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The focus of pediatric cancer research in India has largely been medical and clinical, with little focus on psycho-oncological aspects. Receiving a cancer diagnosis can be life altering for both the patients as well as their families and points to a need for psycho-oncological research. The present narrative review examined original articles on pediatric psycho-oncology research conducted in India particularly in the past two decades. There is promising research in various domains such as survivorship and quality of life, patient needs and psychosocial concerns, communication between health care providers, patients, and caregivers, parent and caregiver needs including psychosocial support and information, as well as some intervention-based studies. With much of the research being conducted within clinical setups through surveys and retrospective data, psychosocial issues faced by patients and their families are discussed along with physical, logistical, and financial concerns, while forays into intervention-based research are still in primary phases but show potential in terms of outcomes and feasibility. There is need for more methodologically rigorous research rooted in strong theoretical foundations, culturally sound models, and with evidence-based examination of all stages and stakeholders involved in providing and receiving care in pediatric cancer. [ABSTRACT FROM AUTHOR]

Purpose. To describe the beliefs, barriers and promotion practices of Indian nurses' regarding healthy eating (HE) behaviours amongst cancer survivors, and to gain insights into whether their educational qualifications might affect the promotion of HE. Methods. Data was gathered using a validated questionnaire, 388 of the approached 400 nurses who worked at a tertiary care hospital in India gave informed consent to participate in the study. The Mann-Whitney U test and the Chi square analysis (for continuous and categorical variables respectively) were performed to carry out sub-group comparisons based on the qualification of the nurses i.e., Bachelor of Science in Nursing (BSc) and General Nursing and Midwifery (GNM). Results. The nurses believed that dieticians/nutritionists were primarily responsible for educating the cancer survivors regarding HE. HE was promoted by nurses' relatively equally across multiple treatment stages ("during" treatment 24.4%, "post" treatment 23.1%; and "pre" treatment 22.3%). Nurses' believed HE practices had numerous benefits, with improved health-related quality of life (HRQoL) (75.7%), and mental health (73.9%) being the most frequent responses. The most frequently cited barriers by the nurses in promoting HE were lack of time (22.2%), and lack of adequate support structure (19.9%). Sub-group comparisons generally revealed no significant difference between the BSc and GNM nurses in their perceptions regarding HE promotion to cancer survivors. Exceptions were how the GNM group had significantly greater beliefs regarding whether HE can "reduce risk of cancer occurrence" (pD0:004) and "whether or not I promote HE is entirely up to me" (pD0:002). Conclusion. The nurses in India believe in the promotion of HEpractices among cancer survivors across various stages of cancer treatments. However, they do face a range of barriers in their attempt to promote HE. Overcoming these barriers might facilitate effective promotion of HE among cancer survivors and help improve survivorship outcomes. Implications for cancer survivors. Indian nurses employed in the two tertiary care hospitals wish to promote HE among cancer survivors, but require further knowledge and support services for more effective promotion of HE. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to explore the health-related quality of life (HRQoL), psychological issues and concerns among sarcoma survivors in India and assess their satisfaction with nursing care. Methods: This study employed a sequential mixed-methods design, enrolling 100 sarcoma survivors from July to December 2021, with data collected using standardised questionnaires for HRQoL, depression, anxiety, stress, cognitive impairment and self-structured satisfaction with nursing care. Qualitative data were gathered through focused group discussions. Results: The mean global health score among sarcoma survivors was 79.48 ± 16.26. A significant number of survivors had symptoms of mild-to-moderate depression (30%), severe anxiety (12%), stress (16%) and mild cognitive impairment (5%). Significant mean rank differences were observed between anxiety and financial difficulty (p < 0.05), emotional functioning (p < 0.001), cognitive functioning (p < 0.001), pain (<0.05), insomnia (p < 0.001), fatigue (p < 0.001), anorexia (p < 0.05) and nausea/vomiting (p < 0.001). Educational qualification had a significant association with depression and anxiety while family history of cancer emerged as a significant factor associated with anxiety and stress among survivors. Qualitative analysis revealed themes related to body image, societal discrimination, socio-economic impact, marriage concerns and fertility issues. Survivor satisfaction with nursing care was good. Conclusion: A substantial number of sarcoma survivors had an average HRQoL and experienced depression, anxiety and stress. Our study emphasizes the importance of holistic survivorship care, involving nurses in post-treatment support, and addressing societal discrimination and psychosocial concerns to enhance their quality of life. Implications for cancer survivors: Our study calls for a holistic approach to sarcoma survivor care and emphasizes the importance of personalised survivorship care plans led by nurses to address the diverse needs of sarcoma survivors in India. Such plans should encompass strategies for managing depression, anxiety and stress, along with addressing body image concerns and social support. [ABSTRACT FROM AUTHOR]

Objective: Measure the satisfaction level of patients visiting a tertiary level cancer institute in Odisha, identify the factors associated with the satisfaction level and assess the health system challenges related to quality service provision for cancer survival. Material and Methods: Analytical cross-sectional study was carried out using a mixed-methods approach in a tertiary cancer care unit in Odisha among 538 cancer patients using the Patient Satisfaction 32 questionnaire and the Patient Health Questionnaire (PHQ)-9 questionnaire. Results: There were 41% and 43% of outdoor and indoor patients who were below poverty line. Hindu was the predominant religion (>90%), 10% were illiterates and 90% were married in each category. Breast cancer (16%) was predominant among outdoor patients, whereas, it was stomach cancer (15%) among indoor patients. The PHQ median score for females was 1.5 and 1 each for indoor and outdoor patients, respectively. Nearly, 72% and 57% of males and females had mild depression to adjustment disorders statistically significant at P < 0.05. 90% of outdoor and 68% of indoor patients with a greater frequency of visits were significantly more depressed than their counterparts. All those accompanied by people other than their family members also showed higher values of adjustment and mild depressive features (69%) at P < 0.05. About 81% were satisfied with both general services and staff and nearly 40% with treatment and diagnosis. Conclusion: It gave us demographic details of cancer morbidity and its associates besides validating the survivorship framework in the Indian setting. Self-help anonymous and rehabilitation centres for a holistic integrative approach at the primary level of care need to be done. [ABSTRACT FROM AUTHOR]

Support groups and meetings are self-help gatherings that provide a unique sense of community, unconditional acceptance, and information on cancer and its treatment. This cross-sectional study examined 12 outpatient meetings within the Kerala model of palliative care, a community-based service provided to patients irrespective of disease, stage, or prognosis starting from the time of diagnosis. The study focused on the pivotal role of community nurses in facilitating these meetings, with participants including cancer patients and survivors. Using in-depth interviews (n = 52) and participant observations, this research used a qualitative approach and explored the dynamics and outcomes of outpatient meetings. Findings highlight the indispensable contributions of these community nurses serving as linchpins in providing support, guiding discussions, and offering crucial education. Outpatient meetings effectively addressed psychosocial concerns, combatted stigmas associated with cancer, and promoted informed decision making in cancer care. The study emphasizes the need for recognizing the role played by community nurses in improving psychosocial support and diminishing stigma, and ultimately the quality of life of patients and survivors through the palliative cancer care within the Kerala model. We also underscore the need for policy initiatives, resource allocation, and training programs tailored to support these frontline health care providers effectively., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 by The Hospice and Palliative Nurses Association. All rights reserved.)

Purpose. To describe the physical activity (PA) promotion practices, beliefs, and barriers of Indian nurses working with cancer survivors, and to gain preliminary insights into how their educational qualification might affect PA promotion practices. Methods. A validated questionnaire was used to obtain the data (N D388). Sub-group comparisons were performed based on nursing qualification i.e., Bachelor of Science in Nursing (BSc) and General Nursing and Midwifery (GNM) using Mann-Whitney U test and chi square analysis for continuous and categorical variables, respectively. Results. The nurses believed that oncologists (47%) followed by physiotherapists (28.9%) were primarily responsible for providing information regarding PA to cancer survivors. The most common period in which the nurses' promoted PA was post treatment (31.7%), although very few nurses (13.3%) promoted PA across more than one of the three treatment periods. Nurses felt that PA had many benefits for cancer survivors; improved mental health (87.7%) and HRQoL (81.1%). Lack of knowledge (42.2%) and lack of time (41.6%) were the most frequently cited barriers. The comparisons based on educational qualification did not typically reveal many significant differences. Conclusion. Indian nurses both BSc andGNMqualified, wish to promote PA to cancer survivors despite numerous barriers, across various stages of treatment and believe PA is beneficial to the survivors in the process of recovery. Overcoming these barriers might aid in better promotion of PA to cancer survivors. Implication for cancer survivors. Nurses working in a tertiary care hospital in India are willing to promote PA amongst cancer survivors but require more training and support in this area of practice. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common cause of cancer mortality in India, yet breast cancer literacy remains poor. This study aimed to assess community perceptions and experiences with breast cancer in order to identify and address the gaps in our understanding of the socio-cultural barriers to awareness and care-seeking for breast cancer. Qualitative focus group discussions and in-depth interviews were conducted among breast cancer survivors and caretakers, health workers, and general population individuals in a tertiary care facility, urban underprivileged community, and rural setting around Bangalore city. Data was thematically analyzed using inductive approach. Breast cancer awareness was commonly gained through interpersonal relationships or self-experiencing breast cancer, mass media, and medical personnel. The most significant barriers to seeking care for breast cancer were cost of care, lack of female doctors, fears of diagnosis, and death. Stigma of breast cancer was attributed to possible isolation by the community members and misconception that cancer is infectious thereby delaying care-seeking. This study provides an understanding of what individuals perceive about breast cancer and highlights some important anecdotes from breast cancer survivors who have experienced the full extent of a breast cancer diagnosis in India. The institutional and social barriers brought out by this study may be taken into consideration when planning targeted interventions for breast cancer in India. [ABSTRACT FROM AUTHOR]

Background: With earlier prostate cancer (PCa) diagnosis and increased survivorship, post-treatment quality of life (QoL) has become increasingly important. The Expanded Prostate Cancer Index Composite (EPIC) is a widely adopted QoL instrument for PCa. We aimed to create a Punjabi version of EPIC to further research in the Punjabi-speaking population., Methods: A prototype of the Punjabi version of EPIC was created by forward-backward translations and revision. After concluding the cultural adaptation phase by interviewing 15 participants, a pilot version was created. Validation of the pilot version was performed by having 72 participants complete the Punjabi EPIC and another commonly used QoL instrument, the EORTC QLQ-c30, twice within a 4-week period. Test retest reliability (Pearson's correlations and difference distribution) and internal consistency (Cronbach's alpha) were measured using SAS version 9.4., Results: Modifications were needed for the prototype Punjabi version after forward-backward translations. Cultural adaptation has highlighted a few issues including syntax and terminology.  Test-retest reliability of the Urinary, Bowel, Sexual and Hormone domains were 0.88, 0.91, 0.91, and 0.95, respectively, and subscale correlations ranged from 0.75 to 0.93. Internal consistency for domains and subscales was good except for Sexual Domain. Performance of EPIC is comparable, and in some cases, slightly better than validated Punjabi version of EORTC QLQ-C30., Conclusions: The EPIC questionnaire was successfully translated into Punjabi and was culturally adapted.  The resultant Punjabi version has high reliability and validity and will be an important tool for QoL research in the Punjabi population. EPIC was successfully translated, culturally adapted, and validated with high reliability and validity into Punjabi. It will be a valuable QoL tool for physicians in clinical and research settings, and for patients in decision-making.

Context: Breast cancer is the most common cancer in Indian women with an annual mortality of around 87,000. Treatment for breast carcinoma may lead to swelling of the ipsilateral arm and shoulder stiffness and arm pain and cancer-related fatigue. Very few centers in India have reported the arm and shoulder morbidity treated in their hospital. Aims: The study aims to evaluate the predictive factors of arm and shoulder morbidity and fatigue among the survivors. Settings and Design: Retrospective analysis from a prospectively maintained database. Materials and Methods: Early and locally advanced cases of breast cancer patients were screened for the study during 2015–2018. Eligible participants were invited to fill up the predetermined questionnaire and their demographic and treatment-related information was accrued from a file archive. Follow-up period was estimated from the date of tissue diagnosis to last contact/time of interview. Statistical Analysis Used: Predictive factors of shoulder morbidity and fatigue were analyzed by independent sample t-test and univariate analysis. Significant predictive factors were selected for further validation in the multivariate cox regression model. A P ≤ 0.05 was considered significant. Results: Shoulder stiffness was the most common complaint followed by arm numbness. Obesity and diabetes played a crucial role in most of the morbidities and fatigue. The median fatigue score was 34 and the median time of appearance of lymphedema was 13 months. Modified radical mastectomy, and radiotherapy to axilla were significantly associated with greater shoulder stiffness and arm swelling. Conclusions: Obesity, diabetes, type of surgery, the extent of axillary dissection, and radiation plan are the major predictive factors of arm and shoulder morbidity. Further prospective validation is necessary for future breast cancer survivorship programs. [ABSTRACT FROM AUTHOR]

Context: Breast cancer is the most common cancer in Indian women with an annual mortality of around 87,000. Treatment for breast carcinoma may lead to swelling of the ipsilateral arm, shoulder stiffness, arm pain, and cancer-related fatigue. Very few centers in India have reported the arm and shoulder morbidity treated in their hospitals. Aims: The aim was to evaluate the predictive factors of arm and shoulder morbidity and fatigue among breast cancer survivors. Settings and Design: This was a retrospective analysis based on a prospectively maintained database. Materials and Methods: Early and locally advanced cases of breast cancer patients were screened for the study during 2015-2018. Eligible participants were invited to fill up the predetermined questionnaire, and their demographic and treatment-related information was accrued from a file archive. Follow-up period was estimated from the date of tissue diagnosis to last contact/time of interview. Results: Shoulder stiffness was the most common complaint followed by arm numbness. Obesity and diabetes played a crucial role in most of the morbidities and fatigue. The median fatigue score was 34, and the median time of appearance of lymphedema was 13 months. Modified radical mastectomy and radiotherapy to axilla were statistically significantly (P = 0.04 and 0.01, respectively) associated with greater shoulder stiffness and arm swelling. Conclusions: Obesity, diabetes, type of surgery, the extent of axillary dissection, and radiation plan are the major predictive factors of arm and shoulder morbidity. Further prospective validation is necessary for future breast cancer survivorship programs. [ABSTRACT FROM AUTHOR]

Background: Continuum of care is an important concern for childhood cancer survivors. Studies from high-income countries indicate a significant development in services to these survivors. Similar information is unavailable from India. Methods: An online survey form was developed and sent to 86 centers. Data were collected over a 6-month period in 2017. Results: Fifty nine centers responded (44.1% private sector, 33.9% public, and 22.0% charitable trust). The services are mainly provided (91%) within routine oncology clinics. There is no upper age limit (61%) or time period limit (63%) for follow-up at most of the centers. The major barriers for follow-up are distance, lack of knowledge, lack of adequate facilities, and patient priority for follow-up. Conclusion: This survey provides baseline information on current service provided to childhood cancer survivors in India. There is a need to inform, educate, and sensitize the survivor and their family as well as improving services. [ABSTRACT FROM AUTHOR]

Background: Long-lasting insecticidal nets (LLINs) are the most favoured vector control tools worldwide. Timely monitoring and evaluation of LLINs is important to sustain the impact of this promising vector control method and for replacement of worn-out and those rendered ineffective. During the mid-2017, LLINs were distributed by the National Vector Borne Disease Control Programme (NVBDCP) in high malaria endemic districts of the eastern coastal state of Odisha. The study was carried out to assess the field performance of the LLINs post 30 months of distribution in Koraput district of Odisha state. Methods: A total of 130 households were randomly selected from three villages of Laxmipur CHC in Koraput district, Odisha, India; one each from hilltop, foothill and plain terrain. The net users were interviewed to elicit information on usage, washing practices, physical integrity, bio-efficacy and survivorship of LLINs to confirm the claimed three-year life of the LLINs. Results: 74.8% of the LLINs were physically present after 30 months of distribution. The numbers (%) of LLINs used previous night varied from 30 to 61% between study villages. 74% respondents were using the LLINs throughout the year and 26% only seasonally. Of the total, 85% of the nets were reported to be washed and 95% nets were dried under shade as recommended. Altogether, 58% of the surveyed nets were found torn with holes. Of these, 74 (57%) nets were in good condition, 10 (8%) nets were in serviceable and 45 (35%) nets were badly torn and needed replacement. A total of 45 (93.75%), 68 (80%) and 71 (63.8%) LLINs were physically present in hilltop, foothill and plain villages, respectively. The LLINs did meet the efficacy criteria, given the 100% mortality to the exposed Anopheles jeyporiensis mosquitoes post 30 months distribution. Conclusions: The findings of this study were communicated to the programme officials of the state and LLINs were replenished soon after 31st month post-distribution of LLINs. [ABSTRACT FROM AUTHOR]

This paper aims to debunk the common myths about cancer that exist among the women of Delhi and NCR Region, in an era where most people feel that cancer related myths are a thing of the past this study highlights the shocking and upcoming myths which are fast catching on in the society, especially with the advent of social media and chat groups. Data from unreliable sources cause more confusion and is fast causing newer myths to develop. Data was collected from 75 cancer breast and 75 cancer cervix patients living in Delhi and NCR region and 150 normal women who had no diagnosis of cancer. Their beliefs about the cause, treatment and survivorship of cancer were collected in a face to face discussion and common myths identified. Several lacunae in the knowledge and false perceptions were identified in the process and resolved and myths identified. [ABSTRACT FROM AUTHOR]

Abstract: Diurnally subperiodic Wuchereria bancrofti (DSPWB) filariasis is transmitted by the Downsiomyia nivea. In India, it is prevalent only in the Nicobar district of Andaman and Nicobar Islands. Knowledge of the population dynamics and bio-ecology of vectors is crucial to develop intervention measures. Entomological studies were performed for 12 months by collecting mosquitoes that landed on human baits for feeding in Teressa Island. Age composition, mosquitoes that had laid eggs at least once, finite rate of natural increase (λ) and vector survival reflecting the population dynamics of Do. nivea in relation to transmission of filariasis were estimated. A total of 3625 Do. nivea were collected. Changes in finite rate of increase (λ> 1) during favorable months indicate an increase in the vector population, suggesting the need for intensified intervention. The proportion of mosquitoes completing more than one gonotrophic cycle was higher in months when λ was 1. Do. nivea abundance and its parous densities varied with seasons. Survival of Do. nivea (indicated by the proportion of parous mosquitoes) was lower in the pre-monsoon season than during the monsoon and post-monsoon seasons. The probability of the daily survival of Do. nivea through one gonotrophic cycle was 0.75, with a declining trend as age increased. The maximum transmission of DSPWB occurred during the pre-monsoon, followed by the late monsoon, post-monsoon and monsoon seasons. Perennial transmission is evident. Therefore intervention measures must be planned throughout the year. Prospects of vector control are limited due to the cryptic breeding and diurnal biting habits. Mass chemotherapy with a single dose of an antifilarial drug is a potential option for control. [Copyright &y& Elsevier]

We use data from the 1931, 1941, and 1951 censuses of India and the 1951 census of Pakistan to examine the demographic consequences of Partition in the Punjab in 1947. Had growth rates for the period 1931-41 for the Punjab as a whole continued to 1951, the population of the Punjab would have been 2.9 million larger than that recorded in 1951. Population losses from migration and mortality above age 20 were approximately 2.7 million greater between 1941 and 1951 than would have been predicted by loss rates between 1931 and 1941. We estimate a net Partition-related population movement out of the combined Punjab of about 400,000. We conclude from several lines of analysis that Partition-related population losses in the Punjab, either from deaths or unrecorded migration, were in the range 2.3-3.2 million. Partition was also marked by a dramatic religious homogenization at the district level. [ABSTRACT FROM AUTHOR]

Competing Interests: None

COVID-19 pandemic has emerged as a disaster for the human beings. All the Governments across the globe have been preparing to deal with this medical emergency, which is known to be associated with mortality in about 5% of the sufferers. Gradually, it is seen that, many patients with COVID-19 infection have mild symptoms or are asymptomatic. Due to the risk of infecting others, persons with COVID-19 infection are kept in isolation wards. Because of the isolation, the fear of death, and associated stigma, many patients with COVID-19 infection go through mental distress. In this report, we discuss the experience of 3 persons diagnosed with COVId-19 infection and admitted to the COVID ward., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This article tracks the entanglement of cancer and patterns of conjugality in Delhi. Building on fieldwork with about 120 households in Delhi, it describes how the disease put pressure on already fraught marital biographies, revealing durable fissures in household relations. Often, these shifts in the distribution of conjugal vulnerability opened cracks that allowed long histories of domestic violence to seep through. In subtle ways, women could accrue a delicate agency through their practices of care. But at the same time, they continued to inhabit the vulnerable space of affinal homes. This article describes how in these arrangements, care and violence followed each other closely in their tracks. Building on these insights, the article deepens and shifts how anthropologists have understood the social life of the cancer. Specifically, anthropologists writing about the disease have demonstrated the ubiquity of a biotechnical imaginary of hope and survivorship in the Global North. This article develops an anthropology of cancer from the Global South that takes seriously the work of palliation and reconciliation, in the process provincializing Global North imaginaries of hope and survivorship., (© 2019 by the American Anthropological Association.)

Objectives: Quality of life (QOL) in breast cancer survivors is affected by various long term sequelae of breast cancer treatment. The present study was conducted with the objectives to estimate prevalence of various survivorship issues, and to identify those which are most predictive of limitations in QOL after completion of primary therapy., Material &methods: This study was conducted in 230 breast cancer survivors (BCs) and 112 controls at an academic centre in Northern India. Assessment of QOL was done by SF-36 and FACT-B questionnaires. Survivorship issues were noted from a checklist of 14 commonly reported symptoms. Main outcome measures were (1) frequencies of survivorship issues and QOL scores among three groups of survivors divided on the basis of time elapsed since treatment (<2, 2-5, and >5 year follow up) (2) Issues most predictive of limitations in QOL, identified by stepwise logistic regression analysis., Results: Longer term BCs showed higher QOL scores as compared to those in early follow up. However their QOL scores remained poorer compared to healthy women. The most prevalent survivorship issues were fatigue (60%), restriction of shoulder movement (59.6%), body and joint pain (63.5%), chemotherapy induced cessation of menstruation (73.3%) and loss of sexual desire (60%). Issues which had maximum impact on QOL scores were emotional distress (r = -11.375), fatigue (r = -9.27) and premature menopause (r = -2.085) and its related symptoms., Conclusion: Management of these issues should be priority areas for supportive care, especially in settings with limited resource., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: With current modalities, cure rates of retinoblastoma are high and hence the number of survivors is increasing. However, data on quality of life (QOL) are minimal., Procedure: We analyzed QOL in 122 retinoblastoma survivors using the PedsQL(TM) 4.0 generic core scale. The self-reported questionnaire was filled by children of more than 5 years of age who had completed treatment for more than 12 months. The questionnaire consists of 23 questions on physical, social, emotional, and school domains on a scale from 0 to 4. This was converted to a scale from 0 to 100, where higher values represented better QOL. The QOL was compared with 50 siblings. Factors predicting the QOL were assessed., Results: The median age of retinoblastoma survivors was 98 months (range 60-247) and 68% were males. Overall QOL was significantly poorer in retinoblastoma survivors as compared with the controls. The emotional health domain of QOL was significantly affected. Difficulties in maintaining friendships and competing were reported in the social health domain. The school health domain showed significantly higher absenteeism. However, the physical health domain, including household work, exercise, and self-care, was similar in both the groups. Lower age at diagnosis (≤ 18 months) predicted better QOL (P = 0.05), whereas age at assessment, sex, IRSS stage, and previous surgery and radiotherapy were not predictive of poor QOL., Conclusions: We found a significantly poorer QOL in retinoblastoma survivors with the psychosocial health domain being more affected than the physical domain. Age less than 18 months at diagnosis predicted better QOL., (© 2015 Wiley Periodicals, Inc.)

A 5 year sentinel surveillance (1989-93) of paralytic poliomyelitis and neonatal tetanus was undertaken at a rural Medical College Hospital at Burdwan, West Bengal. Poliomyelitis incidence showed an overall declining trend, which corroborated with the increased OPV coverage over the years. Incidence was more in males than females. Male:female ratio varied between 2.31:1 to 1.2:1. From 1989 to 1992, age-shift in poliomyelitis was observed when more cases were occurring above 1 year subjects. Cases were reported to be high during the months June to September every year. Incidence of neonatal tetanus (NNT) also showed a declining trend during the 5 year study period. A male preponderance was observed. NNT cases were more prevalent during the months between August and November. In an attempt for eradication of paralytic poliomyelitis and elimination of NNT, containment and other public health measures were undertaken a part of surveillance activities. The obstacles encountered in the surveillance system, as well as lacunae identified in undertaking appropriate health measures was discussed.

Marriage in Indian society is a religious duty. Consanguineous marriage is common, where individuals prefer to marry within their clan (a unilateral kin group based on either matrilineal or patrilineal descent). Keeping in mind that this form of marriage has certain disadvantages for social and biological as well as demographic aspects of individuals and families, the present study examines the influence of mate selection (i.e., close relatives, distant relatives, not related) on female age at marriage, pregnancy wastages, and survival status of the first child. The study was designed based on the information collected on a sample size of 3,948 married women aged 13-49 in Tamil Nadu, India, by the National Family Health Survey (NFHS), 1992. Results suggest that 48 per cent of women in Tamil Nadu marry their relatives. This practice of marrying relatives is high in rural areas, among Hindus, Scheduled Castes/tribes, and illiterate women as compared to urban areas, among non-Hindus, non-SC/ST, and educated women, respectively. The bivariate analysis reveals that women marrying their close relatives had low age at marriage and experienced a higher per cent of pregnancy wastage and child loss (first child) as compared to those women marrying their distant relatives or nonrelatives. The result is found to be consistent even after controlling for selected background variables through multivariate techniques (applied separately for age at marriage, pregnancy wastages, and the survival status of first child). Hence, this study suggests that steps should be taken to inform people about the problems of marrying close relatives through appropriate IEC programs in Tamil Nadu.

Objective: To identify factors for development of dehydration in under five year olds with acute watery diarrhoea., Design: Hospital based unmatched case-control study., Setting: Diarrhoea Treatment Unit, Government Medical College Hospital, Nagpur, India., Participants: The study included 387 cases of diarrhoea having severe or moderate dehydration and 387 controls suffering from diarrhea with mild or no dehydration., Risk Factors: The study included infancy, female sex, religion, residing in urban slums or rural area, under nutrition, cessation of breast feeding during diarrhoeal episode, fluid intake decrease/stopped during diarrhoea, ORS not received, home available funds (HAF) not received, both ORS and HAF not received, non-washing of hands by mother before preparation of food, after defaecation, after disposal of faeces, history of measles in the previous six months, frequency of stools > 8/d, frequency of vomiting more than twice per day and temperature more than 99 degrees F, as risk factors for development of dehydration., Statistical Analysis: Univariate analysis included OR, 95% CI for OR and Chi-square test. Multivariate analysis was carried out by unconditional multiple logistic regression (MLR)., Results: This study identified the significance of infancy, religion, severe undernutrition, non-washing of hands by mother before preparation of food, frequency of stool > 8/d, frequency of vomiting > 2/d, history of measles in previous six months, withdrawal of breast feeding during diarrhoea, withdrawal of fluids during diarrhoea and not giving ORS, HAF or both during diarrhoea, in the outcome of development of moderate or severe dehydration., Conclusions: Timely intervention in the preventable risk factors included in this study may prevent the development of moderate or severe dehydration in the children suffering form acute watery diarrhoea.

Objective: To study the role of birth weight, nutrition, immunization and other medical as well as social factors in determining child survival., Design: A prospective cohort study., Setting: 45 villages in Shirur Development Block in Pune District in Maharashtra., Methods: A cohort of 4129 children were followed from birth till 5 years of age. Weight and length/height of the child was measured at birth and at 3 monthly home visits. Information was also obtained on common childhood morbidities, immunization status and other bio-medical factors. Cause of death was ascertained by verbal autopsy., Results: The neonatal, infant and underfive mortality was rates were estimated to be 37, 60 and 79 per 1000 live births, respectively. Diarrhea and ARI contributed to the major mortality burden. The Kaplan Meier Survival curve showed a sharp fall in the neonatal period, a less rapid decline in the post-neonatal period followed by a marginal fall in the post-infancy period till 5 years age. Girls had a better survival in the early neonatal period but the trend reversed in the late neonatal period. Normal birth weight children had better survival curves compared to low birth weight children. Survival improved with increasing birth order. Multivariate analysis revealed that birth weight, immunization status, and mother's and child's nutritional status influenced infant and under five mortality., Conclusion: Birth weight continues to exert its influence not only on survival/mortality in early life but even as late as 5 years of age. Strategies to improve child survival should include immunization and breastfeeding.

Objective: To determine the impact of Maternal and Child Health (MCH) services on child survival in a socio-economically backward rural community., Setting: Twelve villages in Pondicherry with a population of 16,803., Design: Prospective study., Subjects: A birth cohort of 356 live births (LB) born between January 1st and December 31st 1988., Methods: The live births were followed-up from birth to five years age (1988-1993). The health care received by this cohort and the antenatal services received by the cohort mothers was reviewed. Outcome measures related to child survival were determined and their changing trend since 1967 was examined., Results: Fifty-four per cent of the cohort children were from families below the poverty line. Antenatal registration and tetanus immunization coverage of the mothers of the cohort was 100%. Immunization coverage of the cohort children was more than 98% for BCG, DPT (three doses) and OPV (three doses) and 82% for measles. The infant mortality rate had reduced from 201/1000 LB in 1967 to 64/1000 LB (95% CI 58.9-68.1) in 1989. The child death rate decreased from 29.4/1000 children 1-4 years of age (1970) to 18/1000 (95% CI 13.9-22.1) in 1992. There were no deaths due to neonatal tetanus or measles. Neonatal mortality (35/1000 LB; 95% CI 29.9-40.1) was higher than the post-neonatal mortality (29/1000 LB; 95% CI 24.1-33.9). Fifty eight per cent of the neonatal deaths were due to non-infective causes like prematurity, birth asphyxia, birth injuries and congenital anomalies. Eighty per cent of post neonatal deaths were due to infections. Overall, the child survival index was high (91.27%; 95% CI 88.14-94.26). This was inspite of the low socio-economic background of the children's families., Conclusions: Good MCH services can substantially improve child survival inspite of prevailing low socio-economic situations. Inputs for neonatal care need to be strengthened to further enhance child survival.

A comparative study has been made on two groups of 102 mothers each who delivered children in the postnatal ward of obstetrics and gynaecology department of Calcutta National Medical College before and after the introduction of BFHI (Baby Friendly Hospital Initiative). The study revealed that only 14.3% of the babies who were delivered normally were given their first breast feed in time, the ideal time of half an hour, while not a single baby delivered by caesarean section were given their breast feed within the stipulated time period of 4-6 hours. However, there has been a significant overall reduction in the time gap between the birth and the first breast feed in all types of delivery. BFHI has also made significant reduction of prelacteal feeds and in-between feeds in the newborns especially those delivered normally. The fact that babies of first order and those delivered by caesarean section are lagging behind as far as exclusive breast feeding is concerned has been highlighted in the study.

Objective: To determine risk factors for perinatal asphyxia., Design: Cohort study., Setting: Teaching hospital., Methods: All consecutive hospital births were evaluated during the study period. Asphyxia was defined on intrapartum and neonatal resuscitation criteria. Maternal, intrapartum and neonatal variables were recorded in all births. Data was analyzed after stratifying for live and stillbirths by univariate and logistic regression analyses., Results: Amongst 2371 births (55 fetal deaths and 2316 live births), there were 86 cases of perinatal asphyxia (35 fetal deaths and 51 live births), providing an asphyxia rate of 36.3/1000 births. On multivariate analysis, risk factors significantly associated with asphyxia included prolonged second stage labor (OR 9.4), vaginal breech delivery (OR 6.6), elective cesarean delivery (OR 4.6), pregnancy induced hypertension (PIH) (OR 2.7) and fetal growth retardation (SFD) (OR 2.4). Amongst stillborn, the significant univariate factors associated with asphyxia were prolonged second stage labor (RR 1.7) and cord prolapse (RR 1.7)., Conclusions: There is a need to strengthen intrapartum management and early identification of mothers with PIH or intrauterine growth retardation to reduce asphyxial morbidity and mortality.

Objective: To identify the predictors of mortality due to acute lower respiratory tract infection (ALRI)., Design: Prospective cohort study., Setting: Urban tertiary care teaching hospital., Methods: 201 cases with ALRI between 2 weeks to 5 years of age were prospectively enrolled and followed up to determine outcome. Detailed history and clinical evaluation were recorded on a pretested proforma. Significant independent predictors of mortality were determined by comparison of dead subjects (n = 21) with surviving children (n = 180) in a multiple logistic analytic framework., Results: The case fatality rate (CFR) was 10.45%. Significant independent predictors of mortality were (OR, 95% CI) age less than 1 year (23.1, 2.7-197.5), inability to feed (6.2, 1.3-30.7), associated loose stools (5.1,1.2-27.3), weight for age Z score < -3 (3.9,1.01-9.7), short duration of fever (1.2,1.0-1.5) and bandemia (1.1,1.05-1.2). The WHO guidelines identified 91% of children diagnosed as ALRI by clinical and investigative criteria. The CFR was related to severity of WHO classification ("pneumonia"-0%, "severe pneumonia"-8.7% and "very severe pneumonia"-47.0%). However, 2 of the 18 subjects with a diagnosis of "no pneumonia" expired (CFR 11.1% and 10% of total mortality)., Conclusion: Even in settings of high case fatality, predictors of mortality can be identified in under five children suffering from ALRI. In this context, age below 1 year, inability to feed, presence of loose stools and severe malnutrition merit attention for interventional purposes.

India has an excellent infrastructural layout for the delivery of MCH services in the community through a network of subcenters, primary health centers, community health centers, district hospitals, state medical college hospitals, and other hospitals in the public and private sectors. However, the health pyramid does not function effectively because of limited resources, communication delays, a lack of commitment on the part of health professionals, and, above all, a lack of managerial skills, supervision, and political will. The allocation of financial resources for the delivery of health care continues to be meager. Nevertheless, in spite of obvious constraints, the country has made laudable progress in reducing post-neonatal mortality in recent years. Indeed, the focus has shifted to the young infants and the perinates. Under the CSSM program, a massive expansion of MCH services has occurred at the sub-district and the district levels. The RCH program, to be launched shortly, aims at effective utilization of these facilities to ensure delivery of integrated services of assured quality through decentralized planning. Simultaneously, as a result of the ongoing economic liberalization, the MCH care in the private sector will also expand rapidly. Indeed, India is on the threshold of an extraordinary improvement in the status of its neonatal-perinatal health.

Objectives: To evaluate the impact and sustainability of a baby friendly training intervention for staff at an Indian district hospital on initiation of breast feeding and use of prelacteal feeds by mothers., Design: Intervention study with assessment by interviewing mothers., Subjects: 172 mothers recruited before the intervention, 195 recruited immediately after the intervention, and 101 recruited six months later., Setting: District hospital in a small town in Bihar, India., Main Outcome Measures: Age of infant when breast feeding started, use of prelacteal feeds, and colostrum feeding., Intervention: 10 day training programme for doctors, nurses, and midwives, explaining the benefits and feasibility of early breast feeding and dangers of prelacteal feeds together with instruction on explaining this information to mothers., Results: Breast feeding was started within 24 hours of birth by 53 (29%) of control mothers, 164 (84%) in the early follow up group, and 60 (59%) in the late follow up group. Prelacteal feeds were used by 165 (96%), 84 (43%), and 78 (77%) respectively. Only 36 mothers in the late follow up group reported receiving education on feeding. Mothers in this group who had received the education were significantly more likely than mothers who received no education to breast feed early (28 (78%) v 11 (17%), P < 0.001) and not use prelacteal feeds (21 (58%) v 2 (3%), P < 0.001)., Conclusions: Training doctors and midwives greatly improves the feeding practices of mothers. However, the impact of the training fell off quickly and refresher training is needed to sustain the improvement.

"This paper proposes to construct, for India, a two-regional life table, considering two regions viz., rural and urban. Such a table provides information on the probabilities of survivorship and migration, as well as life expectancy by age, region and place of birth and in particular information on: (1) The probability that an individual living in a rural area at age x will be living in an urban area at age y. (2) Life expectancy at birth in a rural area, and the number of years on average this individual may live in an urban area. The aim here is to compare and contrast rural to urban and urban to rural migration probabilities by sex and age for the years 1971, 1981 and 1991, and provide the underlying reasons. Region-specific life expectancy is also compared for these years." (SUMMARY IN ITA AND FRE), (excerpt)

Interns are being used in two experimental health education projects in a rural area of India. In one the interns talk to mothers waiting with their children at an immunization clinic; in the other they train volunteer schoolchildren to act as school health guides in a child-to-child programme.

The traditional preference for sons may be the main hindrance to India's current population policy of two children per family. In this study, the effects of various sociodemographic covariates, particularly sex preference, on the length of the third birth interval are examined for the scheduled caste population in Assam, India. Life table and hazards regression techniques are applied to retrospective sample data. The analysis shows that couples having two surviving sons are less likely to have a third child than those without a surviving son and those with only one surviving son. Age at first marriage, length of preceding birth intervals, age of mother, and household income have strong effects on the length of the third birth interval.

"This paper proposes the use of Weibull Hazard function to obtain [an] improved estimate of person years lived in infant and childhood ages. As the estimation procedure is too involved for those who construct life tables, an easier method of obtaining the same is provided.... An illustrative application of the procedure is also presented." The data used for this illustration are from the Sample Registration System of India., (excerpt)