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Introduction: LBW continues to remain one of the serious challenges to maternal and child health care with every 3rd born child in India being low birth weight. Hence, it is imperative to monitor birth weights as well as assess the magnitude of neonatal morbidity and mortality and its subsequent causes and predisposing factors in order to prevent it . We conducted a retrospective study at our hospital to assess the morbidity and mortality patterns of LBW neonates and here in present the findings of our study in this paper. Methodology: The present study was conducted at the Pravara Rural Hospital, a tertiary level health care centre in western Maharashtra. Hospital medical records on deliveries and neonatal admissions were reviewed from June 2007 to May 2010. The files of those identified as delivered LBW were reviewed extensively for any morbidity and the cause of death was noted in those deceased. An association between LBW babies and socio-demographic characteristics was evaluated in the form of percentages and chi square test of significance. Results: The occurrence of LBW spectrum in this cohort was 43.1%. A significant association was found between LBW and sex of the neonate (p=0.0001); socioeconomic status (p=0.0001); educational status of mother (p=0.043); gestational age (p<0.0001); maternal weight (p=0.003); utilization of antenatal care (0.024). The infant mortality rate was 35 per 1000 live births Conclusion: Considering the high mortality rate in the rural area with a high cohort of neonates dying from preventable or treatable causes of death like infections, birth asphyxia and hyperbilirubinemia etc., there seems to be an urgent need to define the priorities for LBW baby care services in such backward areas of rural India. [ABSTRACT FROM AUTHOR]

Recent attention to Millennium Development Goals by the international development community has led to the formation of targets to measure country-level achievements, including achievements on health status indicators such as childhood immunization. Using the example of immunization in India, this paper demonstrates the importance of disaggregating national averages for a better understanding of social disparities in health. Specifically, the paper uses data from the India National Family Health Survey 1992–93 to analyze socioeconomic, gender, urban-rural and regional inequalities in immunization in India for each of the 17 largest states. Results show that, on average, southern states have better immunization levels and lower immunization inequalities than many northern states. Wealth and regional inequalities are correlated with overall levels of immunization in a non-linear fashion. Gender inequalities persist in most states, including in the south, and seem unrelated to overall immunization or the levels of other inequalities measured here. This suggests that the gender differentials reflect deep-seated societal factors rather than health system issues per se. The disaggregated information and analysis used in this paper allows for setting more meaningful targets than country averages. Additionally, it helps policy makers and planners to understand programmatic constraints and needs by identifying disparities between sub-groups of the population, including strong and weak performers at the state and regional levels. [Copyright &y& Elsevier]

Summary The paper evaluates an Indian maternal conditional cash transfer scheme. Launched in 2005, the program gives women cash transfers for receiving maternal and child health care services. Data are drawn from India’s District Level Household Survey to evaluate the program’s impact. Results indicate that the program had a limited overall effect: relative to the broader population, the targeted population experienced a 3 percentage point increase in medically supervised births, but no increase in ante-natal or post-natal care. We do however, find evidence of heterogeneity of impact. Women without any formal education and women in rural areas experience disproportionate gains. [ABSTRACT FROM AUTHOR]

This paper models the proximate determinants of height, weight and haemoglobin concentration of over 25,000 Indian children using data from the National Family Health Survey-3. The effects of public and private health care service utilization, food consumption patterns and maternal health status on child health were investigated in a multidisciplinary framework. Methodological issues such as potential endogeneity of explanatory variables and the appropriateness of combining height and weight as the body mass index were tackled. The results from models for children's heights and weight showed beneficial effects of child vaccinations against DPT, polio and measles, and negative effects of not utilizing government health facilities. The models for children's haemoglobin concentration indicated beneficial effects of food consumption patterns and treatment against intestinal parasites. The results provide several insights for improving child health in India. [ABSTRACT FROM AUTHOR]

Justification: India, home to almost 1.5 billion people, is in need of a country-specific, evidence-based, consensus approach for the emergency department (ED) evaluation and management of the febrile child. Process: We held two consensus meetings, performed an exhaustive literature review, and held ongoing web-based discussions to arrive at a formal consensus on the proposed evaluation and management algorithm. The first meeting was held in Delhi in October 2015, under the auspices of Pediatric Emergency Medicine (PEM) Section of Academic College of Emergency Experts in India (ACEE-INDIA); and the second meeting was conducted at Pune during Emergency Medical Pediatrics and Recent Trends (EMPART 2016) in March 2016. The second meeting was followed with futher e-mail-based discussions to arrive at a formal consensus on the proposed algorithm. Objective: To develop an algorithmic approach for the evaluation and management of the febrile child that can be easily applied in the context of emergency care and modified based on local epidemiology and practice standards. Recommendations: We created an algorithm that can assist the clinician in the evaluation and management of the febrile child presenting to the ED, contextualized to health care in India. This guideline includes the following key components: triage and the timely assessment; evaluation; and patient disposition from the ED. We urge the development and creation of a robust data repository of minimal standard data elements. This would provide a systematic measurement of the care processes and patient outcomes, and a better understanding of various etiologies of febrile illnesses in India; both of which can be used to further modify the proposed approach and algorithm. [ABSTRACT FROM AUTHOR]

Background: Convergence of sectoral programs is important for scaling up essential maternal and child health and nutrition interventions. In India, these interventions are implemented by two government programs - Integrated Child Development Services (ICDS) and National Rural Health Mission (NRHM). These programs are designed to work together, but there is limited understanding of the nature and extent of coordination in place and needed at the various administrative levels. Our study examined how intersectoral convergence in nutrition programming is operationalized between ICDS and NRHM from the state to village levels in Odisha, and the factors influencing convergence in policy implementation and service delivery.Methods: Semi-structured interviews were conducted with state-level stakeholders (n = 12), district (n = 19) and block officials (n = 66), and frontline workers (FLWs, n = 48). Systematic coding and content analysis of transcripts were undertaken to elucidate themes and patterns related to the degree and mechanisms of convergence, types of actions/services, and facilitators and barriers.Results: Close collaboration at state level was observed in developing guidelines, planning, and reviewing programs, facilitated by a shared motivation and recognized leadership for coordination. However, the health department was perceived to drive the agenda, and different priorities and little data sharing presented challenges. At the district level, there were joint planning and review meetings, trainings, and data sharing, but poor participation in the intersectoral meetings and limited supervision. While the block level is the hub for planning and supervision, cooperation is limited by the lack of guidelines for coordination, heavy workload, inadequate resources, and poor communication. Strong collaboration among FLWs was facilitated by close interpersonal communication and mutual understanding of roles and responsibilities.Conclusions: Congruent or shared priorities and regularity of actions between sectors across all levels will likely improve the quality of coordination, and clear roles and leadership and accountability are imperative. As convergence is a means to achieving effective coverage and delivery of services for improved maternal and child health and nutrition, focus should be on delivering all the essential services to the mother-child dyads through mechanisms that facilitate a continuum of care approach, rather than sectorally-driven, service-specific delivery processes. [ABSTRACT FROM AUTHOR]

The author discusses the impact of the internet on child mental health, education, and social communication in India. Topics discussed include the estimated number of internet subscribers in the country according to the Telecom Regulatory Authority of India, the definition of electronic media learning, and the establishment of interpersonal connection of adolescents with their peers, parents, siblings, and other adults outside the family unit.

ABSTRACT This article assesses the impact of rural-urban migration on gender disparities in children's access to healthcare in China and India. Much research has shown widespread discrimination against girl children in both countries, including in health investments, contributing to the well-known problem of Asia's 'missing' women. Much less clear is the impact of the massive rural-urban migration now occurring in China and India on discrimination against daughters. Migration is usually thought to have a positive effect on child health, because of improved access to healthcare facilities, but this is not necessarily equally beneficial for both sons and daughters. Based on fourteen months of fieldwork with rural migrant families in Shenzhen (China) and Mumbai (India), this article argues that where migration improves access to healthcare, it may increase rather than decrease the gender gap in treatment of child illness in the short term, as resources are concentrated on the treatment of sons. Furthermore, it is not the case that rural-urban migration necessarily leads to better access to healthcare even for sons: some forms of migration may actually have an overall negative effect on child health outcomes. For these two reasons, development strategies focusing on large-scale rural-urban migration should not be seen as a short-term solution to problems of gender inequity in child health. [ABSTRACT FROM AUTHOR]

Data from the Indian National Family Health Survey, 2005–06 were used to explore how pregnancy intention at the time of conception influences a variety of maternal and child health and health care outcomes. Results indicate that mistimed children are more likely than wanted children to be delivered without a skilled attendant present (OR = 1.3), to not receive all recommended vaccinations (OR = 1.4), and to die during the neonatal and postneonatal periods (OR = 1.8 and 2.6, respectively). Unwanted children are more likely than wanted children to not receive all recommended vaccinations (OR = 2.2), to be stunted (OR = 1.3), and to die during the neonatal, postneonatal, and early childhood periods (OR = 2.2, 3.6, and 5.9, respectively). Given the high levels of unintended fertility in India (21 per cent of all births), these are striking findings that underscore the importance of investments in family planning. [ABSTRACT FROM PUBLISHER]

Uttar Pradesh is the most populous State in India. The utilization rate for maternal and child health care services are abysmally low in the State. Anderson's model for family's use of medical care was used to analyze the factors responsible for individual's decision making in seeking maternal and child health care services. Results show that the "need" component in the model is the most important factor in making the decision to seek maternal and child health care services. In case of contraceptive use it's the "predisposing" component in the model that determines the use of such services. [ABSTRACT FROM AUTHOR]

Background: The burden of chronic conditions is on the rise in India, necessitating long-term support from healthcare services. Healthcare, in India, is primarily financed through out-of-pocket payments by households. Considering scarce evidence available from India, our study investigates whether and how out-of-pocket payments for outpatient care affect individuals with chronic conditions. Methods: A large census covering 9299 households was conducted in Bangalore, India. Of these, 3202 households that reported presence of chronic condition were further analysed. Data was collected using a structured household-level questionnaire. Out-of-pocket payments, catastrophic healthcare expenditure, and the resultant impoverishment were measured using a standard technique. Results: The response rate for the census was 98.5%. Overall, 69.6% (95%CI=68.0-71.2) of households made out-of-pocket payments for outpatient care spending a median of 3.2% (95%CI=3.0-3.4) of their total income. Overall, 16% (95%CI=14.8-17.3) of households suffered financial catastrophe by spending more than 10% of household income on outpatient care. Occurrence and intensity of financial catastrophe were inequitably high among poor. Low household income, use of referral hospitals as place for consultation, and small household size were associated with a greater likelihood of incurring financial catastrophe. The out-of-pocket spending on chronic conditions doubled the number of people living below the poverty line in one month, with further deepening of their poverty. In order to cope, households borrowed money (4.2% instances), and sold or mortgaged their assets (0.4% instances). Conclusions: This study provides evidence from India that the out-of-pocket payment for chronic conditions, even for outpatient care, pushes people into poverty. Our findings suggest that improving availability of affordable medications and diagnostics for chronic conditions, as well as strengthening the gate keeping function of the primary care services are important measures to enhance financial protection for urban poor. Our findings call for inclusion of outpatient care for chronic conditions in existing government-initiated health insurance schemes. [ABSTRACT FROM AUTHOR]

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To assess symptom-specific care-seeking practices for newborns and behavioral factors associated with them to inform strategies to enhance newborn care seeking in urban Lucknow, Northern India. This was a prospective follow-up study of consecutive 326 neonates delivered at an urban reproductive and child health (RCH) center. Focused Group Discussions (n=5) were also conducted in urban slums (n=3) at the RCH center (n=1) and at a district hospital (n=1). Overall, 326 neonates were recruited within 48 h of birth and 289 (88.7%) were followed up at 6 weeks (±15 days) at home. Parents of 51.2% (148/289) neonates reported at least one symptom of illness. Among these, 27.3% (79/289) neonates had at least one reported Integrated Management of Neonatal and Childhood Illnesses (IMNCI) danger sign, of which 15 (18.9%) did not receive any modern medical care, 5(33.3%) of which were dead by early infancy. Care seeking from unqualified providers (spiritual/traditional) was 33.3% (3/9) for persistent diarrhea and 23.5% (4/17) for pneumonia. Qualitative data from Focused Group Discussions showed that when pictures of some danger signs were shown like sunken eyes, reduced skin turgor, chest in-drawing and bulged fontanel, care seeking for these as well as fast breathing were influenced by ‘local beliefs’, which considered them to be untreatable by modern medicines alone. Thus, care seeking from multiple providers and use of traditional/home remedies delayed appropriate and timely medical care seeking. Almost half of the neonates had an illness symptom of which half had an IMNCI danger sign, of which one fifth did not receive medical care. Therefore, there is an urgent need to introduce a locally modified community IMNCI program here, for promoting care seeking from qualified providers for sick neonates.Journal of Perinatology (2008) 28, S69–S75; doi:10.1038/jp.2008.169 [ABSTRACT FROM AUTHOR]

The author reflects on the growth of the journal "Indian Pediatrics" from 1973-1975. Professor O. P. Ghai noted that the journal ranks as one of the foremost in India. He suggested that the journal solicit more articles on applied and operational research on delivery of health care to children. He recounts one of the first articles in 1973 which presents health statistics of India with population of almost 547 million and infant mortality rate of 140 per 1000.