No abstract

Objective To assess household practices that can affect neonatal health, from the perspective of caregivers and health workers; to identify signs in neonates leading either to recognition of illness or health-care seeking; and to ascertain the proportion of caregivers who recognize the individual items of the integrated management of neonatal and childhood illnesses (IMNCI) programme. Methods The study was carried out in a rural community in Sarojininagar Block, Uttar Pradesh, India, using qualitative and quantitative research designs. Study participants were mothers, grandmothers, grandfathers, fathers or "nannies" (other female relatives) caring for infants younger than 6 months of age and recognized health-care providers serving the area. Focus group discussions (n = 7), key informant interviews (n = 35) and structured interviews (n = 210) were conducted with these participants. Findings Many household practices were observed which could adversely affect maternal and neonatal health. Among 200 caregivers, 70.5% reported home deliveries conducted by local untrained nurses or relatives, and most mothers initiated breastfeeding only on day 3. More than half of the caregivers recognized fever, irritability, weakness, abdominal distension/vomiting, slow breathing and diarrhoea as danger signs in neonates. Seventy-nine (39.5%) of the caregivers had seen a sick neonate in the family in the past 2 years, with 30.38% in whom illness manifested as continuous crying. Health care was sought for 46 (23%) neonates. Traditional medicines were used for treatment of bulging fontanelle, chest in-drawing and rapid breathing. Conclusion Because there is no universal recognition of danger signs in neonates, and potentially harmful antenatal and birthing practices are followed, there is a need to give priority to implementing IMNCI, and possible incorporation of continuous crying as an additional danger sign.

BackgroundCommunity-acquired pneumonia (CAP) is the leading cause of under-five mortality globally with almost one-quarter of deaths occurring in India.ObjectivesTo identify predisposing, enabling and service-related factors influencing treatment delay for CAP in rural communities of two states in India. Factors investigated included recognition of danger signs of CAP, health care decision making, self-medication, treatment and referral by local practitioners, and perceptions about quality of care.MethodsQualitative research employing case studies (CS) of care-seeking, key informant interviews (KII), semi-structured interviews (SSI) and focus group discussions (FGD) with both video presentations of CAP signs, and case scenarios. Interviews and FGDs were conducted with parents of under-five children who had suffered CAP, community health workers (CHW), and rural medical practitioners (RMP).ResultsFrom September 2013 to January 2014, 30 CS, 43 KIIs, 42 SSIs, and 42 FGDs were conducted. Recognition of danger signs of CAP among caregivers was poor. Fast breathing, an early sign of CAP, was not commonly recognized. Chest in-drawing was recognized as a sign of serious illness, but not commonly monitored by removing a child’s clothing. Most cases of mild to moderate CAP were brought to RMP, and more severe cases taken to private clinics in towns. Mothers consulted local RMP directly, but decisions to visit doctors outside the village required consultation with husband or mother-in-law. By the time most cases reached a public tertiary-care hospital, children had been ill for a week and treated by 2-3 providers. Quality of care at government facilities was deemed poor by caregivers.ConclusionTo reduce CAP-associated mortality, recognition of its danger signs and the consequences of treatment delay needed to be better recognized by caregivers, and confidence in government facilities increased. The involvement of RMP in community based CAP programs needs to be investigated further given their widespread popularity.

No abstract

Aims:  To investigate the genetic basis of Cr(VI) resistance and its reduction to Cr(III) in indigenous bacteria isolated from tannery effluent. Methods and Results:  Four bacteria resistant to high Cr(VI) levels were isolated and identified as Bacillus spp. Their Cr(VI) reduction ability was tested. To assess the genetic basis of Cr(VI) resistance and reduction, plasmid transfer and curing studies were performed. Among all, B. brevis was resistant to 180 μg Cr(VI) ml−1 and showed the greatest degree of Cr(VI) reduction (75·8%) within 28 h and its transformant was resistant to 160 μg Cr(VI) ml−1 and reduced 69·9% chromate. It harboured a stable 18 kb plasmid DNA. Transfer and curing studies revealed that both the chromate resistance and reduction were plasmid mediated. The presence of other metal cations did not have any significant effect on Cr(VI) bioreduction. Conclusions:  Bacillus brevis was resistant to elevated Cr(VI) levels and may potentially reduce it in short time from an environment where other metal ions are also present in addition to chromium ions. The strain tested shows a positive correlation between genetic basis of Cr(VI) resistance and reduction. Significance and Impact of the Study:  To our knowledge, this is the first study on the genetic correlation between chromium resistance and reduction in bacteria. Such strains may potentially be useful in biotechnological applications and in situ Cr(VI) bioremediation.

c l i n i c a l e p i d e m i o l o g y a n d g l o b a l h e a l t h 5

IntroductionCommunity Acquired Pneumonia (CAP) is the leading cause of mortality in children younger than five years of age in developing countries, including India. Hence, this prospective study was performed to estimate the incidence of CAP in children (2–59 months)in four districts of Northern India.MethodsA cross-sectional survey in rural Lucknow was conducted using cluster sampling technique to assess the proportion of CAP cases that were hospitalized in last 12 months (hospitalization fraction). Another prospective study was done to assess number of hospitalized CAP cases in same districts in 2016. For this, a surveillance network of hospitals that admitted children was established. Cases with WHO-defined CAP with less than 14 days of illness were eligible for inclusion. Informed written parental consent was obtained. A mathematical model was developed to estimate the incidence of CAP in each district, taking into account number of cases hospitalized in one year, assuming it to be equal to hospitalization fraction and using Lucknow district as reference, correcting for child-population per hospital for each district. Population census data of 2011 was taken as denominator.ResultsIn cross-sectional survey (February to May 2016), 3351 children (2–59 months) from 240 villages were included. Of these 24.58% (824/3351) children suffered from CAP in last 12 months and out of these 4% (33/824) children were hospitalized. Computed incidence of CAP per 1000 child-year for Lucknow was 86.50 (95%CI: 85.72–87.29); Etawah 177.01(95%CI: 175.44–178.58); Patna 207.78 (95%CI: 207.20–208.37) and Darbhanga 221.18 (95%CI: 220.40–221.97). Infants (2–11 months)had almost five to ten times higher incidence of CAP than those in 12–59 months age category.ConclusionsIncidence of CAP in Uttar Pradesh and Bihar is high, being much higher in infants. Hence there is an urgent need for introduction of preventive strategies, improving health seeking behavior and quality of care for CAP.

The present study was undertaken to assess the quality of treated tannery effluent discharged from Common Effluent Treatment Plant (CETP), Unnao, India, to various water bodies and agricultural lands. The physico-chemical analyses revealed that the effluent was yellowish-brown in colour, having alkaline pH, high BOD, COD values and contained large quantities of organic and inorganic constituents well above the prescribed standards. The bacteriological quality was assessed in terms of the presence of heterotrophs and total as well as faecal coliforms. All faecal coliforms were identified as Escherichia coli, of which 50% were found pathogenic after serotyping. Most of the serotypes were uropathogenic Escherichia coli (UPEC) 04. The potential risks of the contamination of different ecosystems situated to the vicinity of such sites are obvious. The observations of this investigation indicate that the treated tannery effluent released for various purposes is not satisfactory, and is far from optimal in attaining the safe limits of disposal.