Background Although respiratory syncytial virus (RSV) is the most important viral cause of lower respiratory tract infection deaths in infants, there are few data on infant community deaths caused by RSV. Methods This was an active surveillance of children younger than 2 years of age in 93 villages, 5 primary health centers, and 3 hospitals serving these villages. Village health workers and counselors at the health facilities monitored all lower respiratory tract infections (LRTIs) in consented subjects. Children with severe, or very severe LRTIs and all who died, had nasopharyngeal swabs collected for detection of RSV by molecular methods. Results In the 12 134 subjects, there were 2064 episodes of severe LRTIs and 1732 of very severe LRTIs, of which 271 and 195, respectively, had RSV. Fifteen of 16 (94%) children with RSV died of LRTIs, 14 in the community and 1 in the hospital. The case fatality ratios for severe RSV LRTIs in the first 6 months of life were 3/52 (7.1%) and 1/36 (2.8%) in the community and hospital, respectively. Of those with very severe LRTIs in the community, 17.6% died. There were no very severe RSV LRTI hospital deaths. The adjusted RSV LRTI mortality rates ranged from 1.0 to 3.0/1000 child-years (CY) overall, and 2.0 to 6.1/1000 CY, accounting for 20% of the LRTI deaths and 10% of the postneonatal infant mortality. Conclusions Community deaths from RSV account for the majority of RSV LRTI deaths, and efforts at prevention should be preferentially directed at populations where access to care is limited.
UnderweightWasting SAM a b s t r a c t Objective: Under nutrition has chronically remained a major public health problem among tribal children population in India. The present study aimed to estimate the prevalence of various forms of under nutrition in 'under five' children in Melghat e a difficult to reach, hilly, forest area of Maharashtra in Central India using different standards.Methods: A community based cross-sectional study was conducted in Dharni & Chikhaldara blocks in tribal area of Melghat over a period of two months. A representative sample of 2926 under-five children from randomly chosen 33 villages in two blocks was selected with cluster sampling. Information on various demographic and anthropometric characteristics (e.g. age, sex, height, weight) of study subjects was collected in a pre-designed proforma by trained tribal female village health workers (VHWs). Under nutrition was assessed by using Standard WHO criteria like stunting, underweight, wasting, and IAP grades; alone and in combination. Crude and adjusted prevalence estimates accounting for clustering effect were obtained along with 95% Confidence Intervals.Results: Out of total 2926 U5 children, 1006 (34.4%) were severely stunted, 547 (18.7%) were SUW and 209 (7.1%) were SAM, and 199 (6.8%) were severely under nourished (grade IIIeIV) according to IAP standards. However, when various WHO criteria & IAP gradations were applied in combination, more number 2241 i.e. (76.59%) of the U5 children in Melghat were found to be severely or moderately under nourished. by one or more standards.Conclusion: Very high prevalence of severe stunting, severe underweight and severe acute malnutrition was found in tribal U5 children population in Melghat. A combination of more than one criteria may be useful in tracking more number of under nourished children in tribal communities, which otherwise would be missed by any single criterion alone. The study findings will be helpful in planning prevention and planning of programmes that would focus more on populations most affected.
Keywords: SAM SUW LTF MN BCC a b s t r a c t Objectives: Main objectives of the study were the following: 1. To achieve a recovery rate of 75% in severe acute malnutrition (SAM) children and 35% in severe underweight (SUW) children, in tribal community based management of severe malnutrition.2. To achieve a case fatality rate of <4% in SAM and SUW children in the above setting.3. To reduce current prevalence rate of SAM and SUW by at least 35% after 3 years of intervention.Design: Community-based prospective, single-group intervention study.Setting: Primary and secondary care was given to participants from 14 villages of the tribal area of Melghat.Participants: Severely malnourished children (SMC:734), tribal, male and female of the 6-60 months age group were enrolled and 680 children completed the study over a period of 3 years. Sample size (N = 762) was estimated considering the prevalence of severe malnutrition (SAM and SUW) in 6-60 months population as 21.5%; design effect was 3.0 and relative precision was 10%, with 95% confidence interval.Interventions: LTF (local-therapeutic-food) with MN (micronutrients), treatment of infections and BCC (behavior change communication) were given for 90 days to SMC by VHW (village health worker).
Background Globally, respiratory syncytial virus (RSV) is a common cause of acute lower tract infection (LRTI) in children younger than 2 years of age, but there are scant population-based studies on the burden of RSV illness in rural communities and no community studies in preterm infants. Methods Active surveillance of LRTI was performed in the community and hospital setting for the population of 93 tribal villages in Melghat, Central India, over 4 respiratory seasons. A nasopharyngeal swab was obtained from cases presenting as a severe LRTI for molecular analysis of respiratory pathogens including RSVA and B. Results High rates of RSV-associated LRTI were found in preterm and term infants beyond 6 months of age, extending into the second year of life. Community severe RSV LRTI rates for 0–11 months of age was 22.4 (18.6–27.0)/1000 child-years (CY) and the hospital-associated rate was 14.1 (11.1–17.8)/1000 CY. For preterm infants, these rates were 26.2 (17.8–38.5)/1000 CY and 12.6 (7.2–22.0)/1000 CY. Comparable rates in the first 6 months were 15.9 (11.8–21.4)/1000 CY and 12.9 (9.3–18.0)/1000 CY in term infants and 26.3 (15.4–45.0)/1000 CY and 10.1 (4.2–24.2)/1000 CY for preterms. The single RSV B season had higher incidences of RSV LRTI in every age group than the 2 RSV A seasons in both preterm and term infants. There were 11 deaths, all term infants. Conclusions Studies restricted to the healthcare settings significantly underestimate the burden of RSV LRTI and preterm and term infants have comparable burdens of disease in this rural community.
Background/Introduction: WHO recommended ‘ready to use therapeutic food’ (RUTF) for community-based management (CMAM) of severely malnourished children (SMC). This is often rejected by children. The objective is to identify and map the locally produced and socio-culturally acceptable food items to treat SMC. Methods: Through community participation, eight varieties of MAHAN Local therapeutic foods (LTFs) were prepared by tribal females at our center as per WHO norms with a shelf life of 4 weeks. LTFs with micronutrients were given at the feeding centers in the villages under supervision 3 - 4 times a day. Results: Multiple, palatable, culturally acceptable, safe, feasible with local womanpower, and cost-effective recipes were developed. Hence, our LTFs are qualitatively superior to other therapeutic foods. This mapping exercise provides a ready reference to other government or non-government organizations for CMAM. Conclusion: MAHAN-LTF is a multiple, palatable, generalizable, and sustainable therapeutic food and are being used in other tribal blocks of India.
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