Rapid survey to determine the predictive factors of vaccination coverage in children aged 0 to 59 months in Guinea

Background: The Expanded Program on Immunisation has made it possible to prevent more than 3 million deaths in children under 5 years. The objectives of this study were to estimate the vaccination coverage of children from 0 to 59 months and identify factors associated with incomplete vaccination coverage.Methods: A cross-sectional study was carried out in a dispensary in Conakry, Guinea between January and February 2020. Sociodemographic and vaccination information was collected from mothers of 380 randomly select children aged 0 to 59 months. Information on immunisation coverage was gathered from records vaccination cards and maternal reports. Logistic regression was used to identify factors independently associated with incomplete immunisation coverage.Results: Most (66.5%) children aged 12 months were up-to-date with their vaccinations. Factors associated with incomplete vaccination in this age group included: unavailability of vaccination cards (adjusted odds ratio [aOR] 7.58; 95% confidence interval [CI]: 2.56–22.44) and lack of prenatal consultation attendance (aOR 2.93; 95% CI: 1.15–7.48). In contrast only 19.8% (95% CI: 13.9–26.7) of children aged 12–59 months were fully immunised. Factors associated with incomplete vaccination coverage in children aged 12–59 months included high birth order (aOR 10.23; 95% CI: 2.06–19.43), and lack of prenatal consultation attendance (aOR 5.34; 95% CI: 1.48–19.23).Conclusion: Child immunisation coverage is low in Guinea. These results highlight the need to develop strategies based on an integrated approach to overcome obstacles to childhood immunisation in Guinea.

Regional Disparities and Determinants of Caesarean Deliveries in India

Background: The caesarean rate in India has been increased from 8.5% (NFHS-III) during 2005-06 to 17.2% (NFHS-IV) during 2015-16. Objective: The main objective of the study is to assess the regional disparities and determinants of caesarean deliveries in India. Material and Method: It is a descriptive study. The fourth round of National Family Health Survey, India (NFHS-4), conducted in 2015-16 has been analysed for the purpose of this study. Result: The study found that the C-section deliveries are significantly higher in southern region followed by western region in India. Social factors such as higher education of mother, residing in urban area, belong to richest wealth group, mothers belong to non-SC/ST category are more likely to opt for C-section delivery. Evidence also indicates that risk factors like high age of mother, high birth order, complicated pregnancy, multiple births, size of child at birth, weight of child at birth significantly influences the decision of C-section deliveries. Institutional and Individual Behavioural Factors such as number of ANC visit, place of delivery, access to mass media are also significant determinants of opting C-section delivery. Delivering high quality timely care and counselling measures throughout the gestation period as a measure to minimise C-section deliveries is the responsibility of every midwife healthcare provider, is an effective way. There is an urgent need to monitor the deliveries in clinics and hospitals to find out the right balance between demand and provisioning of high quality health care services.

High birth order pregnancy and unmet need of contraception in semi-urban population in India: a comparison of two cross sectional surveys performed 10 years apart

Background: Rising population is the greatest problem facing the country. The current study was done to find out reasons behind the failure of two child norm policy and to find out the changes in last 10 years in this regard.Methods: A cross sectional survey was done at a referral hospital involving the pregnant women with two or more live children. The Performa used for survey was same as that used 10 years back for a similar study. A comparative analysis was done.Results: A large number of high birth order pregnancies remains unintended (47.47% versus 46.06%). Intended pregnancies still reflect a preference for male child (58.78% versus 54.62%). Unintended pregnancies involves a large population with unmet need of contraception.Conclusions: The prevalence of unmet need for family planning remains high in our society. There is a dire need of better client friendly family planning services especially in antenatal clinics along with educating men and women regarding the importance of planning ones family.

Analytical study to evaluate the relation between vaginal birth and pelvic organ prolapse quantification stages

Background: Pelvic organ Prolapse (POP) is the downward displacement of central pelvic organs that are normally located at the level of or adjacent to the vaginal vault. These conditions are common and affect a progressively larger percentage of women as age advances especially in the postmenopausal years.Methods: Data were collected as a retrospective study. Thorough history was taken and physical examination was done. Demographic details of each patient were recorded including age, residence type, education and socio- economic status. A detailed history of all the patients was obtained included parity, live birth and nutrition status.Results: Significant difference was observed between patients with premenopausal and postmenopausal and POPQ stages (p=0.001). In postmenopausal 41(59.42%) in stage III and 20(28.99%) in stage IV POPQ, chances of POP was higher compared to premenopausal women 33(70.21%) in stage III and 6(12.77%) in Stage IV. Most of the patients belong to birth order 4 or more than that [73 (62.9%)] followed by birth order 3 [26 (22.4%)] and 2 [16 (13.8%)] whereas 38 (32.7%) patients had birth order >4. In patients with birth order ≥4 and 3 had higher distribution of POPQ stage III and IV respectively.Conclusions: From Present study it can be concluded that vaginal child birth plays a major role in development of POP. POPQ stages were statistically significant with high birth order.

Timeliness and completeness of routine childhood vaccinations in young children residing in a district with recurrent vaccine-preventable disease outbreaks, Jerusalem, Israel

Background Childhood vaccination schedules recommend vaccine doses at predefined ages. Aim We evaluated vaccination completeness and timeliness in Jerusalem, a district with recurrent vaccine-preventable disease outbreaks. Methods Vaccination coverage was monitored by the up-to-date method (vaccination completeness at age 2 years). Timeliness of vaccination was assessed in children (n = 3,098, born in 2009, followed to age 48 months, re-evaluated at age 7 years) by the age-appropriate method (vaccine dose timeliness according to recommended schedule). Vaccines included: hepatitis B (HBV: birth, 1 month and 6 months); diphtheria, tetanus, acellular pertussis, polio, Haemophilus influenzae b (DTaP-IPV-Hib: 2, 4, 6 and 12 months); pneumococcal conjugate (PCV: 2, 4 and 12 months); measles-mumps-rubella/measles-mumps-rubella-varicella (MMR/MMRV: 12 months) and hepatitis A (HAV: 18 and 24 months). Results Overall vaccination coverage (2014 cohort evaluated at age 2 years) was 95% and 86% for MMR/MMRV and DTaP-IPV-Hib4, respectively. Most children (94%, 91%, 79%, 95%, 92% and 82%) were up-to-date for HBV3, DTaP-IPV-Hib4, PCV3, MMR/MMRV1, HAV1 and HAV2 vaccines at 48 months, but only 32%, 28%, 38%, 58%, 49% and 20% were vaccinated timely (age-appropriate). At age 7 years, the median increase in vaccination coverage was 2.4%. Vaccination delay was associated with: high birth order, ethnicity (higher among Jews vs Arabs), birth in winter, delayed acceptance of first dose of DTaP-IPV-Hib and multiple-dose vaccines (vs MMR/MMRV). Jewish ultra-Orthodox communities had low vaccination coverage. Conclusions Considerable vaccination delay should be addressed within the vaccine hesitancy spectrum. Delays may induce susceptibility to vaccine-preventable disease outbreaks; tailored programmes to improve timeliness are required.

Prevalence and risk factors of under nutrition among under three children in an urban community in Ludhiana city

Background: Under nutrition is important cause of childhood morbidity and mortality. In India burden of underweight children in under 5 years of age is still 35.7% (NFHS-4) and is 22% in Punjab which is still considered to be a major public health problem. Thus this study was planned to find prevalence and risk factors of under nutrition in under 3 children in urban Ludhiana.Methods: It is community based cross-sectional study conducted in under 3 year children in field practice area of Urban Health Centre under Department of Community Medicine, Dayanand Medical College, Ludhiana. Minimum sample size of 368 was calculated. Data was collected from routine surveillance by ANMs in their visits to area. Under nutrition was taken as weight for age as per standard growth chart used in India (WHO based). Statistical analysis: Microsoft Excel, Chi square test, SPSS.Results: Out of 387 children, 82 (21.2%) were underweight [17 (4.4%) severely and 65 (16.8%) moderately underweight]. Increasing age, partial immunization, low birth weight and high birth order were significantly associated, while gender, type of family, SES, mother’s BMI & literacy and exclusive breast feeding were not significantly associated with prevalence of underweight.Conclusions: Increasing age, partial immunization, low birth weight and high birth order were all significantly associated with underweight. Maternal and child health services need to be strengthened.

THE RELATION OF BIRTH ORDER TO SEXUAL ORIENTATION IN MEN AND WOMEN

Homosexual men have a higher mean birth order than do heterosexual men, primarily because they have a greater number of older brothers. The purpose of this study was to determine whether the same difference occurs in homosexual vs heterosexual women. The probands were 964 homosexual and heterosexual, male and female volunteers, from whom birth order data were collected with self-administered questionnaires. The homosexual men had more older brothers than the heterosexual men, but they did not have more older sisters, younger brothers, or younger sisters. The homosexual women did not differ from the heterosexual women with regard to any class of sibling. These results are consistent with the hypothesis that the high birth order of homosexual men reflects the progressive immunization of certain mothers to H-Y antigen by succeeding male fetuses, and the increasing effects of H-Y antibodies on sexual differentiation of the brain in succeeding male fetuses.

Birth order, interpregnancy interval and birth outcomes among Filipino infants

SummaryThis study examines the effects of birth order and interpregnancy interval on birthweight, gestational age, weight-for-gestational age, infant length, and weight-for-length in a sample of 2063 births from a longitudinal study in the Philippines. First births are the most disadvantaged of any birth order/spacing group. The risks associated with short intervals (<6 months) and high birth order (fifth or higher) are confined to infants who have both attributes; there is no excess risk associated with short previous intervals among lower-order infants, nor for high birth order infants conceived after longer intervals. This pattern is observed for all five birth outcomes and neonatal mortality, and persists in models that control for mother's age, education, smoking, family health history and nutritional status. Since fewer than 2% of births are both short interval and high birth order, the potential reduction in the incidence of low birthweight or neonatal mortality from avoiding this category of high-risk births is quite small (1–2%).

Aspects of neonatal death in St Kilda, 1830–1930

SummaryNeonatal death (mainly due to tetanus) was common in St Kilda until 1891. Two aspects of this phenomenon are studied; factors which pre-dicted death, and the impact of neonatal death on family building. Maternal age appeared to be a predictive factor for death of the first child, but only in children of high birth order were other factors, particularly the number of previous neonatal deaths, important. The first birth interval appeared to be determined mainly by the date of the first birth, independent of neonatal mortality levels. For later intervals, the neonatal death of the previous child appeared to be the main determining factor.