India has a fairly large share in the maternal mortalities of the world. There are many aspects of a healthy pregnancy and immunization is one of them. Maternal immunization protects not just the mother but also imparts protection to the newborn. India introduced TT immunization for pregnant females in 1983. Due to sustained efforts of healthcare providers, training of nurses and midwives about clean delivery practices, strong campaigning of institutional deliveries, maternal and neonatal focused programs and a good coverage of pregnant women with TT immunization-India was finally declared free of maternal and neonatal tetanus on 15th May, 2015. Pertussis continues to be a serious public health problem in India. Pertussis is more dangerous in infancy and leads to substantial morbidity and mortality. The damage is particularly higher when the infant is only weeks old and still haven't received the primary immunization. Thus there is a need to introduce Tdap vaccine for pregnant women so that pertussis burden in infancy can reduce. An important cause of morbidity and mortality in pregnancy is influenza. Thus, influenza vaccine is the second vaccine that needs to be given to pregnant women.

Objective: The aim of this study was to investigate the importance of nutritional de®ciencies and infections in the development of anaemia in pregnant Nepali women. Design: Case-control study. Setting: Patan Hospital, Kathmandu, Nepal. Subjects: A sub-sample (n 479) of all pregnant women (n 2856) coming for their ®rst antenatal visit in a 12 month period, 1994±1995. Women who had already received any micronutrient supplementation (n 82), and those whose serum samples showed macroscopic haemolysis (n 7) were excluded. The remaining women (n 390) were included in the statistical analysis. They were divided into three groups; a non-anaemic control group, haematocrit (Hct)b33% (n 82), and two case-groups: moderately anaemic, Hct 25±33% (n 254), and severely anaemic, Hct`25% (n 54). Results: We found high prevalences of nutritional de®ciencies and intestinal infections, both among cases and controls. The prevalence of low s-ferritin was high, especially among the severely anaemic women (55.6%). In a multiple logistic regression model, the presence of low s-vitamin A, elevated s-C-reactive protein or hookworm infection was associated with a signi®cantly increased risk of severe anaemia. The adjusted odds ratios (95% CI) were 8.38 (1.99, 35.30), 4.91 (1.22, 19.67) and 5.43 (1.20, 24.61), respectively. Conclusions: In addition to the present routine iron and folate supplementation to pregnant Nepali women, vitamin A supplementation needs to be considered. Prevention and treatment of infections should, together with dietary advice, be emphasized more strongly in the antenatal care. Sponsorship: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education.

No abstract

This article is based on an in-depth interview with a pair of twins diagnosed with selective mutism and their parents 2 years after recovery. Selective mutism (SM) is a rare disorder, and identical twins sharing the condition are extremely rare. The twins developed SM simultaneously during their first year of school. The treatment and follow-up they received for several years are briefly described in this article. The interview explored the children's and their parents' narratives about the origin of the condition, the challenges it entailed in their daily lives, and what they found helpful in the treatment they were offered. In the interview, the children conveyed experiences that even the parents were unaware of and revealed examples of daily life-traumas for which they were unable to obtain support and help. The whole family was trapped in the silence. The twins and their parents emphasized different aspects in terms of what they believed were helpful. The implications of these findings for our understanding and treatment of children with SM are discussed, as well as the potential of service user involvement in child and adolescent mental health research.