Prema Ramachandran

Abstract

Background and Objectives: In the last two decades, India witnessed a steep rise in institutional delivery (ID) rates and some increase in Caesarean section (CS) rates. Analysis of raw data from three major surveys was undertaken with the objective of identifying factors associated with both low and high institutional deliveries and Caesarean rates so that appropriate locale specific corrective interventions can be initiated. Materials and Methods: The raw data from NFHS4, AHS and DLHS4 were analysed to assess urban-rural and interstate differences in ID and CS rates in government and private institutions and CS rates in relation to sociodemographic and obstetric profile of the woman. Findings: At national level 3/4 of women had ID. There were substantial interstate variations (50·4% to 99·8%). ID rates were higher in urban areas and in DLHS4 states. CS rate in ID at the national level was 18·5%; CS rates in ID were higher in urban areas, in DLHS4 states and in private institutions in all states. Interstate differences in CS rate were high (2·4% in government institutions in Bihar to 69·2% in private institutions in West Bengal. CS rates were higher in urban, educated women from higher SLI group delivering in private institutions. Interpretation: National surveys help in identifying the states and institutions with lower ID rates and higher CS rates and enable the initiation of appropriate interventions to strengthen institutions. Awareness generation about adverse consequences of home deliveries and CS without obstetric indications will hasten the progress towards universal institutional delivery and optimal CS rates.   Keywords: Caesarean section, Institutional deliveries, interstate differences, National surveys, Caesarean section done without obstetric indications

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Abstract

Background: Prevalence of vitamin D deficiency in pregnant women in India is high. There have been case reports from India of neonatal tetany and vitamin D deficiency in breast-fed infants. India initiated the calcium and vitamin D supplementation programmes for pregnant women a decade ago. There is a need to assess compliance with calcium and vitamin D supplementation and impact of supplements on vitamin D levels in pregnant women. Materials and Methods: Women attending antenatal clinic in an urban maternity centre who fulfilled the eligibility criteria and were willing to participate in the study were enrolled. They were given one month’s supply of supplements, and form for recording compliance and side effects and were followed up every month. Blood samples were drawn at enrolment and after three months of supplementation and plasma vitamin D levels were estimated. Results: Two third of the women had vitamin D level below 20 ng/ml at enrolment There was excellent compliance with supplementation; women who were followed up consumed 94% of the tablets provided. None of the women had clinical signs suggestive of vitamin D deficiency or any major obstetric problems; their offsprings were healthy. A third of the pregnant women continued to have low vitamin D levels after three months supplementation. Conclusion: The current dose of supplements appears to be inadequate to correct the vitamin D levels in deficient individuals. There is a need to undertake studies to find out the optimal dose of vitamin D supplementation which corrects vitamin D deficiency as assessed by maternal vitamin D levels. Keywords: Vitamin D, Pregnant women, Vitamin D supplementation, Vitamin D deficiency

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Abstract

Background: In India, prevalence of nutritional anaemia due to iron, folic acid and vitamin B12 deficiency is high. National anaemia control programme envisaged detection and treatment of anaemic pregnant women. Prevalence of anaemia continues to be high because this strategy was not operationalised and coverage and compliance with iron folic acid supplementation remains low. Materials and Methods: The present study aimed at: 1. Operationalizing Hb estimation in urban maternity center, 2. assessing prevalence of iron, folic acid and vitamin B12 deficiency, 3. undertaking an open randomized study in women with Hb between 8.0 and 10.9 g/dL to assess impact of supplementation with iron and folic acid (Group 1) or iron, folic acid and vitamin B 12 (Group 2). Results: The ‘Test and treat’ strategy was operationalized in urban maternity center. At enrolment 100% of women were anaemic, 60% had ferritin 1.0 g/dL), mean ferritin and folic acid in both Gr 1 and 2. There was a fall in mean vitamin B12 at 8 weeks in Gr 1 women who received 5 mg folic acid. Addition of vitamin B12 to IFA does not improve mean Hb or vitamin B12. With assured regular supply and supportive supervision, iron folic acid supplementation for 8 weeks reduces prevalence of anaemia in pregnancy by 50%; with continued supplementation till 38 weeks of pregnancy, there was 70% reduction in prevalence of anaemia.   Keywords: Pregnant women, Anaemia, Haemoglobin, Iron, Folic acid, Vitamin B12, Open randomized trial.

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