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WHO's 2013 PMTCT guidelines recommended lifelong antiretroviral therapy (ART) for HIV-infected pregnant and breastfeeding women, exclusive breastfeeding (EBF), nevirapine prophylaxis (NVP) and early infant diagnosis (EID) for HIV-exposed-breastfed infants. We examined the association between knowledge and adherence to these guidelines among 550 HIV-infected pregnant women in Maharashtra, India. Knowledge of PMTCT guidelines was assessed using a structured-questionnaire during enrollment. Adherence to ART, NVP, and EBF was assessed using structured questionnaires during post-partum home visits at 2 weeks, 2, and 6 months respectively. EID adherence at 6 weeks was assessed by weekly infants' HIV testing clinical record review. We used Fisher's exact test to assess the association between correct knowledge and subsequent adherence and logistic regression to estimate the odds ratios. The results showed that women's correct responses to specific questions of each PMTCT guideline correlated with subsequent adherence. For instance, awareness of duration and place to obtain ART was associated with a higher likelihood of taking ART at delivery (aOR = 1.93, p = 0.02 and aOR = 3.91, p < 0.01 respectively). Similarly, women knowing only breastmilk should be given to infants for 6 months showed highest adherence to EBF (aOR = 2.59, p = 0.02). Women who correctly knew the reason for infant NVP administration were more adherent to it at 6 weeks (aOR = 1.77; p = 0.03). Women aware of mother-to-child HIV transmission during delivery had highest adherence to EID at 6 weeks (aOR 3.58, p = 0.01). Gaps were identified in women's detailed knowledge of and adherence to each PMTCT guideline. Suboptimal adherence to ART (n = 389, 71%), EBF (n = 179, 33%), NVP (n = 428, 78%), and EID at 6 weeks (n = 369, 67%) was found. Our study suggests providing a comprehensive knowledge of each guideline through the PMTCT program's education strategies can enhance adherence among HIV-infected women. [ABSTRACT FROM AUTHOR]

In March 2021, severe signs of powdery mildew were observed on leaves and stems of Coccinia grandis in the Manchar, Pune District, Maharashtra state, India. Based on morphological examination, phylogenetic analyses, and pathogenicity test, the causal agent of powdery mildew on Coccinia grandis was identified as Golovinomyces tabaci. To our knowledge, this is the first record of G. tabaci infecting C. grandis in India. Previously, G. tabaci had only been reported on C. grandis from Taiwan and Thailand. [ABSTRACT FROM AUTHOR]

In December 2020, Euphorbia leucocephala plants exhibiting symptoms of powdery mildew were observed in the Botanical Garden of Tuljaram Chaturchand College, Baramati, Maharashtra, India. Based on morphological identification, DNA sequence analysis, and pathogenicity, the fungal pathogen of the disease was identified as Leveillula clavata. This is the first report of L. clavata on Euphorbia leucocephala from India and in general. [ABSTRACT FROM AUTHOR]

Introduction: Xpert Mycobacterium tuberculosis/Resistance to Rifampicin (MTB/RIF) assay detects MTB Complex (MTBC) and rifampicin resistance simultaneously. In high prevalence countries like India, detection of rifampicin resistance in sputum specimen of a newly diagnosed case of pulmonary TB with a low pretest probability needs to be confirmed by retesting. Aim: To evaluate the results of retesting of rifampicin resistant specimens in newly diagnosed pulmonary TB cases. Materials and Methods: A retrospective analysis of the data of Xpert assay was performed on specimens received in Department of Microbiology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India from 1st June 2018 to 31st May 2020. If rifampicin resistance was detected in a newly diagnosed case of Tuberculosis (TB), a second specimen was retested by Xpert assay for confirmation. Concordance of retesting was seen with results of Line Probe Assay (LPA). Results: Total 27,429 specimens were processed by Xpert assay of which 803 specimens showed rifampicin resistance, 157 sputum specimens fulfilling criteria of Programmatic Management of Drug resistant Tuberculosis (PMDT) guidelines were retested. High, medium, low and very low bacterial load was observed in 30, 51, 34 and 42 specimens' respectively. All specimens having high or medium bacillary load showed rifampicin resistant result on retesting. On retesting 34 sputum specimens with low bacterial load, rifampicin resistance was confirmed in 30 specimens. LPA done after growing them by liquid culture confirmed rifampicin resistance in remaining four specimens. Conclusion: Xpert assay is recommended when the bacterial load identified by Xpert assay is very low and when there is discordance between Xpert results of rifampicin resistance and the reflex LPA testing. [ABSTRACT FROM AUTHOR]

Nexus research can help address issues arising at the intersection of traditionally independently treated management, policy, and research areas. While an extensive body of literature and reviews have been published on the water, food and energy nexus, biodiversity is less commonly featured in food and water nexus research, particularly in India. India hosts a large proportion of the world's biological diversity. At the same time, it is facing one of the world's highest habitat conversion rates, among others for agricultural production, as well as increasing water scarcity. Hence, the integration of biodiversity considerations into food and water nexus management and governance decisions is particularly critical in India. Here, we explore linkages at the food, water and biodiversity (FWB) nexus in India using a systematic review of peer-reviewed literature. A total of 208 nexus linkages were extracted from 55 articles and mapped using a qualitative systems mapping approach. Results show a strong interdependence between all three nexus nodes, with biodiversity exhibiting the highest number of linkages across the system (137 linkages), followed by water (131 linkages) and food (120 linkages). Our results reflect the state-of-the-art of research on biodiversity at the food-water nexus in India and highlight the importance of better understanding the linkages and tradeoffs at India's FWB nexus. • Biodiversity is less commonly addressed within nexus studies than other nexus pairings. • We also still require national studies assessing nexus linkages, trade-offs and synergies. • Combining a literature review and the kumu software, we develop a systems map to visualize nexus linkages in India. • We show that food, water and biodiversity are highly connected in India, with implications for their governance. • Biodiversity is most connected across the system (137 linkages), followed by water (131) and food (120). [ABSTRACT FROM AUTHOR]

Introduction: India's national AIDS Control Organization implemented World Health Organization's option B+ HIV prevention of mother‐to‐child transmission (PMTCT) guidelines in 2013. However, scalable strategies to improve uptake of new PMTCT guidelines to reduce new infection rates are needed. This study assessed impact of Mobile Health‐Facilitated Behavioral Intervention on the uptake of PMTCT services. Methods: A cluster‐randomized trial of a mobile health (mHealth)‐supported behavioural training intervention targeting outreach workers (ORWs) was conducted in four districts of Maharashtra, India. Clusters (one Integrated Counselling and Testing Center (ICTC, n = 119), all affiliated ORWs (n = 116) and their assigned HIV‐positive pregnant/postpartum clients (n = 1191)) were randomized to standard‐of‐care (SOC) ORW training vs. the COMmunity home Based INDia (COMBIND) intervention – specialized behavioural training plus a tablet‐based mHealth application to support ORW‐patient communication and patient engagement in HIV care. Impact on uptake of maternal antiretroviral therapy at delivery, exclusive breastfeeding at six months, infant nevirapine prophylaxis, and early infant diagnosis at six months was assessed using multi‐level random‐effects logistic regression models. Results: Of 1191 HIV‐positive pregnant/postpartum women, 884 were eligible for primary outcome assessment; 487 were randomized to COMBIND. Multivariable analyses identified no statistically significant differences in any primary outcome by study arm. COMBIND was associated with higher uptake of exclusive breastfeeding at two months (adjusted Odds Ratio (aOR), 2.10; 95% CI 1.06 to 4.15) and early infant diagnosis at six weeks (aOR, 2.19; 95% CI 1.05 to 3.98) than SOC. Conclusions: The COMBIND intervention was easily integrated into India's existing PMTCT programme and improved early uptake of two PMTCT components that require self‐motivated health‐seeking behaviour, thus providing preliminary evidence to support COMBIND as a potentially scalable PMTCT strategy. Further study would identify modifications needed to optimize other PMTCT outcomes. [ABSTRACT FROM AUTHOR]

Background: A cluster-randomized trial recently demonstrated that an integrated behavioral and mobile technology intervention improved uptake of key components of a Prevention of Mother to Child Transmission (PMTCT) Option B+ program, among HIV- infected pregnant/breastfeeding women in India. To guide scale-up and optimize programmatic implementation, we conducted a mixed-methods evaluation of the feasibility and acceptability of this intervention.Methods: The COMmunity Home Based INDia (COMBIND) study, was conducted in four districts of Maharashtra, India and randomized 119 integrated counseling and testing centers (ICTC) and their outreach workers (ORWs) to the COMBIND intervention, an integrated mHealth application that allowed digital data capture, PMTCT educational videos, SMS alerts for missed visits and reminder for visits, combined with personal empowerment and motivational interviewing training for ORWs. This qualitative evaluation was done through 15 in-depth interviews (IDIs) with ORWs and 15 IDIs with HIV-infected pregnant/breastfeeding women from the intervention arm. Utilizing a concurrent nested mixed-method evaluation approach, we assess the feasibility and acceptability of the study intervention.Results: All 30 participants reported that the PMTCT videos were essential in providing easy to understand information on critical aspects of HIV and necessary care related to PMTCT practices. A majority of the ORWs reported that the personal empowerment training with motivational interviewing skills training increased their confidence, motivation and gave them the tools for effectively supporting their clients. The mHealth application improved their working style as it facilitated targeted PMTCT information support, systemized data capture, streamlined their health education delivery practice and provided a sense of work satisfaction. The SMS appointment alerts improved retention in HIV care for mother and baby to the smaller proportion that had access to their phones. Despite reported improvements in knowledge and communication, few ORWs reported that structural challenges such as limited drug stocks, lack of HIV kits or unavailability of trained staff at ICTC, may hamper the uptake of PMTCT services, thus resulting in limited significant impacts of COMBIND on PMTCT outcomes.Conclusion: This study found that COMBIND intervention is scalable, feasible, beneficial and very well accepted by ORWs and patients, however structural challenges in goods and services remain. [ABSTRACT FROM AUTHOR]

Aim: India contributes towards a large part of the worldwide epidemic of diabetes and its associated complications. However, there are limited longitudinal studies available in India to understand the occurrence of diabetes complications over time. This pan‐India longitudinal study was initiated to assess the real‐world outcomes of diabetes across the country. Methods: The LANDMARC study is the first prospective, multicentre, longitudinal, observational study investigating a large cohort of people with type 2 diabetes mellitus across India over a period of 3 years. The primary objective of this ongoing study is to determine the proportion of people developing macrovascular diabetes complications over the duration of the study (36 months ± 45 days) distributed over seven visits; the secondary objective is to evaluate microvascular diabetes complications, glycaemic control and time‐to‐treatment adaptation or intensification. Overall, 6300 participants (aged 25–60 years) diagnosed with type 2 diabetes for at least 2 years will be included from 450 centres across India. Data will be recorded for baseline demographics, comorbidities, glycaemic measurements, use of anti‐hyperglycaemic medications and any cardiovascular or other diabetes‐related events occurring during the observational study period. Conclusions: The LANDMARC study is expected to reveal the trends in complications associated with diabetes, treatment strategies used by physicians, and correlation among treatment, control and complications of diabetes within the Indian context. The findings of this study will help to identify the disease burden, emergence of early‐onset complications and dose titration patterns, and eventually develop person‐centred care and facilitate public health agencies to invest appropriate resources in the management of diabetes. (Trial Registration No: CTRI/2017/05/008452). [ABSTRACT FROM AUTHOR]

Background. Antibiotic resistance mechanisms originating in low- and middle- income countries are among the most common worldwide. Reducing unnecessary antibiotic use in India, the world's largest antibiotic consumer, is crucial to control antimicrobial resistance globally. Limited data describing factors influencing Indian clinicians to start or stop antibiotics are available. Methods. Febrile adults and children admitted to a public tertiary care hospital in Pune, India, were enrolled. Antibiotic usage and clinical history were recorded. Immunoassays for mosquito-borne disease and bacterial cultures were performed by protocol and clinician-directed testing. Clinical factors were assessed for association with empiric antibiotic initiation and discontinuation by day 5 using multivariable logistic regression and propensity score--matched Cox proportional hazard models. Results. Among 1486 participants, 683 (82%) adults and 614 (94%) children received empiric antibiotics. Participants suspected of having mosquito-borne disease were less likely to receive empiric antibiotics (adjusted odds ratio [AOR], 0.5; 95% confidence interval [CI], .4-.8). Empiric antibiotics were discontinued in 450 (35%) participants by day 5. Dengue or malaria testing performed before day 4 was positive in 162 (12%) participants, and was associated with antibiotic discontinuation (AOR, 1.7; 95% CI, 1.2-2.4). In a propensity score--matched model accounting for admission suspicion of mosquito-borne disease, positive dengue or malaria tests increased hazard of antibiotic discontinuation (hazard ratio, 1.6; 95% CI, 1.2-2.0). Conclusions. Most patients with acute febrile illness in an Indian public hospital setting receive empiric antibiotics. Mosquitoborne disease identification is associated with reduced empiric antibiotic use and faster antibiotic discontinuation. [ABSTRACT FROM AUTHOR]

Context Land-cover change in tropical mountains is a significant concern for the loss of biodiversity and ecosystem function. In the eastern Himalaya, knowledge on the factors driving these changes is currently inadequate to development conservation and management plans. Objectives We computed land-cover change over a 23-year period for the Sikkim Himalaya in India for the elevation range 800–2800 m using Landsat satellite data and an extensive set of ground measurements of vegetation types and other landuse. We then tested how these land-cover changes may be influenced by topography, mediated through decisions on landuse. Methods We carried out supervised classification using ‘Random Forests’, and ensemble-based classification algorithm that is robust and accurate. We then used linear discriminant analyses to test which of seven common topographical variables can be used to discriminate the different land-cover types. Results The primary forest in the 800–2200 m elevation range was warm broadleaf forest, whereas the primary forest in the elevation 2200 m −2800 m was Fagaceae dominated forest. Forest cover declined by over 30% in warm broadleaf forest, and primary forest declined by 16% overall, with concomitant increases in secondary forest and agriculture. Elevation was the strongest discriminant of landuse, followed by slope and aspect, presumably reflecting peoples' choice on landuse based on topography. Conclusions Tropical montane forests continue to decline in the Sikkim Himalaya, particularly at lower elevations. Topographical factors determine landuse decisions by local communities. [ABSTRACT FROM AUTHOR]

Purpose: To analyse clinical outcomes in terms of functional changes in children with Autism Spectrum Disorder (ASD), before and after receiving a multidisciplinary developmental intervention programme. Methods: Structured goal-oriented multidisciplinary intervention, individualised to each child, was implemented through 5 child development centres in Mumbai, India, in 2014-2015. Secondary data analysis of 38 children diagnosed with ASD, in the age group of 2.1 - 6.1 years, was conducted. All children received occupational therapy and speech therapy, and parental counselling was also done. The average number of intervention sessions were 48-72 for occupational therapy (twice or thrice a week), 24-48 for speech therapy (once or twice a week) and 5-6 for parental counselling (once a month). Childhood Autism Rating Scale (CARS) and Vineland Social Maturity Scale (VSMS) were used for assessment, before and after intervention. Results: Mean positive difference in CARS total scores through paired t-test was 4.18 (p < 0.0001). Significant positive changes in functional ability were observed in most of the sub-scales (relating to people; object use; visual response; verbal and non-verbal communication; taste, smell and touch response and use; level and consistency of intellectual response and general impression). Paired t-test also showed significant positive changes on all VSMS sub-scales, except Socialisation. Conclusions: The model used in this multidisciplinary intervention, and adherence to its protocols, has the potential to improve functional ability (or the child's adaptation to his/her condition) in children with ASD, in a region with limited awareness of developmental disabilities. Limitations: Separate effects of factors outside the intervention could not be tested due to inadequate sample sizes for sub-analyses. Results also need to be validated by tests that do not depend on parental reporting (e.g., CARS and VSMS) but assess the performance of the child instead. [ABSTRACT FROM AUTHOR]

Background: In India, antimicrobial consumption is high, yet systematically collected data on the epidemiology, risk factors, and outcomes of antimicrobial-resistant infections are limited.Methods: A prospective study of adults and children hospitalized for acute febrile illness was conducted between August 2013 and December 2015. In-hospital outcomes were recorded, and logistic regression was performed to identify independent predictors of community-onset antimicrobial-resistant infections.Results: Among 1524 patients hospitalized with acute febrile illness, 133 isolates were found among 115 patients with community-onset infections; 66 isolates (50.0%) were multidrug resistant and, of 33 isolates tested for carbapenem susceptibility, 12 (36%) were resistant. Multidrug-resistant infections were associated with recent antecedent antibiotic use (adjusted odds ratio [aOR], 4.17; 95% confidence interval [CI], 1.19-19.7) and were independently associated with mortality (aOR, 6.06; 95% CI, 1.2-55.7).Conclusion: We found a high burden of community-onset antimicrobial-resistant infection among patients with acute febrile illness in India. Multidrug-resistant infection was associated with prior antibiotic use and an increased risk of mortality. [ABSTRACT FROM AUTHOR]

One third of the Indian babies are of low birth weight (<2.5 kg), and this is attributed to maternal undernutrition. We therefore examined the relationship between maternal nutrition and birth size in a prospective study of 797 rural Indian women, focusing on macronutrient intakes, dietary quality and micronutrient status. Maternal intakes (24-h recall and food frequency questionnaire) and erythrocyte folate, serum ferritin and vitamin C concentrations were measured at 18 +/- 2 and 28 +/- 2 wk gestation. Mothers were short (151.9 +/- 5.1 cm) and underweight (41.7 +/- 5.1 kg) and had low energy and protein intakes at 18 wk (7.4 +/- 2.1 MJ and 45.4 +/- 14.1 g) and 28 wk (7.0 +/- 2.0 MJ and 43.5 +/- 13.5 g) of gestation. Mean birth weight and length of term babies were also low (2665 +/- 358 g and 47.8 +/- 2.0 cm, respectively). Energy and protein intakes were not associated with birth size, but higher fat intake at wk 18 was associated with neonatal length (P < 0.001), birth weight (P < 0.05) and triceps skinfold thickness (P < 0.05) when adjusted for sex, parity and gestation. However, birth size was strongly associated with the consumption of milk at wk 18 (P < 0.05) and of green leafy vegetables (P < 0.001) and fruits (P < 0.01) at wk 28 of gestation even after adjustment for potentially confounding variables. Erythrocyte folate at 28 wk gestation was positively associated with birth weight (P < 0.001). The lack of association between size at birth and maternal energy and protein intake but strong associations with folate status and with intakes of foods rich in micronutrients suggest that micronutrients may be important limiting factors for fetal growth in this undernourished community. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of blindness and visual impairment (VI), their associated causes and underlying risk factors in three tribal areas of Andhra Pradesh, India and compare this data in conjunction with data from other countries with low and middle income settings. Methods: Using a validated Rapid Assessment of Avoidable Blindness methodology, a two stage sampling survey was performed in these areas involving probability proportionate to size sampling and compact segment sampling methods. Blindness, VI and severe visual impairment (SVI) were defined as per the WHO guidelines and Indian definitions. Results: Based on a prior enumeration, 7281 (97.1%) subjects were enrolled (mean age  = 61.0+/−7.9 years). Based on the presenting visual acuity (PVA), the prevalences of VI, SVI and blindness were 16.9% (95% CI: 15.7–18.1), 2.9% (95% CI: 2.5–3.4), and 2.3% (95% CI: 1.9–2.7), respectively. When based on the Pinhole corrected visual acuity (PCVA), the prevalences were lower in VI (6.2%, 95% CI: 5.4–6.9), SVI (1.5%, 95% CI: 1.2–1.9) and blindness (2.1%, 95% CI: 1.7–2.5). Refractive error was the major cause of VI (71.4%), whereas, cataract was the major cause of SVI and blindness (70.3%). Based on the PVA, the odds ratio (OR) of blindness increased in the age groups of 60–69 years (OR = 3.8, 95% CI: 2.8, 5.1), 70–79 years (OR = 10.6, 95% CI: 7.2, 15.5) and 80 years and above (OR = 30.7, 95% CI: 19.2, 49). The ORs were relatively higher in females (OR = 1.3, 95% CI: 1.0, 1.6) and illiterate subjects (OR = 4.3, 95% CI: 2.2, 8.5), but lower in those wearing glasses (OR = 0.2, 95% CI: 0.1, 0.4). Conclusions: This is perhaps the first study to assess the prevalence of blindness and VI in these tribal regions and the majority of the causes of blindness and SVI were avoidable (88.5%). These findings may be useful for planning eye care services in these underserved regions. [ABSTRACT FROM AUTHOR]

Polybrominated diphenyl ethers (PBDEs) used extensively over the past 3 decades as flame retardants in most types of polymers, all over the world, have been identified as global pollutants. PBDEs pose various health problems such as thyroid hormone disruption, permanent learning and memory impairment, behavioral changes, hearing deficits, delayed puberty onset, fetal malformations, and possibly cancer. Many measurements of PBDEs in various matrices from Sweden, Holland, Japan, the USA, and elsewhere have been reported, but few measurements are available for India. In this study, a preliminary screening of different congeners of PBDEs has been performed in different old electronic and consumer products with an objective to build capacity in order to analyze PBDEs and BFRs. Six different samples, foam from upholstery, motherboard of a computer, children toy composite sample, old vanishing window blind sample, electrical wire sample, and PVC flooring sample, were collected and analyzed for the presence of the following PBDE congeners: BDE-28, BDE-47, BDE-99, BDE-100, BDE-153, BDE-154, BDE-183, and BDE-209. It was found that three out of six samples were positive for the presence of PBDEs. Three congeners were detected in the samples, i.e., BDE-47, BDE-153, and BDE-209, of which, highest concentration was of BDE-209. Among the samples, motherboard of computer showed the highest concentration of BDE-209 followed by window blind and foam from upholstery. The results of this preliminary investigation indicate that PBDEs are still present in the old consumer products which can be an important additional source of exposure to the population. [ABSTRACT FROM AUTHOR]

ObjectiveTo assess the impact of an intervention modifying dietary habits for the prevention of anaemia in rural India.DesignIntervention study with data on anthropometric (weight, height) measurements, Hb and diet pattern. As per the cut-off for Hb in the government programme, women with Hb <11 g/dl had to be given Fe tablets and formed the supplemented group while those with Hb > 11 g/dl formed the non-supplemented group.SettingsThree villages near Pune city, Maharashtra, India.SubjectsRural non-pregnant women (n 317) of childbearing age (15–35 years).ResultsAfter 1 year of intervention, mean Hb increased (from 10·94 (sd 1·22) g/dl to 11·59 (sd 1·11) g/dl) significantly (P < 0·01) with a consequent reduction in the prevalence of anaemia (from 82·0 % to 55·4 %) as well as Fe-deficiency anaemia (from 30·3 % to 10·8 %). Gain in Hb was inversely associated with the initial level of Hb. Significant gain in Hb (0·57 g/dl) was observed among women attending >50 % of the meetings or repeating >50 % of the recipes at home (0·45 g/dl) in the non-supplemented group and was smaller than that observed in the supplemented group. Consumption of green leafy vegetables more than twice weekly increased substantially from 44·7 % to 60·6 %, as did consumption of seasonal fruits. Logistic regression showed that women with lower participation in the intervention had three times higher risk (OR = 3·08; 95 % CI 1·04, 9·13; P = 0·04) for no gain in Hb compared with those having high participation.ConclusionsDeveloping action programmes for improving nutritional awareness to enhance the consumption of Fe-rich foods has great potential for preventing anaemia in rural India. [ABSTRACT FROM AUTHOR]

The study examined the secular trends in growth of preschool children from rural Maharashtra, India, during 1985-2001. Anthropometric data collected on preschool (<6 years old) children during 2001 (n=1,171) and 1985 (n=979) from the same villages were compared. Decadal change increased with age and was marginally higher in boys than girls. It was the lowest among infants (-0.1 to 0.1 kg and 0.4 to 0.7 cm in both sexes) and the highest among boys of 4+ years (1.3 kg and 2.9 cm) and girls of 5+ years (1.2 kg and 2.1 cm). Increase in weight was higher (10-15%) compared to that in height (3-5%) and, consequently, reduction in the prevalence of wasting was marked (around 68% in boys and 48% in girls) than that in stunting (42% in boys and 27% in girls) among these children. The improvement was higher in boys than in girls. Negligible secular changes in younger children indicate the need for creating health and nutritional awareness among rural mothers while relatively higher improvement in weight than height among older children warns the future possibility of childhood adiposity even among rural populations. [ABSTRACT FROM AUTHOR]

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The article discusses a study on hypertension among young adults of India in rural areas and its connection with body mass index (BMI). The study consisted of measuring for anthropometry at early childhood, adolescence and an adult. It was observed that as young as 24 years old, about 33.9 percent of men had high systolic blood pressure or high diastolic blood pressure. Diastolic high blood pressure was linked to stunting at three years and above.

ObjectiveTo examine various sociodemographic aspects related to consumption of micronutrient-rich foods like green leafy vegetables (GLV), which will be helpful in modifying dietary habits, a strategy that merits consideration for prevention of anaemia.DesignCross-sectional study for collecting data on socio-economic and anthropometric (weight, height) variables, Hb, dietary pattern (FFQ) and peripheral smear examination for classifying nutritional and iron-deficiency anaemia (IDA).SettingThree villages near Pune city, Maharashtra, India.SubjectsRural women (n 418) of childbearing age (15–35 years).ResultsMean Hb was 11·07 g/dl. Seventy-seven per cent of the women were anaemic (Hb < 12 g/dl) and 28 % had IDA, indicating that a large proportion of the women had nutritional anaemia. Higher prevalence of IDA was associated with several sociodemographic and maternal parameters, but multiple logistic regression analysis showed significant (P < 0·05) risk of IDA with lower body weight (<40 kg), short maternal height (<145 cm), younger age at marriage (<19 years) and higher parity (≥2). Various socio-cultural reasons associated with low consumption of GLV included non-cultivation of GLV, priority for selling them rather than home consumption, dislike of GLV by husband and children, and lack of awareness about different recipes for GLV.ConclusionsOur findings highlight that low consumption of GLV, which are treasures of micronutrients including Fe, is associated with genuine social reasons. This indicates a need for developing action programmes to improve nutritional knowledge and awareness leading to enhanced consumption of Fe-rich foods for preventing anaemia in rural India. [ABSTRACT FROM AUTHOR]

Despite India achieving the goal of elimination of leprosy as a public health problem, leprosy is still being transmitted in India. However, due to decreased clinical suspicion of leprosy and atypical case presentations, such cases may be not be diagnosed. We present a case report of an unusual presentation of multibacillary leprosy which presented as nodular lesions. This case report indicates that atypical presentations of leprosy may be missed out by primary care physicians. [ABSTRACT FROM AUTHOR]

Background: In poor communities of the Third World, adolescent pregnancy outcomes are likely to be worse in view of the prevailing chronic undernutrition. Aim: The study examined the confounding effect of early life undernutrition on adolescent pregnancy outcome in rural India. Subjects and methods: Retrospective information on socio-economic, demographic and anthropometric variables, gynaecological and obstetric history, pregnancy outcome and birth weight was obtained on 326 primigravid young married rural girls during 1998–2001. Results: Prevalence of pregnancy wastage (stillbirths and abortions) reduced significantly ( p < 0.01) with increase in age at first conception. The risk for pregnancy wastage observed (OR = 1.95, 95% CI = 0.91–4.21) in mothers with early conception (<17.25 years) increased significantly to 4.24 (95% CI = 1.4–12.86) in case of girls with delayed menarcheal age (≥14.5 years) or to 14.2 (95% CI = 1.17–173.2) if they had higher post-menarcheal stature growth (≥4 cm). Similarly, risk for preterm delivery (OR = 2.18, 95% CI = 0.88–5.42) observed among mothers with early conception increased to 36.6 (95% CI = 3.57–374.0) if they had significant post-menarche gain in height. Our findings thus indicate that pregnancy outcome was adversely affected by early conception and prolonged adolescent growth, which are the features of biological immaturity in undernourished populations. Conclusion: Our findings indicate that in view of prevailing socio-cultural conditions, good nutrition in early life for girls is essential to prevent post-menarcheal height growth while health education programmes are essential to prevent early conception in rural India. These observations have wider implications for similar rural settings especially in other developing countries. [ABSTRACT FROM AUTHOR]

Background: Farming populations from developing countries are exposed to seasonal energy stress due to variations in food availability and energy output related to agricultural activities. This study aims to examine the impact of seasonality in maternal intake and activity on neonatal size.Methods: Maternal anthropometry, dietary intakes (24-h recall and food-frequency questionnaire) and activity pattern (questionnaire) at 18 +/- 2 and 28 +/- 2 weeks gestation, and neonatal anthropometry, were measured in a prospective study of 797 rural Indian women.Results: Maternal energy and protein intakes were inadequate (70% of recommended dietary allowance). Both intake and activity showed seasonal variation (P = 0.001), with peak values in winter i.e. during harvest, at 18 weeks (median energy 1863 kcal/day, protein 47.5 g/day) and 28 weeks (median energy 1687 kcal/day, protein 43.7 g/day), coinciding with the maximum maternal activity (median score 86.1 at 18 weeks and 79.5 at 28 weeks). Mean birth weight and length (adjusted for pre-pregnant weight, parity, gestation and sex) of babies was highest in summer (peak at February 2733 g, 48.6 cm, respectively) and lowest in winter (nadir at January 2591 g, 47.1 cm, respectively). Regression analysis showed that maternal intake at 18th week had a positive association (P = 0.05), maternal activity at 28th week had a negative association (P = 0.002) and exposure (in weeks) to winter during gestation had a positive association (P = 0.04) with birth size. Furthermore, higher maternal intakes, coupled with lower maternal activity in late gestation were associated with higher birth weight, especially during winter.Conclusions: If causal, these observations indicate that complete exposure (16 weeks) to the winter season (harvest-time) in late gestation could increase birth weight by 90 g in poor farming communities in rural India, and the benefit would increase further by lowering maternal activity. Our results underscore the importance of considering seasonality in planning targeted intervention strategies in such settings. [ABSTRACT FROM AUTHOR]

Woody plant species diversity at Chandoli National Park, an under-explored area from northern Western Ghats, Maharashtra, was assessed in detail by establishing ten transects of 1000 m × 5 m each. All individuals with GBH ≥15 cm were enumerated. A total of 4200 stems were sampled which represented 107 species belonging to 86 genera and 44 families. Shannon's index value ranged from 2.0 to 3.2. We have identified a new subtype Memecylon—Syzygium—Olea of previously defined Memecylon—Syzygium—Actinodaphne floristic series in the literature. Family importance value of pooled data showed that Melastomataceae was the most dominant family (50.32), followed by Myrtaceae (32.39) and Euphorbiaceae (23.16). The frequency distribution of all the species was highly skewed with Mememecylon umbellatum, Syzygium cumini, Olea dioica, Catunaregam spinosa and Terminalia elliptica accounting for 50% of the population. Twenty-three species were represented by only one individual in the transects sampled, indicating the underlying lognormal distribution. [ABSTRACT FROM AUTHOR]

The article presents a study on the sexual behavior of young people in India by addressing methodological and ethical challenges in field research. It offers an account of field experiences and strategies in order to respond to various methodological and ethical issues covered by the study. The authors stress that the field experiences provided in the research reflect the significant interest of young people in tackling the details of their romantic and sexual knowledge. Some of the major challenges encountered include overcoming negative community reactions, establishing relations with study communities and young people, ensuring privacy for the interview, and addressing the health needs of communities.

Objectives:To examine the magnitude of overweight and its association with blood pressure (BP) among adolescents.Design:Cross-sectional study with all children in age range 9–16 years (n=1146 boys and 1077 girls) from two schools catering to urban affluent high socio-economic class (HSE), for anthropometric measurements by trained investigators and BP measurement by a pediatrician using sphygmomanometer.Results:The prevalence of overweight based on conventional body mass index (BMI) cutoff was 27.5% for boys and 20.9% for girls but varied for different indicators. Prevalence of high systolic blood pressure (HSBP) was 12.0% in boys and 9.7% in girls and increased with increasing levels of BMI, weight, triceps skin fold thickness (TSFT) and percent body fat. Mean level of SBP among overweight children was significantly (P<0.001) higher by about 12 mm Hg, whereas that for diastolic blood pressure was higher by 8 mm Hg (P<0.001) as compared to their non-overweight (age, sex-matched) counterparts. This was true in both sexes and for all indicators used for assessing overweight. Prevalence of HSBP increased suddenly beyond BMI value of 20 kg/m2 in boys and 21.5 kg/m2 in girls, beyond TSFT value of 12 mm for boys and 14 mm for girls whereas such cutoffs for body fat were above 25% in both sexes. These cutoffs appear much lower than the conventional ones and therefore indicate the need for validation of conventional cutoffs in different populations.Conclusions:Our findings highlight that BP measurement needs to be a routine part of physical examination in school children, and the use of cutoffs anchored to metabolic risks may be essential for assessment of obesity.European Journal of Clinical Nutrition (2007) 61, 633–641. doi:10.1038/sj.ejcn.1602555; published online 29 November 2006 [ABSTRACT FROM AUTHOR]

Objective: To develop an activity questionnaire for objective and rapid assessment of maternal habitual physical activity with the aim of describing its relationship with birth size.Design: Prospective observational study.Setting: Six villages near Pune, Maharashtra, India.Subjects: Seven hundred and ninety-seven rural Indian mothers were studied after excluding abortions and termination of pregnancies, foetal anomalies, etc.Method: Principal components analysis (PCA) was used to identify a few leading questions from an elaborate questionnaire involving 36 questions related to 14 typical maternal activities.Results: On the basis of high loading (>0.8), PCA identified three activities, i.e. farming, fetching water and washing clothes. Questions and sub-questions related to these activities only were considered for defining an activity score for rapid assessment. Validation of this new activity score, with the score based on the elaborate questionnaire, showed 70% sensitivity as well as specificity. New activity scores showed strong inverse relationships similar to those observed using the elaborate questionnaire, at early as well as late gestation, with neonatal head circumference (P=0.001 and 0.055) and mid-arm circumference (P=0.02 and 0.03).Conclusions: Simple questionnaires, based on leading activities identified by PCA, can be as informative as longer and detailed questionnaires. This method has potential for adaptation, especially in rural communities in developing countries. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To describe the relationship of the mother's physical activity to the birth size of her baby in a rural Indian population. DESIGN:: Prospective observational study. SETTING:: Six villages near Pune, Maharashtra, India. SUBJECTS:: A total of 797 women were studied after excluding abortions and termination of pregnancies (112), foetal anomalies (8), multiple pregnancies (3), incomplete pre-pregnancy anthropometry (14) and pregnancies detected later than 21 weeks of gestation (168). METHOD:: An activity questionnaire was developed after focus group discussions and incorporated community-specific activities. It was validated against an observer-maintained diary. Activity scores were derived using published data on energy costs to weight the contributions of various activities. It was then administered to assess physical activity at 18 (±2) and 28 (±2) weeks of gestation. OUTCOME MEASURES:: Birth outcome, maternal weight gain and neonatal anthropometry. RESULTS:: The activity questionnaire was used to classify women into light, moderate and heavy activity categories. Maternal activity did not influence the incidence of prematurity or stillbirth, or the duration of gestation. It was inversely related to maternal weight gain up to 28 weeks of gestation (P=0.002). Higher maternal activity in early, as well as mid gestation, was associated with lower mean birth weight (P=0.05 and 0.02, respectively ), and smaller neonatal head circumference (P=0.005 and 0.009) and mid-arm circumference (P=0.03 and 0.01) after adjusting for the effect of major confounding factors. CONCLUSIONS:: The Findings suggest that excessive maternal activity during pregnancy is associated with smaller foetal size in rural India, The approach described for developing an activity questionnaire has potential for adoption in other settings. SPONSORSHIP:: Wellcome Trust, London, UK, and the Medical Research Council, UK.European Journal of Clinical Nutrition (2003) 57, 531-542.... [ABSTRACT FROM AUTHOR]

Measurements other than weight and height are rarely used in adolescent growth assessment. It is necessary to examine changes in other physical dimensions especially in relation to spurt in height as stature growth has a significance in the assessment of adolescent growth. The present study, therefore, reports data on four such measurements viz. foot length, sitting height, leg length and shoulder width along with height in a semilongitudinal growth study carried out over a 3 year period, on rural Indian boys (n =587) and girls (n = 433), to examine the occurrence of their maximum increments in relation to spurt in height. Our analysis shows that the sequence of spurt in these physical dimensions is the same in the case of boys and girls, viz. spurt in foot length and leg length occurs before age at peak height velocity (14.3 yr boys, 12.1 yr girls) while that for sitting height and shoulder width occurs after attaining the peak height velocity. While foot length is the first one to reach peak (14 yr-boys, 11 yr-girls), shoulder width is the last one (16 yr boys, 14 yr girls) in this sequence. Thus the duration between the first spurt and the last spurt was observed to be larger in case of girls (3 yr) as compared to boys (2 yr) and apart from biological differences it could be partly due to the differential treatment received by rural girls. Sitting heights and leg lengths of rural children were significantly ( p < 0.01) lower compared to Indian well-off and British children suggest that undernutrition prevailing in rural community affects all components of linear growth. [ABSTRACT FROM AUTHOR]

Background: Healthcare exposure may increase drug-resistant Enterobacteriaceae colonization risk. Nascent antimicrobial stewardship efforts in low- and middle-income countries require setting-specific data. We aimed to evaluate risk factors for inpatient drug resistant Enterobacteriaceae colonization in a resource-limited setting in India.Methods: Patients age ≥ 6 months admitted with ≥24 h of fever to a tertiary hospital in Pune, India were enrolled in a prospective cohort. Perirectal swabs, collected on admission and hospitalization day 3 or 4, were cultured in vancomycin- and ceftriaxone-impregnated media to assess for ceftriaxone-resistant Enterobacteriaceae (CTRE) and carbapenem-resistant Enterobacteriaceae (CPRE). Multivariable analyses assessed risk factors for drug-resistant Enterobacteriaceae colonization among participants without admission colonization.Results: Admission perirectal swabs were collected on 897 participants; 87 (10%) had CTRE and 14 (1.6%) had CPRE colonization. Admission CTRE colonization was associated with recent healthcare contact (p < 0.01). Follow-up samples were collected from 620 participants, 67 (11%) had CTRE and 21 (3.4%) had CPRE colonization. Among 561 participants without enrollment CTRE colonization, 49 (9%) participants were colonized with CTRE at follow-up. Detection of CTRE colonization among participants not colonized with CTRE at admission was independently associated with empiric third generation cephalosporin treatment (adjusted odds ratio [OR] 2.9, 95% CI 1.5-5.8). Follow-up transition to CPRE colonization detection was associated with ICU admission (OR 3.0, 95% CI 1.0-8.5).Conclusions: Patients who receive empiric third generation cephalosporins and are admitted to the ICU rapidly develop detectable CTRE and CPRE colonization. Improved antimicrobial stewardship and infection control measures are urgently needed upon hospital admission. [ABSTRACT FROM AUTHOR]

Effective guidelines around disclosure of HIV status are lacking and limited data from India reveal low rates of HIV disclosure to perinatally infected children. This study, conducted in Pune, India, attempts to understand the experiences of caregivers of perinatally infected children around the HIV disclosure process. We interviewed 98 caregivers whose children were receiving care at the ART clinic of a large government hospital. Caregivers report that 23% of HIV+ children had been told of their HIV status. Older caregivers had higher odds of disclosure as well as those who were widowed, had limited formal education, and who worked as maids/servants. Older children (14 years+) had higher odds of being disclosed to. Major themes from qualitative data included uncertainty among caregivers about disclosure, concerns about the child's well-being after disclosure, and an overall lack of guidance around disclosure. Significant concerns related to perceived and experienced stigma and discrimination as well as the child's marital future contributed to caregivers' willingness to disclose. There is need for the development and testing of behavioural interventions in India to guide health care workers and caregivers in appropriate disclosure to HIV-infected children, with the ultimate goal of informing national guidelines for pediatric HIV disclosure in resource poor settings. [ABSTRACT FROM AUTHOR]

CONTEXT: Although premarital partnerships--whether or not they involve sex--are widely discouraged in India, some youth do form such partnerships. It is important to know more about the nature of and the factors associated with these relationships. METHODS: Data are drawn from a community-based study of 15-24-year-olds in urban slum and rural settings in Pune District, Maharashtra. Multivariate analyses were conducted to identify associations between youths' individual, peer and family factors and their experience of romantic relationships and physical intimacy, including intercourse. RESULTS: Among young men, 17-24% had had a romantic relationship, 20-26% had engaged in some form of physical intimacy and 16-18% had had sex; the proportions among young women were 5-8%, 4-6% and 1-2%, respectively. Exposure to alcohol, drugs or pornographic films and having more frequent interaction with peers were positively associated with romantic and sexual relationships for both young women and young men. Educational attainment was negatively associated with both types of relationships for young women, but only with sexual relationships for young men. Closeness to parents was negatively associated with relationships only for young women. Young women whose father beat their mother were more likely than other young women to form romantic partnerships, and those beaten by their family had an elevated risk of entering romantic and sexual partnerships. Youth who reported strict parental supervision were no less likely than others to enter relationships. CONCLUSIONS: Program interventions should ensure that youth are fully informed and equipped to make safe choices and negotiate wanted outcomes, while positively influencing their peer networks; encourage closer interaction between parents and children; and be tailored to the different circumstances and experiences of young women and men. [ABSTRACT FROM AUTHOR]

Objective: To introduce community-specific modifications in the conventional 24 h recall method for objectively estimating maternal dietary intake and validate it with a reference method., Design: A modified 24 h recall method was developed with the visit of trained local girls at the subject's home to weigh portion sizes at each mealtime over the 24 h recall period. This was validated with the reference method in which weighed records of the foods consumed were obtained and their laboratory analysis was done to obtain nutrient intakes., Setting: Rural areas located 40-50 km from Pune City, India., Subjects: Forty-one pregnant women participated willingly., Results: The estimates of intake obtained from the reference method were comparable to those obtained from the modified 24 h recall method for energy (7795 (sd 1841) kJ (1863 (sd 440) kcal) v. 7615 (sd 1824) kJ (1820 (sd 436) kcal), respectively), protein (48.6 (sd 12.9) g v. 45.3 (sd 12.6) g, respectively) and fat (35.3 (sd 16.6) g v. 36.0 (sd 14.2) g, respectively). Significant correlation was observed between the estimates obtained by the two methods for energy (0.75, P < 0.001), protein (0.71, P < 0.001) and fat (0.56, P < 0.001) and differences in nutrient intake did not reveal any systematic bias. When compared with the reference method, the modified method showed >80% sensitivity and specificity for identifying inadequate maternal energy intakes., Conclusions: Simple modifications to conventional methods backed by understanding of community specifics and nutritional peculiarities are of immense importance in obtaining objective estimates of daily nutritional intakes of individuals in free-living populations. The approach would be adaptable in similar settings in other developing countries.

Objective: In view of the paucity of data on energy costs, the present study aimed to estimate these for typical daily activities performed by women in rural India., Design: A cross-sectional study covering 26 different activities was done by indirect calorimetry using the Oxylog instrument (Morgan)., Settings: Villages about 30-40 km from Pune city, Maharashtra, India., Subjects: Energy costs were measured on 22 rural Indian women aged 18-45 years., Results: Irrespective of whether an activity was domestic or farming, energy cost was lower when performed in sitting position (cleaning grains 5.24 kJ min-1, plucking leafy vegetables 5.76 kJ min-1) and increased considerably with the extent of muscular movement (carrying two water containers 14.77 kJ min-1, chopping firewood 14.5 kJ min-1), indicating the importance of the postural details of the activity. Physical activity ratio computed using the Food and Agriculture Organization/World Health Organization/United Nations University equation (PARw) was lower for all activities compared with that (PARm) based on measured basal metabolic rate, indicating the need for a population-specific equation. Furthermore, PARw identified more activities as belonging to the 'very light' category (nine out of 26 activities), in contrast to the perception of rural women which was supported with empirical evidence. Estimated daily energy expenditure of the women was 7.69 +/- 0.63 MJ (1837 +/- 150 kcal) and identified their daily activity pattern as 'moderate' based on PALw (1.65 +/- 0.16) while PALm (2.04 +/- 0.18) identified it as 'heavy'., Conclusions: Our results highlight the importance of qualitative descriptions of the various activities. The energy costs for several daily activities reported in this study could potentially be used for estimating daily energy expenditure of women from similar rural settings.

Background: Varying results of worldwide intervention programs to pregnant mothers necessitate the need to understand the relationship between maternal nutrition and birth size among well nourished and undernourished mothers., Objective: To examine this relationship among urban affluent mothers and to compare the findings with those on rural Indian mothers., Subjects: Data collected on urban affluent mothers (n = 236) was compared with rural mothers (n = 633)., Design: Mothers were contacted at 18 +/- 2 and 28 +/- 2 wk of gestation for anthropometry, dietary intakes [24-hr recall, Food Frequency Questionnaire (FFQ)] and after delivery for neonatal anthropometry., Results: Despite large differences in nutritional status of urban and rural mothers ( pre-pregnant weight 55.9 +/- 9.2 Vs 41.5 +/- 5.2 kg, respectively) maternal fat intakes at 18 wk were associated with birth weight (p < 0.05), length (p < 0.01) and triceps skin fold thickness (p < 0.05) of the newborn in urban and rural mothers. Consumption of fruits was associated with birth length (p < 0.05) in urban (18wk) and with birth weight (p < 0.01) and length (p < 0.01) in rural (28wk) mothers, when their energy intakes were low. Maternal consumption of milk too, was associated with newborn's triceps (p < 0.01) in urban (28wk) while with birth weight (p < 0.05) and length (p < 0.05) in rural (18wk) mothers. The findings mainly underscore the importance of consumption of micronutrient rich foods, when energy intakes are limiting during pregnancy, for improving birth size., Conclusions: Creating nutritional awareness and motivating rural mothers for consuming micronutrient rich foods like green leafy vegetables and seasonal fruits that are easily available in rural areas, will be a much affordable solution for combating the problem of low birth weight rather than waiting for improvement in the existing nationwide programs for pregnant women.

Objectives: To examine the importance of somatic disproportion rather than absolute values of leg height and trunk height for predicting risk of high blood pressure among adolescents., Methods: Adolescent girls (9-16 years old) from high (HSE) and low socio-economic (LSE) classes were examined (n = 1036 and n = 1040, respectively) in a cross-sectional study, for skeletal growth (height and sitting height), adiposity [weight, body mass index (BMI) and body fat] and blood pressure levels., Results: Girls from LSE class were thin, short and undernourished compared to those from HSE class (average age-adjusted BMI, 16.47 +/- 2.61 versus 19.77 +/- 3.85, P < 0.000). A high prevalence of high systolic blood pressure (HSBP) was a problem in girls of the HSE (9.7 versus 4.4%, P < 0.001) class, while a high prevalence of high diastolic blood pressure (HDBP) was seen in girls of the LSE (15.3 versus 2.7%, P < 0.001) class. Further, in the HSE class, the prevalence of HSBP was higher only among girls in the third tertile of BMI and body fat, while in the case of the LSE class the prevalence of HDBP was higher (7-11%) even in the lowest tertile of these measures. The odds ratio (OR) for HDBP (2.28) in the LSE class and that for HSBP (2.27) in the HSE class were significantly higher for girls in the lower tertile of leg height to height ratio. This was also true in the case of leg height to sitting height ratio., Conclusions: Our findings showed that rather than absolute leg or trunk length, somatic disproportion may be a relevant biomarker associated with cardiovascular disease (CVD) risk, especially in an adolescent population.

Context/objective: Bone mass is influenced by genetic and environmental factors. Recent studies have highlighted associations between maternal nutritional status during pregnancy and bone mass in the offspring. We hypothesized that maternal calcium intakes and circulating micronutrients during pregnancy are related to bone mass in Indian children. DESIGN/SETTING/PARTICIPANTS/MAIN OUTCOME MEASURES: Nutritional status was measured at 18 and 28 wk gestation in 797 pregnant rural Indian women. Measurements included anthropometry, dietary intakes (24-h recall and food frequency questionnaire), physical workload (questionnaire), and circulating micronutrients (red cell folate and plasma ferritin, vitamin B12, and vitamin C). Six years postnatally, total body and total spine bone mineral content and bone mineral density (BMD) were measured using dual-energy x-ray absorptiometry (DXA) in the children (n = 698 of 762 live births) and both parents., Results: Both parents' DXA measurements were positively correlated with the equivalent measurements in the children (P < 0.001 for all). The strength of these correlations was similar for fathers and mothers. Children of mothers who had a higher frequency of intake of calcium-rich foods during pregnancy (milk, milk products, pulses, non-vegetarian foods, green leafy vegetables, fruit) had higher total and spine bone mineral content and BMD, and children of mothers with higher folate status at 28 wk gestation had higher total and spine BMD, independent of parental size and DXA measurements., Conclusions: Modifiable maternal nutritional factors may influence bone health in the offspring. Fathers play a role in determining their child's bone mass, possibly through genetic mechanisms or through shared environment.

Objectives: To estimate the energy cost of resting (RMR), sitting and standing for urban Indian adults and compare these estimates with the reported values., Design: Energy costs were measured using oxylog while body fat was estimated using equipment (HBF300, OMRON Corporation, Japan) that works on the principle of bioelectrical impedance, for 24 men and 40 women, aged 20-50 y, engaged in sedentary activities., Settings: Agharkar Research Institute, Pune, India., Results: Mean energy cost (kJ/min) of resting (RMR), sitting and standing were significantly (P<0.01, for all) higher for men (4.01+/-0.42, 5.0+/-0.72 and 5.74+/-0.69, respectively) than women (3.54+/-0.28, 4.03+/-0.41 and 4.35+/-0.52, respectively). Gender difference increased with the level of activity, from 13% for RMR to 32% for standing. These differences reduced when adjusted (using analysis of covariance) for body weight and became non-significant on adjusting for fat-free mass (FFM) in the case of RMR and sitting activity. The measured values of energy cost (absolute and per kg weight) for these activities were similar to African subjects but lower compared to Asian or European subjects for both sexes. The stepwise regression analysis done separately by sexes showed weight (29%) in men and body mass index (44%) in women to be the best predictors of RMR, while regression analysis for combined sexes indicated FFM and height as predictors of RMR (r(2)=56%, P<0.01). If means to estimate body fat were not available, RMR could best be predicted with BMI and sex as predictors (r(2)=55%; P<0.01). This was mainly due to the fact that the sex differences in our population were more prominent in FFM than that in BMI. Our observations thus indicate the need to develop prediction equations separately for different populations owing to differences in their body compositions, especially in fat mass (FM) or FFM., Conclusion: The energy costs of activities were associated with body composition, especially with absolute fat-free mass, which may vary even with the same body fat percentage. Therefore, there is a need to develop separate prediction equations for different communities.

Objective: To evaluate impact of undernutrition on various adolescent growth parameters among rural Indian boys., Design: Adolescent boys covering 8-18 yr age group were observed longitudinally for a period of 3 years., Setting: Adolescent boys (n=673) from seven different villages within 30 to 40 km from Pune were studied., Method: Six monthly measurements on weight (upto 50 g) and height (upto 0.1 cm) were recorded and age assessment was done from school records with reasonable accuracy., Results: Stunted and underweight boys were lighter (by 4 kg) and shorter (by 8 cm) at 10 yr age compared to their normal counterparts but this difference increased to 12 kg and 10 cm respectively by adulthood. Undernourished boys however, revealed significant height gains at later ages especially beyond 14+ yr, compared to normals suggesting slow, gradual but continual growth. Undernutrition delayed age at take-off and age at PHV by about 2 yr, and lowered attained height at PHV (by 5 cm) and adult height (by 7 cm)., Conclusion: Normal and maluourished children from the same rural community show wide differences in their adolescent growth performance. Nutritional deprivation thus seems to affect almost all growth parameters and final adult size too.

Objective: To understand the onset of menarche in relation to changes in physical measurements that take place during adolescence, especially the changes in height velocity and changes in body fat., Design: Adolescent girls in the 9-16 year age group were observed longitudinally every six months for a period of two years., Setting: Girls from schools catering to urban high socio-economic class (HSE, n = 135) and those catering to low socio-economic class (LSE, n = 398) were evaluated., Methods: Six monthly measurements of weight, height and triceps skinfold thickness (TSFT) were done. Menarcheal age was recorded by recall method for the girls who were menstruating at the beginning of the study and prospectively for girls whose onset was after the initiation of the study. Body fat (%) was estimated using weight, height and TSFT., Results: The girls from LSE not only had lower attained weight, height, skinfold thickness at triceps and body fat but also had a significant difference (p < 0.05) in menarcheal age (15.4 yr) as compared to girls from HSE (12.1 yr). Although social class differences delayed the occurrence of the event by chronological age, the time between peak height velocity (PHV) and onset of menarche remained similar (1.5 yr) irrespective of social class. The mean weight at menarche, at group level (but not at individual level), was around 38 kg in both socio-economic classes, irrespective of age at onset. Further menarche represented the point of maximum deceleration in height velocity and maximum acceleration in body fat in both social classes., Conclusion: Our data indicated a partial support for critical weight hypothesis and suggested that these limits vary from community to community. The analysis revealed that rather than absolute values of weight, height and body fat, changes in these measurements are of significance with regard to onset of menarche.

Long periods of exclusive as well as partial breast-feeding in poor communities are of considerable importance from a nutritional standpoint, as it is in these communities that malnutrition is predominant. Although benefits of exclusive breast feeding have been well documented, those for partial breast-feeding have not been examined. The present study in particular examines the effects of prolonged breast-feeding, i.e. exclusive breast-feeding beyond 6 months or partial breast-feeding up to 2-3 years, in terms of prevalent malnutrition and morbidity among rural children. A total of 395 children were observed for weight, height, information on duration of breast-feeding, age at weaning and morbidity in terms of recent illness in the 7 days prior to the day of visit. Exclusive breast-feeding beyond 6 months and up to 12 months appeared beneficial in terms of reduced morbidity. Beyond infancy, there was no evidence of any protective effect of partial breast-feeding. This could be due to poor lactational performance of mothers and their unawareness about it resulting in inadequate weaning foods being offered to partially breast-fed children. Significant differences in male and female children in the extent of malnutrition pointed towards discrimination against girls even in respect of exclusive breast-feeding. The study highlights the need for advocating proper weaning practices while recommending prolonged breast-feeding in poor communities.

Two classifications, widely used for assessing malnutrition, those of Gomez and Waterlow, were examined for concordance in a follow-up study. Unlike in cross-sectional studies, the classifications should reflect the changes in the nutritional status of individuals over a period of time. A method of cross-classification is illustrated for assessing these changes. Data were collected on 95 children from a village and on 74 children from an urban slum. Children were measured twice for weight and height, at an interval of 17 months in the village and 12 months in the slum. The usual way of comparing estimates of malnutrition in the initial and final rounds of a follow-up study would not reveal the shifts of individuals from one grade to another grade of malnutrition. The method illustrated in this paper, on the contrary, is able to identify individuals who improve, deteriorate or show no change in their nutritional status. It was found in this follow-up study that identical conclusions were reached by both classifications in only about 17 per cent of the children, whereas about 40 per cent showed only partial concordance (ie, between Gomez and either wasting only or stunting only).