Background. Despite the growing share of neonatal mortality in under-5 mortality in the recent decades in India, most studies have focused on infant and child mortality putting neonatal mortality on the back seat. The development of focused and evidence-based health interventions to reduce neonatal mortality warrants an examination of factors affecting it. Therefore, this study attempt to examine individual, household, and community level factors affecting neonatal mortality in rural India.Data and methods. We analysed information on 171,529 singleton live births using the data from the most recent round of the District Level Household Survey conducted in 2007–08. Principal component analysis was used to create an asset index. Two-level logistic regression was performed to analyse the factors associated with neonatal deaths in rural India.Results. The odds of neonatal death were lower for neonates born to mothers with secondary level education (O R = 0.60, p = 0.01) compared to those born to illiterate mothers. A progressive reduction in the odds occurred as the level of fathers’ education increased. The odds of neonatal death were lower for infants born to unemployed mothers (O R = 0.89, p = 0.00) compared to those who worked as agricultural worker/farmer/laborer. The odds decreased if neonates belonged to Scheduled Tribes (O R = 0.72, p = 0.00) or ‘Others’ caste group (O R = 0.87, p = 0.04) and to the households with access to improved sanitation (O R = 0.87, p = 0.02), pucca house (O R = 0.87, p = 0.03) and electricity (O R = 0.84, p = 0.00). The odds were higher for male infants (O R = 1.21, p = 0.00) and whose mother experienced delivery complications (O R = 1.20, p = 0.00). Infants whose mothers received two tetanus toxoid injections (O R = 0.65, p = 0.00) were less likely to die in the neonatal period. Children of higher birth order were less likely to die compared to first birth order.Conclusion. Ensuring the consumption of an adequate quantity of Tetanus Toxoid (TT) injections by pregnant mothers, targeting vulnerable groups like young, first time and Scheduled Caste mothers, and improving overall household environment by increasing access to improved toilets, electricity, and pucca houses could also contribute to further reductions in neonatal mortality in rural India. Any public health interventions aimed at reducing neonatal death in rural India should consider these factors.

This study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability and less pain on injection.

Objectives:To compare propofol and thiopental as anesthetic agents for electroconvulsive therapy (ECT) with respect to seizure duration, stimulus charge, and clinical effects.Materials and Methods:Randomized, blinded study of 28 patients of depression treated with bilateral ECT. In group P (n = 14), sedation was achieved with propofol 1.5 mg/kg, whereas in group T (n = 14), it was achieved with thiopentone 3 mg/ kg IV. Succinylcholine 0.4 mg/kg intravenous was given in all patients as for neuromuscular blockade.Results:The mean seizure duration of the patients in the thiopental group was 83 ± 34.43 seconds vs. 94.45 ± 21.37 seconds in the propofol group (P < 0.01). The energy delivered per treatment was 10.88 ± 4.78 J in the thiopental group vs. 12.20 ± 4.53 J in the propofol group (P < 0.05). Number of ECTs required were significantly higher in propofol group (9.71 ± 2.87) as compared to thiopental group (5.86 ± 0.36) P < 0.0001. No significant difference in duration of hospitalization was seen in both groups. The mean score on Mini-Mental State Examination (MMSE) was 29.14 in the thiopental group vs. 29.57 in the propofol group (P > 0.05). The mean score on Beck Depression Inventory (BDI) was 7.14 in the thiopental group vs. 3.29 in the propofol group (P < 0.05).Conclusions:Propofol significantly increases number of ECT required to treat although the patients received higher electrical charge and had longer seizure duration. BDI scores suggest this resulted in better outcome. Results, however, might be confounded by the differences in pharmacological treatment in the groups.

Background and Aims:i-gel®, a recently introduced supraglottic airway device (SAD) has been claimed to be an efficient supraglottic airway. It can also be used as a conduit for endotracheal intubation. However, LMA Fastrach® frequently used for this purpose; hence in this randomized study, success rate of blind tracheal intubation through two different SADs i-gel® and LMA Fastrach® was evaluated. The complications if any were also studied.Methods:A total of 100 patients undergoing elective surgery under general anaesthesia were randomised in two groups comprising of 50 patients each to tracheal intubation using either i-gel (I group) or LMA Fastrach (F group). After induction of anaesthesia SAD was inserted and on achieving adequate ventilation with the device, blind tracheal intubation was attempted through the SAD. Success at first-attempt and overall tracheal intubation success rates were evaluated, and tracheal intubation time was measured. Data were analysed using IBM SPSS Statistics 20.0 software (Statistical Package for Social Sciences by International Business Machines Corporation). P < 0.05 was considered as statistically significant.Results:There was no difference in the incidence of adequate ventilation with either of the SAD. The success rate of tracheal intubation in first attempt was 66% in Group I and 74% in Group F, while overall success rate of tracheal intubation was 82% in Group I when compared to 96% in Group F. Time taken for successful tracheal intubation through LMA Fastrach was lesser (20.96 s) when compared to i-gel (24.04 s). Complication rates were statistically similar in both the groups.Conclusion:i-gel® is a better device for rescue ventilation due to its quick insertion but an inferior intubating device in comparison to LMA Fastrach®.

IntroductionThe WHO recommends community mobilisation with women’s groups practising participatory learning and action (PLA) to improve neonatal survival in high-mortality settings. This intervention has not been evaluated at scale with government frontline workers.MethodsWe did a pragmatic cluster non-randomised controlled trial of women’s groups practising PLA scaled up by government front-line workers in Jharkhand, eastern India. Groups prioritised maternal and newborn health problems, identified strategies to address them, implemented the strategies and evaluated progress. Intervention coverage and quality were tracked state-wide. Births and deaths to women of reproductive age were monitored in six of Jharkhand’s 24 districts: three purposively allocated to an early intervention start (2017) and three to a delayed start (2019). We monitored vital events prospectively in 100 purposively selected units of 10 000 population each, during baseline (1 March 2017–31 August 2017) and evaluation periods (1 September 2017–31 August 2019). The primary outcome was neonatal mortality.ResultsWe identified 51 949 deliveries and conducted interviews for 48 589 (93.5%). At baseline, neonatal mortality rates (NMR) were 36.9 per 1000 livebirths in the early arm and 39.2 in the delayed arm. Over 24 months of intervention, the NMR was 29.1 in the early arm and 39.2 in the delayed arm, corresponding to a 24% reduction in neonatal mortality (adjusted OR (AOR) 0.76, 95% CI 0.59 to 0.98), including 26% among the most deprived (AOR 0.74, 95% CI 0.57 to 0.95). Twenty of Jharkhand’s 24 districts achieved adequate meeting coverage and quality. In these 20 districts, the intervention saved an estimated 11 803 newborn lives (min: 1026–max: 20 527) over 42 months, and cost 41 international dollars per life year saved.ConclusionParticipatory women’s groups scaled up by the Indian public health system reduced neonatal mortality equitably in a largely rural state and were highly cost-effective, warranting scale-up in other high-mortality rural settings.Trial registrationISRCTN99422435.

Using data from all three rounds of the National Family Health Survey, this study examines the trends and determinants of unmet need for family planning in the state of Bihar. Bivariate analysis was carried out to examine the level and trends of unmet need for family. Binary logistic regression was used to examine the factor affecting unmet need for family planning. About 25% of the currently married women, aged 15-49 years, in Bihar at present have an unmet need for family planning services, 11% for spacing and 12% for limiting. Only 18% of total demand for spacing methods is met compared to about 72% of total demand for limiting methods. The unmet need for family planning among Muslim (32%), rural (24%) and adolescent (36%) and poor women (26%) is relatively higher than other groups. "Religious prohibition" and "husband opposed" were the main reasons for not using contraception. A considerable proportion of older women (45-49 years) and those living in urban areas cited method-related reasons. About 86% of Muslim women cited opposition to use as the main reason for not using family planning. The same is also substantiated by logistic regression analysis where the odds of unmet need were significantly higher among Muslim women (OR = 1.88; p < 0.05). Women from Other Backward Castes (OR = 0.74; p = 0.05) and rich households (OR = 0.55; p = 0.00) had lower odds of unmet need for family planning. The results highlight the need of an effective implementation of information, education and communication activities in the communities and improvement in the quality of advice and care services related to family planning. Family planning policies and programs in Bihar should focus on reaching out to the women from disadvantaged groups such as adolescent, Muslim, poor and Scheduled Caste.

IMPORTANCE Among the United Nations' Sustainable Development Goals is to reduce the neonatal mortality rate to 12 per 1000 live births by 2030. Identifying high-risk pregnancies can help achieve this target in low-resource countries, such as India, which accounts for one-fourth of global neonatal deaths. OBJECTIVE To analyze the association of maternal history of neonatal death with subsequent neonatal mortality. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included a nationally representative sample of singleton live births from multiparous women. Data were obtained from the 2016 National Family Health Survey in India. Data were analyzed from November 2018 to January 2020. EXPOSURES Maternal history of neonatal death and a comprehensive set of covariates, including socioeconomic environment, maternal anthropometry, and pregnancy care. MAIN OUTCOMES AND MEASURES Subsequent neonatal mortality. Population-attributable risk associated with history of neonatal death was calculated, and sensitivity analyses were performed. RESULTS The overall study population consisted of 127 336 singleton live births from multiparous women aged 15 to 49 (mean [SD] age, 28.8 [5.2] years) years when the survey was undertaken. In our analytic sample, 11 101 (8.7%) mothers had a history of neonatal death, and 506 of 2224 total neonatal deaths (22.8%) were attributed to women with history of neonatal death. The prevalence of history of neonatal death differed by selected covariates and across states or union territories. Maternal history of neonatal death was associated with significantly higher odds of neonatal mortality (adjusted odds ratio, 2.23; 95% CI, 1.96-2.55), and this remained consistent across different subgroups. The population-attributable risk associated with maternal history of neonatal death was 11.8%. Stronger associations were found for maternal history of multiple neonatal deaths (adjusted odds ratio, 3.50; 95% CI, 2.78-4.41) and in respect to the risk of mortality in early neonatal period (ie, 0-2 completed days) (adjusted odds ratio, 2.45; 95% CI, 2.09-2.86). CONCLUSIONS AND RELEVANCE These findings suggest that maternal history of neonatal death is a potentially useful risk factor to identify women and neonates who may need extended and enhanced pregnancy care.

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