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PurposeWe aim to investigate nature, risk factors as well as magnitude of farm injuries and fatalities among agricultural workers in rural India.MethodsAn Agricultural Injury Study (AIS) was conducted using selected 1703 villages in eight states of rural India based on statistical consideration using unstructured proforma for 3086 victims/respodents, who were mostly agricultural workers or farmers. Injury incidence rate (IIR) was estimated per 1000 machines/tools per year for farm machinery and hand tools injuries, and per 100 000 workers per year for other sources. Questions about the injuries involved in farming tasks were used.ResultsAbout 36.2% fatalities were caused by farm machinery that involves tractors. The IIR per year of farm machinery, hand tools and injuries due to other sources were 3.2 per 1000 machines, 0.7 per 1000 tools and 77 per 100 000 workers, respectively. Correlation between number of injury-prone agricultural machines and number of farm machinery injury is r=0.80 (number of injuries increases with increase in number of machines). The χ²=72.53; pConclusionExposures to agricultural machineries during farming operations can result in injuries confounding that may be fatal or non-fatal. Mapping down the cause and taking preventive measure to reduce the losses are of major concern. Also, customised safety programme as well as legislative awareness is needed to be raised for the higher injury incidence group.

Purpose This meta-analysis aims to systematically assess and quantitatively pool the best clinical evidence for migration percentage (MP) and odds ratio (OR) for recurrence/reoperation following treatment for hip subluxation in children with cerebral palsy (CP), including Botulinum Toxin A (BNT-A), soft-tissue lengthening and osteotomies Methods Pubmed, EMBASE and Cochrane were systematically searched from between 1 January 1953 and 11 January 2017 inclusive for studies reporting resubluxation/reoperation rates, and/or MP following treatment for hip subluxation in children with CP. The primary outcome was odds of resubluxation/reoperation. The secondary outcome was change in MP. Studies were graded for quality using the Newcastle Ottawa Scale. This meta-analysis was performed and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results A total of 14 studies were included in analysis of odds of resubluxation/reoperation and 24 studies were included in analysis of MP. The OR for resubluxation/reoperation was lower for combined osteotomies compared with femoral (OR = 0.49; 95% confidence interval (CI) 0.25 to 0.98) and for femoral osteotomy compared to soft-tissue procedures (OR = 0.20; 95% CI 0.07 to 0.61). There was no difference in odds of recurrence/reoperation between pelvic and femoral osteotomies (OR = 2.27; 95% CI 0.37 to 13.88). Combined osteotomies provided the greatest improvement in MP, while BoNT-A showed no improvement in MP. Conclusion Resubluxation/reoperation rates are high; management with osteotomies is preferred to soft-tissue procedures alone in preventing resubluxation/reoperation. This meta-analysis is limited by the observational nature and small sample sizes of many of the included studies, with their inherent risk of bias and lack of homogeneity of patient characteristics at baseline. It is possible that with larger and higher quality studies, the results and conclusions of this analysis may be altered.

The small and marginal farmers in India are 83% with land holding of 46.1% and contribution of 51.2% in the production. On Indian farms, knapsack sprayers are very commonly used by small and marginal farmers for pest control because of affordability and ease of operation but with lower outputs. An attempt was made to develop a solar powered sprayer which had higher output (0.3 ha/hr) with lower physiological energy consumption and discomfort. An electronic control had been embedded for protection against deep discharge and over charging of battery for longer operational life. The system could be fully charged by solar energy within two hours of irradiation and can be operated continuously for six hours.This ensures quality spray with uniform droplet size in the swath. Anti-clogging filter had also been installed before the nozzle in nozzle head for trouble free operation as well as longer service life of nozzle.

Hypoxemia is the major cause of neonatal morbidity and mortality. The study aims to determine the influence of birth weight, Apgar score, gestation age, body mass index and hemoglobin of mother on levels of SpO2 in healthy newborns born vaginally and through cesarean section.A hospital Based, observational study conducted in Department of Pediatrics, Universal College of Medical Sciences-Teaching Hospital, Bhairahawa, Lumbini, Nepal; on 49 vaginal and 49 cesarean deliveries with Apgar Score ≥ 6. SpO2 was estimated by pulse oximeter post-ductally between 1 to 30 minutes of birth. The observed SpO2 values were correlated with neonatal and maternal factors.Vaginal and Cesarean deliveries SpO2 were comparable for birth weight, gestational age, Apgar score of neonates, body mass index and hemoglobin of the mother. Birth weight in vaginally delivered babies and Apgar score in cesarean births showed significant change in SpO2 (P0.05). At all points of time the SpO2 values were higher in neonates, born by cesarean than those born out of spontaneous vaginal deliveries (P0.001).SpO2 levels in neonates born through cesarean section were higher in comparison to thoseborn by vaginal route. Birth weight and Apgar score had correlation with SpO2 in vaginal and cesarean births, respectively.

To assess if linear growth in infant is optimal, with exclusive breast feeding for 6 mo as advised by the WHO. This prospective follow up study included 71 full term babies of middle socio economic group healthy mothers. The mothers were instructed to breast feed the babies who were followed up to 18 mo of age for assessment of linear growth. The study was conducted in Metro General Hospital, Noida, U.P. Fifty six babies weighed ≥2.5 kg, and 15 babies weighed

Effects of Malnutririon and Iron Deficiency on Mental Functions and Study of Possible Mechanisms in Animal Model

A double blind study conducted during January 90–March 91 in a rural part of Varanasi district in Uttar Pradesh state of India on 9987 and 5260 children under six years of age demonstrated that administration of vitamin A reduced overall mortality by 14.0%. The additional data collected from January 1991 to February 92 under similar settings on 1314 and 1200 children of same age in the experimental and control groups respectively and from all children suffering from xerophthalmia who received mega dose of vitamin A (200,000 I.U.), taken together, show that vitamin A supplementation results in 16.9% reduction in mortality. Mortality was reduced in unimmunized children by 22.0%, diarrhea by 18.8% and measles by 9.0%. However, significant reduction in mortality in vitamin A supplemented group was observed only for deaths due to severe malnutrition. No death was recorded in xerophthalmia children who received mega dose of vitamin A (200,000 I.U.). The child survival pattern remained unaltered and mortality pattern remained unchanged significantly even after one year of withdrawal, thus denying the possibility of any substantial change in the study area for births and deaths. Thus the finding that vitamin A supplementation protects against overall mortality and in particular deaths due to gastroenterits, severe malnutrition and in unimmunized children is of significance.

The present study was carried out on 120 (9–12.5 and 15–17.5 years), rural, male, school children of Kashi Vidyapeeth Block of Varanasi District. Out of these 60 children 30 wellnourished and 30 in grade II or III undernutrition (height for age

The Augmented Partial Diallel Cross (APDC) represents an intermediate position between the Complete Diallel Cross (CDC) and the Partial Diallel Cross (PDC) in which one or more primary lines are crossed with all the other lines but the lines of secondary interest form a PDC system. The method of sampling adopted for crosses of secondary lines is from arrangement of secondary lines on circumference of a circle. The mathematics for analysis of such APDC has been given systematically. The efficiency of estimates of general combining ability (g.c.a.) effects obtained from APDC has been compared with that of Pederson's estimator and CDC. It is observed that there are four types of variances for g.c.a. effects where as for comparing specific combining ability (s.c.a.) effects there are large number of variances indicating that the design is totally unbalanced for s.c.a. comparisons.

Infant feeding and weaning practices in India continue to demonstrate that a significant number of infants do not receive colostrum (62.8% according to the National Family Health Survey, NFHS-2), though breastfeeding is universal and continued for a longer period. In NFHS-3 (2005-2006), there is improving trend for breastfeeding within the first hour of birth (23.4%) and exclusive breastfeeding up to 5 months (46.3%); however, weaning for semisolids is delayed (55.8% only at 6-9 months of age). The infant weaning foods are inadequate in energy-protein and micronutrients. Further, weaning foods and feeding/cooking utensils are contaminated with bacteria, resulting in frequent episodes of diarrhea. Indeed, these are the factors responsible for initiation and continuation of early malnutrition which the country has failed to control as observed in the three NFHS. Over a span of 7 years, i.e. from NFHS-2 (1998-1999) to NFHS-3, there was only marginal reduction in undernutrition. Thus, uncontrolled fetal malnutrition, poor initiation of breastfeeding, inadequate and delayed weaning, and contaminated food and water demand urgency to develop affordable hygienic weaning foods, education to clean utensils, timely weaning and available potable chlorinated water to prevent and control malnutrition.

In protein-energy malnutrition (PEM) there is a significant impairment of immunity, both cell-mediated and humoral, which may be reversed with nutritional rehabilitation. With the use of probiotics like curd (dahi) and micronutrient-rich leaf protein concentrate (LPC), this immune recovery may be hastened. This study was conducted to assess the impact of supplementation of curd and LPC on nutritional status, and immunity as assessed by anthropometry, haemoglobin, ferritin levels, T- cell subpopulation and C-reactive protein (CRP), in children suffering from PEM.Eighty moderate to severely malnourished children (1-5 yr) were randomized to receive either curd or LPC in addition to WHO recommended two-step diet over 15 days. Nutritional, immunological and haematological parameters were measured before and after supplementation and compared within the groups.The change in weight, haemoglobin level and CD4:CD8 T-cell subpopulation was significant in both the groups after supplementation. Response of CRP was blunted in PEM. Serum ferritin decreased significantly after supplementation in both groups.Curd and LPC when added to diet of malnourished children, may have therapeutic value by accelerating immune recovery. More studies need to be done on a larger sample to confirm these findings.

The prevalence of anaemia during pregnancy and lactation was significantly lower in the National Family Health Survey 1998-1999 (NFHS-2), using the hemocue method for haemoglobin estimation compared to earlier surveys. The present study selected seven States and used the same districts and villages studied in the NFHS-2, to see if the reported reduction in prevalence of anaemia was due to health and nutrition inputs and/or due to a different method for haemoglobin estimation.A total of 1,751 women (1,148 pregnant and 603 lactating- exclusively breastfeeding up to 3 months of age), from seven States- Himachal Pradesh and Haryana in north; Assam and Orissa in east; Kerala and Tamil Nadu in south and Madhya Pradesh in central India, were selected. Haemoglobin was estimated by the cyanmethaemoglobin method, so that comparison was possible with earlier studies. Data on socio-demographic characteristics, pregnancy, nutritional status and dietary intakes were collected.Prevalence as well as severity of anaemia was significantly higher in the present study as compared to the NFHS-2 study data. The difference could be due to haemocue method, which gives higher haemoglobin values. The contributing factors found on multiple regression analysis for anaemia in pregnancy and lactation were: literacy, occupation and standard living index of the study women; their awareness about anaemia, its prevention by regular consumption of ironfolate tablets and increase in food intake. Maternal height, age of marriage, parity and foetal loss also contributed to haemoglobin level. There were interstate differences; lower fertility, higher literacy and better diet was observed in Himachal Pradesh as compared to Haryana. The literacy and nutritional status of women in Tamil Nadu was lower than Kerala. The remaining 3 states had poor fertility, lower social living index and nutritional status with90 per cent women being anaemic in pregnancy and lactation. Low prevalence of severe anaemia in Orissa as compared to Assam was due to availability and consumption of iron folate tablets. The antenatal services in the first trimester and checkup by a doctor, along with availability and consumption of iron folate tablets over 3 months in all the States influenced haemoglobin levels.Despite the measures taken to control anaemia in pregnancy and lactation in the last two decades, the severity of nutritional anaemia continues to remain a public health issue of great magnitude, suggesting that these measures have been largely ineffective. The present findings also showed interstate differences particularly in fertility, women education, nutrition status and occupation; availability of antenatal services and iron folate tablets as possible factors responsible for differences in prevalence of anaemia.

Eruption pattern of permanent teeth in Delhi boys was studied in 1800 well nourished children age 5-14 years. Relationship of height, weight and sexual maturity with eruption of teeth was calculated. Earliest teeth to appear were lower first molar (5.64 years) followed by lower central incisors (6.02 years), The sequence of eruption in maxilla was first molar, incisors-central then lateral, first premolar, canine, second premolar and second molar. In mandible eruption pattern canine preceded first premolar. Eruption of teeth was significantly positively related to height, weight and sexual maturity.

A community-based, randomized trial was designed to compare the effect of nutrition education and/or iron supplementation (weekly) on iron status of children in an urban slum in Delhi.Four hundred and fifty one children, 9-36 months of age and their caretakers (mothers), assigned to one of the following groups were included in the cohort. Group 1, nutrition education. Group 2, supplementation (with 20 mg elemental iron). Group 3, nutrition education with supplementation (with 20 mg elemental iron) and Group 4, control given placebo. The intervention program was of four months duration, with a treatment phase of 8 wk followed by 8 wk of no treatment.Post intervention, at 8 wk and at 16 wk, the hemoglobin change in the nutrition education, supplementation, nutrition education with supplementation and control groups was 2.9, 1.9, 3.8 and -5.9%, respectively and 2.1, -1.9, 0 and -9.3%, respectively (as compared to initial values). There was no significant effect of any of the intervention at 8 weeks. At 16 wk, there was significant positive effect of nutrition education group (p less than 0.05). The percent change in serum ferritin value at 16 wk in the nutrition education, supplementation, nutrition education with supplementation and control groups was 5.7, -2.3, -3.4 and -40%, respectively. Serum ferritin values were significantly higher for the nutrition education group (p0.001) as compared to the control. At 16 wk, the nutrition education group mothers showed significantly higher nutrition knowledge and the dietary iron intake of children was significantly higher than their control group counterparts (p0.0001).The study suggests that nutrition education did have a positive effect on the iron status possibly by improving the dietary iron intake.

To examine the benefits of anemia prophylaxis in adolescent school.girls by weekly or daily iron-folate supplementation.Prospective study.Government girl schools of northeast Delhi.2088 subjects (with hemoglobin greater than 7.9 g/dL), including 702 on daily and 695 on weekly iron-folate administration; 691 girls served as controls.About 85% girls were iron deficient out of which 49.3% were anemic. Weekly administration took longer time to raise hemoglobin but was effective as well as practical. Plasma ferritin estimation in girls showed rise in level in both the treated groups.Weekly administration of iron-folate was a practical and effective strategy for anemia prophylaxis in adolescent school girls.

Two hundred eighty children including wellnourished, malnourished and infants with intrauterine growth retardation (IUGR) were examined for dental eruption and enamel hypoplasia. In malnourished and IUGR children eruption of teeth was delayed. The prevalence of enamel hypoplsia in wellnourished children was 20% being significantly higher in females as compared to males in age group 1-2 years. Enamel hypoplasia was seen in 36.6% malnourished subjects. Breast-feeding was protective against enamel hypoplasia.

About 30 per cent newborns (preterm and term) weigh2500 g at birth. The immunological system is less mature in low birth weight (LBW) babies compared to term and normal birth weight (NBW) babies. Bacille Calmettee Guerin (BCG) vaccine is given at birth under the national immunization programme. There is a paucity of information on the immunogenicity of BCG vaccine in preterm and LBW babies. It was, therefore, proposed to study the reaction of BCG vaccination in LBW, preterm and normal birth weight newborns.A total of 143 newborns (90 term and 53 preterm; of these 78 were LBW) received during March to September 1998, 0.1 ml of BCG vaccine (Danish 1331 strain) intradermally on the left arm just above the insertion of the deltoid muscle within 7 days of life. At the same time trivalent oral polio vaccine was administered as per the national immunization programme. These babies were followed up in the immunization clinic at 4, 6, 8, 10 and 12 +/- 1 wk to observe reactions at the BCG vaccination site.After 4 wk reaction at the vaccination site was significantly (P0.001) delayed in preterm babies as compared to term infants, and in the LBW babies (P0.05) as compared to NBW babies. The reaction at the site of vaccination was not found to be different at 6, 8, 10, 12 wk. BCG scar was seen in 47.5 per cent infants (45.4% in2500 g birth weight and 50% inor = 2500 g birth weight infants) at 12 wk. But 33 (42.3%) LBW and 24 (36.9%) NBW infants also showed papule, pustule, ulceration or scab at the BCG vaccination site.The BCG reaction was seen in the sequential order from papule to scar formation. No significant difference was seen in the scar formation in infants studied with varying gestation and birth weights after 12 wk of BCG vaccination. Fifty seven (40.4%) babies still showed different stages of BCG reaction at 12 wk. BCG vaccine along with OPV administered in early neonatal life showed successful BCG reaction in 95.5 per cent infants.

Available studies on prevalence of nutritional anemia in India show that 65% infant and toddlers, 60% 1–6 years of age, 88% adolescent girls (3.3% had hemoglobin < 7.0 g/dl; severe anemia) and 85% pregnant women (9.9% having severe anemia) were anemic. The prevalence of anemia was marginally higher in lactating women as compared to pregnancy. The commonest is iron deficiency anemia. National programmes to control and prevent anemia have not been successful. Experiences from other countries in controlling moderately-severe anemia guide to adopt long-term measures i.e. fortification of food items like milk, cereal, sugar, salt with iron. Use of iron utensils in boiling milk, cooking vegetables etc may contribute significant amount of dietary iron. Nutrition education to improve dietary intakes in family for receiving needed macro/micro nutrients as protein, iron and vitamins like folic acid, B12, A and C etc. for hemoglobin synthesis is important. As an immediate measure medicinal iron is necessary to control anemia. Addition of folate with iron controls anemia and is neuroprotective. Evidence in early childhood suggests vitamin B12 deficiency anemia; thus it may also be given alongwith iron and folate.

To compare the effectivity of weekly versus daily iron therapy in reducing maternal anemia and to evaluate the association of maternal hemoglobin and fetal growth.Prospective.Tertiary care teaching hospital in an urban metropolis.40 pregnant women received daily and 40 pregnant women received weekly oral therapy (335 mg of ferrous sulphate and 500 g folic acid) for a period of 14 weeks. The age of each pregnant woman and their baseline anthropometric data (weight, height and body mass index) were estimated. Hemoglobin and hematocrit estimations were carried out during follow period at 4 wks, 8 wks and 14 weeks. Serum ferritin values as a marker of iron status were also calculated in both the groups initially, at 14 weeks and at the time of delivery. Fetal anthropometric indices of 137 full term neonates delivered to mothers included in either of the supplementation groups or admitted to the hospital were also studied in relation to maternal hemoglobin concentration.Forty subjects each were initially randomized into groups I and II. The age of pregnant women along with their baseline anthropometric data were similar in both groups. A total of 29 pregnant women in group I and 27 pregnant women in group II could be regularly followed up. The increase in hemoglobin and hematocrit values were similar in daily and weekly supplemented mothers. An intention to treat analysis also showed similar results. The ferritin values were similar at the start of supplementation and after 14 wks of weekly or daily iron therapy. Birth weight, crown heel length, head circumference of the neonate and placental weight increased significantly with rise in maternal hemoglobin levels.Weekly iron supplementation is an effective mode of treating anemia among pregnant women and maternal anemia during pregnancy is adversely associated with fetal growth.

To study the birth weight pattern in chronic as well as currently undernourished pregnant women.Prospective study of rural pregnant women by following eligible women.Two adjoining blocks of rural Varanasi.3700 pregnant women from rural areas of Varanasi for whom data for anthropometry, hemoglobin, dietary intake, birth weight, fundal height and abdominal girth at 16 +/- 2, 28 +/- 2 and 36 +/- 2 weeks of gestation were recorded. Outcome measure was birth weight pattern of newborns.Of the births, 7.2% were2250 g and 27.4%2500 g. The weekly birth weight increments in gestation 36-42 weeks were 5-53 g, only. The fundal height did not increase during 35-39 weeks of gestation (lower by 5 cm as compared to normal). Nutrition supplement in the third trimester significantly increased fundal height and abdominal girth. Fundal height below 24.5 cm at 28 weeks of gestation (1368 women) was associated with higher low birth weight deliveries.Birth weight and fundal height increments during later pregnancy are low in undernourished pregnant women. Fundal height24.5 cm at 28 weeks of gestation identified women with higher risk for lowbirth weight infants. The prevalence of low birth weight was 27.4% and of prematurity was 6.6%.

To describe ponderosity indices body mass index--"BMI" and ponderal index "PI" and skin fold thicknesses (triceps, biceps, subscapular and suprailiac) for affluent Indian school going adolescents.Cross sectional.Measurements were recorded in healthy affluent school going adolescents in public schools of 12 cities in India (boys=11,863 and girls 7,694). Means and percentiles of ponderosity indices and skinfold thicknesses at yearly intervals were derived for each sex and related to sexual maturity.BMI, PI and skin fold thickness (SFT) were higher in girls. There was lower variability of these parameters with sexual maturity rating (breast/genital development stages) as compared to age, suggesting use of these indices in relation to sexual maturity for assessment of adolescent growth.Pediatricians and endocrinologists can use these indices for assessment of thinness and obesity, in adolescent Indian children, in relation to sexual maturity for the age.

Earlier studies show that in iron deficiency with anaemia and in latent iron deficiency neurotransmitters are altered. The changes induced in the fetal brain are irreversible on rehabilitation. The important alterations in glutamate metabolism in latent iron deficiency stimulated studies on gamma aminobutyric acid and glutaminate receptors. It was observed that binding of 3H-muscimol at pH 7.5 and 1 mg protein/assay increased significantly in synaptic vesicular membranes and under similar conditions 3H-glutamate binding showed reduction. Thus iron deficiency played a role in both excitatory and inhibitory neurotransmitter receptors. To elucidate the role of body iron status on the brain, anaemic children with thalassemia and iron deficiency were subjected to 'magnetic resonance spectroscopy' of globus pallidus, caudate and dentate nuclei and there was no change in iron content. The concentrations of creatinine and aspartate increased, with lowering of choline content. The findings were similar in thalassemia as well as iron deficiency anaemia, suggesting that in anaemia changes operate through reduced oxygen availability.

To determine the utility of certain clinical and hematological parameters as diagnostic markers of dengue hemorrhagic fever (DHF), namely, (i) tourniquet test, (ii) association of bleeding manifestations with the platelet count, and (iii) "cut off" value of hematocrit diagnostic of DHF in Indian population.Prospective study.Tertiary care hospital.304 children of DHF presenting between September 1996 to December 1996.The tourniquet test had a low sensitivity and was positive only in 61/239 (25.5%) cases. There was no statistical difference in the incidence of bleeding manifestations between thrombocytopenic and non-thrombocytopenic individuals highlighting poor association of thrombocytopenia with bleeding manifestations. A "cut off" hematocrit value of 36.3% diagnostic of DHF was estimated by discriminant analysis in Indian population.The study highlights tourniquet test as a less sensitive diagnostic marker of DHF, poor association of thrombocytopenia with bleeding manifestations and also defines the hematocrit value diagnostic of DHF in Indian population.

The present study was undertaken to investigate if massage with oils commonly used in the community for massage in infancy is beneficial.Full term born healthy infants (n = 125), 6 +/- 1 wk of age, wt3000 g were randomly divided into five groups. Infants received (i) herbal oil, (ii) sesame oil, (iii) mustard oil, or (iv) mineral oil for massage daily for 4 wk. The fifth group did not receive massage and served as control. The study tools were anthropometeric measurements; microhaematrocrit; serum proteins, creatinine and creatine phosphokinase; blood flow using colour doppler and sleep pattern.Massage improved the weight, length, and midarm and midleg circumferences as compared to infants without massage. However, in the group with sesame oil massage increase in length, midarm and midleg circumferences by 1.0, 0.9 and 0.7 cm, respectively was significant (P0.05,0.010.05). There was no change in microhaematocrit, serum: proteins, albumin, creatinine and creatine phosphokinase between both the groups. The femoral artery blood velocity, diameter and flow improved significantly by 12.6 cm/sec, 0.6 cm and 3.55 cm3/sec respectively in the group with sesame oil massage as compared to the control group. Massage improved the post massage sleep, the maximum being 1.62 h in the sesame oil group (P0.0001).Massage in infancy improves growth and post-massage sleep. However, only sesame oil showed significant benefit.

To evaluate the impact of ICDS on maternal nutrition and birth weight.28 ICDS and 21 non-ICDS villages in two adjoining blocks of Varanasi.5289 pregnancies were registered during 1987-1993 in these two blocks. In the ICDS block 916 and 1453 nutrition supplemented and unsupplemented, respectively and 1748 of the non-ICDS live births with weight recorded within 48 h formed the study subjects.The ICDS supplemented mothers gained 100g more in pregnancy and birth weight was higher by 58 g (p0.05) as compared to unsupplemented ICDS mothers. Birth weight in unsupplemented ICDS areas was 25g higher as compared to non ICDS area. ICDS supplemented women had a significantly smaller proportion of low birth weight babies (14.4%) compared to ICDS unsupplemented (20.4%) and non-ICDS women (26.3%). The corresponding prevalence of preterm births was 2.0, 2.4 and 4.3%, respectively (P0.001). Multiple regression analysis showed that increased wight gain in pregnancy, length of gestation, caloric intake and term hemoglobin were significantly associated with birth weight. However, the length of gestation was not influenced by factors improving the birth weight.Undernourished pregnant women are benefitted by late pregnancy nutrition supplement

To study the relationship between pregnancy wastage and matrnal undernutrition and other sociodemographic factors in rural Indian women.Rural community of Varanasi.Longitudinal observation.In 49 villages during 1988-92, 8111 pregnancies were registered to observe for wastage. The pregnancy outcome was correlated with various factors.There were 1321 abortions and 141 still births. Women's incomeRs. 250 per month, education10th class and protein intake50 g/day had significantly higher relative risks (RR) (4.1, 2.9 and 2.8, respectively) for abortions. Poor maternal nutrition was in additional important risk factor, for still births (RR 5.1 and 4.2 for maternal weight and height, respectively). A pregnancy interval over 2 years reduced both.Low socioeconomic status, chronic undernutrition and illiteracy in rural India are associated with high pregnancy wastage.

To find out the degree of current undernutrition in rural reproductive age women.49 villages of two adjoining rural blocks of Varanasi.6130 non-pregnant and non-lactating rural women in the age group 18-45 year were studied for sociodemographic characteristics and anthropometry, i.e., weight, height and midarm circumferance. Their percentiles for age and for weight for height were calculated by using cubic spline method.The women in 10th centile weighed38 kg and those in90th centile weighed 47-48 kg; 74.2% had weight45 kg. The 50th centile height ranged between 148-150 cm; 13.5% were145 cm. For mid arm circumference 50th and 90th centile values were around 22 and 24 cm, respectively. Mid arm circumference and height had significant linear correlation with weight.Around 50% rural UP women in pre-pregnancy state are undernourished. With age these rural women did not change in weight or mid-arm circumference.

To identify risk factors for high perinatal (PMR) and infant (IMR) mortality in a rural area.In 49 randomly selected villages from two adjoining blocks of rural Varanasi, all pregnant women and live births were followed for perinatal and infant mortality, during the years 1988-1992.6790 births and their 6649 live births.The PMR was 90.7 per thousand births and IMR was 98.6/1000 live births. These mortalities were significantly higher if weight gain during pregnancy was less than 7.0 kg. Low weight gain during pregnancy was also associated with significantly higher low birth weight deliveries and to some extent increased still birth rate. PMR and IMR decreased with higher levels of hemoglobin in third trimester and socioeconomic index; however, the calculated RR were not significant.Low weight gain during pregnancy is an important risk factor for PMR and IMR.

The present study was carried out to find out the prevalence and etiology of nutritional anaemia among preschool children from an urban slum. Randomly selected 300 children aged 3 months-3 yr were analysed over a period of one year for estimating prevalence of nutritional anaemia. Prevalence was also assessed by the rise in haemoglobin after 8 wk of haematinic supplementation in 159 of the 300 subjects. Ninety anaemic children were evaluated for the etiology of anaemia. Prevalence of anaemia, as judged by WHO recommended 'cut-off' value of haemoglobin11 g/dl, was 76 per cent while comparable value of 74.8 per cent was derived by response to haematinic supplementation. Pure iron deficiency anaemia (IDA) was detected in 41.4 per cent (37/90) of anaemic children. Vitamin B12 deficiency alone or in combination with iron was diagnosed in 14.4 and 22.2 per cent anaemic children respectively. Similarly folate deficiency, IDA with infection and anaemia of chronic diseases (ACD) was diagnosed in 2.2, 3.3 and 12.2 per cent cases respectively. Childhood anaemia continues to be a significant public health problem in preschoolers and iron deficiency is by far the commonest nutritional cause of anaemia. Vitamin B12 deficiency per se or in combination with iron is an important yet not commonly recognised cause of anaemias in preschool children in the community.

85 undernourished rural school children at 11-14 yr of age were randomly selected on the basis of their nutritional status during first five years of life for assessment of reaction time (RT). Audio-visual RT apparatus and electromyograph were used for the study. Early life undernourished children had prolonged RT as compared to their matched control maintaining normal nutrition status in first five years of life. The total, premotor and motor RT for audio as well as visual stimuli were affected in these undernourished children. The RT increased with severity of current undernutrition; those achieving normal nutritional status at this age continued to have prolonged RT. The study suggests that the early life undernutrition affects perceptual abilities, information processing and analytical capabilities.

Undernourished rural children 10-12 years of age demonstrated the following, when compared to normal nourished children : (i) a relative deficit of memory quotients assessed by the Wechsler memory scale ; (ii) lower scores for abilities related to personal and current information, orientation, mental control, logical memory, digit span, visual reproduction and associative learning ; (iii) impaired set formation and flexibility in attention as assessed by the card sorting test ; and (iv) impairment in conditional learning on maze and conditional associative learning tests. The performance on the finger dexterity test for fine motor coordination was not affected in undernourished children.

Growth characteristics, viz, height, weight and circumferences of head, chest and mid-arm were measured on urban affluent children from seven centres (Bangalore, Calcutta, Delhi, Kota, Ludhiana and Varanasi--Nutrition Foundation of India study). On each age and sex point there were 200 observations except at 18 and 72 months. The percentiles on pooled data were calculated by smoothed cubic spline least square method. This pooled data showed values lower than European and NCHS (American) standards. Centrewise comparison showed that Ludhiana children approached the latter. The differences in growth seem to be possibly due to lower velocity in Indian children of present study in the first 18 months as compared to American children.

The feasibility of acute respiratory infection (ARI) control in 5,535 rural preschool children was studied. The Primary Health Centre (PHC) staff and local practitioners (drug distribution centres) were identified and trained in recognition of moderate/severe ARI, referral, drug administration and in the education of the community. Functional ARI classification as envisaged in ARI control programme was followed. There was significant reduction in moderate (42% reduction) and severe (89% reduction) ARI episodes from year 1985 to 1987. Both ARI (27.8%) and non-ARI (18.3%) deaths showed reduction. Majority of children who died due to ARI were also unimmunized. The moderate and severe ARI related morbidity and mortality was significantly reduced in immunized children compared to unimmunized children. Although, strategies of National ARI control programme by health education, standard case management and strengthening of immunization is a good thought but it is clear that proper implementation of immunizations is going to pay more dividends. It is also evident that the local medical practitioners should be trained and involved in this control programme to have community faith as well as to avoid opposition.

The present study was conducted to study growth parameters on 12,899 boys and 9,951 girls of affluent class from 8 States of the country. In pooled data, the 50th centile height approached 30-40th centile till 6 1/2 years in boys and up to 10 years in girls, and ultimately the height growth curves for both fell between the 10-20th centile of NCHS standards. Similarly, for weight, they approached 10-20th centile of NCHS at the age of 17 yr. Comparison with other European countries showed that Indian affluents are shorter and lighter; however, they are similar to their counterparts of Asian origin. The secular trend for height in Delhi showed increase of 2.1 cm for boys, and 2.7 cm for girls per decade at 17 yr and 14 yr, respectively. In Varanasi, the corresponding trend was 1.5 and 2.1 cm at 16 yr for boys and girls, respectively. The mean ages for genital development stages G 2-5 were 11.9, 13.3, 14.6 and 15.9 yr; respectively. In girls, the breast development Stages B 2-5 had mean ages of 10.9, 12.8, 13.9 and 14.8 yr, respectively. The mean age for menarche was 12.6 yr. In 14 yr old boys, the mean height may vary between 150.3, 155.8, 161.2 and 165.2 cm and mean weight between 38.0, 42.5, 46.8 and 52.9 kg for genital stages G 2-5, respectively. Similarly, girls of 12.5 yr (close to menarcheal age of 12.6 yr) had mean height 145.3, 150.3, 152.1 and 153.8 cm and mean weight 34.7, 41.2, 45.4 and 54.4 kg for breast stages B 2-5, respectively. It is recommended that for growth assessment during adolescence these charts in relation to sexual development and age be used for comparison.

A group of 224 children from a rural cohort of 625 children registered from 1981 to 1983 in 10 villages of KV Block, Varanasi was assessed for morbidity, physical growth, and behavior development (Gesell's developmental schedule). By first birthday children of normal nutrition grade were reduced to one fourth and numbers in Grade II and III malnutrition doubled. This deterioration in nutritional status was probably due to high morbidity, i.e., gastrointestinal, respiratory infections, etc. The skull circumference was 43 cm at the age of one year, being lower by 3 cm than the average size. Children having Grades II and III malnutrition showed poor development in all the areas of behavior, i.e., motor, adaptive, language and personal social. Besides malnutrition, environmental factors like mother's involvement in teaching, encouraging the child, talking to him or being within the visual range; the parental education, their caste and the child's birth order contributed significantly to the development of the child during infancy.The goal of this study was to better understand the risk of developing malnutrition, the age of onset and its severity, and common morbidities and causes of mortality. The aim was also to determine whether malnutrition or other behavioral factors affected behavior development. A cohort of 625 children born between November 1981 and March 1983 from 10 rural villages in KV Block, Varanasi, India, was registered and followed for 1 year. Data from 224 children, who provided continuous data for at least 4 age points out of 5, was analyzed. Information was obtained on morbidity, physical growth, and behavior based on Gesell's development schedule. Children were grouped based on degrees of malnutrition (weight-for-age schedule of the Indian Academy of Pediatrics) at 4, 16, 28, and 52 weeks. Some Caldwell Home Inventory items and other environmental and socioeconomic measures were obtained by questionnaire. The village population mirrored the characteristics of the 120,000 rural population in the surrounding 112 villages covering 147 sq. miles. The male/female ratio was 10009:39. Infant mortality rates were 133/1000 live births; neonatal mortality rates were 64/1000 live births. 26% have low birth weight (2500 g). 13% of preschool children suffer from severe malnutrition and 50% from mild malnutrition. 79.4% of mothers and 21.2% of fathers were illiterate. 56% had an income of less than Rs.100/year/capita. The findings showed that the height and weight of study children declined from the 20th centile at 3 months to the 3rd centile after 6 months. By 1 year, those children with normal nutrition were reduced by 25% and the numbers of children with Grade II and III malnutrition doubled. Underfeeding as well as high morbidity may be responsible for the deterioration. The skull circumference was 3 cm smaller than the average of 43 cm at 1 year of age. All areas of behavioral development were poorer among children with Grade II and III malnutrition. Environment influenced development later in infancy, particularly mother's teaching, encouraging, or talking and parental education, caste, and birth order.

Forty anaemic (iron deficiency anaemia-27, thalassemia major-8, and aplastic anaemia-5) and 10 non-anaemic children (serving as controls) aged from 8 months to 10 years were selected for the study. The salivary iron was significantly higher in iron deficient and iron overload conditions compared to controls. The mean salivary:serum iron ratio was same in control and iron overload cases, while it was twice as high in iron deficient anaemic children. The correlation between salivary iron and serum iron was significant (r = 0.7392, P less than 0.001) in these cases. The iron deficient anaemic children with hypoalbuminaemia had significantly reduced serum and salivary protein (P less than 0.001), but iron concentrations in serum and saliva remained unaltered. The salivary protein level had significant correlations with serum albumin and serum protein (P less than 0.001). Thus, the iron in saliva is maintained at a higher level and more so in iron deficiency anaemia; it correlates well with serum iron (r = 0.6853, P less than 0.001) in iron deficient anaemic children also and is not affected by co-existing hypoproteinaemic situation.

In a rural cohort of 625 children registered from 1981 to 1983 in 10 villages of K.V. Block, Varanasi, 196 children were assessed for physical growth, development, intelligence and concept development between 1 and 3 years of age. Home environment was also assessed using Caldwell Home inventory. These rural children remained below 3rd centile of NCHS standard for weight, height, skull and mid-arm circumferences throughout the study. Malnourished children scored poorly in all the areas of development, i.e., motor, adaptive, language and personal social, 9% in Grade I and 16.6% children in Grade II + III had IQ less than 79 (inferior). Concept for color shape and size was poorly developed in malnourished children. Maternal involvement and stimulation was strongly associated with better behavior development and intelligence. Multiple regression analysis showed that the effect of home environment on development and intelligence was of a higher magnitude as compared to status and family variables and nutritional status during 1-3 years of age.The effects of nutrition and home environment on behavior development and intelligence of mild, moderate, and severely malnourished children are examined for a sample population of 196 children born in 1981-83 from 10 villages of Kashi Vidyapeeth Block of Varanasi district, India. Development was followed from the 1st year of life until 3 years of age. Children were grouped by degree of malnutrition at 18, 24, 30, and 36 months using the National Center for Health Statistics 50th centile weight for age as a reference point. Gesell's developmental schedule was also administered at the aforementioned ages. Some of the Caldwell Home Inventory and socioeconomic measures were used to measure home environment. The general characteristics of the villages mirror the larger rural population of 112 villages in the area. The developmental quotient (DQ) for motor, adaptive, language, and personal social areas was determined for the Gesell inventory, and the Binet Kulshrestha Intelligence Scale was used to determine level of cognitive ability at 36 months. Concept development was measured with the Block-Sort test. The findings indicate that all children were below the 3rd percentile for height and weight at all ages. Head and chest circumference mean values were statistically significantly below the average for affluent Varanasi children at all ages. The mid-arm circumference was below the 3rd centile, which indicates moderate to severe undernutrition. 50-60% of children were malnourished at Grade II and III. DQ decreased with the severity of malnutrition; scores for all except personal social development were below average for children with Grade III malnutrition. Significant differences in language and social development scores were found between Grade II and III malnourished and normal children, even with increases at 36 months for motor, language, and social behavior scores. Inferior IQ scores were found for 9% of Grade I malnourished and 16.6% of Grade II and III malnourished children. There were significant differences in scores between the normal, Grade I, and Grade II and III scores. The most critical period for delays is 10-12 months, when home environment vitally influences physical growth and mental development.

A total of 418 pregnant women at 16-24 wk of gestation, from six subcentres of a rural block of Varanasi district were selected. Pregnant women (137 of 215) from 3 subcentres received the supplementation of 60 mg elemental iron as ferrous sulphate combined with 500 micrograms folic acid, daily for 100 days (study group) and 123 (of 203) pregnant women from the other 3 subcentres without supplementation (control group) could be evaluated for their pregnancy outcome. The haemoglobin and serum ferritin levels increased significantly in the study group. In the latter, the mean birth weight was 2.88 +/- 0.41 kg with low birth weight incidence of 20.4 per cent as compared to the control figures of 2.59 +/- 0.34 kg and 37.9 per cent respectively. The incidence of low birth weight was further reduced to 12.1 per cent if the supplementation could be started by 16-19 wk of gestation.

In rural primary school children observed for two years, 12.97 per cent of those having IQ greater than or equal to 90 were found to have poor achievement in arithmetic test and teacher's assessment. These learning disabled children had impaired perceptual maturity and conceptual grasp as observed on MISIC (Indian modification of WISC), Bender Gestalt test and Piaget's test. On WISC Bannatyne categories learning disabled children scored highest in verbal conceptualization (similarities, vocabulary, comprehension), followed by spatial (picture completion, object assembly, block design) and sequencing (arithmetic, digit span, coding) abilities. These children on Bender Gestalt test made more errors particularly distortions (distortion of parts, incorrect number of dots, shape of design lost etc). They also showed delayed development on Piagetian tasks class inclusion, conservation (for length, substance, liquid and number) ordinal relation and one to one correspondence. These observations indicate impaired perceptual maturity, conception and information processing deficit.