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Key Points: Question: How does a package of multidomain interventions addressing health, nutrition, psychosocial care and support, and environmental hygiene delivered during preconception, pregnancy, and early childhood affect child neurodevelopment at 24 months? Findings: In this second report of a randomized trial in India assessing interventions during preconception, pregnancy, and early childhood on childhood preterm births and childhood growth as primary outcomes, the secondary outcome was neurodevelopment at 24 months. Among 1712 children assessed, preconception, pregnancy, and early childhood interventions were associated with modest improvements in scores and lower incidence of moderate to severe neurodevelopmental delay in the cognitive, language, and socioemotional domains. Meaning: Multidomain interventions in the preconception period, along with those in pregnancy and early childhood, may be beneficial for child neurodevelopment. Importance: Multidomain interventions in pregnancy and early childhood have improved child neurodevelopment, but little is known about the effects of additional preconception interventions. Objective: To evaluate the effect of a multifaceted approach including health; nutrition; water, sanitation, and hygiene (WASH); and psychosocial support interventions delivered during the preconception period and/or during pregnancy and early childhood on child neurodevelopment. Design, Setting, and Participants: In this randomized trial involving low- and middle-income neighborhoods in Delhi, India, 13 500 participants were assigned to preconception interventions or routine care for the primary outcome of preterm births and childhood growth. Participants who became pregnant were randomized to pregnancy and early childhood interventions or routine care. Neurodevelopmental assessments, the trial's secondary outcome reported herein, were conducted in a subsample of children at age 24 months, including 509 with preconception, pregnancy, and early childhood interventions; 473 with preconception interventions alone; 380 with pregnancy and early childhood interventions alone; and 350 with routine care. This study was conducted from November 1, 2000, through February 25, 2022. Interventions: Health, nutrition, psychosocial care and support, and WASH interventions delivered during preconception, pregnancy, and early childhood periods. Main Outcomes and Measures: Cognitive, motor, language, and socioemotional performance at age 24 months, assessed using the Bayley Scales of Infant and Toddler Development 3 tool. Results: The mean age of participants at enrollment was 23.8 years (SD, 3.0 years). Compared with the controls at age 24 months, children in the preconception intervention groups had higher cognitive scores (mean difference [MD], 1.16; 98.3% CI, 0.18-2.13) but had similar language, motor, and socioemotional scores as controls. Those receiving pregnancy and early childhood interventions had higher cognitive (MD, 1.48; 98.3% CI, 0.49-2.46), language (MD, 2.29; 98.3% CI, 1.07-3.50), motor (MD, 1.53; 98.3% CI, 0.65-2.42), and socioemotional scores (MD, 4.15; 98.3% CI, 2.18-6.13) than did controls. The pregnancy and early childhood group also had lower incidence rate ratios (RRs) of moderate to severe delay in cognitive (incidence RR, 0.62; 98.3% CI, 0.40-0.96), language (incidence RR, 0.73; 98.3% CI, 0.57-0.93), and socioemotional (incidence RR, 0.49; 98.3% CI, 0.24-0.97) development than did those in the control group. Children in the preconception, pregnancy, and early childhood intervention group had higher cognitive (MD, 2.60; 98.3% CI, 1.08-4.12), language (MD, 3.46; 98.3% CI, 1.65-5.27), motor (MD, 2.31; 98.3% CI, 0.93-3.69), and socioemotional (MD, 5.55; 98.3% CI, 2.66-8.43) scores than did those in the control group. Conclusions and Relevance: Multidomain interventions during preconception, pregnancy and early childhood led to modest improvements in child neurodevelopment at 24 months. Such interventions for enhancing children's development warrant further evaluation. Trial Registration: Clinical Trials Registry–India CTRI/2017/06/008908 This randomized trial assesses interventions that span preconception through early childhood compared with usual care on neurodevelopment among children at age 24 months in low- and middle-income neighborhoods in India. [ABSTRACT FROM AUTHOR]

Objective: In this secondary analysis of data from an intervention trial, we assessed the performance of Mid Upper Arm Circumference (MUAC) as a predictor of mortality in children aged 6–59 months from Delhi, India, one year after their initial MUAC measurements were taken. Additionally, we assessed MUAC as an absolute value and MUAC z-scores as predictors of risk of mortality. Methods: In the trial, children were screened using MUAC prior to referral to the study clinic. These children were revisited a year later to ascertain their vital status. Baseline MUAC and MUAC z-scores were used to categorize children as severely (MUAC <115 mm, MUAC z-score <-3SD) or moderately (MUAC 115 to <125 mm, MUAC z-score <-2SD) malnourished. The proportion of malnutrition, risk of mortality, relative risk estimates, positive predictive value and area under the curve (AUC) by MUAC and MUAC z-scores were calculated. Results: In the resurvey, the first 36159 children of the 48635 in the initial survey were contacted. Of these, vital status of 34060 (94.2%) was available. The proportion of severe malnutrition by MUAC (<115 mm) was 0.5% with an associated mortality of 4.7% over a one year period and an attributable mortality of 13% while the proportion of the severe malnutrition by MUAC z-score (<-3SDwas 0.9% with an associated mortality of 2.2%. Conclusions: MUAC is a significant predictor of subsequent mortality in under-five children. In settings where height measurement is not feasible, MUAC can be used as a screening tool for identifying severely malnourished children for management. [ABSTRACT FROM AUTHOR]

A case of congenital toxoplasmosis manifesting as hepatosplenomegaly and cholestatic jaundice in a 4 month old child is reported. To the best of our knowledge this is the first report of cholestatic jaundice due to congenital toxoplasmosis from India. The child was successfully treated with sulphadiazine and pyremethamine combination. [ABSTRACT FROM AUTHOR]

In order to relate etiology of diarrhea to the duration of the episode, a cohort of 452 children up to 36 months of age was visited once weekly at their households for 18 consecutive months to record diarrheal morbidity. Fecal specimens were obtained in 453 diarrheal episodes occurring in 354 children during this period. The common putative agents as single isolations associated with diarrhea were EA-AggEC (17.2%), ETEC (14.1%), EPEC (6.0%) and rotavirus (4.0%). The pathogens with higher median duration of diarrhea were Shigella (13.5; mean +/- SD 13.7 +/- 2.7), Salmonella (8.8: 15.3 +/- 4.5) and EA = AggEC (12.0: 15.1 +/- 1.8). Of 55 episodes with duration of greater than 14 days, the main pathogens isolated were EA-AggEC (32.7%), ETEC (9.0), Salmonella, G. lamblia (5.5% each) and Shigella (3.5%). These data provide a preliminary evidence to suggest that EA = AggEC may well be the main long sought microbial agent responsible for diarrhea of long duration. [ABSTRACT FROM AUTHOR]

District wise rice and wheat yield prediction equations were developed for seven districts of eastern Madhya Pradesh using weakly weather data from 1980-2009. The coefficient of determination (R2) varied between 0.4 - 0.78 for rice and 0.6 - 0.92 for wheat in different districts. Model performance was evaluated with independent reported data for year 2010 and 2011. As the deviations for both the years were less than ± 15 per cent, the models can be used for predicting the rice and wheat yields in Madhya Pradesh. [ABSTRACT FROM AUTHOR]

During a period of 20 months, 1467 children suffered from 1663 diarrheal attack in a rural community of Haryana. As many as 23 diarrhoea related deaths were recorded. Although diarrheal attack /100children were similar in different nutritional groups (P>0.05), the case fatality rate (%) was higher In grade III (7.69; P<0⋅001) as compared to normal (0⋅32) and grades 1 (0⋅49) nod II (2⋅23) real malnutrition. The mortality was higher in protracted diarrhoea (P<0.001) than when the duration was <2wk (0⋅7%,). Twenty one (91⋅3%,) of the 23 children who died, had sought treatment from a practicing physician (6), hospital (6) or local dispensary. Oral rehydration therapy was used in 38⋅7 per cent of diarrhoeal episodes. Past malnutrition, protracted diarrhoeal illness and non-me of ORT appear to be Important associated factors In diarrhoeal mortality in a rural community. [ABSTRACT FROM AUTHOR]

Objective: To compare the acceptability and energy intake of Ready-to-Use Therapeutic Food (RUTF) with cereal legume based khichri among malnourished children. Design: An acceptability trial with cross-over design. Setting: Urban low to middle socioeconomic neighborhoods in Delhi. Subjects: 31 children aged ≥6 to ≥36 months with malnutrition, defined as Weight for height (WHZ) < -2 to &ge - 3 SD, with no clinical signs of infection or edema. Intervention: Children were offered weighed amounts of RUTF and khichri in unlimited amounts for 2 days, one meal of each on both days. Water was fed on demand. Caregivers' interviews and observations were conducted on the second day. Outcome Measures: Acceptability of RUTF compared to khichri based on direct observation and energy intake for test and control meals. Results: The proportion of children who accepted RUTF eagerly was 58% as against 77% for khichri. 42% children on RUTF and 23% on khichri accepted the meal but not eagerly. The median (IQR) energy intake over the two day period in children aged 6 to 36 months from RUTF was 305 (153, 534) kcal, and from khichri was 242 (150, 320) kcal (P=0.02). Conclusion: RUTF and khichri were both well accepted by study children. The energy intake from RUTF was higher due to its extra energy density. [ABSTRACT FROM AUTHOR]

Six accessions of geranium ( Pelargonium sp. 'hybrid') were introduced in temperate and subtropical regions of Jammu and Kashmir. The herbaceous parts in the commercial distillation gave 0.09-0.13% oil on fresh weight basis. The calculated herbage yield (tonnes/ha) and oil yield (litre/ha) varied from 31.5 ± 1.87 to 49.1 ± 2.73 and 32.40 to 57.12, respectively. The geranium oil produced in different regions of Jammu and Kashmir was comparable to that produced in other geranium-growing areas in India in terms of its major constituents, citronellol (22.5-34.5%) and geraniol (13.9-24.7%), respectively. This suggests that geranium can be successfully grown in the state of Jammu and Kashmir. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Summary Typhoid fever is estimated to have caused 21·6 million illnesses and 216 500 deaths globally in 2000, affecting all ages. There is also one case of paratyphoid fever for every four of typhoid. The global emergence of multidrug-resistant strains and of strains with reduced susceptibility to fluoroquinolones is of great concern. We discuss the occurrence of poor clinical response to fluoroquinolones despite disc sensitivity. Developments are being made in our understanding of the molecular pathogenesis, and genomic and proteomic studies reveal the possibility of new targets for diagnosis and treatment. Further, we review guidelines for use of diagnostic tests and for selection of antimicrobials in varying clinical situations. The importance of safe water, sanitation, and immunisation in the presence of increasing antibiotic resistance is paramount. Routine immunisation of school-age children with Vi or Ty21a vaccine is recommended for countries endemic for typhoid. Vi vaccine should be used for 2-5 year-old children in highly endemic settings. [ABSTRACT FROM AUTHOR]

Six varieties/strains belonging to three species of Cymbopogon, viz., C. flexuosus, C. khasianus and C. pendulus, or their hybrids, were evaluated for oil yield across four years (1997-98-2000- 01) as very limited information is available on variety-by-environment interaction from multi-environment trials. The main effects, varieties and years, were significant, but variety-by-year interaction was not significant. Log-transformation of data reduced coefficients of variation from 45.52% to 16.7% and increased R-square for the linear model from 70.8% to 81.9%. A traditional analysis of variance indicated that CKP25 and F2-38 were not different in oil yield and were superior to other varieties. Principal component analysis of GGE biplot methodology also revealed CKP25 to be the highest yielding genotype in all four years, followed by F2-38. Variety CKP25 could be used in a breeding program to develop new high yielding, consistent-performing varieties. Both untransformed and log-transformed data analyses revealed that 1998-99 and 2000-01 were closest to the ideal environment, i.e., they were most discriminating of genotypes and most representative of all environments. GGE biplot methodology can be used effectively in variety trials, whether or not genotype-by-environment interaction is significant. [ABSTRACT FROM PUBLISHER]

We sought to determine the proportion of rotavirus (RV) infections among children with severe diarrhea in Bangalore, India, and to determine the role of neonatal infection with the asymptomatic RV strain 1321 in protection against subsequent RV diarrhea. At 2 major hospitals, there was a >42% decrease in diarrhea-specific admissions during the study period. At 6 hospitals, asymptomatic infections were found in 25%-50% of neonates, when screening was performed randomly, and in >58% of neonates, when screening was performed daily, with the majority of infections occurring within the first 7 days of life. All the RVs found in asymptomatic neonates were strain 1321. A 24-month follow-up of a cohort of 44 children who had been neonatally infected with strain 1321 and 28 children who had not (control group) revealed comparable rates of RV detection but a marked decrease in the number of RV diarrhea episodes in the strain 1321-infected group (2.3%), compared with the control group (39.3%) (P< .0001). This preliminary study suggests a possible association between neonatal infection with strain 1321 and protection against subsequent RV illness. [ABSTRACT FROM AUTHOR]

Rotavirus is the leading cause of childhood diarrhea worldwide, causing an estimated 600,000 deaths each year. To assess the potential benefits of a national rotavirus immunization program in India, we analyzed 40 published studies of rotavirus that were conducted between 1976 and 1997 and included a total of approximately 13,000 Indian pediatric inpatients. Pediatric studies featuring 100 or more patients and lasting at least 12 months in duration and all neonatal studies were analyzed. Rotavirus was detected in a median of 18% of pediatric patients and 28% of neonates surveyed. Fifty percent of all children hospitalized with rotavirus by age 5 were hospitalized by the age of 6 months, 75% by the age of 9 months, and almost 100% by the age of 2 years. Rotavirus was most prevalent (31%) in children between 7 and 12 months of age, followed by children between 1 and 2 years of age (20%), and children < 7 months of age (13%). VP7 genotypes G1 and G2 were most commonly isolated although significant heterogeneity of serotypes was observed. P[11], G9 strains were most frequently isolated among neonates. In 1998; approximately 98,000 childhood deaths were caused by rotavirus. These data underscore the urgent need for safe and effective interventions against rotavirus such as vaccines. The significant diversity of rotavirus strains and young age of hospitalization pose unique challenges to the formulation of a rotavirus immunization program in India, but raise the possibility of utilizing a neonatal vaccine to provide effective coverage. [ABSTRACT FROM AUTHOR]

Two hundred and five cases (mean age 13.4, SD 9.5) of persistent diarrhoea (PD) of 14–28 days duration, attending an urban slum clinic and treated according to standard WHO guidelines, were monitored at weekly intervals to obtain an estimate of treatment failure rates and to identify its clinical predictors. Vitamin and micronutrients (daily 2RDA) were additionally provided. Only 9 (8.2%) of 109 children with criteria for hospital care accepted in-patient care. Weight gain was considered inadequate if the daily increment between enrolment and day 7 of follow up was < 10 g at age 0–3 months, < 5 g at 4–6 months, and any weight loss for those older than 6 months. Recovery was considered delayed if diarrhoea ceased 7 days after enrolment. Overall, 28.3 % cases had inadequate weight gain and 25.6% had delayed recovery. The non-breast milk calorie intake was 11.2 % during infancy and 40.6 % at later ages of the recommended intakes. In a logistic regression model, initial watery stool frequency greater than median (adjusted OR 2.30, p=0.01), age < 6 months (adjusted OR 2.24, p=0.04) and low consumption of micronutrient mixture (adjusted OR 2.62, p=0.01) were associated with an increased risk of delayed recovery. In a Cox proportional hazards model for time to recovery from diarrhoea, low consumption of the micronutrient mixture and age < 6 months reduced the chances of recovery by 29 % and 37 % respectively. Low consumption of the prescribed micronutrient mixture (adjusted OR 2.21, p=0.04), fever (adjusted OR 1.91, p=0.05) and diarrhoea continuing beyond study day 7 (adjusted OR 2.29, p=0.03) increased the risk of inadequate weight gain. Breast feeding status and animal milk consumption did not influence weight gain or recovery. Due to the low compliance for advised hospitalisation, approaches for care at community level itself need to be evolved. Focus should be on increasing the overall dietary intake and provision of generous but safe amount of micronutrients; our findings do not support need for routine elimination of animal milk. The efficacy of individual micronutrients needs evaluation in controlled trials. [ABSTRACT FROM AUTHOR]