Objective.To assess the validity of human touch (HT) method to measure hypothermia compared against axillary digital
thermometry (ADT) and study association of hypothermia with poor suckle and underweight status in newborns and
environmental temperature in 11 slums of Indore city, India.
Methods.Field supervisors of slum-based health volunteers measured body temperature of 152 newborns by HT and ADT,
observed suckling and weighed newborns. Underweight status was determined using WHO growth standards.
Results.Hypothermia prevalence (axillary temperature <36.5o
C) was 30.9%. Prevalence varied by season but insignificantly.
Hypothermia was insignificantly associated with poor suckle (31% vs19.7%, p=0.21) and undernutrition (33.3% vs 25.3%,
p=0.4). HT had moderate diagnostic accuracy when compared with ADT (kappa: 0.38, sensitivity: 74.5%, specificity: 68.5%).
Conclusions.HT emerged simpler and programmatically feasible. There is a need to examine whether trained and supervised
community-based health workers and mothers can use HT accurately to identify and manage hypothermia and other simple
signs of newborn illness using minimal algorithm at home and more confidently refer such newborns to proximal facilities linked
to the program to ensure prompt management of illness. [Indian J Pediatr 2010; 77 (7) : 759-762] E-mail: siddharth@uhrc.in,
sids62@yahoo.com
Quantitative Statistical Analysis Work Sample From StatsworkStats Statswork
Quantitative Data Collection perhaps the most widely used method for primary data collection. A variety of different collection methods of research, including mail surveys and face to face interviews.
Sample Work of an Meta-Analysis | Hire a Meta-Analysis Expert: Pubrica.comPubrica
Pubrica has a broad experience in all aspects of Scientific Medical Writing, Editing, and Publishing. A global leader in comprehensive manuscript publication support service for academic and scientific journals, We provide a wide range of services that include Scientific medical research writing, Clinical data analysis, Literature review, Meta-analysis, medical Communication and medico-marketing solutions to healthcare/pharmaceutical/food and beverage companies.
Find freelance Meta-Analysis professionals, consultants, freelancers and get your project done - https://bit.ly/30V8QUK
Why Pubrica:
When you order our services, we promise you the following – Plagiarism free, always on Time, outstanding customer support, written to Standard, Unlimited Revisions support and High-quality Subject Matter Experts.
Contact us:
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom : +44-1143520021
Watch the video of the presentation on Youtube: https://www.youtube.com/watch?v=WRegqg5yvRs
El Dr Welte té nombroses publicacions en àrees diverses relacionades amb el malalt crític. Particularment interessants són els seus estudis en relació al trasplantament pulmonar, així com els seus estudis sobre pneumònia i sèpsia. Així mateix, participa activament en la xarxa alemanya Capnetz, emprada per a l'elaboració d'estudis multicèntrics relacionats amb la pneumònia adquirida a la comunitat.
Cooling of sepsis patients - Morten Bestle - SSAI2017scanFOAM
A talk by Morten Bestle at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Content delivered in collaboration between scanFOAM, SSAI & SFAI.
Exponentially Distributed Outages of Decreased ACTH and Cortisol Responses to...IJERA Editor
Preclinical research findings suggest that exposure to stress and concomitantly hypothalamus-pituitary-adrenal
(HPA) axis activation during early development can have permanent and potentially deleterious effects. A
history of early-life abuse or neglect appears to increase risk for mood and anxiety disorders. Abnormal HPA
response to stress challenge has been reported in adult patients with Major Depressive Disorder and PostTraumatic
Stress Disorder. This paper discussed the constant stress level of adult patients with times to damage
of stress effect and recoveries. Also In adults without diagnosable psychopathology, childhood maltreatment is
associated with diminished HPA axis response to a psychosocial stressor.
Quantitative Statistical Analysis Work Sample From StatsworkStats Statswork
Quantitative Data Collection perhaps the most widely used method for primary data collection. A variety of different collection methods of research, including mail surveys and face to face interviews.
Sample Work of an Meta-Analysis | Hire a Meta-Analysis Expert: Pubrica.comPubrica
Pubrica has a broad experience in all aspects of Scientific Medical Writing, Editing, and Publishing. A global leader in comprehensive manuscript publication support service for academic and scientific journals, We provide a wide range of services that include Scientific medical research writing, Clinical data analysis, Literature review, Meta-analysis, medical Communication and medico-marketing solutions to healthcare/pharmaceutical/food and beverage companies.
Find freelance Meta-Analysis professionals, consultants, freelancers and get your project done - https://bit.ly/30V8QUK
Why Pubrica:
When you order our services, we promise you the following – Plagiarism free, always on Time, outstanding customer support, written to Standard, Unlimited Revisions support and High-quality Subject Matter Experts.
Contact us:
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom : +44-1143520021
Watch the video of the presentation on Youtube: https://www.youtube.com/watch?v=WRegqg5yvRs
El Dr Welte té nombroses publicacions en àrees diverses relacionades amb el malalt crític. Particularment interessants són els seus estudis en relació al trasplantament pulmonar, així com els seus estudis sobre pneumònia i sèpsia. Així mateix, participa activament en la xarxa alemanya Capnetz, emprada per a l'elaboració d'estudis multicèntrics relacionats amb la pneumònia adquirida a la comunitat.
Cooling of sepsis patients - Morten Bestle - SSAI2017scanFOAM
A talk by Morten Bestle at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Content delivered in collaboration between scanFOAM, SSAI & SFAI.
Exponentially Distributed Outages of Decreased ACTH and Cortisol Responses to...IJERA Editor
Preclinical research findings suggest that exposure to stress and concomitantly hypothalamus-pituitary-adrenal
(HPA) axis activation during early development can have permanent and potentially deleterious effects. A
history of early-life abuse or neglect appears to increase risk for mood and anxiety disorders. Abnormal HPA
response to stress challenge has been reported in adult patients with Major Depressive Disorder and PostTraumatic
Stress Disorder. This paper discussed the constant stress level of adult patients with times to damage
of stress effect and recoveries. Also In adults without diagnosable psychopathology, childhood maltreatment is
associated with diminished HPA axis response to a psychosocial stressor.
Human Touch vs. Axillary Digital Thermometry for Detection of Neonatal Hypoth...Siddharth Agarwal
We examined the diagnostic accuracy of human touch (HT) method in assessing hypothermia against
axillary digital thermometry (ADT) by a trained non-medical field investigator (who supervised
activities of community health volunteers) in seven villages of Agra district, Uttar Pradesh, India. Body
temperature of 148 newborns born between March and August 2005 was measured at four points in time
for each enrolled newborn (within 48 h and on days 7, 30 and 60) by the field investigator under the
axilla using a digital thermometer and by HT method using standard methodology. Total observations
were 533. Hypothermia assessed by HT was in agreement with that assessed by ADT (<36.5
C) in 498
observations. Hypothermia assessed by HT showed a high diagnostic accuracy when compared against
ADT (kappa 0.65–0.81; sensitivity 74%; specificity 96.7%; positive predictive value 22; negative
predictive value 0.26). HT is a simple, quick, inexpensive and programmatically important method.
However, being a subjective assessment, its reliability depends on the investigator being adequately
trained and competent in making consistently accurate assessments. There is also a need to assess
whether with training and supervision even the less literate mothers, traditional birth attendants and
community health volunteers can accurately assess mild and moderate hypothermia before promoting
HT for early identification of neonatal risk in community-based programs.
Determination of baseline Widal titre among apparently healthy population in ...IOSR Journals
Present study was conducted to determine the baseline widal titer of healthy population of Dehradun city. A total of 300 serum samples were collected from healthy individual with no history of fever and who had not received any vaccination for enteric fever. Tube agglutination test was done with commercially available antigens which contained the Salmonella enterica serovar typhi O and H antigens, the Salmonella enterica serovar paratyphi AH antigen and paratyphi BH antigen. In the present study an agglutination titer for TO – 1:20 is 28%, for 1:40 is 24%, followed by 1:80 and 1: 160 which is 10%, 4% respectively. The highest sample with an anti-H titre found with 1:20 (22%) followed by 1:40(17%). Based upon the results of the study it has been recommended that a single Widal can be significant in an endemic region when higher titre (1:160) is obtained.
Comparison of Tympanic and Rectal temperature in febrile pediatric patients a...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
DIAGNOSIS OF PEDIATRIC INFECTIOUS DISEASES - Slideset by professor Susanna Esposito, president WAidid, presented at the 7th International Congress of Laboratory and Clinic, held in Tehran (Iran) from 12 to 14 February 2015
Zyvac tcv the Indian typhoid conjugate vaccination - Yamunanagar aug 2018Gaurav Gupta
Zyvac TCV by Zydus Vaccines is the Indian Typhoid Conjugate vaccination with Indian Carrier TT protein.
Recent data from Lancet regarding TCV efficacy is featured in this presentation
ABSTRACT- Enteric fever is a major public health problem in developing countries like India. An early and accurate diagnosis is necessary for a
prompt and effective treatment. We have evaluated the diagnostic accuracy of ENTEROSCREEN-WBTM as compared to Widal test in rapid and early
diagnosis of enteric fever. A total of 145 patients serum samples were tested by Rapid ENTEROSCREEN-WBTM and Widal test including clinically
suspected cases of enteric fever of all age groups. Vaccinated individuals, patients on antibiotic therapy, patients who have other associated conditions,
patients suffering from fever due to non-enteric etiology & non consent patients were excluded. The overall sensitivity, specificity, positive
predictive value (PPV) and negative predictive value (NPV) of ENTEROSCREEN-WBTM considering Widal test as gold standard were 50% and
96%, 66.66% and 92.30% respectively. ENTEROSCREEN-WBTM was found to be significantly more specific. Although the Rapid ENTEROSCREEN-
WBTM tests are meant to diagnose of S. typhi. Ten patients who were ENTEROSCREEN-WBTM positive for S. typhi were also positive by
Widal test.
Key words- Enteric fever, Rapid ENTEROSCREEN-WBTM, Non-enteric etiology, S. typhi, Widal test
Central Adiposity and Mortality after First-Ever Acute Ischemic StrokeErwin Chiquete, MD, PhD
Erwin Chiquete a José L. Ruiz-Sandoval c Luis Murillo-Bonilla e
Carolina León-Jiménez g Bertha Ruiz-Madrigal d, f Erika Martínez-López d, f
Sonia Román d, f Arturo Panduro d, f Alma Ramos b Carlos Cantú-Brito
Background: The waist-to-height ratio (WHtR) may be a better
adiposity measure than the body mass index (BMI). We
evaluated the prognostic performance of WHtR in patients
with acute ischemic stroke (AIS). Methods: First, we compared
WHtR and BMI as adiposity measures in 712 healthy
adults by tetrapolar bioimpedance analysis. Thereafter,
baseline WHtR was analyzed as predictor of 12-month allcause
mortality in 821 Mexican mestizo adults with first-ever
AIS by a Cox proportional hazards model adjusted for baseline
predictors. Results: In healthy individuals, WHtR correlated
higher than BMI with total fat mass and showed a higher
accuracy in identifying a high percentage of body fat (p <
0.01). In AIS patients a U-shaped relationship was observed
between baseline WHtR and mortality (fatality rate 29.1%).
On multivariate analysis, baseline WHtR ≤ 0.300 or >0.800 independently
predicted 12-month all-cause mortality (h
Conceptual Core
Informal Economy: Concepts, Definitions, Significance, Progress made in this new field of statistics
• Existing Practices - MDGs, SDGs and SaarcDGs - Data availability - Data on informal employment in South Asia - Categories of informal workers
• India Experiences - Improper enumeration and women’s work - Changes in Survey design in employment-unemployment rounds of NSSO
More Related Content
Similar to Human Touch to Detect Hypothermia in Neonates in Indian Slum Dwellings
Human Touch vs. Axillary Digital Thermometry for Detection of Neonatal Hypoth...Siddharth Agarwal
We examined the diagnostic accuracy of human touch (HT) method in assessing hypothermia against
axillary digital thermometry (ADT) by a trained non-medical field investigator (who supervised
activities of community health volunteers) in seven villages of Agra district, Uttar Pradesh, India. Body
temperature of 148 newborns born between March and August 2005 was measured at four points in time
for each enrolled newborn (within 48 h and on days 7, 30 and 60) by the field investigator under the
axilla using a digital thermometer and by HT method using standard methodology. Total observations
were 533. Hypothermia assessed by HT was in agreement with that assessed by ADT (<36.5
C) in 498
observations. Hypothermia assessed by HT showed a high diagnostic accuracy when compared against
ADT (kappa 0.65–0.81; sensitivity 74%; specificity 96.7%; positive predictive value 22; negative
predictive value 0.26). HT is a simple, quick, inexpensive and programmatically important method.
However, being a subjective assessment, its reliability depends on the investigator being adequately
trained and competent in making consistently accurate assessments. There is also a need to assess
whether with training and supervision even the less literate mothers, traditional birth attendants and
community health volunteers can accurately assess mild and moderate hypothermia before promoting
HT for early identification of neonatal risk in community-based programs.
Determination of baseline Widal titre among apparently healthy population in ...IOSR Journals
Present study was conducted to determine the baseline widal titer of healthy population of Dehradun city. A total of 300 serum samples were collected from healthy individual with no history of fever and who had not received any vaccination for enteric fever. Tube agglutination test was done with commercially available antigens which contained the Salmonella enterica serovar typhi O and H antigens, the Salmonella enterica serovar paratyphi AH antigen and paratyphi BH antigen. In the present study an agglutination titer for TO – 1:20 is 28%, for 1:40 is 24%, followed by 1:80 and 1: 160 which is 10%, 4% respectively. The highest sample with an anti-H titre found with 1:20 (22%) followed by 1:40(17%). Based upon the results of the study it has been recommended that a single Widal can be significant in an endemic region when higher titre (1:160) is obtained.
Comparison of Tympanic and Rectal temperature in febrile pediatric patients a...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
DIAGNOSIS OF PEDIATRIC INFECTIOUS DISEASES - Slideset by professor Susanna Esposito, president WAidid, presented at the 7th International Congress of Laboratory and Clinic, held in Tehran (Iran) from 12 to 14 February 2015
Zyvac tcv the Indian typhoid conjugate vaccination - Yamunanagar aug 2018Gaurav Gupta
Zyvac TCV by Zydus Vaccines is the Indian Typhoid Conjugate vaccination with Indian Carrier TT protein.
Recent data from Lancet regarding TCV efficacy is featured in this presentation
ABSTRACT- Enteric fever is a major public health problem in developing countries like India. An early and accurate diagnosis is necessary for a
prompt and effective treatment. We have evaluated the diagnostic accuracy of ENTEROSCREEN-WBTM as compared to Widal test in rapid and early
diagnosis of enteric fever. A total of 145 patients serum samples were tested by Rapid ENTEROSCREEN-WBTM and Widal test including clinically
suspected cases of enteric fever of all age groups. Vaccinated individuals, patients on antibiotic therapy, patients who have other associated conditions,
patients suffering from fever due to non-enteric etiology & non consent patients were excluded. The overall sensitivity, specificity, positive
predictive value (PPV) and negative predictive value (NPV) of ENTEROSCREEN-WBTM considering Widal test as gold standard were 50% and
96%, 66.66% and 92.30% respectively. ENTEROSCREEN-WBTM was found to be significantly more specific. Although the Rapid ENTEROSCREEN-
WBTM tests are meant to diagnose of S. typhi. Ten patients who were ENTEROSCREEN-WBTM positive for S. typhi were also positive by
Widal test.
Key words- Enteric fever, Rapid ENTEROSCREEN-WBTM, Non-enteric etiology, S. typhi, Widal test
Central Adiposity and Mortality after First-Ever Acute Ischemic StrokeErwin Chiquete, MD, PhD
Erwin Chiquete a José L. Ruiz-Sandoval c Luis Murillo-Bonilla e
Carolina León-Jiménez g Bertha Ruiz-Madrigal d, f Erika Martínez-López d, f
Sonia Román d, f Arturo Panduro d, f Alma Ramos b Carlos Cantú-Brito
Background: The waist-to-height ratio (WHtR) may be a better
adiposity measure than the body mass index (BMI). We
evaluated the prognostic performance of WHtR in patients
with acute ischemic stroke (AIS). Methods: First, we compared
WHtR and BMI as adiposity measures in 712 healthy
adults by tetrapolar bioimpedance analysis. Thereafter,
baseline WHtR was analyzed as predictor of 12-month allcause
mortality in 821 Mexican mestizo adults with first-ever
AIS by a Cox proportional hazards model adjusted for baseline
predictors. Results: In healthy individuals, WHtR correlated
higher than BMI with total fat mass and showed a higher
accuracy in identifying a high percentage of body fat (p <
0.01). In AIS patients a U-shaped relationship was observed
between baseline WHtR and mortality (fatality rate 29.1%).
On multivariate analysis, baseline WHtR ≤ 0.300 or >0.800 independently
predicted 12-month all-cause mortality (h
Conceptual Core
Informal Economy: Concepts, Definitions, Significance, Progress made in this new field of statistics
• Existing Practices - MDGs, SDGs and SaarcDGs - Data availability - Data on informal employment in South Asia - Categories of informal workers
• India Experiences - Improper enumeration and women’s work - Changes in Survey design in employment-unemployment rounds of NSSO
Community Model to Improve Slum Health in Smart Cities,Wards,Localities:Pract...Siddharth Agarwal
Slum families live amidst dirt leading to contamination of water, spread of flies, rodents, mosquitoes, which carry diseases e.g. diarrhea, typhoid, jaundice, dengue, chikungunya, malaria. U¬5 undernutrition in the poorest urban quartile are 2.5 times higher than the richest urban quartile.
Practical approaches:
1.City map: Govt. of India’s NUHM & Housing Policy mandate mapping of all listed/unlisted/hidden slums on city map. UHRC's social facilitators, women's group members with govt. ANMs, Anganwadi workers identified, mapped hidden, unlisted and newly formed slums in Indore.
Slum Women’s groups use hand-drawn basti maps to a)prevent exclusion of family from lists for housing, entitlements; b)Track access to health services e.g. vaccination, ANC, c) identify recent migrants, vulnerable slums.
2.Basti women’s groups in Indore & Agra function as slum women’s health groups (Mahila Arogya Samitis or MAS) mandated in Govt. of India’s NUHM to strengthen demand for health, environmental services. With knowledge, confidence & skills, women’s groups increase access to Govt. address proof and Picture ID.
3. MAS members save monthly to build savings pool. This saving helps in time of health emergency, marriage, child's education, rescues poor people from moneylenders.
Based on Indore & Agra experience, India’s National Urban Health Mission (NUHM) mandates Mahila Arogya Samiti as a demand side strategy and creation a Revolving Community Fund as two of eight core NUHM strategies (Government of India, 2013).
4. With motivation youth-children groups bring more vigour to community efforts. Youth requests to authorities for streets, garbage cleaning. Basti children’s group members apply & avail govt. scholarship.
5. Outreach Health Services by Govt & Pvt Providers in deprived clusters are facilitated by basti women’s groups. They help ANMs identify vulnerable pockets, improve service access, infection prevention, promote healthy behaviours.
With mentoring support from UHRC, they promote nutrition & health with simple recipes e.g. sprouted cooked, garnished black gram. Women take up gardening for nutrition despite space constraints.
6. Women’s groups submit requests to different depts. for paving of basti lanes, water supply, sewage system, electric connections.
7. Ladies & children making jewellery & greeting cards gives creative & psycho-emotional energy despite living in dirt. Creative art stimulates right brain which enhances skills, intellectual responses, learning ability, confidence. These help slum populations gather more strength and hope to better deal with the vagaries of life.
8. Women’s Livelihoods: Tailoring & Stitching training centres for women are run. Women/girls stitch frocks, trousers, girls’ tops, shirts at home on per piece basis. Women also sell vegetables, grocery, run slum convenience store, tiffin service.
Using a pre-tested interview schedule, the following
aspects were enquired from 230 adult female respondents residing in slum of North East Delhi. Background characteristics, type of cooking salt that they
predominantly use; reasons for the same and awareness
about the benefits of iodized salt were assessed. Iodine content of the cooking salt consumed was tested using a rapid iodine field-testing kit using similar standard procedures, used
in the Third National Family Health Survey.
Three important findings emerged from this study.
Although three-fourth households of a north-east Delhi
slum were consuming adequately iodized salt, the
level of awareness regarding the benefits of consuming
iodized salt among the studied population was extremely
low. Even among those households consuming refined
salt, nearly one-fifth households were not consuming
adequately iodized salt.
More persevering efforts need to be made to generate awareness about the health benefits of iodized salt and to enhance demand and availability of iodized salt. Continued dialogue by state level Iodine Deficiency Disorders (IDD) Control Cell with salt producers and traders and their periodic monitoring would increase production and market availability of
adequately iodized salt. Regular community-based
awareness activities on the benefits of iodized salt can
be conducted through Anganwadi workers, auxillary
nurse midwives, non-government organizations, self-help groups, and schools.
Community-based health financing: CARE India's experience in the maternal an...Siddharth Agarwal
Abstract
In a rural Indian population beset with inadequate health access to people owing to socio-cultural and economic factors, CARE India under the Maternal andInfant Survival Project encouraged village women to form Community Based Oragnisations (CBOs) and collectively save funds for health.
15 months of implementation showed that CBOs were formed in 345 of 447 project villages and health funds were operational in 203. 292 persons benefited from health funds through loans for treatment. 56% loans being repaid within the grace/low interest period.
The experience shows that village women when appropriately encouraged are capable of evolving rules and managing health funds. The process empowers village women (through access to resources and information and the strength of social capital) to take decisions and act to improve their well being.
Health funds have been have proved to be useful in addressing obstetric complications, infant illnesses and have also led to additional initiatives (social marketing of disposable delivery kits, village drug bank and plugging gaps in government supplies), that improve health care.
Encouraging Appropriate Infant Feeding Practices in Slums: A Positive Devian...Siddharth Agarwal
Abstract:
Nutritional Positive Deviant (PD) infants grow ‘bigger’ and ‘faster’ than other infants living in a similarly socio-economically deprived environment. Certain positive feeding and care giving practices adopted by mothers of PD infants enable them rear better nourished and active infants. Limited data is available on using PD mothers as counselors encouraging appropriate and feasible infant feeding practices (IFP) in India. Hence, the present study was undertaken. The study was conducted in a slum of Delhi (India). Twenty-Five infants aged 6-12 months were weighed. Three infants with normal weight for age status (as per Gomez classification) were classified as PD infants. A PD inquiry (PDI) was conducted on current IFP
in these families to identify PD behaviours adopted and determinants for the same. PD behaviours identified
included:feeding modified family pot (energy dense) complementary food at least two times a day,
supervised bowl feeding by the mother and father support to the mother in infant feeding and care giving.
Two,of these three PD mothers volunteered to discuss the benefits of PD behaviours they had been
practicing with the other 22 members of the group. The strategy promoted collective dialogue and discussion
to try the PD behaviours through weekly group discussions over a period of four weeks. After four weeks,
feeding modified family pot food with addition of 1 tea spoon of ghee (milk fat) in food (10/22), feeding an extra
mid-day cereal snack (12/22) were PD behaviours adopted by other members of the group (22). It can be
concluded that i) behaviours requiring least preparation time were easily adopted and ii) PD mothers can
be effective counselors to encourage appropriate IFP
Migrant adolescent girls in India’s fast-growing urban-slum population face multiple intersecting vulnerabilities, including gender, poverty and migrant-status.
This qualitative study of newer migrant and older settler girls and slum women’s groups found:
• Push/pull factors linked with employment/educational opportunities in urban areas motivated families of unmarried girls to migrate. Recently married girls joined city-based families or accompanied labour migrant husbands.
• Neither married nor unmarried girls played decision-making roles in migration.
• Married migrant adolescent girls faced challenges in accessing education, employment, social opportunities and services owing to less awareness, restricted freedom of movement, weak social networks.
• Childbearing migrant girls faced particular risks. Contact with their natal families being limited, the quality of relationship with husbands and marital families was crucial for married girls’ well-being.
• Many unmarried girls attending schools were positive about migration experience, perceiving the city to offer greater educational opportunities. Through school they accessed opportunities for new relationships and social activities. Some unmarried adolescent-girls were unable to access opportunities owing to family restrictions and economic circumstances. These girls’ worlds remained small despite moving to a large city.
The study brings forth potential approaches to overcome the above challenges:: Where girls’ economic and/or family and social circumstances allowed, migration entailed a positive change that enhanced their opportunities. Specific challenges of this population segment need focus in policies and programs, prioritizing three particularly vulnerable groups: girls who are neither in education nor employment, pregnant girls or new mothers, and those with difficult relationships in marital homes.
Proactive outreach to raise awareness about opportunities and services and fostering social networks through frontline workers and slum women’s groups are recommended.
Slum community groups use negotiation skills, knowledge, to improve access to...Siddharth Agarwal
Urban Health Resource Centre's practical experiences shared at Urban Thinkers Campus on Health and Wellbeing
Convened by United Nations University IIGH,
Kuching, Malaysia
Ignited slum community groups engage as active citi-zens, negotiate collaboratively for equity and access to contribute to better urban governance .
i) Trained, empowered slum women’s groups and cluster-level teams of slum women’s groups gives stronger voice and greater negotiation power.
ii) Increase Access to Govt. Address Proof and Picture ID: During Apr 2013 gave legitimacy to urban informal settlement families– Mar 2015: 20,000 persons benefited from Govt. proof of address and Picture ID
iii) Empowered women facilitate reduction in alcoholism, domestic violence against women, enhance caring capacity of woman, family, improved social support. With over 125 million women among urban vulnerable in India, women-power has immense potential towards improved health, social justice, wellbeing.
iv) Trained slum community groups pull regular outreach health Services by Government providers in Migrant, other Deprived clusters
v) With training, mentoring, hand-holding support community groups engage in gentle, tactful negotiation through collective written petitions/requests to officers of Municipal Authorities, Nutrition Dept, Electricity Dept. Disadvantaged communities actively participate in governance, collaborate for equity, justice, access: maintain paper trail, persevere with tact (including tea + biscuits, polite thank you) to achieve “Right to the City”.
vi) Slum youth-children groups emerging as ‘Force Gen-next’: With continual mentoring, motivation Youth-children groups in slums improve their own lives; contribute to their communities in tangible ways, bring more vigour and joy to ‘ignite the senses”. It is noteworthy that there are 150 million youth 15-32 yr, 125 million 10-24 yr in urban India
vii) Spatial City and Neighborhood Mapping helps make invisible, voiceless poverty clusters and recent migrants, weaker families visible and their social inclusion.
viii) Let us Build Human Capability, Expertise, Ignite Action & Engagement, Collaborative efforts and Resilience of Urban Excluded, Deprived Citi-zens, and to bounce forward, prevent their learning to survive in impoverishment Let us translate words into real action towards inclusive, socially just cities.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Human Touch to Detect Hypothermia in Neonates in Indian Slum Dwellings
1. Correspondence and Reprint requests : Dr. Siddharth Agarwal,
Urban Health Resource Center, 89/4, Krishna Nagar, Safdarjung
Enclave, New Delhi-110029, India.
[DOI-10.1007/s12098-010-0115-0]
[Received September 20, 2009; Accepted January 12, 2010]
Human Touch to Detect Hypothermia in Neonates in
Indian Slum Dwellings
Siddharth Agarwal, Vani Sethi1
, Karishma Srivastava, Prabhat Jha2
and Abdullah H. Baqui3
Urban Health Resource Center, New Delhi, 1
Formerly, with Urban Health Resource Center, New Delhi, India
2
Urban Health Resource Center, Indore, Madhya Pradesh, India, 3
Department of International Health, Johns
Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
ABSTRACT
Objective. To assess the validity of human touch (HT) method to measure hypothermia compared against axillary digital
thermometry (ADT) and study association of hypothermia with poor suckle and underweight status in newborns and
environmental temperature in 11 slums of Indore city, India.
Methods. Field supervisors of slum-based health volunteers measured body temperature of 152 newborns by HT and ADT,
observed suckling and weighed newborns. Underweight status was determined using WHO growth standards.
Results. Hypothermia prevalence (axillary temperature <36.5o
C) was 30.9%. Prevalence varied by season but insignificantly.
Hypothermia was insignificantly associated with poor suckle (31% vs 19.7%, p=0.21) and undernutrition (33.3% vs 25.3%,
p=0.4). HT had moderate diagnostic accuracy when compared with ADT (kappa: 0.38, sensitivity: 74.5%, specificity: 68.5%).
Conclusions. HT emerged simpler and programmatically feasible. There is a need to examine whether trained and supervised
community-based health workers and mothers can use HT accurately to identify and manage hypothermia and other simple
signs of newborn illness using minimal algorithm at home and more confidently refer such newborns to proximal facilities linked
to the program to ensure prompt management of illness. [Indian J Pediatr 2010; 77 (7) : 759-762] E-mail: siddharth@uhrc.in,
sids62@yahoo.com
Key words: Urban poor; Newborn; Hypothermia
Urban poor constitute one-third of India’s urban
population.1
Despite a plethora of health facilities in cities,
56% urban poor newborns are born at home.2
Among
home births, 87% are attended by an unskilled provider
resulting in poor intra and postpartum care.2
These factors
contribute to high rates of hypothermia. Hypothermia is
an important contributor of neonatal deaths. Hence, its
early recognition and prompt management is crucial.
Human touch (HT) is one simple programmatically
feasible method to detect neonatal hypothermia.3
However, there is no study that validated HT in Indian
slum settings. This study estimated the prevalence of
neonatal hypothermia through trained slum-level field
workers using HT and axillary digital thermometry
(ADT) and assessed diagnostic accuracy of HT.
MATERIAL AND METHODS
The study was conducted in 11 slums of Indore between
December 2004 and February 2006. These slums were
among the 79 slums where a health intervention of a non-
government organization was operational, through a
network of slum-based women groups, health volunteers
(1/3,000 population) and field extension workers (1/
15,000 population).
A trained Field Extension Worker (FEW) measured
body temperature of 152 newborns in day time during
field visits, first using HT and then ADT. She used
dorsum of her right hand to assess newborn’s skin
temperature at abdomen (just below the umbilicus) and
soles of feet. She classified the newborn as warm, mildly
hypothermic and moderately hypothermic if both
abdomen and soles were warm, abdomen warm and soles
cold, both abdomen and soles were cold, respectively.
Based on the condition, FEW counselled the mother on
home-based warming measures3
and danger signs for
referral.
Original Article
Indian Journal of Pediatrics, Volume 77—July, 2010 759
2. Siddharth Agarwal et al
760 Indian Journal of Pediatrics, Volume 77—July, 2010
FEW measured axillary temperature using digital
thermometer with soft flexible tip (Becton and Dickinson,
New-Jersey; accuracy of 0.1°C; measuring range 32-
43.9°C). She first placed the thermometer’s tip high in the
apex of baby’s axilla, ensured it was free from moisture
using a cotton ball and then folded the baby’s arm over
the chest for 4 minutes. Mother was requested to hold
baby close to her chest for better positioning.4
Newborns
were classified warm, mildly hypothermic and
moderately hypothermic if their axillary temperatures
were 36.5-37.5°C, 36-36.4°C and <36°C respectively. 3
On a sub-sample of 110 newborns, undernutrition
status and suckling, was also examined by FEW.
Weighing was done using a portable hanging Salter’s
spring balance (range: 0-25 kg; accuracy: 100 gm) using
WHO guided procedures.5
Z scores for weight-for-age
were calculated compared to WHO standards 2006.6
For
assessing suckling, a 4 min breastfeeding observation was
conducted. If the newborn took slow deep sucks with
pauses, suckling was regarded as effective; else it was
considered poor.7
Data was entered and analyzed using SPSS version 9.
Hypothermia rates were calculated according to season
and newborn’s age, sex, underweight status and poor
suckle. Chi-square test was used, to detect statistically
significant association of hypothermia with these
variables. To compare agreement between the two
methods, kappa statistic was calculated.8
To assess the
TABLE 2. Association Between Prevalence of Hypothermia and Selected Characteristics
N n (%)
By HT method By ADT method
Warm Hypothermia Hypothermia
(N=84) Mild Moderate Warm Mild Moderate
(N=59) (N=9) (N=105) (N=33) (N=14)
Season (mean environment
temperature at the time of
assessment)
- Dry summer(26-33°C) 46 30 (65.2) 15 (32.6) 1 (2.2) 38 (82.6) 7 (15.2) 1 (2.2)
- Wet summer (22-28°C) 51 25 (49.0) 21 (41.2) 5 (9.8) 32 (62.7) 13 (25.5) 6 (11.8)
- Winter (14-23°C) 55 29 (52.7) 23 (41.8) 3 (5.5) 35 (63.6) 13 (23.6) 7 (12.7)
Age of newborn (days)
- 0-7 44 23 (52.3) 18 (40.9) 3 (6.8) 28 (63.6) 9 (20.4) 7 (16.0)
- 8-28 108 61 (56.5) 41 (38.0) 6 (5.5) 77 (71.3) 24 (22.2) 7 (6.5)
Gender of newborn
- Male 80 47 (58.8) 28 (35.0) 5 (6.3) 55 (68.8) 19 (23.8) 6 (7.5)
- Female 72 37 (51.4) 31 (43.1) 4 (5.6) 50 (69.4) 14 (19.4) 8 (11.1)
N 110 58 46 6 81 22 7
Underweight#
- Mild (WAZ <-1 to -2 SD) 35 23 (65.7) 10 (28.6) 2 (5.7) 29 (82.9) 4 (11.4) 2 (5.7)
- Moderate (WAZ <-2 to 3 SD) 20 8 (40.0) 10 (50.0) 2 (10.0) 13 (65.0) 5 (25.0) 2 (10.0)
- Severe (WAZ <-3SD) 10 7 (70.0) 3 (30.0) 0 (0.0) 7 (70.0) 3 (30.0) 0 (0.0)
- Not underweight (WAZ>=-1SD) 45 20 (44.4) 23 (51.1) 2 (4.4) 32 (71.1) 10 (22.2) 3 (6.7)
Poor suckling
- Yes 25 11 (44.0) 12 (48.0) 2 (8.0) 16 (64.0) 7 (28.0) 2 (8.0)
- No 85 47 (55.3) 34 (40.0) 4 (4.7) 65 (76.5) 15 (17.6) 5 (5.9)
#
Based on Z score for weight-for-age (WAZ) calculated as per WHO standards 2006
The percentage values given in parentheses indicates the row %
TABLE 1. Diagnostic Accuracy of Human Touch Method in Identifying Hypothermia
Axillary Method
(Gold Standard)
Hypothermia No Hypothermia Total
(<36.5°C) (>=36.5°C)
Human Touch Method Result 35 (True +ve) 33 (False +ve) 68
Positive
Negative 12 (False –ve) 72 (True –ve) 84
Total 47 105 152
PV= predictive value; LR = likelihood ratio
Prevalence = 30.9%
Sensitivity = 74.5%
Specificity = 68.5%
PV+ = 51.4%
PV- = 85.7%
LR+ = 2.36
LR- = 0.38
3. Human Touch to Detect Hypothermia in Neonates in Indian Slum Dwellings
Indian Journal of Pediatrics, Volume 77—July, 2010 761
diagnostic accuracy of HT method, ADT was considered
as gold standard and sensitivity, specificity, positive and
negative predictive values and likelihood ratios were
calculated.
DISCUSSION
The percentage of newborns categorized as warm and
mildly hypothermic by ADT were 69.1% and 21.7%
respectively. Significantly higher percentage of newborns
were assessed mildly hypothermic and fewer as warm by
HT (p<0.05). Overestimation by HT prompted FEW to
counsel for extra warmth/ care, which was not
disadvantageous, since in slum households thermal care
practices are sub-optimal.
Hypothermia assessed by HT was in agreement, with
hypothermia assessed by ADT (<36.5°C), in 107 out of 152
observations. Kappa value of 0.38 (95% C.I. 0.33-0.43)
showed a moderate agreement between the two tests.
Taking ADT as gold standard, sensitivity and specificity
of HT method to correctly identify hypothermic (true
positive) and non-hypothermic babies (true negative) was
74.5% and 68.5% respectively (Table 1). Other studies
comparing accuracy of HT method against axillary
thermometry, showed that its accuracy to correctly
identify hypothermic babies varies, depending on the
investigator carrying out the assessment being 96%, 74%,
34.4% and 23.4% sensitive when assessed by
paediatricians4
, non-medical post-graduate field
supervisor9
, community-based workers10
and mothers 10
respectively.
Hypothermia rates differed significantly by season.
Hypothermia rates were 17.4%, 37.2% and 36.3% in dry
summer, wet summer and winter season respectively
(Table 2). High neonatal hypothermia even during wet
and dry summer, could possibly be contributed to – a)
poor thermal care practices in slum households; b)
thermal care was possibly neglected assuming that
thermal protection is not relevant in warm season; and c)
physiological vulnerability of newborns to hypothermia
owing to3
– i) incompletely developed thermo-regulatory
capacity, ii) relative to body-weight, the body surface of
the newborn being approximately 3 times, iii) the rate of
heat loss being approximately 4 times that of the adult
and iv) insulating layer of subcutaneous fat that produces
and conserves heat being thinner. Hence, health programs
should continue to emphasize on thermal protection at
birth and hypothermia identification, even during
summer or in areas with sufficiently warm climate.
By HT, 88.4% of all hypothermia was mild hypo-
thermia, 26% and 61% newborns having mild hypo-
thermia also had a poor suckle and were underweight
(WAZ < -1SD) respectively (Table 2). This indicates that
mild hypothermia is a simple and easy to detect early sign
of neonatal sickness, just as is poor suckle.
As reported by FEW, HT method was simpler to use
and enabled FEW to focus on counseling and prompt
appropriate management/referral. ADT provided an
exact measurement of body temperature, which is an
advantage over HT. However, use of ADT adds cost to a
program; considering initial cost of thermometer and
replacements of non-functioning, damaged or lost
thermometers. Further, using ADT took more time than
HT, FEW's focus got singly directed to the instrument, to
ensure accurate positioning and accurate measurement
rather than providing counselling on management of
hypothermia.
CONCLUSIONS
Overall, HT with a moderate diagnostic accuracy, may be
programmatically more feasible for field settings and the
two criteria (mild hypothermia and poor suckle) emerge
as a promising minimal algorithm, for early neonatal
sickness identification at community level.
Acknowledgements
We are grateful to mothers, slum-level community-based
organizations and non-government organization partners, of Indore
for their active participation in this study. We also thank other
members of the study team: Sandeep Kumar, Dr. S Kaushik, Dr.
Praween Agrawal, Kirti Sangar, Madhvi Mathur, Aashima Garg,
Shabnam Verma, Neeraj Verma, Dimple Kondal and Abhilasha
Anand.
Contributions: SA; conceptualized and designed the study,
participated in conceptualization and writing of the manuscript and
provided inputs in data interpretation. VS; supervised data
collection, conducted the data analysis and drafted the paper. AHB;
conceptualized the manuscript including analysis plan and
participated in data interpretation. KS; participated in
conceptualization of the study. PJ; supervised data collection. All
authors reviewed the manuscript and provided inputs in
substantially revising it.
Conflict of Interest : None.
Role of Funding Source: The original study on which this paper is
based was funded by the United States Agency for International
Development, India (USAID, India) vide grant to World Learning
USAID GSM009. The views expressed in this paper do not
necessarily reflect those of the USAID, India.
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