Background : The current WHO recommendation is to use the Z-Score or SD system to grade undernutrition which allows us to measure all the three indices and express the results in terms of Z scores or standard deviation units from the median of the international reference population. Objectives : To estimate the prevalence of undernutrition among under-five children in Coimbatore slums, using the Z-Score system of classification and the recently constructed Composite Index of Anthropometric Failure (CIAF). 2. To compare the Z-Score system with the Indian Academy of Pediatrics (IAP) classification of undernutrition. Methods : Nutritional assessment was done using anthropometry and clinical examination. Children were weighed and measured as per the WHO guidelines on Anthropometry. Epi-Info 2002 software package was used to calculate the Z scores and for statistical analysis. Results : Only 31.4% of the children studied were normal; 68.6% were in a state of "Anthropometric Failure". As per the Z score system, 49.6% were underweight (21.7% severely); 48.4% were stunted (20.3% severely) and 20.2% were wasted (6.9% severely). Whereas, as per IAP criteria, 51.4% were undernourished and 3.2% were severely undernourished. Using Underweight (low weight-for-age) as the only criterion for identifying undernourished children (as done in the Integrated Child Development Services currently) may underestimate the true prevalence of undernutrition, by as much as 21.9%. Conclusions : More widespread use of the Z-Score system is recommended for identifying all the facets of undernutrition. Estimates of the true prevalence of undernutrition must incorporate a composite index of anthropometric failure.

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Background: Childhood obesity is a fast emerging problem for which national representative data is scarce. Effective preventive of adult obesity will require prevention and management of childhood obesity. Objectives: To know the prevalence of obesity in two affluent school children of Davangere city studying between 5th and 10th standard and to identify the factors influencing childhood obesity. Methods: A cross sectional study followed by a case control study was conducted in two affluent schools of Davangere city - Sri. Siddaganga and Sri. Taralabalu residential school. A total of 1496, school children studying between 5th & 10th standard aged between 10 and 15 years were enrolled and data on family history of obesity, diet, snacking habits and physical activity was collected. Results: Out of 1496 children 86 were obese. Prevalence of obesity was 5.74 %. Prevalence of obesity was more in girls (8.82%) than boys ( 4.42%). Prevalence of obesity increased, with increase in age in both boys and Girls. Family history of obesity, snacking of high energy foods and lack of physical activity were the important influencing factors of obesity. Conclusion : Consumption of high fat and high energy (Junk foods) and snacking in between the meals should be avoided by children. Health education should be given to parents, teachers and children regarding dietary habit and sedentary life style.

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Background : Repidly declining sex ratio has highlighted a strong son preference among many societies various methods are employed by people to get a son. Objective: To determine the use pattern of sex selection drugs (SSDs) in rural North India. Methods: An integrated qualitative and quantitative study was conducted in rural North India. A rapid population and hospital based survey of women in their early reproductive life was done in the study area to enlist the respondents. Few SSD samples were collected and analyzed. Results: SSDs were freely available from grocers, chemist shops and specific people in villages. These contained Shivalingi (Bryonia Laciniosa) and Majuphal (Gtuercus infectoria). SSD use rate was 46% and 30% in community based and hospital based studies respectively. Use rate was significantly higher in women who did not have any son. Of the SSD samples and two individual ingredients analyzed by thin layer chromatography, 3 contained testosterone and one progesterone; one ingredient contained testosterone and the other natural steroids. Conclusion: Use of SSDs seems to be very common in North India. Implication of presence of steroids in SSDs needs further evaluation.

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Background: Full breastfeeding refers to exclusive breastfeeding, which is the practice of feeding only breast milk excluding water, breast milk substitutes, other liquids and solid foods. `Full breastfeeding for the first six months is the most appropriate infant feeding practice. The duration of full breastfeeding varies considerably among women belonging to different sections of the population. Objective: To estimate the probabilities at various time intervals for the duration of full breastfeeding. Study Design: A group of 102 women who were interviewed at immunization centre in Varanasi in 2004, where they came with their youngest child for vaccination. Women reporting continuance of full breastfeeding (31 %) on the date of interview were considered as censored cases. Survival analysis procedure using life table approach was applied. Result: The median duration of full breastfeeding was found 5.53 months: Relationship between duration of full breastfeeding and practice of breastfeeding (at fixed time or on demand) was also studied. The mean and median duration of full breastfeeding were observed higher in women feeding at fixed time than those on demand of the child, though by log-rank test the difference was found not statistically significant. Conclusions : The observed data do not provide sufficient evidence to establish a relationship between duration of full breast feeding and practice of breastfeeding.

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Background : Reproductive health is closely associated with culture of a country. Its sign and symptoms can be best understood within the ethnomedical contest rather then biomedical theories. Objective : To ascertain the views of the respondents regarding vaginal discharge. Methods : Three roadside villages of Panchkula, Haryana was purposively selected. A house to house survey was done and a total of 236 married women 15-45 years were interviewed by a female social worker on various aspect on vaginal discharge. Six FGDs and five case studies were also done. Results: Prevalence of vaginal discharge was 28.7%. Weakness, backache and poor vision were told as the main health effects of vaginal discharge. Heat, melting of bones, sexual promiscuity, poor hygiene and diet were told as the major causes of vaginal discharge. Consultation rate for vaginal discharge was 59%. Conclusion: The views of the rural north Indian women regarding vaginal discharge reflected the Ayurvedic system of thinking of the Indian masses.

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Background : Diarrhoeal diseases are a leading cause of morbidity and mortality among children in developing countries requiring hospitalisation. AIDS and indiscriminate use of antibiotics have further worsen the condition. Objectives : To assess the etiological agents causing diarrhea with the aim to limit indiscriminate use of antimicrobial agents. Methods : A cross-sectional study was done involving children and adults (of all age groups) suffering from gastrointestinal infection attending the OPD or admitted to Guru Teg Bahadur Hospital. The study was analysed using chi-square test and crosstab chi-square test. Results : Of the 2534 stool samples processed, 23.2% were positive for pathogens. 4.6% were positive for Shigella species, 2.37% for Salmonella species and 1.5% for Escherichia coli (E.coli). Vibrio cholerae OI El Tor serotype Ogawa (82.55%) was more common than serotype Inaba (19.5%). Vibrio cholerae strains were generally resistant to all drugs except Ciprofloxacin, Gentamicin, and Cefotaxime. Multidrug resistant Shigella and Salmonella species was also an important observation made. However parasitic and viral (rota virus) associated diarrhea did not exceed the bacterial causes. Conclusions : New pathogens have emerged as causative organisms of diarrhoa. Indiscriminate use of antibiotics can lead to drug resistance necessitating monitoring of drug susceptibility and formulation of drug policy in hospitals.

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Background : Role of different social factors on fertility control is evident from different studies. What is the impact of religious faith and female literacy on fertility? Objectives : To study the role of religious faith and female literacy on fertility regulation in a rural community of West Bengal. Methods : Cross Sectional Study at rural field practice area of Department of Community Medicine, NRS Medical College, Kolkata, based on interview of married women in reproductive age group. A total of 671 filled in schedules were analyzed by Epi info package. Results : Average number of pregnancies ever occurred among Muslim mothers (2.8) were higher in comparison with Hindu mothers (1.68). Regarding current fertility, live births in last 2 yrs was more among Muslim mothers (25.2%) as compared with their counterparts among Hindu community (12.4%). In both the cases differences were found to be statistically significant. Female literacy was found to have no impact on fertility as a whole, but while stratified, its positive role was evident among Hindu mothers but not among Muslim mothers. Conclusions : Factors, which have made differences in fertility between two religious groups, should be properly assessed and duly addressed for better fertility control in the community.

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Background : Automobile repair shop is a place where workers are exposed to harmful chemicals and toxic substances. Objective : To study the occurrence of obstructive and restrictive pulmonary impairment among automobile garage workers. Methods : A cross sectional study involving 151 automobile garage workers from 14 randomly selected garages of urban Kolkata. The study variables were Forced Expiratory Volume in 1 second (FEV ₁ ), Forced Vital Capacity (FVC), Peak Expiratory Flow Rate (PE FR), age, smoking habit, duration of work, type of work, and respiratory symptoms. The study was analysed using Regression equations, and Chi-square test. Results : All the workers were male. Obstructive impairment was seen in 25.83% of the workers whereas restrictive impairment was seen in 21.19% of the workers. Mixed obstructive and restrictive impairment was seen in 10.6% of the workers. The frequency of obstructive impairment was higher in older workers. In the age group of less than 20 years, 13.6% of the workers had obstructive impairment while 42.86% of workers above 40 years of age had obstructive impairment. Obstructive impairment was more frequently observed in battery repair workers (58.33%) and spray painters (37.5%) while 16.67% of the body repair workers and 30.19% of the engine mechanics had obstructive impairment. Obstructive impairment was more frequently observed in smokers (53.1 %) as compared to ex-smokers (33.3%) and non-smokers (6.4%). Obstructive impairment was more frequently observed in workers who had been working for a longer duration. Conclusion: Nearly 36.4% of the automobile garage workers had some form of pulmonary function impairment; obstructive and/or restrictive. The use of personal protective equipment, worker education, and discontinuation of the use of paints containing toxic pigments are recommended.

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Background : Anemia is widely prevalent in India and affects both sexes and all age group. Although the National Anemia Prophylaxis Programme (NAPP) has been set up in all states of the country since 1970, the benefits have not yet been appreciated in the target population. Objective : 1. To assess the prevalence of anemia and its severity in tribal children. 2. To find out age & sex wise distribution of Hb level in these children. 3. To explore different underlying factors of development of anemia. Methods : The present study is a cross sectional study conducted in tribal villages of Mohana block in Gajapati district of Orissa. A total of 599 tribal children in the age group 6 month - 14 years were recruited from August 2004 to February 2005. The study variables included age, sex, Hb level, food consumption and clinicoepidemiological factors which were analysed by simple proportion and Z test. Results : About 94% of under five children were found to be anemic and 8.8% of them were severely anemic. Almost all children of age group 5-14 years were anemic, amongst them 59.4% were moderately anemic and 5. 4% were severely anemic. There is no significant difference in mean Hb level between male and female in both the age groups. It was significantly more in the age group of 5-14 years. About 94% were taking food of low iron bioavailability. Pallor was found in 33.6% and H/O irregular fever in 28.7% of children. 26.9% children had splenomegaly. Only 2.3% children had taken IFA supplementation in last one year. Conclusions : Anemia is a major health problem in tribal children. Reorientation of primary health care functionaries to cover the children under NNAPP with the help of ICDS workers and school authorities.

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Background: Rapid growth of urban slums due to alarmingly increasing urbanization is adversely affecting the growth and development of infants residing in such deprived areas. Objectives: To study the association of postnatal growth and psychosocial development of urban slum infants. Methods: 202 infants and their mothers were included in a cross-sectional study conducted in Raja bazaar in 2002. Growth was assessed using anthropometric measurements: weight & length for age and development by psychosocial developmental scale developed by ICMR. Results: Development was delayed in significantly higher percentage of underweight (W/A<-2 S.D) than normal infants (p value<0.05): gross motor (15.3%& 4.5%), Vision &fine motor (21.1%, 4.6%) and social skills (27.6%, 12.1%). Development of gross motor milestones was also delayed in significantly high percentage of stunted infants with L/A<-2S.D (22.2%) compared to normal L/A (5.6%, p value=0.003). Difference in the percentages of infants was significantly very high (p value0.000) for vision & fine motor (27.5% & 6.9 %), hearing, language & concept development (22.5% & 4.2%) and social skills (42.5% & 11.9%). Conclusions: Interventions to improve the postnatal growth will be helpful in facilitating the psychosocial development of infants living in urban slums.

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Background : With a view to eliminate leprosy, Government launched National Leprosy Eradication Programme in 1983. Modified Leprosy Elimination Campaigns further helped in case detection. Objective : To evaluate the impact of National Leprosy Eradication Programme in Jamnagar district. Methods : A retrospective record based study was conducted in Urban Leprosy Centre of Jamnagar district. Prevalence rate, New case detection rate, Percentage of cases released from treatment, Proportion of multibacillary (MB) cases among new cases, Proportion of grade II disability among new cases and Proportion of child cases among new cases were evaluated. Results: Analysis of records of ten years indicated a decrease in prevalence rate of leprosy. Over the years a declining trend in grade II disability among new cases was noted. There was an increase in percentage of patients being released from treatment. Case detection rate was increasing steadily from year 1992 to1998. Analysis of data relating to proportion of cases among children did not show a consistency in trend. Conclusion : The national leprosy eradication programme has a favorable impact towards elimination of leprosy in the district of Jamnagar.

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Background : This study was conducted in JIPMER & Kurusukuppam, Pondicherry. Objectives : To identify the socioeconomic factors influencing the utilization of cataract surgery & to identify the persons motivating the patients to utilize these services. This was a case-control study; cases were patients (age group 50-70 years) who were operated in JIPMER for senile cataract without complications and one control was selected for each case. Controls were also of the same age group residing at Kurusukuppam with complaints of dimness of vision and who had not undergone cataract surgery, selected by random sampling. Both the groups were interviewed using a pretested interview schedule. Results : Subjects who were literate and with high school education and more and with income more than Rs.1050 (class III) utilized the cataract surgery services more. In majority of cases, motivation for getting operated comes from relatives. Peer groups who have undergone the surgery before, were the predominant sources of health information about the surgery. Higher income & higher education affect the utilization significantly. Relatives & Previously operated peers play an important role.

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Background: Studies assessing the prevalence of reproductive morbidity among males in India have chiefly focused on prevalence of Reproductive Tract Infections/Sexually Transmitted Infections (RTIs/STIs) among males attending Sexually Transmitted Disease clinics, blood donors and other selected population groups, with only few focused on the magnitude and the type of reproductive morbidity amongst Indian males at community level. Objective: To estimate prevalence of reproductive morbidity including (RTIs/STIs) among males in the age group of 20-50 years residing in an urban slum of Delhi. Methods: Out of 268 males in the targeted age group, selected by systematic random sampling, residing in an urban sum of Delhi, 260 males were subjected to clinical examination and laboratory investigations for diagnosis of reproductive morbidity. Laboratory investigations were done for diagnosis of Hepatitis B and C, Syphilis, Gonorrhoea, Non gonococcal urethritis and urinary tract infection. Results: A total of 90 (33.6%) of 268 study subjects reported one or more perceived symptoms of reproductive tract / sexual morbidity in last six months. Overall reproductive morbidity based on clinical and laboratory diagnosis was present in 76 (29.2%) study subjects and of this sexually acquired morbidity accounted for 21.2% cases. Hepatitis B was most common (10.3%) reproductive morbidity followed by Urinary Tract Infection (5.0%), scabies (3.5%) and congenital anomalies (3.5%). Conclusion: High prevalence of reproductive morbidity (29.2%) amongst males in an urban slum highlights the need for more studies in different settings. There is a need for developing interventions in terms of early diagnosis and treatment and prevention.

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