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In the year 2000, the United Nations (UN) Member States pledged to work towards a series of Millennium Development Goals (MDGs), including the target of a three-quarters reduction in the 1990 Maternal Mortality Ratio (MMR; maternal deaths per 100 000 live births), to be achieved by 2015. This target (MDG 5A) and that of achieving universal access to reproductive health (MDG 5B) together formed the two targets for MDG 5: Improve maternal health (1).

Backgro u nd: The prevention of malnutrition is crucial for improving human resources. Child malnutrition is the major public health issue in many developing countries such as India. Despite global efforts for improving nutritional status of children, desired outcomes could not be achieved. Me t hodology The study was carried out in the villages under RHTC, field practice area of department of community Medicine, Dehradun. A sample of 500 mothers with children in the age group of 0-36 months living in the registered population of RHTC were included, where socio demographic profile were recorded. Results : Factors as Religion, family size and type parental education, father’s occupation emerged as significant predictors of under nutrition. Conclusion: The findings confirm the association of sociodemographic factors with malnutrition of their children.

Background: Physical activity is important for prevention of overweight and obesity in growing children. Objective: The present study aims to explore the association of overweight and obesity in school children of the district of Dehradun with physical activity, sports, and recreation at home and school. Materials and Methods: A cross-sectional survey of 1266 schoolchildren of select private and government schools in urban and rural areas was done. Results: Overall 15.6% of children were overweight, of which 5.4% were obese. Overweight and obesity were significantly associated with physical inactivity related to passive transport to school, missed opportunities for play during lunch breaks, lack of participation in household work, and excessive viewing of television. Conclusion: We found a significant association between the lack of physical activity and overweight and obesity. There is a need to enhance physical activity, sports, and recreational opportunities at school as well as home to prevent overweight and obesity in children. Family physicians should include counseling for this important and cheap modifiable risk factor in their family care practice.

Background The purpose of this open-label study was to correlate the auscultation findings of ZargisCardioscan™ with the echocardiographic findings in our patient population who were referred for echocardiography so as to investigate and ensure the validity of this technology before instituting its applicability in community health events among rural Indian population. Materials and Methods This was a double blinded prospective correlation study in outpatients presenting for echocardiography. Methods: One hundred patients, who had presented for echocardiography at Cardiology Center of an academic university hospital in rural India, were enrolled in this double blinded prospective correlation study. Principal investigator who is a community medicine physician performed the auscultation of patients’ hearts in sitting position. Subsequently, the ZargisCardioscan™ software was used to analyze the heart sounds auscultated by the 3M™ Littmann® Model 3200 stethoscope. Thereafter, the scheduled echocardiography for which the patient had presented to hospital was performed by co-investigator cardiologist who was blinded to the results obtained by the ZargisCardioscan™.Finally, all these data were statistically analyzed by blinded investigator for the presence of correlation between the two modalities. Results The most important finding was the high 90s negative predictive values when the stethoscope-software combination was used for auscultation and analysis of heart murmurs. Additionally, presence of isolated systolic murmurs had higher incidence of appreciable significant valvular lesions and presence of isolated diastolic murmurs primarily had underlying minimal-mild regurgitant valvular lesion, if any. The Bland-Altman Plot confirmed good correlation between stethoscope-echocardiography findings. Conclusion Stethoscope-software combination, 3M™ Littmann® Model 3200 and ZargisCardioscan™, accurately predicts the absence of valvular heart disease on echocardiography. DOI: http://dx.doi.org/10.3126/nje.v4i3.10665 Nepal Journal of Epidemiology 2014; 4(3): 363-369

Context: In India, adolescent girls face serious health problem due to socio-economic, environmental and cultural conditions as well as gender discrimination. A vast majority of girls in India are suffering from either general or reproductive morbidities. Unhygienic practices during menstruation expose them for Reproductive Tract Infections (RTI). If not treated early, it could lead to various disabilities and consequently affect their valuable lives. This study was done with the aim of estimating the magnitude of gynaecological morbidities among unmarried adolescent girls as well as to find out the relation between menstrual hygiene and RTI. Settings and Design: Cross-Sectional Observational study conducted in two randomly selected Inter colleges (one rural and one urban) of district Dehradun, Uttarakhand state. Methods and Material: A cross-sectional study was undertaken in school going unmarried adolescent girls to know their menstrual hygiene practices as well as reproductive morbidity. Data was collected by interview method using a pretested, prestructured questionnaire after taking consent. Statistical analysis used: percentages and Chi-square test. Results: Approximately 65 % of the girls reported having dysmenorrhoea and 19 % of the girls had given the history of excessive vaginal discharge with or without low backache/lower abdominal pain. Strong association was found between Reproductive Tract Infections and poor menstrual hygiene. Conclusions: Girls should be made aware of the process of menstruation and importance of maintaining its hygiene before attaining menarche. They should also be made aware about its linkages with their forthcoming reproductive health. DOI: http://dx.doi.org/10.3329/bjms.v13i2.14257 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.170-174

Introduction Overweight and obesity are a public health problem in India not only in adults but also in children. The authors sought to estimate the prevalence of overweight and obesity in school-going children of 6–17 years of age and examine its demographic and dietary correlates in context of their urban-rural status and socio-economic status. Methods In this cross-sectional survey height and weight were measured in 1266 school children in government and private schools of urban and rural areas. Dietary assessment was done using single day 24-hour dietary recall method. The data were analyzed using SPSS (IBM SPSS Statistics Version 19) and WHO AnthroPlus Software. Factorial ANOVA was used for testing interaction within and between subgroups for continuous variables and Chi-square test was used for categorical variables. Results It was found that the overall prevalence of overweight was 15.6% of which 5.4% were obese, with maximum prevalence in boys attending urban private schools. The mean caloric intake in the study population with 24-hour dietary recall method was 1558.2 kilocalories (SD: 428 kilocalories). Conclusion Overweight and obesity is a significant problem in school-going children. Higher socio-economic status continues to remain an important driver of this epidemic in the younger generation and affects demographic and dietary determinants of this problem.

Background: In India, marriage at an early age is still common and unfortunately any institution does not provide any education either regarding safe maternal health and infant care. The first two years of child are very crucial for infant development and it is quite evident that the well-being and nutrition of the child and his or her future is totally dependent upon the knowledge of the mother that she has about child care. The aim of the study was to evaluate the awareness of breastfeeding amongst young female students from three different teaching institutions i.e. school, nursing and medical and to evaluate the influence of educational intervention on them.Methods: Dehradun has total 6 blocks of which 1 block was selected randomly i.e. CBD Doiwala. For selection of school, one school was randomly selected from the list of schools under CBD Doiwala. Out of 75 schools going young females 71 participated in the study. 66 Students each of 3rd Year Nursing and 3rd Year MBBS students of HIMS participated in the study.Results: In school girls scaling of awareness was maximally seen in average duration of breastfeed (35%) and adequacy of each breastfeed (27%). In nursing students scaling was maximum in awareness regarding breastfeeding a baby in HIV/TB infected mother (85%) and positioning of baby (52%), similarly, in medical students also, it was maximum in HIV/TB infected mother (81%) and positioning of baby during feeding (48%).Conclusions: Educational intervention is an effective tool to improve awareness regarding breastfeeding practices.

Background: First-aid (FA) is the providing of initial care for an illness or injury, by a non-expert but trained person, till medical treatment can be accessed. Aim of the study is to impart knowledge in first aid among students to build a safe and healthier community. The objectives of the study were to assess the basic knowledge and understanding of it among the school children, to find out their attitude and to provide appropriate education regarding first aid.Methods: This cross-sectional study was conducted in randomly selected public school of Doiwala, Dehradun among all the school children of classes 9th to 12th. A pretested oral questionnaire was used to assess their knowledge and attitude about first aid. Knowledge, attitude and practices (KAP) about the first aid for common medical emergencies were assessed. Following which, education and training regarding first aid was provided to them. The data were presented as frequencies and percentages. Chi squared test was used as tests of significance.Results: Out of 441 students, majority (91%) had heard about the first aid of which the proportion of boys and girls were almost similar i.e. 92: 92.2. Only 17% of students complete knowledge of first aid and 33.3% of students had partial knowledge. On an average complete knowledge and partial knowledge was present only in 0.04 and 0.06 respectively.Conclusions:Students have revealed that first aid study is in the curriculum of the course but it seems from the study that practically no stress is being given in imparting knowledge regarding first aid in these schools. To conclude all students had shown their keen interest and positive attitude towards getting knowledge about first aid.

Background: First few years of life is the most crucial period of life as this age is known for accelerated growth and development, warranting regular monitoring. During this period about 40% of physical growth and 80% of mental development occurs. Any adverse influences during this period may result in severe limitations in their development. Methods: A cross-sectional study was conducted in the field practice area of Rural Health Training Centre. Mothers of children between 0-3 years of age were enquired about the morbidity in the past two months. Results: Diarrhea (47.9%) followed by ARI (22.21%), Pica (13%) and Worm Infestation (9.21%) were the commonest morbidities found in the study population. Morbidities were found to be common in males as compared to females. Amongst the nutritional deficiencies anaemia & Vitamin B deficiencies were the commonest. Conclusion: There was considerable sickness load amongst the toddlers. Morbidity can be reduced by improvement in the health care system at peripheral level

This study was undertaken to find out the reasons for not using the contraception among Ever Married Women aged 15-49 years in rural population of Dehradun District and to study the factors for discontinuation of contraceptive methods among women who had everusedany method. A Cross-sectional descriptive study was conducted among 2278 Ever Married Women aged 15-49 years in 20 villages from Doiwala block of Dehradun District, Uttaranchal. A multistage sampling technique was used for the selection of villages. Personal interview method with house-to-house visit was adopted as the study method. In this study, Knowledge of any method of contraception was almost universal (96.9%) among ever-married women but 61.81% of the couples had ever used while only 49.9% were currently using any method of contraception. Most common reasons for not using contraception were the desire for more children (21.5%) or particularly a male child (5.4%) followed by religious reasons (9.1%) and opposition by husband or family members (3.3%). Present study revealed that awareness about contraceptive methods is almost universal but counseling of eligible couples on importance of small families and assisting them in making informed choice is needed to remove the obstacles in practicing contraception.

Introduction Major non-communicable diseases (NCDs) include cardiovascular diseases, cancers and type 2 diabetes mellitus. The important risk factors identified for NCDs are high blood pressure, high cholesterol, being overweight or obese, and tobacco use. Primary prevention of risk factors, along with their early identification and management can help delay the progress of NCDs. The present study was undertaken with the objective of profiling risk-factors for NCDs in the rural population of Uttarakhand, India. Methods 707 participants aged over 15 years were included. Behavioural risk factor profiles were obtained by interview, followed by anthropometric measurements and biochemical assessment of all the individuals. Results 14.8% of the study population was found to be overweight or obese (BMI≥25 kg/m 2 ) and this was twice as common in females. Using the weight hip ratio, 44.8% population was in the moderate to high risk category (male >0.96, female >0.80). Overall, 6.7% of he population was found to be hypertensive. 3.7% of the subjects had diabetes (random blood glucose >200 mg/dl). Blood cholesterol levels were >200 mg/dl (the at risk category) in 7.4% of subjects. Conclusions Prevalence of NCD risk factors is lower than expected in the area. However, the “at risk” population is large and requires appropriate and timely action to prevent an epidemic of NCDs.

The midterm objective of the National Population Policy (NPP) formulated in the year 2000 is to bring the total fertility rate (TFR) to the replacement level of 2.1 by 2010. No study regarding the fertility status and its related variables has been conducted in the newly formed state of Uttaranchal till date. The National Family Health Survey -II (NFHS-II) was conducted prior to the formation of the state and therefore its findings pertain to the undivided state of Uttar Pradesh. The objective of the present study covering a large sample of 2278 ever-married women was to estimate the fertility rates in different areas and among different groups in 20 villages around the capital city of the newly-formed state of Uttaranchal. (excerpt)

Background: Weaning plays a major role in determining the nutritional status of a child. Poor weaning practices during infancy and early childhood, resulting in malnutrition, contribute to impairment of cognitive and social development, poor school performance and reduced productivity in later life. The objective of this study is to know weaning practices of mothers of difficult terrain. Methods: Cross-sectional study was conducted in all villages under Rural Health Training Center, the field practice area of Department of Community Medicine. A total of 500 mothers with children within 3 years of age were included in the study. Pre-tested pre-designed semi-structured questionnaire was used to collect information on weaning practices. Results: Majority of children (51.57%) were weaned at >6 months and were observed to be more under nourished (79.34%) as compared with those between 4 months and 6 months (61.50%). Majority of boys were weaned earlier than girls irrespective of the age of the weaning. Malnutrition was found in majority of those children who were weaned inadequately in terms of both frequency and amount. Conclusions: The present study revealed suboptimal weaning practices among the mothers of hilly region. Thus, appropriate educational strategies should be directed particularly on counteracting various myths related to infant feeding Moreover, promotion of appropriate feeding should target not only on maternal caregivers, but also on other family members, particularly husbands and grandmothers, taking into account the social and cultural situation of the area.

Background : Breast milk feeding is the first fundamental right of the child. However, there are many cultural practices associated with infant feeding of which certain undesirable practices need to be discouraged. Objectives : To assess the feeding practices of under five year children in urban slum and to determine the factors influencing it, if any. Methodology : Community based analytical cross sectional study was conducted in urban slums amongst mothers over one-year period. A house to house survey was conducted and Data was collected using a pre-tested, structured questionnaire on breastfeeding practices & data pertaining to breastfeeding practices was asked in detail from mothers of babies who were breastfed. Results : A total of 381 children were studied. A total of 87.0% of the children were delivered at health facilities and the rest at home. 65.9% received prelacteal feed in the form of water, infant milk formula, cow milk and honey. Most of the children (54.1%) received breast milk within 24 hrs of birth. 95.0% received colostrum and 67.2% received exclusive breast feeding for 6 months. It was observed that children who were exclusively breastfed for six months were found to be better nourished (51.3%). Conclusions : Majority of the mothers were practicing exclusive breast feeding, however a significant proportion of children was deprived of timely initiation of breast feeding. About 2/3 of the mothers were still practicing pre-lacteal feeds to their children. The study documents that there was significantly increased risk of PEM if the child is not exclusive breastfed for 6 months. Bangladesh Journal of Medical Science Vol.15(1) 2016 p.15-19