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This document explores the regioselective N-allylation of various heterocycles using organoboron-palladium catalysis. The authors emphasize the significance of this reaction in organic synthesis, particularly in drug design. They discuss different methods for achieving selective N-alkylation or O-alkylation, including base-mediated reactions, transition-metal-catalyzed couplings, and O-to-N rearrangements. The authors then present their own protocol using organoboron catalysts in combination with a palladium/Xantphos complex to achieve N-allylation. They demonstrate the effectiveness of their method through successful allylation of different heterocycles. The document also discusses the use of arylboronic acid as a catalyst in palladium-catalyzed couplings of allylic alcohols with pyridones and related heterocycles, highlighting its potential advantages such as low palladium catalyst loadings and applicability to various heterocyclic scaffolds. Future research will focus on expanding this catalyst system to other types of transformations. [Extracted from the article]

Background: To facilitate the delivery of proven maternal, neonatal, and child health (MNCH) services, a new cadre of village-based frontline workers, called the Accredited Social Health Activists (ASHAs), was created in 2005 under the aegis of the National Rural Health Mission in India. Evaluations have noted that coverage of selected MNCH services to be delivered by the ASHAs is low. Reasons for low coverage are inadequate supervision and support to ASHAs apart from insufficient skills, poor quality of training, and complexity of tasks to be performed. The proposed study aims to implement and evaluate an innovative intervention based on mobile phone technology (mHealth) to improve the performance of ASHAs through better supervision and support in predominantly tribal and rural communities of Gujarat, India.Methods/design: This is a two-arm, stratified, cluster randomized trial of 36 months in which the units of randomization will be Primary Health Centers (PHCs). There are 11 PHCs in each arm. The intervention is a newly built mobile phone application used in the public health system and evaluated in three ways: (1) mobile phone as a job aid to ASHAs to increase coverage of MNCH services; (2) mobile phone as a job aid to ASHAs and Auxiliary Nurse Midwives (ANMs) to increase coverage of care among complicated cases by facilitating referrals, if indicated and home-based care; (3) web interface as a job aid for medical officers and PHC staff to improve supervision and support to the ASHA program. Participants of the study are pregnant women, mothers, infants, ASHAs, and PHC staff. Primary outcome measures are a composite index made of critical, proven MNCH services and the proportion of neonates who were visited by ASHAs at home within the first week of birth. Secondary outcomes include coverage of selected MNCH services and care sought by complicated cases. Outcomes will be measured by conducting household surveys at baseline and post-intervention which will be compared with usual practice in the control area, where the current level of services provided by the government will continue. The primary analysis will be intention to treat.Discussion: This study will help answer some critical questions about the effectiveness and feasibility of implementing an mHealth solution in an area of MNCH services.Trial Registration: Clinical Trial Registry of India, CTRI/2015/06/005847 . Registered on 3 June 2015. [ABSTRACT FROM AUTHOR]

The study was undertaken to determine diagnostic accuracy of Haemoglobin Colour Scale (HCS) in hands of village-based community health workers (CHWs) in real-life community setting in India. Participants (501 women) were randomly selected from 8 villages belonging to a project area of SEWA-Rural, a voluntary organization located in India. After receiving a brief training, CHWs and a research assistant obtained haemoglobin readings using HCS and HemoCue (reference) respectively. Sensitivity, specificity, positive and negative predictive-values, and likelihood ratios were calculated. Bland-Altman plot was constructed. Mean haemoglobin value, using HCS and HemoCue were 11.02 g/dL (CI 10.9-11.2) and 11.07 g/dL (CI 10.9-11.2) respectively. Mean difference between haemoglobin readings was 0.95 g/dL. Sensitivity of HCS was 0.74 (CI 0.65-0.81) and 0.84 (CI 0.8-0.87) whereas specificity was 0.84 (CI:0.51-0.98) and 0.99 (CI:0.97-0.99) using haemoglobin cutoff limits of 10 g/dL and 7 g/dL respectively. CHWs can accurately diagnose severe and moderately-severe anaemia by using HCS in real-life field condition after a brief training. [ABSTRACT FROM AUTHOR]

The study was undertaken to determine diagnostic accuracy of Haemoglobin Colour Scale (HCS) in hands of village-based community health workers (CHWs) in real-life community setting in India. Participants (501 women) were randomly selected from 8 villages belonging to a project area of SEWA-Rural, a voluntary organization located in India. After receiving a brief training, CHWs and a research assistant obtained haemoglobin readings using HCS and HemoCue™ (reference) respectively. Sensitivity, specificity, positive and negative predictive-values, and likelihood ratios were calculated. Bland-Altman plot was constructed. Mean haemoglobin value, using HCS and HemoCue™ were 11.02 g/dL (CI 10.9-11.2) and 11.07 g/dL (CI 10.9-11.2) respectively. Mean difference between haemoglobin readings was 0.95 g/dL. Sensitivity of HCS was 0.74 (CI 0.65-0.81) and 0.84 (CI 0.8-0.87) whereas specificity was 0.84 (CI:0.51-0.98) and 0.99 (CI:0.97- 0.99) using haemoglobin cutoff limits of 10 g/dL and 7 g/dL respectively. CHWs can accurately diagnose severe and moderately-severe anaemia by using HCS in real-life field condition after a brief training. [ABSTRACT FROM AUTHOR]

The article discusses a study on spontaneous adverse events in sitagliptin-associated drug allergy. Approved by the U.S. Food and Drug Administration (FDA) in October 2006, sitagliptin, a dipeptidyl peptidase-4 inhibitor (DPP-4), is used for the treatment of type 2 diabetes mellitus. From October 16, 2006 to November 24, 2008, 48 reports from the Adverse Event Reports System (AERS) database of the FDA satisfied all predefined criteria for inclusion and exclusion as cases.

The majority of adolescent girls in rural India lack awareness regarding menstrual hygiene management (MHM), access to sanitary absorbents and necessary facilities in schools, homes, and workplaces. This study evaluated an intervention to strengthen a public health programme aimed to increase the use of safe, sanitary absorbents and knowledge of MHM among tribal adolescent girls. This project was implemented in 202 villages of two sub-districts of Narmada district in Gujarat, India, for one year (2018–2019). The intervention consisted of capacity building of 892 government frontline health workers and teachers, followed by supportive supervision. Convergence with concerned departments was achieved through meetings with stakeholders. "MHM-corners" and "MHM-Committees" were created at schools and Anganwadi-centres to improve access to menstrual absorbents and information. Household surveys of adolescent girls were conducted at baseline (n = 507) and end-line (n = 550) in 27 randomly selected villages to evaluate outcomes. Of 550 girls at the end-line, mean age 16.3 years, 487 (88.5%) were tribal, and 243 (44%) were out-of-school. The primary outcome of interest, the proportion of adolescent girls using safe, sanitary absorbents, increased from 69% to 90.5% (OR: 5.19, CI: 3.61–7.47). Their knowledge of the uterus as the origin of menstrual blood and hormonal changes as the cause for menstruation improved from 6.3% to 66% (p-value < 0.001) and 7.5% to 73% (p-value < 0.001), respectively. School absenteeism during menstruation reduced from 24% to 14% (p-value < 0.001). It is possible to improve MHM knowledge and practices among adolescent girls from tribal communities by utilising existing government systems. Awareness and access to safe absorbents can lead to safe and hygienic MHM practices. [ABSTRACT FROM AUTHOR]

This letter to the editor discusses the ethical and clinical considerations of using hydroxyurea (HU) in pregnant women with sickle cell disease (SCD). Pregnant women with SCD face increased risks of adverse maternal, fetal, and neonatal outcomes, including maternal death, intrauterine growth restriction, stillbirth, anemia, low birth weight, and preeclampsia/eclampsia. HU is currently not recommended during pregnancy due to concerns about fetal malformations, but case series and cohort studies have reported no increased risk of malformations. The authors argue for the need for rigorous studies to evaluate the effectiveness and risks of using HU in pregnant women with SCD, including a randomized control trial. [Extracted from the article]

The article reports on the launch of influenza vaccination campaign in Guyana from June 18-July 30, 2009. It states that the donation of 30,000 doses of seasonal influenza vaccine was facilitated by the Pan American Health Organization (PAHO). It indicates that vaccination campaign aimed to reduce morbidity and mortality due to seasonal influenza and to educate for the mass vaccination against H1N1 influenza.

Background: Anemia during adolescence affects growth and development of girls and boys increasing their vulnerability to dropping out-of-school. Hence investing in preventing anemia during adolescence is critical for their survival, growth and development. Objective: To find out the burden of anemia on adolescent age group in the tribal area of Jhagadia block and to assess the change in the hemoglobin level through the weekly Iron and Folic Acid IFA (DOTS) directly observed treatment supplementation under Supervision by Peer Educators at Community level among adolescents. Methods: Community based intervention study conducted with adolescents (117 girls and 127 boys) aged 10-19 years, through supplementation of IFA (DOTS) by trained Peer Educators for 52 weeks in 5 tribal villages of Jhagadia. Hemoglobin level was determined by HemoCue method before and after intervention and sickle cell anemia by Electrophoresis method. Primary data on hemoglobin and number of tablets consumed was collected and statistically analyzed in SPSS 16.0 software by applying paired t-test. Results: The overall findings suggest that the prevalence of anemia reduced from 79.5% to 58% among adolescent girls and from 64% to 39% among boys. Mean rise of hemoglobin seen was 1.5 g/dl among adolescent boys and 1.3 g/dl among girls. A significant association was found in change in hemoglobin before and after intervention (P = 0.000) Conclusion: Prevalence of anemia among girls and boys can be reduced in their adolescent phase of life, through weekly supplementation of iron folic acid tablets under direct supervision and Nutrition Education by Peer Educator at community level. [ABSTRACT FROM AUTHOR]

The Health and Family Welfare Department, Government of Gujarat, is implementing a program named Technology for Community Health Operation or TeCHO+ addressing state's priority health issues. This program envisages replacing the existing mother and child tracking system or e-Mamta application in the state. This program is based on ImTeCHO--Innovative Mobile Technology for Community Health Operations--which was piloted in Jhagadia, Bharuch district of Gujarat in 2013. The program showed improvements not only in terms of coverage of maternal and newborn care packages averting malnutrition but also was cost-effective. This paper details the protocol for health technology assessment to assess the impact of TeCHO+ program on data quality, improvement in service delivery coverage, reduction in morbidity and mortality as well as assess the cost-effectiveness. The study will be conducted in five districts of the state. A mixedmethod approach will be adopted. Data will be validated in a phased manner over a period of 3 years along with an assessment of key outcome indicators. Additionally, key informant interviews will be conducted and cost data will be gathered to perform cost-effectiveness analysis. The study will inform policymakers about the impact of TeCHO+ program on quality, access and cost-effectiveness of healthcare services. [ABSTRACT FROM AUTHOR]

Objectives: Sickle cell anemia is the commonest genetic disorder in India, and the frequency of the sickle cell gene is very high in the remote tribal areas where facilities are generally limited. Therefore, a rapid and affordable point-of-care test for sickle cell disease is needed.Methods: The diagnostic accuracy of HemoTypeSC was evaluated against automated high-performance liquid chromatography (HPLC) as the gold standard for its efficacy in a newborn screening program.Results: A total of 1,559 individuals (980 newborns and 579 adults) from four participating centers were analyzed by both methods. HemoTypeSC correctly identified 209 of 211 total hemoglobin (Hb) SS cases, for a 99.1%/99.9% total HbSS sensitivity/specificity. Overall, HemoTypeSC exhibited sensitivity and specificity of 98.1% and 99.1% for all possible phenotypes (HbAA, HbAS, and HbSS) detected. HPLC is relatively expensive and not available in most laboratories in remote tribal areas.Conclusions: We conclude that the rapid, point-of-care testing device HemoTypeSC test is suitable for population and newborn screening for the HbS phenotype. [ABSTRACT FROM AUTHOR]

Background: The Health and Family Welfare Department of Gujarat implemented a mHealth Programme called TeCHO+ (Technology for Community Health Operations) in 2018. TeCHO+ is aimed at making progress across all dimensions of the comprehensive primary healthcare services. Objective: The objective of this study is to record the document rollout and early implementation experience of TeCHO+ programme in Gujarat. Methods: The present participatory process documentation exercise was undertaken in Gujarat. The various steps for process documentation were decided after participation in multiple task force meetings and state/district‑ and taluka‑level action seminars and reviewing the TeCHO+ programme data and progress reports. The perceptions of the health officials and field staff were gathered using key informant interviews from five districts of Gujarat: Bharuch, Narmada, Gandhinagar, Mahisagar, and The Dangs. In addition, stakeholders involved with TeCHO+ Programme were interviewed to understand the process of rollout, implementation challenges, and success. Results: In the initial phase, the TeCHO+ application focussed only on updating the Family Health Survey to improve the quality of data captured in the system. FHWs log‑in the mobile application daily to access their daily work plan for which SMS alerts were are also generated. Most FHWs were in their 50s and were first‑time smartphone users. Although, they were enthusiastic and open to the new technology, initially they faced certain difficulties in operating the application. The programme had a strong troubleshooting mechanism in terms of the use of WhatsApp group, helpline numbers, and voice calls in addition to supportive supervision. Discussion: TeCHO+ showed the potential to enhance the quality of the collected data and also service coverage. However, poor technology literacy of old FHWs, the launch of multiple programme memes at the same time, and target‑driven task assignments pose major challenges. [ABSTRACT FROM AUTHOR]

Background: The coverage of community-based maternal, neonatal, and child health (MNCH) services remains low, especially in hard-to-reach areas. We evaluated the effectiveness of a mobile-phone-and web-based application, Innovative Mobile-phone Technology for Community Health Operations (ImTeCHO), as a job aid to the government's Accredited Social Health Activists (ASHAs) and Primary Health Center (PHC) staff to improve coverage of MNCH services in rural tribal communities of Gujarat, India.Methods and Findings: This open cluster-randomized trial was conducted in 22 PHCs in six tribal blocks of Bharuch and Narmada districts in India. The ImTeCHO mobile-phone-and web-based application included various technology-based job aids to facilitate scheduling of home visits, screening for complications, counseling during home visits, and supportive supervision by PHC staff. Primary outcome indicators were a composite index calculated based on coverage of important MNCH services and coverage of at least two home visitations by ASHA within the first week of birth. Primary analysis was intention to treat (ITT). Generalized Estimating Equation (GEE) was used to account for clustering. Eleven PHCs each were randomly allocated to the intervention (280 ASHAs, population: 234,134) and control (281 ASHAs, population: 242,809) arms. The intervention was implemented from February, 2016 to January, 2017. At the end of the implementation, 6,493 mothers were surveyed. Most of the surveyed women were tribal (5,571, 85.8%), and reported having a government-issued certificate for living below poverty line (4,916, 75.7%). The coverage of at least two home visits within first week of birth was 32.4% in the intervention clusters compared to 22.9% in the control clusters (adjusted effect size 10.2 [95% CI: 6.4, 14.0], p < 0.001). Mean number of home visits within first week of birth was 1.11 and 0.80 for intervention and control clusters, respectively (adjusted effect size 0.34 [95% CI: 0.23, 0.45], p < 0.001). The composite coverage index was 43.0% in the intervention clusters compared to 38.5% (adjusted effect size 4.9 [95% CI: 0.2, 9.5], p = 0.03) in the control clusters. There were substantial improvements in coverage home visits by ASHAs during antenatal period (adjusted effect size 15.7 [95% CI: 11.0, 20.4], p < 0.001), postnatal period (adjusted effect size 6.4, [95% CI: 3.2, 9.6], p <0.001), early initiation of breastfeeding (adjusted effect size 7.8 [95% CI: 4.2, 11.4], p < 0.001), and exclusive breastfeeding (adjusted effect size 13.4 [95% CI: 8.9, 17.9], p < 0.001). Number of infant and neonatal deaths was similar in the two arms in the ITT analysis. The limitations of the study include potential risk of inaccuracies in reporting events that occurred during pregnancy by the mothers and the duration of intervention being 12 months, which might be considered short.Conclusions: In this study, we found that use of ImTeCHO mobile- and web-based application as a job aid by government ASHAs and PHC staff improved coverage and quality of MNCH services in hard-to-reach areas. Supportive supervision, change management, and timely resolution of technology-related issues were critical implementation considerations to ensure adherence to the intervention.Trial Registration: Study was registered at the Clinical Trial Registry of India (www.ctri.nic.in). Trial number: CTRI/2015/06/005847. The trial was registered (prospective) on 3 June, 2015. First enrollment was done on 26 August, 2015. [ABSTRACT FROM AUTHOR]

Selection of aptamers from oligonucleotide libraries currently requires multiple rounds of alternating steps of partitioning of binders from nonbinders and enzymatic amplification of all collected oligonucleotides. Herein, we report a highly practical solution for reliable one‐step selection of aptamers. We introduce partitioning by ideal‐filter capillary electrophoresis (IFCE) in which binders and nonbinders move in the opposite directions. The efficiency of IFCE‐based partitioning reaches 109, which is ten million times higher than that of typical solid‐phase partitioning methods. One step of IFCE‐based partitioning is sufficient for the selection of a high‐affinity aptamer pool for a protein target. Partitioning by IFCE promises to become an indispensable tool for fast and robust selection of binders from different types of oligonucleotide libraries. [ABSTRACT FROM AUTHOR]

Selection of aptamers from oligonucleotide libraries currently requires multiple rounds of alternating steps of partitioning of binders from nonbinders and enzymatic amplification of all collected oligonucleotides. Herein, we report a highly practical solution for reliable one‐step selection of aptamers. We introduce partitioning by ideal‐filter capillary electrophoresis (IFCE) in which binders and nonbinders move in the opposite directions. The efficiency of IFCE‐based partitioning reaches 109, which is ten million times higher than that of typical solid‐phase partitioning methods. One step of IFCE‐based partitioning is sufficient for the selection of a high‐affinity aptamer pool for a protein target. Partitioning by IFCE promises to become an indispensable tool for fast and robust selection of binders from different types of oligonucleotide libraries. A good selection: Ideal‐filter capillary electrophoresis (IFCE) is introduced to facilitate the reliable and practical one‐step selection of oligonucleotide aptamers for protein targets. IFCE will also be applicable to the selection of binders from DNA‐encoded libraries of small molecules. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of an mHealth intervention in improving knowledge and skills of accredited social health activists in improving maternal, newborn and child health care in India.Methods: This was a nested cross-sectional study within a cluster randomised controlled trial. The intervention was a mobile phone application which has inbuilt health education videos, algorithms to diagnose complications and training tools to educate accredited social health activists. A total of 124 were randomly selected from the control (n = 61) and intervention (n = 63) arms of the larger study after six months of training in Bharuch and Narmada districts of Gujarat.Results: The knowledge of accredited social health activists regarding pregnancy (OR: 2.51, CI: 1.12-5.64) and newborn complications (OR: 2.57, CI: 1.12-5.92) was significantly higher in the intervention arm compared to the control arm. The knowledge of complications during delivery (OR: 1.36, CI: 0.62-2.98) and the postpartum (OR: 1.06, CI: 0.48-2.33) period was similar in both groups. The activists from the intervention arm demonstrated better skills for measuring temperature (OR: 4.25, CI: 1.66-10.89) of newborns compared to the control group.Conclusion: The results suggest potential benefits of this mHealth intervention for improving knowledge and skills of accredited social health activists. [ABSTRACT FROM AUTHOR]

Background: Even though the caesarean section is an essential component of comprehensive obstetric and newborn care for reducing maternal and neonatal mortality, there is a lack of data regarding caesarean section rates, its determinants and health outcomes among tribal communities in India. Objective: The aim of this study is to estimate and compare rates, determinants, indications and outcomes of caesarean section. The article provides an assessment on how the inequitable utilization can be addressed in a community-based hospital in tribal areas of Gujarat, India. Method: Prospectively collected data of deliveries (N = 19923) from April 2010 to March 2016 in Kasturba Maternity Hospital was used. The odds ratio of caesarean section was estimated for tribal and non-tribal women. Decomposition analysis was done to decompose the differences in the caesarean section rates between tribal and non-tribal women. Results: The caesarean section rate was significantly lower among tribal compared to the non-tribal women (9.4% vs 15.6%, p-value < 0.01) respectively. The 60% of the differences in the rates of caesarean section between tribal and non-tribal women were unexplained. Within the explained variation, the previous caesarean accounted for 96% (p-value < 0.01) of the variation. Age of the mother, parity, previous caesarean and distance from the hospital were some of the important determinants of caesarean section rates. The most common indications of caesarean section were foetal distress (31.2%), previous caesarean section (23.9%), breech (16%) and prolonged labour (11.2%). There was no difference in case fatality rate (1.3% vs 1.4%, p-value = 0.90) and incidence of birth asphyxia (0.3% vs 0.6%, p-value = 0.26) comparing the tribal and non-tribal women. Conclusion: Similar to the prior evidences, we found higher caesarean rates among non-tribal compare to tribal women. However, the adverse outcomes were similar between tribal and non-tribal women for caesarean section deliveries. [ABSTRACT FROM AUTHOR]

Background: Sickle cell disease (SCD) is a hereditary blood disorder prevalent in tribal regions of India. SCD can increase complications during pregnancy and in turn negatively influence pregnancy outcomes. This study reports the analysis of tribal maternal admissions in the community-based hospital of SEWA Rural (Kasturba Maternity Hospital) in Jhagadia block, Gujarat. The objective of the study is to compare the pregnancy outcomes among SCD, sickle cell trait and non-SCD admissions. This study also estimated the risk of adverse pregnancy outcomes for SCD admissions.Methods: The data pertains to four and half years from March 2011 to September 2015. The total tribal maternal admissions were 14640, out of which 10519 admissions were deliveries. The admissions were classified as sickle cell disease, sickle cell trait and non-sickle cell disease. The selected pregnancy outcomes and maternal complications were abortion, stillbirth, Caesarean section, haemoglobin levels, blood transfusion, preterm pregnancy, newborn birth weight and other diagnosed morbidities (IUGR, PIH, eclampsia, preterm labour pain). The odds ratios for each risk factor were estimated for sickle cell patients. The odds ratios were adjusted for the respective years.Results: Overall, 1.2% (131 out of 10519) of tribal delivery admissions was sickle cell admissions. Another 15.6% (1645 out of 10519) of tribal delivery admissions have sickle cell trait. The percentage of stillbirth was 9.9% among sickle cell delivery admission compared to 4.2% among non-sickle cell deliveries admissions. Among sickle cell deliveries, 70.2% were low birth weight compared to 43.8% of non-sickle cell patient. Similarly, almost half of the sickle cell deliveries needed the blood transfusion. The 45.0% of sickle cell delivery admissions were pre-term births, compared to 17.3% in non-SCD deliveries. The odds ratio of severe anaemia, stillbirth, blood transfusion, Caesarean section, and low birth weight was significantly higher for sickle cell admissions compared to non-sickle cell admissions.Conclusions: The study exhibited that there is a high risk of adverse pregnancy outcomes for women with SCD. It may also be associated with the poor maternal and neonatal health in these tribal regions. Thus, the study advocates the need for better management of SCD in tribal Gujarat. [ABSTRACT FROM AUTHOR]

The Government of India has started a new scheme aimed at offering sanitary pads at a subsidized rate to adolescent girls in rural areas. This paper addresses menstrual health and hygiene practices among adolescent girls in a rural, tribal region of South Gujarat, India, and their experiences using old cloths, a new soft cloth (falalin) and sanitary pads. Qualitative and quantitative data were collected in a community-based study over six months, with a pre-and post- design, among 164 adolescent girls from eight villages. Questions covered knowledge of menstruation, menstrual practices, quality of life, experience and satisfaction with the different cloths/pads and symptoms of reproductive tract infections. Knowledge regarding changes of puberty, source of menstrual blood and route of urine and menstrual flow was low. At baseline 90% of girls were using old cloths. At the end of the study, 68% of adolescent girls said their first choice was falalin cloths, while 32% said it was sanitary pads. None of them preferred old cloths. The introduction of falalin cloths improved quality of life significantly (p<0.000) and to a lesser extent also sanitary pads. No significant reduction was observed in self-reported symptoms of reproductive tract infections. Falalin cloths were culturally more acceptable as they were readily available, easy to use and cheaper than sanitary pads. Le Gouvernement indien a lancé un plan qui propose des serviettes hygiéniques à prix subventionné aux adolescentes vivant dans les zones rurales. Cet article aborde la santé menstruelle et l'hygiène des adolescentes dans une région tribale rurale du Gujarat méridional, et leur expérience de l'utilisation de vieux chiffons, d'un nouveau tissu doux (falalin) et de serviettes hygiéniques. Les données qualitatives et quantitatives ont été recueillies par une étude communautaire sur six mois, avec évaluation préalable et postérieure, auprès de 164 adolescentes originaires de huit villages. Elles ont été interrogées sur leurs connaissances de la menstruation, leurs pratiques menstruelles, leur qualité de vie, l'utilisation et la satisfaction avec les différents linges/serviettes et les symptômes d'infections de l'appareil reproducteur. Elles connaissaient mal les changements de la puberté, la source des règles et la voie de l'urine et du flux menstruel. Au début de l'étude, 90% des adolescentes utilisaient de vieux chiffons. À la fin de l'étude, 68% des filles ont déclaré que leur premier choix était le linge en falalin, contre 32% pour les serviettes hygiéniques. Aucune n'a préféré les vieux chiffons. L'introduction des linges en falalin a sensiblement amélioré la qualité de vie (p<0,000) comme, dans une moindre mesure, les serviettes hygiéniques. Aucune réduction notable des symptômes auto-signalés d'infections de l'appareil reproducteur n'a été observée. Les linges en falalin étaient culturellement plus acceptables car les adolescentes pouvaient se les procurer et les utiliser aisément, et ils étaient moins onéreux que les serviettes hygiéniques. El Gobierno de India ha puesto en marcha un nuevo plan para ofrecer toallas sanitarias a una tarifa subsidiada a las adolescentes de zonas rurales. En este artículo se trata la salud menstrual y las prácticas de higiene entre las adolescentes de una región tribal rural de Gujarat meridional, en India, y sus experiencias usando paños viejos, un paño suave nuevo (falalin) y toallas sanitarias. Durante un plazo de seis meses, se recolectaron datos cualitativos y cuantitativos en un estudio comunitario, con un diseño preliminar y posterior, entre 164 adolescentes de ocho poblados. Las preguntas abarcaron sus conocimientos de la menstruación, prácticas menstruales, calidad de vida, experiencia y satisfacción con los diferentes paños y toallas sanitarias, y síntomas de las infecciones del tracto reproductivo. Pocas tenían conocimientos de los cambios relacionados con la pubertad, la fuente de la sangre menstrual y la vía del flujo urinario y menstrual. En la línea base, el 90% de las adolescentes estaban usando paños viejos. Al final del estudio, el 68% dijo que su primera elección era el paño falalin, mientras que el 32% dijo que prefería las toallas sanitarias. Ninguna prefirió los paños viejos. La introducción del paño falalin mejoró la calidad de vida considerablemente (p<0.000) y a menor grado también las toallas sanitarias. No se observó ninguna reducción significativa en los síntomas autoreportados de infecciones del tracto reproductivo. Los paños falalin fueron más aceptados culturalmente, ya que eran fáciles de adquirir y usar y más baratos que las toallas sanitarias. [ABSTRACT FROM AUTHOR]

The article presents a case study conducted to examine the effectiveness of the maternity schemes in Gujarat to increase institutional deliveries. It mentions that the study is based on a secondary analysis of community based data collected by village level frontline workers of SEWA‑Rural (SR), a NGO located in Jhagadia block of Gujarat since 1980. It concludes that most of the women who delivered at hospital after initiation of maternity schemes chose hospital for subsequent delivery.

A new cadre of village-based frontline health workers, called Accredited Social Health Activists (ASHAs), was created in India. However, coverage of selected community-based maternal, newborn and child health (MNCH) services remains low. This article describes the process of development and formative evaluation of a complex mHealth intervention (ImTeCHO) to increase the coverage of proven MNCH services in rural India by improving the performance of ASHAs. The Medical Research Council (MRC) framework for developing complex interventions was used. Gaps were identified in the usual care provided by ASHAs, based on a literature search, and SEWA Rural's1 three decades of grassroots experience. The components of the intervention (mHealth strategies) were designed to overcome the gaps in care. The intervention, in the form of the ImTeCHO mobile phone and web application, along with the delivery model, was developed to incorporate these mHealth strategies. The intervention was piloted through 45 ASHAs among 45 villages in Gujarat (population: 45,000) over 7 months in 2013 to assess the acceptability, feasibility, and usefulness of the intervention and to identify barriers to its delivery. Inadequate supervision and support to ASHAs were noted as a gap in usual care, resulting in low coverage of selected MNCH services and care received by complicated cases. Therefore, the ImTeCHO application was developed to integrate mHealth strategies in the form of job aid to ASHAs to assist with scheduling, behavior change communication, diagnosis, and patient management, along with supervision and support of ASHAs. During the pilot, the intervention and its delivery were found to be largely acceptable, feasible, and useful. A few changes were made to the intervention and its delivery, including 1) a new helpline for ASHAs, 2) further simplification of processes within the ImTeCHO incentive management system and 3) additional web-based features for enhancing value and supervision of Primary Health Center (PHC) staff. The effectiveness of the improved ImTeCHO intervention will be now tested through a cluster randomized trial. [ABSTRACT FROM AUTHOR]