Effect of geographical access to health facilities on child mortality in rural Ethiopia: a community based cross sectional study

Background

There have been few studies that have examined associations between access to health care and child health outcomes in remote populations most in need of health services. This study assessed the effect of travel time and distance to health facilities on mortality in children under five years in a remote area of rural north-western Ethiopia.

Methods and Findings

This study involved a randomly selected cross sectional survey of 2,058 households. Data were collected during home visits to all resident women of reproductive age (15–49 years). A geographic information system (GIS) was used to map all households and the only health centre in the district. The analysis was restricted to 2,206 rural children who were under the age of five years during the five years before the survey. Data were analysed using random effects Poisson regression. 90.4% (1,996/2,206) of children lived more than 1.5 hours walk from the health centre. Children who lived ≥1.5 hrs from the health centre had a two to three fold greater risk of death than children who lived <1.5 hours from the health centre (children with travel time 1.5–<2.5 hrs adjusted relative risk [adjRR] 2.3[0.95–5.6], travel time 2.5–<3.5 hrs adjRR 3.1[1.3–7.4] and travel time 3.5–<6.5 hrs adjRR 2.5[1.1–6.2]).

Conclusion

Distance to a health centre had a marked influence on under five mortality in a poor, rural, remote area of Ethiopia. This study provides important information for policy makers on the likely impact of new health centres and their most effective location in remote areas.     

Religion and intensity of inbreeding in Tamil Nadu,South India

Abstract

A representative random sample of 11,628 rural couples and 8,998 urban couples from North Arcot District of Tamil Nadu in South India are under follow up since 1969 in a study of inbreeding eflFects. This paper describes the level of inbreeding and its relationship to religion of the couples. Wright's F for autosomal genes in the rural and urban areas were 0.0371 and 0.0205, respectively. The F for sex‐linked genes was significantly higher than that for autosomal and was 0.0411 in the rural areas and 0.0228 in the urban. Hindus had the highest inbreeding coefficients as compared to Muslims or Christians for both autosomal and sex‐linked genes, but there were significant variations among the different castes. The level of inbreeding among Muslims and Christians was similar and fairly high. Significant rural‐urban differentials persist in all religions. There is no appreciable change in the level of inbreeding over the past few decades in any religion, although minor declines are observed in certain castes in the urban areas.     

Occurrence of cyclopiazonic acid in feeds and feedstuffs in Tamil Nadu,India

Out of 100 samples (67 randomly collected and 33 known to contain aflatoxin) of feeds and feedstuffs examined, 40 showed cyclopiazonic acid (CPA) activity i.e., maize 10/26, groundnut cake 10/20, sunflower seed cake 7/10, sorghum 4/10, wheat 1/1, little millet 1/1, rice 1/1, deoiled rice bran 0/1, fishmeal 0/1, chick mash 1/3, grower mash 0/7, layer mash 3/11, broiler mash 2/6 and cattle feed 0/2, concentrations ranged from 0.4 to 12, 0.5 to 20, 0.3 to 20, 0.3 to 20,20, 10, 10, 1.5, 1 to 15, 8, and 15 ppm, respectively. Co-occurrence of CPA was found in 14 of 33 aflatoxin-containing samples. Part of Ph.D. thesis submitted by the first author to the Tamil Nadu Veterinary and Animal Sciences University, Madras 600 007, India.     

Canvases of Political Competition: Image Production as Politics in Tamil Nadu,India

In this article, I explore the production of political images in the Indian state of Tamil Nadu. The state is known for the ubiquitous presence of banners, murals and posters in its public spaces, featuring prominent politicians and actors. It is commonly argued that these images help to convey the heroic or exclusive status of political leaders. However, such images are actually produced by party workers and therefore do not simply transpose status and image. Instead, political supporters praise their leader via these images and act as ‘kingmakers’ in constructing reputation and power. Simultaneously, by putting political images on display, supporters also authorise their own power. While praise is important in showing a person's dedication to a political party, the images, in the motivations of their producers, are suffused with ambivalence and competition as well. Hence, I argue, political image practices are not representative of politics, they are politics.     

Insect resistance in tomato accessions and their hybrid derivatives in Tamil Nadu, India

Host plant resistance offers a viable alternative to the use of chemical insecticides for managing insects Infesting tomato. Hence, a study was carried out in Tamil Nadu, India during 1996 to 2004. An exhaustive germplasm comprising 321 tomato accessions including cultivars, wild lines, land races, tribal/native tomatoes was gathered from various sources and screened for resistance against the major pest namely fruit worm, Helicoverpa armigera Hubner (Noctuidae: Lepidoptera). In the field screening, larval population and fruit damage was evaluated while in the glasshouse, foliage and fruit damage was assessed and ten promising accessions were selected. Based on further laboratory studies on the various mechanisms and bases of resistance, four accessions namely, Varushanadu Local, Seijima Jeisei, Ac 238 and Roma were selected and subjected to intercrossing by conventional hybridization, which yielded three viable hybrids. The resistance potentials of these hybrids against the fruit worm, H. armigera, leaf caterpillar, Spodoptera litura Fab. Noctuldae: Lepidoptera), leaf miner, Liriomyza trifolii Blanchard (Agromyzidae: Diptera) and whitefly, Bemisia tabaci Genn. (Aleyrodidae: Hemiptera) were probed both in the field and glasshouse along with their respective parents. The hybrids exerted lesser feeding and ovipositional preference and higher antibiotic effects on insect stages. The density of three types of non-glandular and two types of glandular trichomes and phenol content in the foliage, lycopene and ascorbic acid content in the fruits were the major factors of resistance. Based on these studies, Hybrid 3 (Ac 238 x Roma) and its derivatives were adjudged as potential accessions possessing insect tolerance.     

Keratinophilic fungi of poultry farm and feather dumping soil in Tamil Nadu,India

Soils of 10 poultry farms from Namakkal and 12 feather dumping sites from Chennai were studied for the presence of keratinophilic fungi. A total of 34 species belonging to 19 genera and one non-sporulating fungus were recovered. Sixteen species of fungi and one non-sporulating fungi were common to both sites, eight species were specific to Namakkal and nine species were specific to Chennai. Dermatophytes and closely related fungi were represented by six species belonging to five genera. Fungal species commonly found in the soil samples included Chrysosporium keratinophilum (73%), Trichophyton mentagrophytes (68.2%), Microsporum gypseum (64%), Myceliopthora vellerea (32%), Chrysosporium state of Arthroderma tuberculatum (27.3%) and Geomyces pannorum (23%). Non-dermatophyte fungi were represented by 28 species belonging to 14 genera and one non-sporulating fungus.     

HIV/AIDS and the Gendering of Stigma in Tamil Nadu,South India

Drawing on the seminal theoretical work on stigma by Goffman, this article analyzes stigma through the lens of Parker and Aggleton, who call for the joining of Goffman and Foucault to better grasp relationships among stigma, power and social inequality. Studies on the social impact of HIV/AIDS globally have demonstrated that women tend to be blamed for the spread of HIV/AIDS, and as a result, HIV-positive women face greater stigma and discrimination than HIV-positive men. Based on ethnographic research among 50 HIV-positive women in South India in 2002–2003 and 2004, my research supports this standard argument. However, my findings suggest that the gendering of stigma and discrimination is more complex and context specific. The gendering of stigma varies depending on the social context of private versus public spheres. The tendency to stigmatize women is due in part to cultural constructions of gendered bodies and not only to a gendered double standard of sexual morality, as has been previously reported. Even when a cultural argument about women’s wayward sexuality is evoked, this rhetoric must be understood in part as a strategy to mask economically motivated responses, rather simply being attributed to sexist ideology per se.     

Maternal morbidity and mortality associated with interpregnancy interval: cross sectional study

ObjectiveTo study the impact of interpregnancy interval on maternal morbidity and mortality.DesignRetrospective cross sectional study with data from the Perinatal Information System database of the Latin American Centre for Perinatology and Human Development, Montevideo, Uruguay.SettingLatin America and the Caribbean, 1985-97.Participants456 889 parous women delivering singleton infants.ResultsShort (<6 months) and long (>59 months) interpregnancy intervals were observed for 2.8% and 19.5% of women, respectively. After adjustment for major confounding factors, compared with those conceiving at 18 to 23 months after a previous birth, women with interpregnancy intervals of 5 months or less had higher risks for maternal death (odds ratio 2.54; 95% confidence interval 1.22 to 5.38), third trimester bleeding (1.73; 1.42 to 2.24), premature rupture of membranes (1.72; 1.53 to 1.93), puerperal endometritis (1.33; 1.22 to 1.45), and anaemia (1.30; 1.18 to 1.43). Compared with women with interpregnancy intervals of 18 to 23 months, women with interpregnancy intervals longer than 59 months had significantly increased risks of pre-eclampsia (1.83; 1.72 to 1.94) and eclampsia (1.80; 1.38 to 2.32).Conclusions Interpregnancy intervals less than 6 months and longer than 59 months are associated with an increased risk of adverse maternal outcomes.     

Venomous snakebites: Rapid action saves lives—A multifaceted community education programme increases awareness about snakes and snakebites among the rural population of Tamil Nadu,India

The lack of public awareness surrounding the dangers of snakebite envenomation (SBE) is one of the most critical factors contributing to SBE-induced complications, and subsequently exacerbating the number of deaths and disabilities resulting from SBE. In this study, we deployed a multifaceted community education programme to educate students, healthcare professionals and members of the public in rural areas of Tamil Nadu, India about the dangers of SBE, appropriate first aid measures and the ‘do’s and don’ts’ following a snakebite. An assessment of prior knowledge within these communities identified several misconceptions concerning snakes and SBE. Using a combination of direct engagement (estimated to reach over 200,000 people), information leaflets (200,000 distributed), posters, video documentaries, media and social media (>2.8 million engagements), over the course of one year (January to December 2019) we reached over 3 million people in rural Tamil Nadu (around 8% of population). Evaluation of community-based assemblies indicated that at least 90% of attendees were able to recall the key messages at the end of the events, and at least 85% were able to recall the key messages even after 12 months. Due to high demand, a one-day symposium was organised to provide clinical knowledge and training on SBE to 250 healthcare professionals in rural Tamil Nadu. Notably, an assessment of patient data (291 victims) collected from a snakebite referral hospital over the same 12-month period (2019) indicated that arrival time at hospital following a snakebite was significantly faster and the effective first aid measures were administered to patients who were aware of our activities compared to those that were not. Overall, our approach provides a framework on how to educate rural communities about the dangers of SBE and thereby, mitigate delayed SBE treatment leading to an overall reduction in SBE-induced mortality, morbidity, treatment costs and other socio-economic ramifications.     

Paperwork,patronage, and citizenship: the materiality of everyday interactions with bureaucracy in Tamil Nadu,India

This article explores the material practices through which lower-caste and poor villagers engage with bureaucracy in contemporary India. We take documents and paperwork – such as ration cards and community certificates – as a ‘lens’ through which to explore how paper materiality is infused with the politics of power, patronage, and identity. The article brings ethnography from rural Tamil Nadu, South India, in conversation with two bodies of literature: one on the materiality of bureaucracy and one on the nature of political mediation in contemporary India. We demonstrate how everyday engagements with paperwork as well as processes of applying, form filling, and securing recommendations are constitutive of social and political relationships and, ultimately, of citizenship itself. Political mediation around paperwork and bureaucracy generates a hierarchy of citizens rather than equal citizenship for all, yet ordinary villagers transpire as anything but passive. Drawing on patronage networks, engaging in affective performances, and navigating a politics of identity, they actively negotiate access to the state in an attempt to claim their rights as citizens.     

Plant species diversity and tree population structure of a humid tropical forest in Tamil Nadu, India

Vegetation structure and species composition of tropical ecosystems were studied through nine transects at Veerapuli and Kalamalai reserve forests in the Western Ghats of Tamil Nadu, India. Species diversity, dominance, species richness and evenness indices of plant communities and also population structure of woody plants were enumerated. A total of 244 species (183 genera and 76 families) were recorded. Species richness (number of species) were 82,142 and 96 species per 0.3 ha respectively for the study areas of low-elevation forest (LEF), mid-elevation forest (MEF) and high elevation forest (HEF). Species diversity indices were greater in MEF compared to the other two forests except juveniles. In contrast, greater dominance value indices were recorded in LEF than other forests. Density and basal area of the MEF were twice greater than the LEF, while HEF showed greater tree density and low basal area when compared to LEF. The stem density and species richness (number of species) decreased with increased size classes of trees observed in the present study indicated good regeneration status. Population structure of juveniles and seedlings also reflects good regeneration status. Terminalia paniculata (IVI of 99.9) and Hopea parviflora (IVI of 103.8) were dominant tree species respectively in LEF and MEF whereas in HEF Agrostistachys meeboldii (63.65), Cullenia excelsa (63.67) and Drypetes oblongifolia (39.67) share the dominance. Past damage (anthropogenic perturbation) may be one of the reasons for single species dominance in LEF and MEF. Occurrence of alien species such as Eupatorium odoratum and Ageratum conyzoides also indicated the past disturbance in LEF. The variations in plant diversity and population structure are largely due to anthropogenic perturbation and other abiotic factors.     

Distributional ecology of snails (Gastropoda: Mollusca) in seasonal ponds of Tamil Nadu,South India

The present study was focused to examine diversity and distributional pattern of freshwater snails and to identify the schistosome infected snails in ten different ponds of Madurai district, Tamil Nadu, South India. Snails were collected from native substrates in ponds using dip net from Madurai North, Tamil Nadu province of south India and microscopic examination for detecting cercariae larvae in snails were assessed. In total, 1250 individuals belonging to six species under five families of freshwater snails were collected. The alpha and beta diversity analyses were calculated for estimating the diversity of snails. The cercariae infection was observed in four collected freshwater snail species. Of four infected snails, Lymnaea luteola had the highest percentage of cercariae infection. Statistical tests showed that the environmental factors of total dissolved solids, pH and salinity were significantly related with snail distribution and cercariae infection rather than spatial factor. The study demonstrated that the salinity, conductivity and total dissolved solids of pond water play a key factor for the distribution of snails and cercariae infection. The findings of our study will improve the understanding of the dynamics of schistosomiasis transmission and would ease the implementation of integrated disease control measures based on ecological knowledge of schistosomiasis vector in Madurai and Tamil Nadu zones.     

Factors affecting birth weight of a newborn--a community based study in rural Karnataka, India

Background

Low birth weight (LBW) is a major public health problem in many developing countries, especially so in India. Although we do not know all the causes of LBW, maternal and environmental factors appear to be significant risk factors in its occurrence.

Objectives

To know the factors affecting the birth weight of a newborn and to estimate the prevalence of LBW.

Methods

The present study was carried out amongst 1138 pregnant women and their newborns residing in area covered by Kinaye Primary Health Centre in rural Karnataka, India. The study was conducted from 1^st June 2008 to 31^st December 2009.

Results

The mean birth weight of newborns was 2.6 kg with a range of 1.2 to 3.8 kg. The prevalence of LBW was 22.9%. Among the studied risk factors, 25 of them were significantly associated with the birth weight of a newborn on univariate logistic regression analysis. Maternal education [Odds Ratio (OR) 3.2], exposure to passive smoking [OR 2.3], age at first pregnancy ≥25 years [OR 3.6], birth interval <2 years [OR 2.4], previous history of LBW baby [OR 3.3], weight gain ≤4 kg during pregnancy [OR 7.0], maternal weight at last week of gestation ≤45 kg [OR 2.3], pregnancy induced hypertension [OR 3.3], high risk pregnancy [OR 3.6] and late antenatal registration [OR 3.6] emerged as significant risk factors on multivariate analysis.

Conclusion

The problem of LBW is multidimensional, and hence, we need an integrated approach incorporating medical, social, economical and educational measures to address this issue.     

Cumulative exposure and dietary risk assessment of phthalates in bottled water and bovine milk samples: A preliminary case study in Tamil Nadu,India

Exposure to phthalates may cause adverse health effects in wildlife and humans. Study on phthalates exposure and risk is limited in the Indian context. Therefore, this preliminary investigation was performed to ascertain the phthalates exposure through bottled water and milk among the Indian sub-population. Phthalates were extracted from water and milk by solid-phase and ultrasonication methods, respectively, and analysis was performed using gas chromatography–mass spectrometry. Total phthalates in bottled water and milk were in the range of 39–7820 ng/L and 56–686 ng/g, respectively, with the highest contribution from diethylhexyl phthalate (DEHP). A substantial increase in phthalates concentration in bottled water was observed with increased shelf life. Total mean phthalates in packed milk (245 ng/g) and raw milk (134 ng/g) shows potential enrichment during “farm to table” process. Among phthalates, the lowest risk was expected from diethyl phthalate, whereas the highest risk was observed for DEHP with cumulative dietary exposure of 0.23 μg/kg bw/day (median). The human health risk based on tolerable daily intake and reference dose was found safe. This is the first study reporting phthalates migration in packed commodities from a developing country, India, which further warrants extensive phthalates exposure assessment to understand its effect on public health.     

Sediment Heavy Metal Contents,Ostracod Toxicity and Risk Assessment in Tropical Freshwater Lakes,Tamil Nadu,India

ABSTRACT

Coimbatore is one of the industrial cities in Tamil Nadu, India, which has been experiencing rapid urbanization and population growth. Coimbatore is also known for its unique freshwater lakes environment and serves as a rich ecosystem. However, the assessment of heavy metal levels in aquatic environments is limited. This study was aimed to investigate physicochemical parameters, heavy metals level and sources, and ecotoxicity in sediments collected from five different lakes in Coimbatore. The concentrations of heavy metals (Cr, Cu, Zn, As, Cd, and Pb) in sediments were determined by Inductive Coupled Plasma-Mass Spectroscopy (ICP-MS). Hg level was measured using Advanced Mercury Analyzer (AMA). The determined heavy metal concentrations in sediments varied significantly according to the lake location and consistent with local human linked anthropogenic activities. The metal concentrations in urban lakes were exceeding both the Sediment Quality Guidelines (SQGs) and the probable effect levels” (PELs) mostly; e.g., in sediments from the Lake Ukkadam, the values of 5.08 and 203.32 mg kg-1 dry weight were observed for Hg and Cu, respectively. The ecotoxicity test with ostracods exposed to the sediment samples revealed that mortality ranged between 6 and 23% for countryside lakes and 28 and 88% for the lakes within urban Zone. We used Spearman rank-order correlation and Principal components analysis (PCA) to assess the sources of pollutants and if they related to anthropogenic pressure and eutrophication of lakes. The main sources of heavy metals from studied lakes differed significantly. Urban and industrial effluents were dominant sources in urban lakes. Agricultural runoff, domestic wastes, and natural weathering were responsible for the metal sources in country lakes. This study provides baseline information on the heavy metal pollution status of sediments in the freshwater lakes in Coimbatore, which will be useful for pollution control measures to prevent possible metal sources on these lakes and impose appropriate management practices and continuous monitoring by relevant authorities.