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Nair, Nirmala A Bridge on No Rivers: A Fictional Memoir. Nirmala Nair. Observatory: Lot sha, 2006. 162 pp. R90. Nirmala Nair, an Indian woman married to a white man in [...]

Melasma is a skin disorder characterized by hyperpigmented patches due to increased melanin production and deposition. In this pilot study, we evaluate the potential of multiphoton microscopy (MPM) to characterize non-invasively the melanin content, location, and distribution in melasma and assess the elastosis severity. We employed a clinical MPM tomograph to image in vivo morphological features in melasma lesions and adjacent normal skin in 12 patients. We imaged dermal melanophages in most dermal melasma lesions and occasionally in epidermal melasma. The melanin volume fraction values measured in epidermal melasma (14% ± 4%) were significantly higher (p

Background Recent data suggest that case fatality from severe acute malnutrition (SAM) in India may be lower than the 10%-20% estimated by the World Health Organization (WHO). A contemporary quantification of mortality and recovery from acute malnutrition in Indian community settings is essential to inform policy regarding the benefits of scaling up prevention and treatment programmes. Methods and findings We conducted a cohort study using data collected during a recently completed cluster-randomised controlled trial in 120 geographical clusters with a total population of 121,531 in rural Jharkhand and Odisha, eastern India. Children born between October 1, 2013, and February 10, 2015, and alive at 6 months of age were followed up at 9, 12, and 18 months. We measured the children's anthropometry and asked caregivers whether children had been referred to services for malnutrition in the past 3 months. We determined the incidence and prevalence of moderate acute malnutrition (MAM) and SAM, as well as mortality and recovery at each follow-up. We then used Cox-proportional models to estimate mortality hazard ratios (HRs) for MAM and SAM. In total, 2,869 children were eligible for follow-up at 6 months of age. We knew the vital status of 93% of children (2,669/2,869) at 18 months. There were 2,704 children-years of follow-up time. The incidence of MAM by weight-for-length z score (WLZ) and/or mid-upper arm circumference (MUAC) was 406 (1,098/2,704) per 1,000 children-years. The incidence of SAM by WLZ, MUAC, or oedema was 190 (513/2,704) per 1,000 children-years. There were 36 deaths: 12 among children with MAM and six among children with SAM. Case fatality rates were 1.1% (12/1,098) for MAM and 1.2% (6/513) for SAM. In total, 99% of all children with SAM at 6 months of age (227/230) were alive 3 months later, 40% (92/230) were still SAM, and 18% (41/230) had recovered (WLZ [greater than or equal to] -2 standard deviation [SD]; MUAC [greater than or equal to] 12.5; no oedema). The adjusted HRs using all anthropometric indicators were 1.43 (95% CI 0.53-3.87, p = 0.480) for MAM and 2.56 (95% CI 0.99-6.70, p = 0.052) for SAM. Both WLZ < -3 and MUAC [greater than or equal to] 11.5 and < 12.5 were associated with increased mortality risk (HR: 3.33, 95% CI 1.23-8.99, p = 0.018 and HR: 3.87, 95% CI 1.63-9.18, p = 0.002, respectively). A key limitation of our analysis was missing WLZ or MUAC data at all time points for 2.5% of children, including for two of the 36 children who died. Conclusions In rural eastern India, the incidence of acute malnutrition among children older than 6 months was high, but case fatality following SAM was 1.2%, much lower than the 10%-20% estimated by WHO. Case fatality rates below 6% have now been recorded in three other Indian studies. Community treatment using ready-to-use therapeutic food may not avert a substantial number of SAM-related deaths in children aged over 6 months, as mortality in this group is lower than expected. Our findings strengthen the case for prioritising prevention through known health, nutrition, and multisectoral interventions in the first 1,000 days of life, while ensuring access to treatment when prevention fails., Author(s): Audrey Prost 1,2,*, Nirmala Nair 2, Andrew Copas 1, Hemanta Pradhan 2, Naomi Saville 1, Prasanta Tripathy 2, Rajkumar Gope 2, Shibanand Rath 2, Suchitra Rath 2, Jolene Skordis [...]

Background The World Health Organization recommends participatory learning and action (PLA) in women's groups to improve maternal and newborn health, particularly in rural settings with low access to health services. There have been calls to understand the pathways through which this community intervention may affect neonatal mortality. We examined the effect of women's groups on key antenatal, delivery, and postnatal behaviours in order to understand pathways to mortality reduction. Methods and findings We conducted a meta-analysis using data from 7 cluster-randomised controlled trials that took place between 2001 and 2012 in rural India (2 trials), urban India (1 trial), rural Bangladesh (2 trials), rural Nepal (1 trial), and rural Malawi (1 trial), with the number of participants ranging between 6,125 and 29,901 live births. Behavioural outcomes included appropriate antenatal care, facility delivery, use of a safe delivery kit, hand washing by the birth attendant prior to delivery, use of a sterilised instrument to cut the umbilical cord, immediate wrapping of the newborn after delivery, delayed bathing of the newborn, early initiation of breastfeeding, and exclusive breastfeeding. We used 2-stage meta-analysis techniques to estimate the effect of the women's group intervention on behavioural outcomes. In the first stage, we used random effects models with individual patient data to assess the effect of groups on outcomes separately for the different trials. In the second stage of the meta-analysis, random effects models were applied using summary-level estimates calculated in the first stage of the analysis. To determine whether behaviour change was related to group attendance, we used random effects models to assess associations between outcomes and the following categories of group attendance and allocation: women attending a group and allocated to the intervention arm; women not attending a group but allocated to the intervention arm; and women allocated to the control arm. Overall, women's groups practising PLA improved behaviours during and after home deliveries, including the use of safe delivery kits (odds ratio [OR] 2.92, 95% CI 2.02-4.22; I.sup.2 = 63.7%, 95% CI 4.4%-86.2%), use of a sterile blade to cut the umbilical cord (1.88, 1.25-2.82; 67.6%, 16.1%-87.5%), birth attendant washing hands prior to delivery (1.87, 1.19-2.95; 79%, 53.8%-90.4%), delayed bathing of the newborn for at least 24 hours (1.47, 1.09-1.99; 68.0%, 29.2%-85.6%), and wrapping the newborn within 10 minutes of delivery (1.27, 1.02-1.60; 0.0%, 0%-79.2%). Effects were partly dependent on the proportion of pregnant women attending groups. We did not find evidence of effects on uptake of antenatal care (OR 1.03, 95% CI 0.77-1.38; I.sup.2 = 86.3%, 95% CI 73.8%-92.8%), facility delivery (1.02, 0.93-1.12; 21.4%, 0%-65.8%), initiating breastfeeding within 1 hour (1.08, 0.85-1.39; 76.6%, 50.9%-88.8%), or exclusive breastfeeding for 6 weeks after delivery (1.18, 0.93-1.48; 72.9%, 37.8%-88.2%). The main limitation of our analysis is the high degree of heterogeneity for effects on most behaviours, possibly due to the limited number of trials involving women's groups and context-specific effects. Conclusions This meta-analysis suggests that women's groups practising PLA improve key behaviours on the pathway to neonatal mortality, with the strongest evidence for home care behaviours and practices during home deliveries. A lack of consistency in improved behaviours across all trials may reflect differences in local priorities, capabilities, and the responsiveness of health services. Future research could address the mechanisms behind how PLA improves survival, in order to adapt this method to improve maternal and newborn health in different contexts, as well as improve other outcomes across the continuum of care for women, children, and adolescents., Author(s): Nadine Seward 1,2,*, Melissa Neuman 1,3, Tim Colbourn 1, David Osrin 1, Sonia Lewycka 4, Kishwar Azad 5, Anthony Costello 1, Sushmita Das 6, Edward Fottrell 1, Abdul Kuddus [...]

Objective To determine whether a women's group intervention involving participatory learning and action has a sustainable and replicable effect on neonatal survival in rural, eastern India. Methods From 2004 to 2011, births and neonatal deaths in 36 geographical clusters in Jharkhand and Odisha were monitored. Between 2005 and 2008, these clusters were part of a randomized controlled trial of how women's group meetings involving participatory learning and action influence maternal and neonatal health. Between 2008 and 2011, groups in the original intervention clusters (zone 1) continued to meet to discuss post-neonatal issues and new groups in the original control clusters (zone 2) met to discuss neonatal health. Logistic regression was used to examine neonatal mortality rates after 2008 in the two zones. Findings Data on 41 191 births were analysed. In zone 1, the intervention's effect was sustained: the cluster-mean neonatal mortality rate was 34.2 per 1000 live births (95% confidence interval, CI: 28.3-40.0) between 2008 and 2011, compared with 41.3 per 1000 live births (95% CI: 35.4-47.1) between 2005 and 2008. The effect of the intervention was replicated in zone 2: the cluster-mean neonatal mortality rate decreased from 61.8 to 40.5 per 1000 live births between two periods: 2006-2008 and 2009-2011 (odds ratio: 0.69, 95% CI: 0.57-0.83). Hygiene during delivery, thermal care of the neonate and exclusive breastfeeding were important factors. Conclusion The effect of participatory women's groups on neonatal survival in rural India, where neonatal mortality is high, was sustainable and replicable. Objectif Determiner si un groupe feminin menant des activites d'apprentissage et des actions participatives a un effet durable et reproductible sur la survie neonatale dans l'Inde de l'Est rurale. Methodes De 2004 a 2011, les naissances et la mortalite neonatale ont ete suivies dans 36 zones geographiques des Etats du Jharkhand et de l'Odisha. Entre 2005 et 2008, ces zones ont ete integrees dans un essai controle randomise portant sur l'influence sur la sante maternelle et neonatale des reunions de groupes feminins menant des activites d'apprentissage et des actions participatives. Entre 2008 et 2011, les groupes provenant des zones d'intervention d'origine (zone 1) se reunissaient toujours pour debattre des questions post-neonatales, et les nouveaux groupes provenant des zones de controle d'origine (zone 2) se sont reunis pour aborder le sujet de la sante neonatale. On a eu recours a la regression logistique pour analyser les taux de mortalite neonatale apres 2008 dans ces deux zones. Resultats Les donnees de 41 191 naissances ont ete analysees. Dans la zone 1, l'effet de l'intervention s'est revele durable: le taux de mortalite neonatale moyen de la region a ete de 34,2 pour 1 000 naissances vivantes (intervalle de confiance de 95%, IC: 28,3-40) entre 2008 et 2011, par rapport a 41,3 pour 1 000 naissances vivantes (IC de 95%: 35,4-47,1) entre 2005 et 2008. L'effet de l'intervention s'est reprod uit dans la zone 2: le taux de mortalite neonatale moyen de la zone a baisse de 61,8 a 40,5 pour 1 000 naissances vivantes entre les deux periodes: 2006-2008 et 2009-2011 (rapport des cotes, RC: 0,69, IC de 95%: 0,57-0,83). L'hygiene pendant l'accouchement, le maintien de la temperature corporelle du nouveau-ne et l'allaitement maternel exclusif ont ete des facteurs importants. Conclusion L'effet des groupes feminins participatifs sur la survie neonatale dans l'lnde rurale, ou la mortalite neonatale est elevee, s'est revele durable et reproductible. Objetivo Determinar si las intervenciones con aprendizaje y accion participativos con grupos de mujeres tienen un efecto sostenible y reproducible en la supervivencia neonatal en las zonas rurales del este de India. Metodos Desde 2004 hasta 2011 se controlaron los nacimientos y muertes neonatales en 36 agrupaciones geograficas en Jharkhand y Odisha. Entre 2005 y 2008, esas agrupaciones formaron parte de un ensayo controlado aleatorio para averiguar como las reuniones de grupos de mujeres que incluyen un aprendizaje y accion participativos influyen en la salud materna y neonatal. Entre 2008 y 2011, los grupos en las agrupaciones originales de intervencion (zona 1) siguieron reuniendose para debatir sobre cuestiones posneonatales y otros grupos nuevos en las agrupaciones originales de control (zona 2) se reunieron para debatir sobre la salud neonatal. Se empleo una regresion logistica para examinar las tasas de mortalidad neonatal en ambas zonas tras del ano 2008. Resultados Se analizaron los datos de 41 191 nacimientos. En la zona 1, el efecto de la intervencion fue prolongado: la tasa de mortalidad neonatal media en la agrupacion fue de 34,2 por cada 1000 nacidos vivos (intervalo de confianza del 95%, IC: 28,3-40,0) entre 2008 y 2011, comparada con el 41,3 por cada 1000 nacidos vivos (IC del 95%: 35,4-47,1) entre los anos 2005 y 2008. El efecto de la intervencion se repitio en la zona 2: la tasa de mortalidad neonatal media descendio del 61,8 hasta el 40,5 por cada 1000 nacidos vivos entre dos periodos: 2006-2008 y 2009-2011 (cociente de probabilidades: 0,69, IC del 95%: 0,57-0,83). Algunos factores importantes fueron la higiene durante el parto, la atencion termica de los neonatos y la lactancia materna exclusiva. Conclusion El efecto de los grupos participativos de mujeres sobre la supervivencia neonatal en las zonas rurales de India, donde la mortalidad neonatal es elevada, resulto sostenible y reproducible., Introduction Of the world's 2.9 million neonates who die in the first month of life each year, (1) around 30% (i.e. approximately 876000) are born in India. (2) Meeting the [...]

Background Recent calls for continuous monitoring of large-scale public health interventions in low-income countries (1) have coincided with the increased use of routine monitoring for outcomes after episodes of care [...]