Widespread non-adherence to evidence-based maternity care guidelines: a population-based cluster randomised household survey.

Objective: To assess the quality of maternity care in an Indian metropolitan city.

Study Design: Three-stage cluster randomised cross-sectional survey.

Setting: Sixty selected colonies of Delhi.

Height-for-age z scores increase despite increasing height deficits among children in 5 developing countries.

Background: Growth failure remains a persistent challenge in many countries, and understanding child growth patterns is critical to the development of appropriate interventions and their evaluation. The interpretation of changes in mean height-for-age z scores (HAZs) over time to define catch-up growth has been a subject of debate. Most studies of child growth have been cross-sectional or have focused on children through age 5 y.

A review of literature to understand the complexity of equity, ethics and management for achieving public health goals in India.

In the context of inadequate public spending on health care in India (0.9% of the GDP); government liberalized its policies in the form of subsidized lands and tax incentives, resulting in the mushrooming of private hospitals and clinics in India. Paradoxically, a robust framework was not developed for the regulation of these health care providers, resulting in disorganized health sector, inadequate financing models, and lack of prioritization of services, as well as a sub-optimal achievement of the Millennium Development Goals (MDG).

Preventing rheumatic fever: M-protein based vaccine.

Group A beta hemolytic streptococcus (GAS), the organism which initiates rheumatic fever (RF) continues to be sensitive to penicillin. However, penicillin cannot prevent RF if the preceding sore throat is asymptomatic in more than 70 percent children. Prevention of rheumatic fever (RF) may be possible only with the use of a vaccine.

Efficacy of fermented milk and whey proteins in Helicobacter pylori eradication: a review.

Helicobacter pylori (H. pylori) eradication is considered a necessary step in the management of peptic ulcer disease, chronic gastritis, gastric adenocarcinoma and mucosa associated lymphoid tissue lymphoma. Standard triple therapy eradication regimens are inconvenient and achieve unpredictable and often poor results.

On criminalisation and pathology: a commentary on the Supreme Court judgment on Section 377.

The judgment delivered last week by the Supreme Court of India, upholding the constitutionality of Section 377 of the Indian Penal Code (IPC), overturns a judgment by the Delhi High Court in 2009 that decriminalised sexual activity between two consenting adults. This judgment has unleashed a veritable firestorm of protest in the public space. There has been a heated and vitriolic debate on this issue in the print and social media, as well as television, with public opinion, in the main, being critical of the judgment.

Resolution of Bitot's spots following mega-dose vitamin A supplementation in children between 1 and 5 years of age.

Objective: The prevalence of Bitot's spots (BS) is often used to quantify vitamin A deficiency burden in India, both before and after mega-dose vitamin A supplementation (MVAS) programmes. However, the proportion of BS cured following this intervention is unclear in contemporary times. The current study evaluated the responsiveness of BS over 1 year to MVAS administered as per the national programme in rural India.

Preventing childhood anemia in India: iron supplementation and beyond.

Childhood anemia has major adverse consequences for health and development. It's prevalence in India continues to range from 70 to 90%. Although anemia is multifactorial in etiology, preventative efforts have predominantly focused on increasing iron intake, primarily through supplementation in pregnant and lactating women.

Revisiting the pathogenesis of rheumatic fever and carditis.

Rheumatic fever is one of the most-neglected ailments, and its pathogenesis remains poorly understood. The major thrust of research has been directed towards cross-reactivity between streptococcal M protein and myocardial α-helical coiled-coil proteins. M protein has also been the focus of vaccine development.

Chronic hepatitis B virus infection and pregnancy.

Planning of pregnancy and management of chronic hepatitis B virus during pregnancy includes recognition of maternal virological status, assessment of liver disease severity and minimization of risk for mother to infant transmission of infection. Decisions regarding the use of antivirals during pregnancy need to be individualized. Monitoring for infection and immunization in newborns is also important.

Rheumatic fever pathogenesis: Approach in research needs change.

Despite identifying that rheumatic fever (RF) is the result of an immunological reaction following group-A beta-hemolytic streptococcal infection, the pathogenesis remains elusive. RF has been incorrectly designated as causing pancarditis, since it does not cause myocarditis. Research directed toward myocarditis, targeting myosin to unravel the pathogenesis has not succeeded in more than 60 years.

Statico-Dynamic Island Laryngoplasty with Crossed Musculoplasty and Transmitted Dynamism (for Vocal Cord Palsy): a New Technique.

Only static medialisation of the paralysed vocal cord is most commonly performed today for vocal cord palsy which does not offer very good voice post-operatively. Colledge and Balance's (1927) operation of anastomosis of the phrenic nerve to the recurrent laryngeal nerve for laryngeal palsy or Tuckers (1976) nerve muscle pedicle technique has not offered significant reanimation of the paralysed muscles of the vocal cord. Moreover, it is virtually impossible to offer dynamism to the paralysed muscles; but dynamism can conveniently be transmitted to the paralysed vocal cord by appropriate muscle transplantation as has been done in palatopharyngoplasty for rhinolalia aperta (Ghosh 1983, 1986).

Postpartum Uterine Wound Dehiscence Leading to Secondary PPH: Unusual Sequelae.

Secondary postpartum haemorrhage due to partial or complete dehiscence of uterine wound after caesarean section is unusual. Authors present here a patient with secondary postpartum haemorrhage following uterine dehiscence after caesarean delivery. Conservative management failed to control the bleeding, and she eventually needed hysterectomy.

Overcoming challenges to accelerating linear growth in Indian children.

This policy review highlights the need to focus on stunting as an indicator of under-five undernutrition and explores the major challenges and priority public health options for accelerating linear growth in children. Early childhood stunting predicts poor human capital including shorter adult height, lower attained schooling, reduced adult income, and decreased offspring birth weight. The current prevalence of stunting is disconcerting but there has been a relatively faster decline recently.

Zinc supplements for preventing otitis media.

Background: Otitis media (OM) is inflammation of the middle ear and is usually caused by infection. It affects people of all ages but is particularly common in young children. Around 164 million people worldwide have long-term hearing loss caused by this condition, 90% of them in low-income countries.

Neonatal zinc supplementation for prevention of mortality and morbidity in breastfed low birth weight infants: systematic review of randomized controlled trials.

Objectives: To evaluate whether zinc supplements prevent mortality and morbidity in breastfed low birth weight infants.

Methods: All randomized or qausi-randomized trials with individual or cluster allocation and using concurrent controls were included. Study population included LBW infants irrespective of gestational status who were exclusively or predominantly breastfed at the initiation of intervention.

The development of 'Quality of Life Instrument for Indian Diabetes patients (QOLID): a validation and reliability study in middle and higher income groups.

Purpose: To develop a reliable and valid quality of life questionnaire for Indian patients with diabetes.

Methods: A draft of 75 questions was prepared on the basis of expert opinion, focus group discussions, review of existing literature and detailed semi-structured interviews of patients with diabetes with the intention of including all aspects of diabetes-specific and quality of life considered relevant by patients and care providers to enable constrict validity. A Stage 2 questionnaire was then prepared with 13 domains and 54 items (questions) after expert panel review for obvious irrelevance and duplication of issues.

Consensus Statement National Consensus Workshop on Management of SAM Children through Medical Nutrition Therapy.

Justification: Severe acute malnutrition (SAM) is an important preventable and treatable cause of morbidity and mortality in children below five years of age in India. The concerned stakeholders are not in agreement about the role of product based medical nutrition therapy in the management of this condition.

Process: In November 2009, a National Consensus Workshop was organized by the Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi in collaboration with the Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, and the Sub-specialty Chapter on Nutrition, Indian Academy of Pediatrics.

Home visits by community health workers to prevent neonatal deaths in developing countries: a systematic review.

Objective: To determine whether home visits for neonatal care by community health workers can reduce infant and neonatal deaths and stillbirths in resource-limited settings.

Methods: We conducted a systematic review up to 2008 of controlled trials comparing various intervention packages, one of them being home visits for neonatal care by community health workers. We performed meta-analysis to calculate the pooled risk of outcomes.

Pregnancy and chronic hepatitis B virus infection.

The combination of chronic hepatitis B virus (HBV) infection and pregnancy presents unique management questions. Aspects of care that need to be considered include effects of hepatitis B on pregnancy, effects of pregnancy itself on the course of hepatitis B infection, treatment of hepatitis B during pregnancy and prevention of mother-to-infant transmission. Chronic HBV infection is usually mild in pregnant women, but may flare shortly after delivery.

Efficacy of short course (<4 days) of antibiotics for treatment of acute otitis media in children: a systematic review of randomized controlled trials.

Objective: To determine the efficacy of a short course of antibiotics (<4 days) in comparison to a longer course (>4 days) for the treatment of acute otitis media in children.

Data Sources: Electronic databases, hand search of reviews, bibliographies of books, abstracts and proceedings of international conferences.

Review Methods: Randomized controlled trials of the empiric treatment of acute otitis media comparing antibiotic regimens of <4 days versus > 4 days in children between four weeks to eighteen years of age were included.

Quality of care, maternal attitude and common physician practices across the socio-economic spectrum: a community survey.

Purpose: To evaluate the quality of maternity care, women's perception of the quality of care and factors influencing the same in Delhi.

Method: Women who delivered a viable live birth in the past 6 months were recruited from South Delhi by a two-stage stratified cluster randomized sampling. In stage 1, two colonies each from three predefined economic strata (high-, middle- or low-income areas) were selected by simple-random sampling.

Direct cost of maternity-care services in South Delhi: a community survey.

The study was conducted to estimate the direct maternity-care expense for women who recently delivered in South Delhi and to explore its sociodemographic associations. A survey was conducted using the two-stage cluster-randomized sampling technique. Two colonies each from high-, middle- and low-income areas were selected by simple random sampling, followed by a house-to-house survey in each selected colony.