes 1 to 10, single colonies isolated from the patient; C, Control strain 26695. (a) Three types of colonies were identified in PG93. Lane 1 and 6 gave a higher amplicon than that of 26695; lanes 3, 4, 7 and 8 yielded same amplicon while lanes 2, 5, 9, 10 produced lower amplicon than that of 26695. (b) Mixed infections detected on the basis of <i>vapD</i> genetic locus PCR. M, 100 bp marker; lanes 1–10, single colonies isolated from PG137; 11, positive control (PCR225); 12, Negative control (<i>E. coli</i> DNA). All the colonies are positive for <i>vapD</i> except colony numbers 1, 6, 9 and 10.</p