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This study was planned to study caregiver's perception of barriers to implementation of the Rights of Persons with Disabilities (RPWD) Act, 2016 in India. An online cross-sectional survey was carried out among parents of children with disabilities. A prevalidated structured and semi-structured questionnaire was used. Results of structured items are summarized as mean (SD), frequencies and percentages. For open-ended questions, responses were analyzed by manual content analysis; results were presented in the form of a framework. From 316 responses, 44.8% of respondents availed disability certificate however utilization was largely limited to travel and educational settings. 82.2% of respondents were not aware of any of the national health schemes. Only 6.2% of children could engage in play activity at the playground. Accessibility, health issues and social stigma were the main barriers to recreation for children with disabilities. While 25.8% of children did not attend school at all, 58.1% of children attending normal school were facing difficulties due to lack of appropriate school infrastructure, transportation issues, and untrained teachers. Responses to open-ended questions were predominantly related to needs of homegrown research, better infrastructure, and trained teachers in schools, life security of child and development of national registry for better health information. The study highlights the importance of implementation of concrete strategies at every level of policy decisions to create more awareness regarding RPWD act in India. [ABSTRACT FROM AUTHOR]

Byline: Isha. Deshmukh, Akash. Bang, Manish. Jain, Krishna. Vilhekar Acute disseminated encephalomyelitis (ADEM) and Guillain-Barré syndrome (GBS) are distinct demyelinating disorders that share an autoimmune pathogenesis and prior history of [...]

Background: Whether facility-based implementation of Helping Babies Breathe (HBB) reduces neonatal mortality at a population level in low and middle income countries (LMIC) has not been studied. Therefore, we evaluated HBB implementation in this context where our study team has ongoing prospective outcome data on all pregnancies regardless of place of delivery.Methods: We compared outcomes of birth cohorts in three sites in India and Kenya pre-post implementation of a facility-based intervention, using a prospective, population-based registry in 52 geographic clusters. Our hypothesis was that HBB implementation would result in a 20 % decrease in the perinatal mortality rate (PMR) among births ≥1500 g.Results: We enrolled 70,704 births during two 12-month study periods. Births within each site did not differ pre-post intervention, except for an increased proportion of <2500 g newborns and deliveries by caesarean section in the post period. There were no significant differences in PMR among all registry births; however, a post-hoc analysis stratified by birthweight documented improvement in <2500 g mortality in Belgaum in both registry and in HBB-trained facility births. No improvement in <2500 g mortality measures was noted in Nagpur or Kenya and there was no improvement in normal birth weight survival.Conclusions: Rapid scale up of HBB training of facility birth attendants in three diverse sites in India and Kenya was not associated with consistent improvements in mortality among all neonates ≥1500 g; however, differential improvements in <2500 g survival in Belgaum suggest the need for careful implementation of HBB training with attention to the target population, data collection, and ongoing quality monitoring activities.Trial Registration: The study was registered at ClinicalTrials.gov: NCT01681017 . [ABSTRACT FROM AUTHOR]

Background: Pneumonia is the leading cause of child mortality under five years of age worldwide. For pneumonia with chest indrawing in children aged 3-59 months, injectable penicillin and hospitalization was the recommended treatment. This increased the health care cost and exposure to nosocomial infections. We compared the clinical and cost outcomes of a seven day treatment with oral amoxicillin with the first 48 h of treatment given in the hospital (hospital group) or at home (home group).Methods: We conducted an open-label, multi-center, two-arm randomized clinical trial at six tertiary hospitals in India. Children aged 3 to 59 months with chest indrawing pneumonia were randomized to home or hospital group. Clinical outcomes, treatment adherence, and patient safety were monitored through home visits on day 3, 5, 8, and 14 with an additional visit for the home group at 24 h. Clinical outcomes included treatment failure rates up to 7 days (primary outcome) and between 8-14 days (secondary outcome) using the intention to treat and per protocol analyses. Cost outcomes included direct medical, direct non-medical and indirect costs for a random 17% subsample using the micro-costing technique.Results: 1118 children were enrolled and randomized to home (n = 554) or hospital group (n = 564). Both groups had similar baseline characteristics. Overall treatment failure rate was 11.5% (per protocol analysis). The hospital group was significantly more likely to fail treatment than the home group in the intention to treat analysis. Predictors with increased risk of treatment failure at any time were age 3-11 months, receiving antibiotics within 48 h prior to enrolment and use of high polluting fuel. Death rates at 7 or 14 days did not differ significantly. (Difference -0.0%; 95% CI -0.5 to 0.5). The median total treatment cost was Rs. 399 for the home group versus Rs. 602 for the hospital group (p < 0.001), for the same effect of 5% failure rate at the end of 7 days of treatment in the random subsample.Conclusions: Home based oral amoxicillin treatment was equivalent to hospital treatment for first 48 h in selected children of chest indrawing pneumonia and was cheaper. Consistent with the recent WHO simplified guidelines, management with home based oral amoxicillin for select children with only fast breathing and chest-indrawing can be a cost effective intervention.Trial Registration: ClinicalTrials.gov NCT01386840, registered 25th June 2011 and the Indian Council of Medical Research REFCTRI/2010/000629. [ABSTRACT FROM AUTHOR]

Background: Although immunization coverage has increased in recent times in India, the quality of the Indian national immunization programme is still debatable. So, this study was conducted to assess the quality of documentation of immunization and health education to mother during Expanded Programme on Immunization (EPI) which is the national immunization programme of India and stresses on childhood Immunization against diseases of public health importance. The quality of maintenance of cold chain was also assessed in the study along with other factors. Method: This cross sectional study involved female Junior Health Worker (JHW) of Davangere taluk in South India as participants. These were selected based on lot quality assurance sampling (LQAS). Each Junior Health worker Female (initially called multipurpose workers) who did immunization was considered as 1 lot. The numbers of lots rejected were considered for analysis and if rejection was higher than the allowed defect (obtained from LQAS table) the quality was considered poor. Results: Identification of needed vaccine by the JHW was poor as determined by LQAS technique. Vaccination status of children and vaccine recommendation for sick children was poor. Care of vaccine was good except for contamination during loading. Vaccination technique practiced by female JHW of Davangere taluk was poor. EPI education given to mother had failed in many places by LQAS. Maintenance of cold chain and supply of vaccine was good. Knowledge about immunization process among service providers was 100% about all vaccine. Conclusion: The quality of immunization sessions were not up to the mark [ABSTRACT FROM AUTHOR]

Justification: The first National Guidelines on Infant and Young Child Feeding (IYCF) were formulated by Ministry of Women and Child Development (Food and Nutrition Board) in 2004, and the same guidelines were revised in 2006. India is committed to halving the prevalence of under weight children by 2015 as one of the key indicators of progress towards the Millennium Development Goals (MDG). By the end of 2009 nutritional achievement goals did not make for happy reading. So there was need to revise the existing guidelines and to have more viable and scientifically accepted national guidelines on Infant and Young child feeding., Process: A National Consultative Meet was organized by Indian Academy of Pediatrics at Gurgaon in 2009 where members of IYCF and Nutrition Chapters of IAP, BPNI, WHO, UNICEF, USAID, WFP were present. Each group made detailed presentations after reviewing recent literature on the subject. After extensive discussions a consensus was reached and the guidelines were formulated., Objectives: To formulate, endorse, adopt and disseminate guidelines related to Infant and Young Child feeding from an Indian perspective (including infant feeding in the context of HIV infection)., Recommendations: Optimal infant and young child feeding: Early initiation of breastfeeding, exclusive breastfeeding for the first six month of life followed by continued breastfeeding for up to two years and beyond with adequate complementary foods is the most appropriate feeding strategy for infants and young children. Adequate nutrition and anemia control for adolescent girls, pregnant and lactating mother is also advocated.