BackgroundAccording to WHO estimates, 35% of global measles deaths in 2011 occurred in India. In 2013, India committed to a goal of measles elimination by 2020. Laboratory supported case based measles surveillance is an essential component of measles elimination strategies. Results from a case-based measles surveillance system in Pune district (November 2009 through December 2011) are reported here with wider implications for measles elimination efforts in India.MethodsStandard protocols were followed for case identification, investigation and classification. Suspected measles cases were confirmed through serology (IgM) or epidemiological linkage or clinical presentation. Data regarding age, sex, vaccination status were collected and annualized incidence rates for measles and rubella cases calculated.ResultsOf the 1011 suspected measles cases reported to the surveillance system, 76% were confirmed measles, 6% were confirmed rubella, and 17% were non-measles, non-rubella cases. Of the confirmed measles cases, 95% were less than 15 years of age. Annual measles incidence rate was more than 250 per million persons and nearly half were associated with outbreaks. Thirty-nine per cent of the confirmed measles cases were vaccinated with one dose of measles vaccine (MCV1).ConclusionSurveillance demonstrated high measles incidence and frequent outbreaks in Pune where MCV1 coverage in infants was above 90%. Results indicate that even high coverage with a single dose of measles vaccine was insufficient to provide population protection and prevent measles outbreaks. An effective measles and rubella surveillance system provides essential information to plan, implement and evaluate measles immunization strategies and monitor progress towards measles elimination.
ObjectivesTo compare the proportion of postpartum depression at 6 weeks among women who had caesarean delivery and women who had vaginal delivery and to assess its association with some sociodemographic factors.DesignThis is a descriptive comparative study with prospective enrolment. We followed the enrolled women and assessed them for postpartum depression 6 weeks after delivery.SettingWe conducted the study in Pune District, India from July 2017 to December 2018. The study sites were all non-teaching government hospitals performing five or more caesarean sections per month and two teaching hospitals: one government and one private.ParticipantsWe included in the study group women who have undergone caesarean section in the participating hospitals and were residents of Pune District. Women who delivered vaginally and matched in age and parity were included in the comparison group. We followed 1556 women in each group.Main outcome measuresAn Edinburgh Postnatal Depression Scale score of 10 or more for each woman was the primary outcome. χ2 test and multivariable binary logistic regression were performed to assess the effect of mode of delivery on postpartum depression.ResultsThe proportion of postpartum depression at 6 weeks was 3.79% among women who had caesarean delivery and 2.35% among those who had vaginal delivery (χ2=4.50, p=0.03). The adjusted OR was 1.86 (95% CI 1.14 to 3.03). Women of age less than 25 years had higher risk of postpartum depression. The adjusted OR was 2.10 (95% CI 1.21 to 3.65). The study did not observe any association between postpartum depression and income, education, occupation or sex of the newborn child.ConclusionsWe conclude that young women particularly those who had caesarean delivery should be screened 6 weeks after delivery.
Context: Many women have postpartum sexual dysfunction. The mode of delivery is an important determinant. Aims: To calculate the risk ratio of non-resumption of vaginal sex and dyspareunia during the postpartum period among cesarean-delivered women. Settings and Design: This large multisite study was conducted in 13 selected hospitals in Pune District during 2017–19. Methods and Material: A total of 3,112 women (half cesarean delivered and half vaginally) were interviewed by trained health workers using a structured questionnaire. Women were interviewed at 4 weeks, 6 weeks, and 6 months. Statistical analysis used: Chi-square test was applied. A risk ratio with a 95% confidence interval was calculated. Results: At 6 weeks, the risk ratio of non-resumption of vaginal sex was significantly high among cesarean-delivered participants (1.14). Cesarean-delivered women had a lesser risk ratio of dyspareunia at both follow-ups (0.59, 0.49). Even at 6 months, about one-third vaginally delivered women had dyspareunia. The proportion of women non-resuming vaginal sex gradually decreased from 6 weeks to 6 months. The proportion of women having dyspareunia also decreased from 6 weeks to 6 months following childbirth. Residence in the rural area and cesarean delivery were the significant determinants of an early resumption of vaginal sex. Dyspareunia was significantly high among vaginal delivered than cesarean. About 25% of women continued to have dyspareunia up to 6 months. Conclusions: A large number of women suffer from dyspareunia; hence antenatal and postnatal care should include some counseling and management about the resumption of sex and dyspareunia.
Background Although critical, the preconception phase in women’s lives is comparatively ignored. The presence of some risk factors during this phase adversely affects the wellbeing of the woman and the pregnancy outcome. The study objectives were to measure the prevalence of various known risk factors for adverse pregnancy outcome in the preconception period of women and their comparison between blocks. Methods This was a community-based cross-sectional study in two tribal and two non-tribal blocks each in Nasik district, Maharashtra, India. The study included married women desiring to conceive within 1 year. Trained Accredited Social Health Activists (field level health worker) collected information from women using a validated interview schedule through house-to-house visits and obtained women’s anthropometric measurements in a standard manner. The study assessed the presence of 12 documented risk factors. Results The study enlisted 7875 women desiring pregnancy soon. The mean age of women was 23.19 (± 3.71) years, and 16% of them were adolescents. Women’s illiteracy was higher in tribal areas than non-tribal (p < 0.001). About two-thirds of women have at least one risk factor, and 40.0% have a single risk factor. The most common risk factor observed was no formal education (44.35%). The prevalence of selected risk factors was significantly higher among women from tribal areas. The mean BMI of women was 19.73 (± 3.51), and a higher proportion (40.5%) of women from tribal areas had BMI < 18.5. Despite being of high parity status (≥ 4), about 7.7% of women from the tribal area and 3% from non-tribal desired pregnancy. Tobacco and alcohol consumption was higher among tribal women. The majority of women consumed meals with family members or husbands. Protein and calorie intake of about 1.4% of women was less than 50% of the recommended daily allowance; however, most of them perceived to have abundant food. Conclusions Health risks, namely younger age, illiteracy, high parity, consumption of tobacco, low protein, and calorie intake, were quite prevalent, and the risks were significantly more among women from tribal areas. “Continuum of care” must comprise preconception care inclusive of Behavioral Change Communication, particularly for easily modifiable risk factors and specially for tribal women.
Introduction: The COVID-19 epidemic is fast-evolving and restrictions to contain it changes quickly. The secondary attack rate (SAR) indicates the infectiousness at the household level, and it provides a clue of load of infections in the community. Rapid implementation of a large scale, but brief survey provides a nationally representative view of the pandemic's progression and impact as well as the effect of the measures taken to control the spread. Materials and Methods: This cross-sectional study was done for a period of 2 months July–August 2020, in one of the rural health and demographic surveillance system (HDSS) site in India among 11,507 households having 46,571 individuals with the objective to determine the prevalence of the COVID-19 infection and to estimate the family SAR. The data were collected using the mobile phone by calling the head of the households registered under the HDSS. The research tool was created using questions based on the guidelines provided by the Ministry of Health and Family Welfare, India. The interviewers were first trained in data collection. Results: The households of 33,780 individuals were contacted and 33 patients were diagnosed as COVID positive, prevalence rate of 0.1% was thus documented through telephonic survey. The mean age of COVID patients was found to be 37 ± 16 years, and 63% of the diagnosed patients were males, majority of them belonged to above poverty line households. During the survey, 46 individuals reported to have the symptoms suggestive of COVID, fever and cough were the most commonly reported symptoms. The family SAR of 17.2% was documented. Conclusion: Thus to conclude a low COVID-19 prevalence rate of 0.1%, a higher family SAR of 17.2% was reported in the current study. Timely diagnosis and quarantine of close contacts should be continued to be implemented rigorously to prevent the spread of the COVID-19 virus. These efforts will be useful to contain the epidemic before it reaches an alarming level in the rural areas. Materials and Methods: This cross-sectional study was done for a period of 2 months July–August 2020, in one of the rural health and demographic surveillance system (HDSS) site in India among 11,507 households having 46,571 individuals with the objective to determine the prevalence of the COVID-19 infection and to estimate the family SAR. The data were collected using the mobile phone by calling the head of the households registered under the HDSS. The research tool was created using questions based on the guidelines provided by the Ministry of Health and Family Welfare, India. The interviewers were first trained in data collection.
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