Home Care and Prevention

This article focuses on the practices and conceptions of prevention in home care that were prevalent among Quebec families during the first half of the 20th century. The analysis is based on an examination of 585 recipes in which prevention was an objective. The analysis finds that there are three prevention purposes in home care: strengthening, which includes caregiving acts that maintain good health and fortify the whole or particular parts of the body; cleansing and purifying, which include any care aimed at eliminating accumulated substances from the body; and finally, warding off illness. The discussion insists on the holistic nature of these practices and on their relationship to women's work. [prevention, home care, ethnomedicine, self-care, women]     

Predicting potential distribution of poorly known species with small database: the case of four‐horned antelope Tetracerus quadricornis on the Indian subcontinent

Information gaps on the distribution of data deficient and rare species such as four‐horned antelope (FHA) in Nepal may impair their conservation. We aimed to empirically predict the distribution of FHA in Nepal with the help of data from the Indian subcontinent. Additionally, we wanted to identify core areas and gaps within the reported range limits and to assess the degree of isolation of known Nepalese populations from the main distribution areas in India. The tropical part of the Indian subcontinent (65°–90° eastern longitude, 5°–30° northern latitude), that is, the areas south of the Himalayan Mountains. Using MaxEnt and accounting for sampling bias, we developed predictive distribution models from environmental and topographical variables, and known presence locations of the study species in India and Nepal. We address and discuss the use of target group vs. random background. The prediction map reveals a disjunct distribution of FHA with core areas in the tropical parts of central to southern–western India. At the scale of the Indian subcontinent, suitable FHA habitat area in Nepal was small. The Indo‐Gangetic Plain isolates Nepalese from the Indian FHA populations, but the distribution area extends further south than proposed by the current IUCN map. A low to intermediate temperature seasonality as well as low precipitation during the dry and warm season contributed most to the prediction of FHA distribution. The predicted distribution maps confirm other FHA range maps but also indicate that suitable areas exist south of the known range. Results further highlight that small populations in the Nepalese Terai Arc are isolated from the Indian core distribution and therefore might be under high extinction risk.     

Onchocerca parasites and Wolbachia endosymbionts: evaluation of a spectrum of antibiotic types for activity against Onchocerca gutturosa in vitro

Background

In the Dominican Republic, a Latin American country with filariasis-endemic areas, more than 63,000 people have lymphatic filariasis and more than 400,000 people are at risk of future infection. In this paper, we explore the health beliefs, health-seeking behaviors and self-care practices of women with lymphoedema in filariasis-endemic areas to better understand the needs of women when developing lymphoedema morbidity control programs.

Methods

Qualitative data were collected through semi-structured interviews of 28 women, 3 focus group discussions with 28 women, field notes and photographs.

Results

Women described exhaustive and expensive attempts at seeking a cure for their lymphoedema. Family members were influential in providing women with initial care seeking referrals to indigenous healers credited with influence over physical, mental, spiritual and supernatural properties of illness. When indigenous treatments proved to be ineffectual, the women sought care from trained healthcare providers. Most healthcare providers incorrectly diagnosed the edema, failed to adequately treat and meet the needs of women and were viewed as expensive. Most women resorted to self-prescribing injectable, oral, or topical antibiotics along with oral analgesics as a standard practice of self-care.

Conclusion

Healthcare providers must understand a woman's cultural perspectives of illness, her natural networks of support and referral, her behavioural practices of care-seeking and self-care and the financial burden of seeking care. In the culture of the Dominican Republic family members and traditional healthcare providers are influential advisors on initial health-seeking behaviors and self-care practices. For this reason family-oriented interventions, support groups for women and their families, community education and training on simple, low cost lymphoedema management techniques for indigenous healers are viable ways to influence the early detection, diagnosis and treatment of women with lymphoedema. The extensive use of injectable, oral and topical antibiotics by indigenous healers and women without medical supervision suggests a need for health education messages related to the risks of such practices.     

Development and Validation of the 34-Item Disability Screening Questionnaire (DSQ-34) for Use in Low and Middle Income Countries Epidemiological and Development Surveys

Background

Although 80% of persons with disabilities live in low and middle-income countries, there is still a lack of comprehensive, cross-culturally validated tools to identify persons facing activity limitations and functioning difficulties in these settings. In absence of such a tool, disability estimates vary considerably according to the methodology used, and policies are based on unreliable estimates.

Methods and Findings

The Disability Screening Questionnaire composed of 27 items (DSQ-27) was initially designed by a group of international experts in survey development and disability in Afghanistan for a national survey. Items were selected based on major domains of activity limitations and functioning difficulties linked to an impairment as defined by the International Classification of Functioning, Disability and Health. Face, content and construct validity, as well as sensitivity and specificity were examined. Based on the results obtained, the tool was subsequently refined and expanded to 34 items, tested and validated in Darfur, Sudan. Internal consistency for the total DSQ-34 using a raw and standardized Cronbach’s Alpha and within each domain using a standardized Cronbach’s Alpha was examined in the Asian context (India and Nepal). Exploratory factor analysis (EFA) using principal axis factoring (PAF) evaluated the lowest number of factors to account for the common variance among the questions in the screen. Test-retest reliability was determined by calculating intraclass correlation (ICC) and inter-rater reliability by calculating the kappa statistic; results were checked using Bland-Altman plots. The DSQ-34 was further tested for standard error of measurement (SEM) and for the minimum detectable change (MDC). Good internal consistency was indicated by Cronbach’s Alpha of 0.83/0.82 for India and 0.76/0.78 for Nepal. We confirmed our assumption for EFA using the Kaiser-Meyer-Olkin measure of sampling well above the accepted cutoff of 0.40 for India (0.82) and Nepal (0.82). The criteria for Bartlett’s test of sphericity were also met for both India (< .001) and Nepal (< .001). Estimates of reliability from the two countries reached acceptable levels of ICC of 0.75 (p<0.001) for India of 0.77 for Nepal (p<0.001) and good strength of agreement for weighted kappa (respectively 0.77 and 0.79). The SEM/MDC was 0.80/2.22 for India and 0.96/2.66 for Nepal indicating a smaller amount of measurement error in the screen.

Conclusions

In Nepal and India, the DSQ-34 shows strong psychometric properties that indicate that it effectively discriminates between persons with and without disabilities. This instrument can be used in association with other instruments for the purpose of comparing health outcomes of persons with and without disabilities in LMICs.     

Distribution and conservation of the Gaur Bos gaurus in the Indian Subcontinent

The Gaur Bos gaurus ranges from India to peninsular Malaysia. Its distribution, status and conservation in the Indian subcontinent are reviewed here on the basis of available information, both published papers and unpublished census reports of forest departments, and field survey data from north‐eastern India and parts of Bhutan and Nepal. The Gaur is found in three disjunct regions, south‐western India, central India and north‐eastern India (including Nepal, Bhutan and Bangladesh). Within these regions the distribution is highly fragmented and includes a number of small non‐viable isolated populations. The habitat in north‐eastern India is still contiguous with that in Bhutan, Myanmar and Bangladesh and to some extent with Nepal. Although the estimated population of the Gaur is 23 000–34 000, it is declining alarmingly. Populations outside the protected areas may not last long. An action plan has been proposed for its conservation.     

Socioeconomic Disparities in Maternity Care among Indian Adolescents, 1990–2006

Background

India, with a population of more than 1.21 billion, has the highest maternal mortality in the world (estimated to be 56000 in 2010); and adolescent (aged 15–19) mortality shares 9% of total maternal deaths. Addressing the maternity care needs of adolescents may have considerable ramifications for achieving the Millennium Development Goal (MDG)–5. This paper assesses the socioeconomic differentials in accessing full antenatal care and professional attendance at delivery by adolescent mothers (aged 15–19) in India during 1990–2006.

Methods and Findings

Data from three rounds of the National Family Health Survey of India conducted during 1992–93, 1998–99, and 2005–06 were analyzed. The Cochran-Armitage and Chi-squared test for linear and non-linear time trends were applied, respectively, to understand the trend in the proportion of adolescent mothers utilizing select maternity care services during 1990–2006. Using pooled multivariate logistic regression models, the probability of select maternal healthcare utilization among women by key socioeconomic characteristics was appraised. After adjusting for potential socio-demographic and economic characteristics, the likelihood of adolescents accessing full antenatal care increased by only 4% from 1990 to 2006. However, the probability of adolescent women availing themselves of professional attendance at delivery increased by 79% during the same period. The study also highlights the desolate disparities in maternity care services among adolescents across the most and the least favoured groups.

Conclusion

Maternal care interventions in India need focused programs for rural, uneducated, poor adolescent women so that they can avail themselves of measures to delay child bearing, and for better antenatal consultation and delivery care in case of pregnancy. This study strongly advocates the promotion of a comprehensive ‘adolescent scheme’ along the lines of ‘Continuum of Maternal, Newborn and Child health Care’ to address the unmet need of reproductive and maternal healthcare services among adolescent women in India.     

Risk Factors for Maternal Mortality in Rural Tigray,Northern Ethiopia: A Case-Control Study

Background

Maternal mortality continues to have devastating impacts in many societies, where it constitutes a leading cause of death, and thus remains a core issue in international development. Nevertheless, individual determinants of maternal mortality are often unclear and subject to local variation. This study aims to characterise individual risk factors for maternal mortality in Tigray, Ethiopia.

Methods

A community-based case-control study was conducted, with 62 cases and 248 controls from six randomly-selected rural districts. All maternal deaths between May 2012 and September 2013 were recruited as cases and a random sample of mothers who delivered in the same communities within the same time period were taken as controls. Multiple logistic regression was used to identify independent determinants of maternal mortality.

Results

Four independent individual risk factors, significantly associated with maternal death, emerged. Women who were not members of the voluntary Women’s Development Army were more likely to experience maternal death (OR 2.07, 95% CI 1.04–4.11), as were women whose husbands or partners had below-median scores for involvement during pregnancy (OR 2.19, 95% CI 1.14–4.18). Women with a pre-existing history of other illness were also at increased risk (OR 5.58, 95% CI 2.17–14.30), as were those who had never used contraceptives (OR 2.58, 95% CI 1.37–4.85). Previous pregnancy complications, a below-median number of antenatal care visits and a woman’s lack of involvement in health care decision making were significant bivariable risks that were not significant in the multivariable model.

Conclusions

The findings suggest that interventions aimed at reducing maternal mortality need to focus on encouraging membership of the Women’s Development Army, enhancing husbands’ involvement in maternal health services, improving linkages between maternity care and other disease-specific programmes and ensuring that women with previous illnesses or non-users of contraceptive services are identified and followed-up as being at increased risk during pregnancy and childbirth.     

Snakebites in “Invisible Populations”: A cross-sectional survey in riverine populations in the remote western Brazilian Amazon

In the Brazilian Amazon, long distances, low healthcare coverage, common use of ineffective or deleterious self-care practices, and resistance to seeking medical assistance have an impact on access to antivenom treatment. This study aimed to estimate snakebite underreporting, and analyze barriers that prevent victims from obtaining healthcare in communities located in 15 municipalities on the banks of the Solimões, Juruá and Purus Rivers, in the remote Western Brazilian Amazon. Information on the participants’ demographics, previous snakebites, access to healthcare, time taken to reach medical assistance, use of self-care practices, and the reason for not accessing healthcare were collected through semi-structured interviews. In the case of deaths, information was collected by interviewing parents, relatives or acquaintances. A total of 172 participants who reported having suffered snakebites during their lifetime were interviewed. A total of 73 different treatment procedures was reported by 65.1% of the participants. Participants living in different river basins share few self-care procedures that use traditional medicine, and 91 (52.9%) participants reported that they had access to healthcare. Living in communities along the Juruá River [OR = 12.6 (95% CI = 3.2–49.7; p<0.001)] and the use of traditional medicine [OR = 11.6 (95% CI = 3.4–39.8; p<0.001)] were variables that were independently associated to the lack of access to healthcare. The main reasons for not accessing healthcare were the pprioritization of traditional treatments (70.4%), and the failure to recognize the situation as being potentially severe (50.6%). Four deaths from complications arising from the snakebite were reported, and three of these were from communities on the banks of the Juruá River. Only one of these received medical assistance. We found an unexpectedly high underreporting of snakebite cases and associated deaths. Snakebite victims utilized three main different healing systems: 1) self-care using miscellaneous techniques; 2) official medical healthcare generally combined with traditional practices; and 3) self-care using traditional practices combined with Western medicines. To mitigate snakebite burden in the Brazilian Amazon, an innovative intervention that would optimize timely delivery of care, including antivenom distribution among existing community healthcare centers, is needed.     

Illness behavior of housewives in a rural area in Japan: A health diary study

A health diary study was conducted to examine the incidence and nature of health problems and illness behavior among rural residents in Japan. Attention was paid in particular to the utilization of folk medicine or alternative practitioners in the context of illness behavior. One hundred and sixty-one health problems were recorded over a 4-week diary period by 28 housewives aged 35–64 years. Headache, tiredness and gastrointestinal problems were among the most common problems. Emotional/psychological problems, the most frequently recorded problems in the health diary studies conducted in the United States or England, were recorded by only 3 participants. Only 6 problems (3.7 percent) resulted in consulting a doctor. Three women utilized an acupuncturist, shinkyshi, during the diary period. Self-care, such as resting by lying down, using home remedies and self-medication including household drugs, Toyama kusuri and folk medicine, was practiced for 101 problems (62.7 percent). Folk medicine or alternative practitioners played important roles in the health seeking process. The health diary method was shown to be suitable not only to Western communities but also in a rural Japanese context.     

Development and psychometric testing of a theory-based tool to measure self-care in diabetes patients: the Self-Care of Diabetes Inventory

Background

Self-care is essential for patients with diabetes mellitus. Both clinicians and researchers must be able to assess the quality of that self-care. Available tools have various limitations and none are theoretically based. The aims of this study were to develop and to test the psychometric properties of a new instrument based on the middle range-theory of self-care of chronic illness: the Self-Care of Diabetes Inventory (SCODI).

Methods

Forty SCODI items (5 point Likert type scale) were developed based on clinical recommendations and grouped into 4 dimensions: self-care maintenance, self-care monitoring, self-care management and self-care confidence based on the theory. Content validity was assessed by a multidisciplinary panel of experts. A multi-centre cross-sectional study was conducted in a consecutive sample of 200 type 1 and type 2 diabetes patients. Dimensionality was evaluated by exploratory factor analyses. Multidimensional model based reliability was estimated for each scale. Multiple regression models estimating associations between SCODI scores and glycated haemoglobin (HbA1c), body mass index, and diabetes complications, were used for construct validity.

Results

Content validity ratio was 100%. A multidimensional structure emerged for the 4 scales. Multidimensional model-based reliabilities were between 0.81 (maintenance) and 0.89 (confidence). Significant associations were found between self-care maintenance and HbA1c (p?=?0.02) and between self-care monitoring and diabetes complications (p?=?0.04). Self-care management was associated with BMI (p?=?0.004) and diabetes complications (p?=?0.03). Self-care confidence was a significant predictor of self-care maintenance, monitoring and management (all p?<?0.0001).

Conclusion

The SCODI is a valid and reliable theoretically-grounded tool to measure self-care in type 1 and type 2 DM patients.

     

Clinical Presentation and Birth Outcomes Associated with Respiratory Syncytial Virus Infection in Pregnancy

Background

Respiratory syncytial virus (RSV) is the most important cause of viral pneumonia in children worldwide. A maternal vaccine may protect both the mother and infant from RSV illness. The epidemiology and clinical presentation of RSV in pregnant and postpartum women is not well-described.

Methods

Data were collected from a prospective, randomized trial of influenza immunization in pregnant women in rural southern Nepal. Women were enrolled in their second trimester of pregnancy and followed until six months postpartum. Active weekly home-based surveillance for febrile respiratory illness was performed. Mid-nasal swabs collected with episodes of respiratory illness were tested for RSV by real-time polymerase chain reaction.

Results

RSV was detected in 14 (0.4%) illness episodes in 3693 women over 3554 person-years of surveillance from 2011–2014. RSV incidence was 3.9/1000 person-years overall, and 11.8/1000 person-years between September and December. Seven (50%) women sought care for RSV illness; none died. Of the 7 (50%) illness episodes during pregnancy, all had live births with 2 (29%) preterm births and a median birthweight of 3060 grams. This compares to 469 (13%) preterm births and a median birthweight of 2790 grams in women without RSV during pregnancy. Of the 7 mothers with postpartum RSV infection, RSV was detected in 4 (57%) of their infants.

Conclusions

RSV was an uncommon cause of febrile respiratory illness in mothers during pregnancy in Nepal. These data will inform prevention and therapeutic strategies against RSV in resource-limited settings.     

A National Survey of Skin Infections,Care Behaviors and MRSA Knowledge in the United States

A nationally representative sample of approximately 2000 individuals was surveyed to assess SSTI infections over their lifetime and then prospectively over six-months. Knowledge of MRSA, future likelihood to self-treat a SSTI and self-care behaviors was also queried. Chi square tests, linear and multinomial regression were used for analysis. About 50% of those with a reported history of a SSTI typical of MRSA had sought medical treatment. MRSA knowledge was low: 28% of respondents could describe MRSA. Use of protective self-care behaviors that may reduce transmission, such as covering a lesion, differed with knowledge of MRSA and socio-demographics. Those reporting a history of a MRSA-like SSTI were more likely to respond that they would self-treat than those without such a history (OR 2.05 95% CI 1.40, 3.01; p<0.001). Since half of respondents reported not seeking care for past lesions, incidence determined from clinical encounters would greatly underestimate true incidence. MRSA knowledge was not associated with seeking medical care, but was associated with self-care practices that may decrease transmission.     

CENTURY ecosystem model application for quantifying vegetation dynamics in shifting cultivation areas: A case study from Rampa Forests, Eastern Ghats (India)

In India, slash and burn agriculture is one of the major factors contributing to deforestation, especially in the hilly north-eastern region and Eastern Ghats. Studies on vegetation dynamics associated with slash and burn agricultural practices have been intensively studied in the north-eastern part of India. These have covered semi-evergreen/evergreen vegetation, but similar studies on tropical mixed dry deciduous ecosystems are not as common. In the present study, we used the century ecosystem model to study vegetation dynamics in shifting cultivation areas on the mixed dry deciduous forests covering the Eastern Ghats of India. The site-specific parameters, temperature, precipitation, biomass and nutrient pools were used, and, by collecting information from local management practices, a 12-year shifting cultivation cycle during a 70-year period from 1960 to 2030 was simulated. century estimated a total loss of 239 tonnes carbon (tC) in soil organic matter over the simulation period, and the total nitrogen content of the soil organic matter showed an initial increase followed by a decline (344.3 g m² during 1960 to less than 318.3 g m² during 2030). century estimated that 66 tC ha^–1 would be lost from the forest system, reducing the initial forest system carbon level from 118.5 tC ha^–1. An increase in productivity from 0.49 tC ha^–1 during 1960 to 1.2 tC ha^–1 during the initial forest slash and burn in 1962 was observed, but thereafter productivity declined to 0.7 tC ha^–1 during the year 2030. Results obtained in other studies of similar types of agricultural practices are also reviewed.     

Mesozoic origin and ‘out-of-India’ radiation of ricefishes (Adrianichthyidae)

The Indian subcontinent has an origin geologically different from Eurasia, but many terrestrial animal and plant species on it have congeneric or sister species in other parts of Asia, especially in the Southeast. This faunal and floral similarity between India and Southeast Asia is explained by either of the two biogeographic scenarios, ‘into-India’ or ‘out-of-India’. Phylogenies based on complete mitochondrial genomes and five nuclear genes were undertaken for ricefishes (Adrianichthyidae) to examine which of these two biogeographic scenarios fits better. We found that Oryzias setnai, the only adrianichthyid distributed in and endemic to the Western Ghats, a mountain range running parallel to the western coast of the Indian subcontinent, is sister to all other adrianichthyids from eastern India and Southeast–East Asia. Divergence time estimates and ancestral area reconstructions reveal that this western Indian species diverged in the late Mesozoic during the northward drift of the Indian subcontinent. These findings indicate that adrianichthyids dispersed eastward ‘out-of-India’ after the collision of the Indian subcontinent with Eurasia, and subsequently diversified in Southeast–East Asia. A review of geographic distributions of ‘out-of-India’ taxa reveals that they may have largely fuelled or modified the biodiversity of Eurasia.     

Health,illness, and immigration. East Indians in the United States.

East Indian immigrants to the United States represent the diversity in religion, language, and culture that exists in India, so it is difficult to make unequivocal statements about their health beliefs and behaviors. Despite the diversity, an understanding of Ayurvedic humoral concepts of health and illness provides a key to some pervasive and persistent ideas and practices. India has a pluralistic medical system in which Western medicine, which is increasingly popular for some ailments, is one option among many. Even those who are familiar with the "Western" medical system in India may find American medicine alien.     

Continuity of Microblade Technology in the Indian Subcontinent Since 45 ka: Implications for the Dispersal of Modern Humans

We extend the continuity of microblade technology in the Indian Subcontinent to 45 ka, on the basis of optical dating of microblade assemblages from the site of Mehtakheri, (22° 13'' 44″ N Lat 76° 01'' 36″ E Long) in Madhya Pradesh, India. Microblade technology in the Indian Subcontinent is continuously present from its first appearance until the Iron Age (~3 ka), making its association with modern humans undisputed. It has been suggested that microblade technology in the Indian Subcontinent was developed locally by modern humans after 35 ka. The dates reported here from Mehtakheri show this inference to be untenable and suggest alternatively that this technology arrived in the Indian Subcontinent with the earliest modern humans. It also shows that modern humans in Indian Subcontinent and SE Asia were associated with differing technologies and this calls into question the “southern dispersal” route of modern humans from Africa through India to SE Asia and then to Australia. We suggest that modern humans dispersed from Africa in two stages coinciding with the warmer interglacial conditions of MIS 5 and MIS 3. Competitive interactions between African modern humans and Indian archaics who shared an adaptation to tropical environments differed from that between modern humans and archaics like Neanderthals and Denisovans, who were adapted to temperate environments. Thus, while modern humans expanded into temperate regions during warmer climates, their expansion into tropical regions, like the Indian Subcontinent, in competition with similarly adapted populations, occurred during arid climates. Thus modern humans probably entered the Indian Subcontinent during the arid climate of MIS 4 coinciding with their disappearance from the Middle East and Northern Africa. The out of phase expansion of modern humans into tropical versus temperate regions has been one of the factors affecting the dispersal of modern humans from Africa during the period 200–40 ka.     

Socioeconomic Inequalities in Childhood Undernutrition in India: Analyzing Trends between 1992 and 2005

Background

India experienced a rapid economic boom between 1991 and 2007. However, this economic growth has not translated into improved nutritional status among young Indian children. Additionally, no study has assessed the trends in social disparities in childhood undernutrition in the Indian context. We examined the trends in social disparities in underweight and stunting among Indian children aged less than three years using nationally representative data.

Methods

We analyzed data from the three cross-sectional rounds of National Family Health Survey of India from 1992, 1998 and 2005. The social factors of interest were: household wealth, maternal education, caste, and urban residence. Using multilevel modeling to account for the nested structure and clustering of data, we fit multivariable logistic regression models to quantify the association between the social factors and the binary outcome variables. The final models additionally included age, gender, birth order of child, religion, and age of mother. We analyzed the trend by testing for interaction of the social factor and survey year in a dataset pooled from all three surveys.

Results

While the overall prevalence rates of undernutrition among Indian children less than three decreased over the 1992–2005 period, social disparities in undernutrition over these 14 years either widened or stayed the same. The absolute rates of undernutrition decreased for everyone regardless of their social status. The disparities by household wealth were greater than the disparities by maternal education. There were no disparities in undernutrition by caste, gender or rural residence.

Conclusions

There was a steady decrease in the rates of stunting in the 1992–2005 period, while the decline in underweight was greater between 1992 and 1998 than between 1998 and 2005. Social disparities in childhood undernutrition in India either widened or stayed the same during a time of major economic growth. While the advantages of economic growth might be reaching everyone, children from better-off households, with better educated mothers appear to have benefited to a greater extent than less privileged children. The high rates of undernutrition (even among the socially advantaged groups) and the persistent social disparities need to be addressed in an urgent and comprehensive manner.     

Association between Clean Delivery Kit Use,Clean Delivery Practices,and Neonatal Survival: Pooled Analysis of Data from Three Sites in South Asia

Background

Sepsis accounts for up to 15% of an estimated 3.3 million annual neonatal deaths globally. We used data collected from the control arms of three previously conducted cluster-randomised controlled trials in rural Bangladesh, India, and Nepal to examine the association between clean delivery kit use or clean delivery practices and neonatal mortality among home births.

Methods and Findings

Hierarchical, logistic regression models were used to explore the association between neonatal mortality and clean delivery kit use or clean delivery practices in 19,754 home births, controlling for confounders common to all study sites. We tested the association between kit use and neonatal mortality using a pooled dataset from all three sites and separately for each site. We then examined the association between individual clean delivery practices addressed in the contents of the kit (boiled blade and thread, plastic sheet, gloves, hand washing, and appropriate cord care) and neonatal mortality. Finally, we examined the combined association between mortality and four specific clean delivery practices (boiled blade and thread, hand washing, and plastic sheet). Using the pooled dataset, we found that kit use was associated with a relative reduction in neonatal mortality (adjusted odds ratio 0.52, 95% CI 0.39–0.68). While use of a clean delivery kit was not always accompanied by clean delivery practices, using a plastic sheet during delivery, a boiled blade to cut the cord, a boiled thread to tie the cord, and antiseptic to clean the umbilicus were each significantly associated with relative reductions in mortality, independently of kit use. Each additional clean delivery practice used was associated with a 16% relative reduction in neonatal mortality (odds ratio 0.84, 95% CI 0.77–0.92).

Conclusions

The appropriate use of a clean delivery kit or clean delivery practices is associated with relative reductions in neonatal mortality among home births in underserved, rural populations. Please see later in the article for the Editors'' Summary     

Secular Trends in Menarcheal Age in India-Evidence from the Indian Human Development Survey

Background

Evidence from a number of countries in Europe and North America point towards the secular declining trend in menarcheal age with considerable spatial variations over the past two centuries. Similar trends were reported in several developing countries from Asia, Africa and Latin America. However, data corroborating any secular trend in the menarcheal age of the Indian population remained sparse and inadequately verified.

Methods

We examined secular trends, regional heterogeneity and association of socioeconomic, anthropometric and contextual factors with menarcheal age among ever-married women (15–49 years) in India. Using the pseudo cohort data approach, we fit multiple linear regression models to estimate secular trends in menarcheal age of 91394 ever-married women using the Indian Human Development Survey.

Results

The mean age at menarche among Indian women was 13.76 years (95 % CI: 13.75, 13.77) in 2005. It declined by three months from 13.83 years (95% CI: 13.81, 13.85) among women born prior to 1955–1964, to nearly 13.62 years (95% CI: 13.58, 13.67) among women born during late 1985–1989. However, these aggregate national figures mask extensive spatial heterogeneity as mean age at menarche varied from 15.0 years in Himachal Pradesh during 1955–1964 (95% CI: 14.89–15.11) to about 12.1 years in Assam (95% CI: 11.63–12.56) during 1985–1989.

Conclusion

The regression analysis established a reduction of nearly one month per decade, suggesting a secular decline in age at menarche among Indian women. Notably, the menarcheal age was significantly associated with the area of residence, geographic region, linguistic groups, educational attainment, wealth status, caste and religious affiliations among Indian women.     

The Population Decline of Gyps Vultures in India and Nepal Has Slowed since Veterinary Use of Diclofenac was Banned

Populations of oriental white-backed vulture (Gyps bengalensis), long-billed vulture (Gyps indicus) and slender-billed vulture (Gyps tenuirostris) crashed during the mid-1990s throughout the Indian subcontinent. Surveys in India, initially conducted in 1991–1993 and repeated in 2000, 2002, 2003 and 2007, revealed that the population of Gyps bengalensis had fallen by 2007 to 0.1% of its numbers in the early 1990s, with the population of Gyps indicus and G. tenuirostris combined having fallen to 3.2% of its earlier level. A survey of G. bengalensis in western Nepal indicated that the size of the population in 2009 was 25% of that in 2002. In this paper, repeat surveys conducted in 2011 were analysed to estimate recent population trends. Populations of all three species of vulture remained at a low level, but the decline had slowed and may even have reversed for G. bengalensis, both in India and Nepal. However, estimates of the most recent population trends are imprecise, so it is possible that declines may be continuing, though at a significantly slower rate. The degree to which the decline of G. bengalensis in India has slowed is consistent with the expected effects on population trend of a measured change in the level of contamination of ungulate carcasses with the drug diclofenac, which is toxic to vultures, following a ban on its veterinary use in 2006. The most recent available information indicates that the elimination of diclofenac from the vultures’ food supply is incomplete, so further efforts are required to fully implement the ban.