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BACKGROUND Haemolytic Disease of Fetus and Newborn (HDFN) is characterised by lysis of red blood cells resulting in anaemia and its hypoxic effects thereafter. Following anaemia, the production of fetal red blood cells is drastically increased. This is followed by extramedullary haematopoiesis in a widespread manner and erythroblastosis characterized by nucleated red cells in the circulation. Since this is an illness affecting many a newborn, assessing the patterns of anaemia in both ABO and Rh-D HDFN may help in effective planning and implementation of better management protocols. METHODS This is a cross sectional study with comparative analysis. The study was performed among 154 neonates who were diagnosed to have HDFN. Setting for this study was Department of Transfusion Medicine and Pediatrics of Government Medical College, Trivandrum. During the time of delivery, 5 mL umbilical cord blood was collected. That sample was used for analyzing haemoglobin levels of the neonate. Duration of treatment of the neonate was noted down during follow up. Statistical analysis was done using SPSS software version 16. RESULTS The mean cord blood haemoglobin value in ABO haemolytic disease was 17.1 ± 2.7 g %. The mean cord blood haemoglobin value in Rh-D haemolytic disease was 14.5 ± 1.9 g %. In infants with ABO haemolytic disease, 53 (48.2 %) had undergone no treatment in ICU. Remaining 51.8 % had undergone 3 - 10 days of treatment in neonatal ICU. Infants with Rh-D HDFN 20 (45.5 %), had undergone no treatment in ICU. Remaining 54.5 % has got 3 - 9 days of treatment in neonatal ICU. Mean treatment duration in infants with ABO haemolytic disease was 3.1 ± 3.3 days. Mean treatment duration in infants with Rh-D haemolytic disease was 2.9 ± 2.9 days. A comparison of mean values of cord blood haemoglobin in neonates with both categories of haemolytic disease was performed. The p value was 0.00 and it was significant. Mean values of duration of treatment of neonates with ABO and Rh-D haemolytic anaemias were compared statistically. No significant difference was observed. CONCLUSIONS Mean haemoglobin levels in Rh-D HDFN showed a significant decrease as compared to ABO-HDFN. Duration of treatment in ABO HDFN and Rh-D HDFN presented no significant difference. KEYWORDS Haemolytic Disease of Fetus and Newborn, Umbilical Cord Haemoglobin, Anaemia, ICU Stay, ABO HDFN, Rh-D HDFN

BACKGROUND Lifespan of fetal or neonatal red cells is decreased by placental transfer of maternally produced IgG antibodies in immune mediated Haemolytic Disease of Fetus and Newborn (HDFN). We wanted to compare cord blood bilirubin levels and the duration of ICU stay in maternal ABO and RH-D antibody mediated haemolytic disease of fetus and newborn. METHODS This research work was designed as a cross sectional study. 154 neonates who were diagnosed to have HDFN were studied in the Department of Transfusion Medicine and Pediatrics, Government Medical College, Trivandrum, Kerala. 5 mL umbilical cord blood was collected at the time of delivery. The collected sample was used for analyzing bilirubin levels. Duration of ICU stay of the neonates was recorded. SPSS version 16 was used for statistical analysis. RESULTS The mean cord blood bilirubin levels in ABO haemolytic disease was 5.16 ± 1.91. The mean cord blood bilirubin level in Rh-D haemolytic disease was 4.15 ± 1.10. In infants with ABO haemolytic disease, 55 (50 %) stayed in ICU for 5 days. Remaining 50 % stayed in ICU ranging from 6 - 14 days. Among infants with RhD haemolytic disease 22 (50 %) stayed in ICU for 5 days. Remaining 50 % had stayed in ICU for 6 - 15 days. Mean duration of stay of infants with ABO haemolytic disease in ICU was 7.2 ± 2.9 days. The mean duration of stay of infants with RhD haemolytic disease in ICU was 6.8 ± 2.7 days. Mean values of cord blood bilirubin levels in both categories of haemolytic disease (ABO and Rh-D HDFN) were compared using independent t test. Significant difference was observed with a p value of 0.001. Mean values of duration of stay of neonates in both categories of haemolytic disease (ABO and Rh-D HDFN) in ICU were compared using independent t test. No significant difference was observed during the analysis. CONCLUSIONS Umbilical cord blood bilirubin levels were significantly higher in ABO haemolytic disease as compared to Rh-D haemolytic disease. Even though duration of stay in ICU was higher for neonates suffering from ABO HDFN as compared to Rh-D HDFN category, the difference was not statistically significant.

Objectives: A three-member central Rapid Response Team (RRT) was deputed to Union Territory of Ladakh on 26th March 2020, to assess the situation and support the preparedness measures including implementation of cluster containment plan and social distancing measures for coronavirus disease 2019 (COVID-19). Methods: Central RRT addressed the panchayat sarpanch and religious leaders, sensitized doctors and paramedical staff on COVID-19 situation; conducted situational analysis, review of records and logistics, key informant interviews of senior administrative and healthcare officials, focus group discussions with local community people and field visits to various hospitals, isolation centers, quarantine facilities, and containment zones. Results: A total of 14 COVID-19 cases with no deaths were reported and nine patients had recovered till 4 April 2020. The median (range) age of positive cases was found to be 32.5 (6 months–76 years) years and overall attack rate was 1.65 per 1000 population. Ladakh Government declared Chuchot Gongma, Yokma and Sankoo as the containment zones and deputed surveillance teams. A total of 2397 persons were quarantined and 496 samples were tested from Ladakh. COVID-19 sample testing, Srinagar-Leh highway opening and Iran pilgrimage returnees were the major challenges identified. Conclusions: The Ladakh government must continue the robust surveillance system and stringent strategies in key areas for management of COVID-19 namely – aggressive screening and testing, isolation, quarantine, hand hygiene, respiratory etiquettes and social distancing.

BackgroundDespite the success of adult vaccination against COVID-19, providing vaccines to children remains a challenge for policymakers globally. As parents are primary decision-makers for their children, we aimed to assess parents' perceptions and intentions regarding COVID-19 vaccination in India.MethodsA cross-sectional web-based study was designed, parents or caregivers (N = 770) were recruited through snowball sampling using Google form. Cross-tabulation was performed by parents' intention to vaccinate their children against COVID-19 virus with sociodemographic characteristics and their risk perception toward COVID-19, trust in the healthcare system, and their history of vaccine hesitancy behavior. Multivariable logistic regression analysis was performed to compute the predictors of child vaccination intention among Indian parents.ResultsSeven hundred and seventy parents across the country have completed the survey. Of the 770 participants, 258 (33.5%) have shown intent to vaccinate their children. The stated likelihood of child vaccination was greater among parents who had a bachelor's degree or higher education (aOR: 1.98, 95% CI: 1.15–3.51); as well as among parents who intended to vaccinate themselves (aOR: 2.35, 95% CI: 1.30–4.67). Parental concerns centered around vaccine safety and side effects.ConclusionIndian parents reported high knowledge of the COVID-19 virus and were aware of the development of a vaccine. However, about one-third of parents intended to vaccinate their children, and about half of them were not sure whether to vaccinate their children or not against the COVID-19 virus. The study highlighted the need for health promotion strategies that promote vaccine uptake among parents.

Background: Vaccine hesitancy is of considerable concern as it threatens the great potential of a vaccine against COVID-19. Community health workers (CHWs) bridge the gap between the community and the health care system. Their intention to get vaccinated will not only affect them but will also affect the community’s perception of the vaccine. This study aims to understand the intention to get vaccinated against COVID-19 among community health care workers in India and its determinants.Methods: A web-based, cross-sectional study was conducted among 357 community health workers using snowball sampling. A self-administered anonymous questionnaire was shared with study participants across major geographical regions in India through social media during the first wave (November-December 2020).Results: Among 357 community health workers, 208 (58%) responded positively regarding their intention to get a COVID-19 vaccine. Graduate [aOR 2.26 (95% CI: 1.27-4.01), p=0.006] and post-graduate participants [aOR 2.85 (95% CI: 1.43-5.68), p=0.003], those with lower risk perception [aOR 1.86 (95% CI: 1.03-3.35), p=0.038] and respondents who trusted the healthcare system [aOR 2.60 (95% CI:1.59-4.26), pConclusions: Increasing knowledge regarding the COVID-19 vaccine might not be enough to improve vaccine acceptance rates. Enhancing trust among community health workers in the healthcare system and regarding the available vaccines seem necessary. In addition, targeted interventions addressing socio-demographic determinants related to COVID-19 vaccination should help improve acceptance of the vaccine.

BackgroundThe associated risk factors, co-morbid conditions and biological variations varying with gender and age might be the cause of higher COVID-19 infection and deaths among males and older persons. The objective of this study was to predict and specify the biological attributes of variation in age and gender-based on COVID-19 status (deceased/recovered).MethodsIn this retrospective study, the data was extracted from a recognised web-based portal. A total of 112,860 patients’ record was filtered out and an additional 9,131 records were separately analyzed to examine age and gender relationship with patient’s COVID-19 status (recovered/deceased). Chi-square, t-test, binary logistic regression, and longitudinal regression analysis were conducted.ResultsThe male COVID-19 cases (65.39%) were more than females (34.61%) and mean age of infected and recovered patients was 39.47±17.59 years and 36.85±18.51 years respectively. The odds for infection was significantly higher among females for lower age categories, which declines with age. The age-adjusted odds for recovery were significantly higher among females (O.R.=1.779) and odds for recovery was highest in 5-17 years age category (O.R.=88.286) independent of gender.ConclusionThe chances of being COVID-19 infected was higher for females of lower age categories (