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Iron deficiency anaemia (IDA) is unusual in sickle cell disease (SCD). However, excessive urinary iron loss and mucosal/submucosal infarcts may result in poor absorption of iron in SCD. During the first decade of the disease, environmental factors and poor nutrition may also affect iron metabolism and contribute to iron deficiency in SCD. The present study assessed iron status and haematological profile of young children with SCD using serum Iron, Ferritin and Total Iron Binding Capacity (TIBC) to establish early diagnosis of IDA.Results showed that out of 6276 newborns screened, 33(0.52%) were detected to have SCD. Amongst 33,14(14.28%) children were suspected to have IDA. Iron studies revealed 42.4% of coexistent IDA with low serum Iron among 3 children, whereas high normal or raised TIBC was seen in 14 children. The findings emphasize that raised TIBC with normal serum iron may indicate early onset of IDA in the early decade of SCD, highlighting the need of timely initiation of iron therapy to prevent further severe events. [ABSTRACT FROM AUTHOR]

Objective: Early identification, referrals and timely treatment is crucial to improve the outcome of Birth Defects (BDs). The role of Community Health Workers (CHWs) in India is largely fulfilled by Accredited Social Health Activists (ASHAs) who can play an important role in community‐based reporting and referrals of BDs in newborn. In the study area, ASHAs have been previously trained for identification of BDs under Rashtriya Bal Swasthya Karyakram (RBSK); however, reporting through them was found to be sub‐optimal. Methods: To strengthen the community based reporting of BDs through ASHAs, audio visual based training was provided to 1225 ASHAs in 6 tribal blocks of Palghar district in Maharashtra, India. The change in knowledge about BDs before and after training among 1023 participants was analyzed using paired sample t test & McNemar test. Results: Findings reveal a significant increase in the knowledge of participants with regards to prevention, risk factors and identification of BDs after intervention as compared to before intervention. Discussion: The study suggests that audio‐visual based refresher training increased knowledge of ASHAs with respect to identification, prevention and risk factors of BDs which may eventually improve reporting and referrals of BDs at community level. [ABSTRACT FROM AUTHOR]

Objective: To investigate the causes and contributory factors of perinatal mortality by verbal autopsy in Maharashtra. Materials and Methods: Rural and urban areas in six districts in Maharashtra were selected by Probability proportional to size sampling. Verbal autopsies for perinatal deaths were conducted using standard tools and by visiting households; cause of death was assigned according to the International Classification of Diseases-10 using a standard algorithm. Statistical analysis was done using the SPSS-11 version software. Results: A total of 83 perinatal deaths (31 stillbirths and 52 early neonatal deaths) were investigated out of which cause of death for perinatal deaths could be assigned in 96.4% deaths. The leading causes of perinatal deaths were prematurity (19.3%) and complications of placenta, cord and membranes (12.9%) among stillbirths, while low birth weight (36%) and prematurity (26%) accounted for early neonatal deaths

Background: The unprecedented onset of coronavirus disease 2019 (COVID-19) had a huge impact on health-care facilities, leading to different psychosocial challenges among health-care workers (HCWs) during this pandemic. Aim: This study aimed to explore the impact of COVID-19 on the work, family, and personal life of HCWs engaged in COVID-19 duties during the first wave in India and gain insights on the coping strategies. Materials and Methods: The findings from 12 qualitative in-depth interviews were analyzed and presented in this article. This study is a part of a mix-method design study conducted at two hospitals and one community site in Mumbai, Maharashtra. The present qualitative sample was drawn conveniently from the randomly selected quantitative sample chosen from the three sites. Results: This study highlights that in the early stage of the COVID-19 pandemic, HCWs experienced transition in work life, burnout, disruption in family life, negative emotions such as fear, and experiences of stigma. The findings also reveal that while institutional workers faced discrimination and stigma outside their workplace, noninstitutional workers faced discrimination at multiple sites during traveling and at in their residential places and additionally faced harassment while working in the community. The findings also suggest that despite numerous challenges faced by HCWs, they were driven by a sense of responsibility and displayed resilience. Conclusion: Considering the HCWs as the backbone of the health-care system, it is crucial to boost and maintain the mental well-being of HCWs by providing timely and tailored interventions to sustain their resilience and build better responses to future pandemic. [ABSTRACT FROM AUTHOR]

The National Family Health Survey (NFHS) data is useful in setting benchmarks and examining the progress of various health indicators over time. The main objective of the present paper is to critically review the findings of NFHS-5 and NFHS-4 regarding the trends on maternal health indicators and implications for India. Data from NFHS-5 (First round 2019-2020) and NFHS-4 (2015-16) for 17 states and five Union territories (UTs) pertaining to maternal health indicators was extracted from the factsheets. Trends and implications in line with Sustainable Development Goals (SDGs) and National Health Policy (NHP) 2017 have been critically appraised. Substantial improvement in maternal health indicators in NFHS-5 over NFHS-4 is noted; however, there is a lot of interstate variation. NFHS-5 findings indicate that the percentage of women in the age group 15-19 years, already mothers or pregnant, has increased in four states while the percentage of mothers who had antenatal checkup in first trimester has increased in 12 states. Percentage of those with anaemia during pregnancy has increased from 15 to 17 states in NFHS-5 as compared to NFHS-4. Institutional births are over 90% in 14 states while only three states have below 79%. Out of pocket expenditure (OOPE) per delivery at public health facilities has increased in 12 states over the time period and it is above 5000 INR in 8 states. In India, improvement in maternal health indicators can be achieved by increasing quality of care, strengthening the Janani Suraksha Yojana (JSY), skilled birth attendants training program, reduction of anaemia among pregnant women and reduction in OOPEper delivery at public health facilities. [ABSTRACT FROM AUTHOR]

Background & objectives: In India, community based data on chronic obstetric morbidities (COM) are scanty and largely derived from hospital records. The main aim of the study was to assess the community based prevalence and the factors associated with the defined COM - obstetric fistula, genital prolapse, chronic pelvic inflammatory disease (PID) and secondary infertility among women in Nashik district of Maharashtra State, India. Methods: The study was cross-sectional with self-reports followed by clinical and gynaecological examination. Six primary health centre areas in Nashik district were selected by systematic random sampling. Six months were spent on rapport development with the community following which household interviews were conducted among 1560 women and they were mobilized to attend health facility for clinical examination. Results: Of the 1560 women interviewed at household level, 1167 women volunteered to undergo clinical examination giving a response rate of 75 per cent. The prevalence of defined COM among 1167 women was genital prolapse (7.1%), chronic PID (2.5%), secondary infertility (1.7%) and fistula (0.08%). Advancing age, illiteracy, high parity, conduction of deliveries by traditional birth attendants (TBAs) and obesity were significantly associated with the occurrence of genital prolapse. History of at least one abortion was significantly associated with secondary infertility. Chronic PID had no significant association with any of the socio-demographic or obstetric factors. Interpretation & conclusions: The study findings provided an insight in the magnitude of community-based prevalence of COM and the factors associated with it. The results showed that COM were prevalent among women which could be addressed by interventions at personal, social and health services delivery level. [ABSTRACT FROM AUTHOR]

Background: Access to reproductive health services in Human Immunodeficiency Virus (HIV) programs can greatly enhance program's potential to limit the spread of disease, reduce unintended pregnancies and safeguard the health of infected people. Objectives: To assess (i) knowledge, attitude, and use regarding contraceptives; safe sex and dual protection; (ii) fertility desires and unintended pregnancies post HIV and (iii) symptoms of reproductive tract infection/sexually transmitted infection (RTI/STI) among women infected with HIV. Materials and Methods: A cross-sectional study among 300 currently married HIV-positive women who had not undergone permanent sterilization with no immediate desire for pregnancy. Study site was Integrated Counseling and Testing Centers (ICTC) in tertiary hospitals of Mumbai and women were interviewed using a semistructured questionnaire. Results: In spite of good awareness about modern methods, 42.7 felt that contraceptives other than condoms were harmful to use due to their HIV status. Knowledge on dual protection was limited to condom (75%). Condom use increased from 5.7% pre-HIV to 71.7% post-HIV, with 89.6% reporting regular use. Future fertility desire was expressed by 8.7% women. Induced abortions post-HIV was reported by16.6% women, as pregnancies were unintended. About 69% wished to use dual contraceptive methods for effective protection if it was not harmful to be used by people living with HIV (PLHIV). Conclusion: Data reveals a need to promote modern contraceptive methods along with regular condom use to prevent unintended pregnancies and improve health-seeking behavior for contraception. Health system models that converge or link HIV services with other reproductive health services need to be tested to provide comprehensive reproductive healthcare to infected women in India. [ABSTRACT FROM AUTHOR]

A qualitative cross sectional study was conducted at the village level in six districts of Maharashtra to assess the knowledge, attitudes and practices of Self Help Group women regarding reproductive health. The study highlights the available knowledge and existing gaps on various reproductive health issues related to their gynaecological problems, pregnancy, delivery and post partum period, abortion, infertility, menopause, family planning, reproductive tract cancers and sexual health concerns among the SHG women. [ABSTRACT FROM AUTHOR]

Background & objectives: Reliable data on mortality and morbidity among women of reproductive age group are scarce in India. The present study is the Maharashtra component of a large multicentric task force study on the cause of death by verbal autopsy conducted in five States of India. The data pertaining to deaths among reproductive age group women are presented along with the factors contributing to these deaths. Methods: House-to-house surveys of a representative population from rural and urban areas in six districts of Maharashtra were undertaken by probability of proportion to size (PPS) sampling. Information on death was obtained from the relatives of the deceased and cause of death was assigned using the standardized algorithm prepared. International Classification of Diseases - ICD- 10 was used to code the assigned cause of death. Results: A total of 103 deaths in reproductive age group women were investigated, of which 7 (5.6%) were maternal while 96 (93.2%) were due to non maternal causes. Six out of seven maternal deaths were in rural area. Among the non maternal deaths, 46.8 per cent women had symptoms suggestive of anaemia and the leading cause of death was infectious and parasitic diseases (25%), tuberculosis being the top killer in this group. This was followed by injury and poisoning (20.8%), suicides being the leading cause in this category. Among non-communicable diseases, cancers contributed to 10.6 per cent deaths among which cancer esophagus and cancer cervix took a major toll. Interpretation & conclusion: Communicable diseases, injury and poisoning and cancers are the major killers among reproductive age group women. Several factors responsible for accidents and suicides also contributed substantially to the mortality load among these women. Majority of the maternal deaths were seen in rural areas indicating the need to strengthen the maternal health care. [ABSTRACT FROM AUTHOR]