SummaryBackgroundEvidence on the optimal time to initiation of complementary feeding in preterm infants is scarce. We examined the effect of initiation of complementary feeding at 4 months versus 6 months of corrected age on weight for age at 12 months corrected age in preterm infants less than 34 weeks of gestation.MethodsIn this open-label, randomised trial, we enrolled infants born at less than 34 weeks of gestation with no major malformation from three public health facilities in India. Eligible infants were tracked from birth and randomly assigned (1:1) at 4 months corrected age to receive complementary feeding at 4 months corrected age (4 month group), or continuation of milk feeding and initiation of complementary feeding at 6 months corrected age (6 month group), using computer generated randomisation schedule of variable block size, stratified by gestation (30 weeks or less, and 31–33 weeks). Iron supplementation was provided as standard. Participants and the implementation team could not be masked to group assignment, but outcome assessors were masked. Primary outcome was weight for age Z-score at 12 months corrected age (WAZ12) based on WHO Multicentre Growth Reference Study growth standards. Analyses were by intention to treat. The trial is registered with Clinical Trials Registry of India, number CTRI/2012/11/003149.FindingsBetween March 20, 2013, and April 24, 2015, 403 infants were randomly assigned: 206 to receive complementary feeding from 4 months and 197 to receive complementary feeding from 6 months. 22 infants in the 4 month group (four deaths, two withdrawals, 16 lost to follow-up) and eight infants in the 6 month group (two deaths, six lost to follow-up) were excluded from analysis of primary outcome. There was no difference in WAZ12 between two groups: −1·6 (SD 1·2) in the 4 month group versus −1·6 (SD 1·3) in the 6 month group (mean difference 0·005, 95% CI −0·24 to 0·25; p=0·965). There were more hospital admissions in the 4 month group compared with the 6 month group: 2·5 episodes per 100 infant-months in the 4 month group versus 1·4 episodes per 100 infant-months in the 6 month group (incidence rate ratio 1·8, 95% CI 1·0–3·1, p=0·03). 34 (18%) of 188 infants in the 4 month group required hospital admission, compared with 18 (9%) of 192 infants in the 6 month group.InterpretationAlthough there was no evidence of effect for the primary endpoint of WAZ12, the higher rate of hospital admission in the 4 month group suggests a recommendation to initiate complementary feeding at 6 months over 4 months of corrected age in infants less than 34 weeks of gestation.FundingIndian Council of Medical Research supported the study until Nov 14, 2015. Subsequently, Shuchita Gupta's salary was supported for 2 months by an institute fellowship from All India Institute Of Medical Sciences, and a grant by Wellcome Trust thereafter.

Objectives:To study the knowledge and practices related to newborn care in urban slums of Lucknow city, UP, and to identify critical behaviors, practices, and barriers that influence the survival of newborns.Materials and Methods:A cross-sectional study in urban slums of Lucknow city, UP, included 524 women who had a live birth during last 1 year preceding data collection. Data were analyzed using statistical software SPSS 10.0 for windows.Results:Study findings showed that about half of the deliveries took place at home. Majority (77.1%) of the mothers believed that baby should be bathed with warm water and dried with clean cloth and 79.7% mothers practiced it. Only 36.6% mothers initiated breast-feeding within 1 h of birth and 30.2% initiated after 1 day. The mothers who have not given colostrum to their baby, in majority the reason was customs.Conclusion:In majority of cases, correct knowledge and correct practices regarding newborn care were lacking among mothers and this should be promoted through improved coverage with existing health services.

Background:Immunization remains one of the most important public health interventions and a cost-effective strategy to reduce both the morbidity and mortality associated with infectious diseases. Over two million deaths are delayed through immunization each year worldwide.Aims:This study sought to identify specific factors associated with immunization coverage in order to advance improved intervention, policies/strategies therefore raising overall immunization coverage.Materials and Methods:A cross-sectional study was conducted among a total of 198 children aged 12-23 months at Urban Health and Training Centre (UHTC), Era's Lucknow Medical College, Lucknow, over a period of 6 months i.e., from July 2012-December 2012. Data were collected, compiled and tabulated using Microsoft Excel and analyzed using SPSS 17.0 version.Results:A total of 198 children of age 12-23 months were included in this study, of which 74.7% of children were fully immunized, 11.1% were partially immunized and 14.1% were not immunized at all. The most common reason for partial or non-immunization was family problems (24%) of the respondents followed by lack of knowledge of immunization (20%), and fear of side effects (16%). The odds of risk of partial/non-immunization in illiterate women is 5.78 more than the graduate women (P = 0.039).Conclusions:Although in the present study, majority of the children were immunized, it is still not up to the mark. We have to make it 100%, so that we can reduce mortality due to vaccine-preventable diseases. Increasing awareness and reducing fear of side effects of immunization among parents through health education, counseling, etc. can increase the percentage of immunized children.

Background:HIV/AIDS has emerged as the single most formidable challenge to public health. School children of today are exposed to the risk of HIV/AIDS.Aims:The study was conducted to determine the knowledge among secondary school students regarding HIV/AIDS and provide suggestions for HIV/AIDS education in schools.Materials and Methods:A cross-sectional study was conducted among students of tenth to twelfth standard in the intermediate schools of Lucknow, India, from July to October 2011. A total of 215 students, both boys and girls, were enrolled in the study.Results:In this study, for majority of the students (85%), the source of information about HIV/AIDS was the television. Regarding knowledge about modes of transmission of HIV/AIDS among girl students, 95.1% of them told that it is through unprotected sex. A total of 75.8% students said that it was transmitted from mother to child.Conclusion:It was observed that the knowledge of the school students was quite satisfactory for most of the variables like modes of transmission, including mother-to-child transmission of the disease. However, schools should come forward to design awareness campaigns for the benefit of the students.

Background: School health is an important branch of community health. School health services is an economical and powerful means of raising community health. In school child is vulnerable to stress, tension and endangerment of group life because all children are not the same and comes from different socioeconomic and cultural background and with different immunity status. Child is quite vulnerable at this growing age and hence become easy victims of many non-communicable diseases such as dental caries, anaemia, visual and hearing defects. The objective of the study was to assess health status of primary school children in rural areas of Lucknow.Methods: The present school-based descriptive cross-sectional study was conducted in the rural area of Lucknow from February to July 2015. Purposive sampling technique was adopted to select primary schools from 1st to 5th standard. All students who were present at the time of survey were included in the study. A pre-structured performa for each student was used to record information regarding anthropometric measurements, physical examination/ personal hygiene, clinical findings.Results: A total of 170 children were examined, among these 82 (48.23%) were boys and 88 (51.77%) were girls. Dental caries was the most common infirmity observed in 63 (37.05%) children with 95% CI (33.35- 40.75) and was statistically significant (p<0.05) with boys 29.27% and girls 44.31%. Anaemia were found in 65 (38.23%), boys were 32.92% and girls 43.18%. Ear discharge was seen in 17 (10%) children, boys were 6.10% and girls 13.63%.Conclusions: The common infirmity found were dental caries, anaemia and ear discharge. Effective strategy with good monitoring and evaluation is imperative in ensuring adequate and optimal implementation of school health services in primary schools in rural Lucknow.

Background:Roughly 3 million children die every year of vaccine preventable diseases and a significant number of these children live in developing countries. The present study was conducted to assess the reasons for failure of immunization among 12-23-month-old children of Lucknow city in India.Materials and Methods:Out of all villages in rural areas and mohallas in urban areas of Lucknow district, eight villages and eight mohallas were selected by simple random sampling. A community based cross-sectional study was done among 450 children aged 12-23 months. The immunization status of the child was assessed by vaccination card and by mother's recall. A pre-designed and pre-tested questionnaire was used to elicit information on reasons for failure of immunization. Data was analysed using statistical package for social services (SPSS) version 11.5. Chi square test was used to find out the significant association.Results:Overall, 62.7% children were fully immunized, 24.4% children were partially immunized, and 12.9% children were not immunized. The major reasons for failure of immunization were postponing it until another time, child being ill and hence not brought to the centre for immunization, unaware of the need of immunization, place of immunization being too far, no faith in immunization, unaware of the need to return for 2nd and 3rd dose, mother being too busy, fear of side reactions, wrong ideas about immunization, and polio was considered only vaccine, and others.Conclusion:More awareness should be generated among the people living in rural and urban areas to immunize their children.

Context: Once a rare occurrence, MAP is becoming an increasing threat to maternal lives. Aims: To summarize our experience in the management of patients with morbidly adherent placenta. Introduction: MAP is a potentially life threatening hemorrhagic condition responsible for 7% - 10% maternal mortality. Settings and Design: Tertiary care center. Methods and Material: Retrospective study in which data of twelve patients with clinical diagnosis of morbidly adherent placenta was reviewed from Jan 2009 till Sept 2012. Results: The incidence of placenta accreta was found to be increasing every year. Out of twelve cases with clinical diagnosis of MAP, placenta previa was present in 10/12 patients with MAP. All patients had history of previous section. Two patients with preoperative diagnosis of MAP on USG/MRI were found to be normal intra-operative and in one patient focal accreta was diagnosed intraoperatively. Nine patients of MAP underwent caesarean hysterectomy due to excessive bleeding during placental separation and were confirmed histo-pathologically (3 accreta vera, 3 increta and 3 percreta). Internal iliac artery ligation was done in 2 patients. Two patients with placenta percreta had bladder rupture which was repaired and these two patients subsequently expired. Conclusions: The incidence of placenta accreta is increasing due to higher cesarean section (C/S) rate. Key to successful outcome is awareness, anticipation, preoperative counseling, planning and multidisciplinary approach.

The present study was designed to establish norms for pulmonary functions in urban healthy children of Delhi under the age group of 10-15 years. Pulmonary functions were assessed using an electronic lung function spirometer in 222 boys and 188 girls belonging to middle income group families of East Delhi. The pulmonary functions were separated by age and sex. All pulmonary functions showed an increase with advancing age. FEV1 and FVC were more in boys as compared to girls. Values of PEFR, FRC and TLC were similar in both sexes till the age of 13 years after which boys attained higher values. Prediction equations were obtained using height, age and weight as independent variables. Forward selection method was used to choose the best equation for each pulmonary function. Maximum variance in the lung functions was explained with the height. It is felt that norms established in the present study will act as reference standards for various lung functions in well nourished urban Delhi children under the age group of 10-15 years.