Indian Girls Research Articles

Maternal-related deaths and impoverishment among adolescent girls in India and Niger: findings from a modelling study.

BackgroundHigh levels of maternal mortality and large associated inequalities exist in low-income and middle-income countries. Adolescent pregnancies remain common, and pregnant adolescent women face elevated risks of maternal mortality and poverty. We examined the distribution across socioeconomic groups of maternal deaths and impoverishment among adolescent girls (15–19 years old) in Niger, which has the highest total fertility rate globally, and India, which has the largest number of maternal deaths.MethodsIn Niger and India, among adolescent girls, we estimated the distribution per income quintile of: the number of maternal deaths; and the impoverishment, measured by calculating the number of cases of catastrophic health expenditure incurred, caused by complicated pregnancies. We also examined the potential impact on maternal deaths and poverty of increasing adolescent girls' level of education by 1 year. We used epidemiological and cost inputs sourced from surveys and the literature.ResultsThe number of maternal deaths would be larger among the poorer adolescents than among the richer adolescents in Niger and India. Impoverishment would largely incur among the richer adolescents in Niger and among the poorer adolescents in India. Increasing educational attainment of adolescent girls might avert both a large number of maternal deaths and a significant number of cases of catastrophic health expenditure in the 2 countries.ConclusionsAdolescent pregnancies can lead to large equity gaps and substantial impoverishment in low-income and middle-income countries. Increasing female education can reduce such inequalities and provide financial risk protection and poverty alleviation to adolescent girls.

Prevalence of iron-deficiency anaemia and risk factors in 1010 adolescent girls from rural Maharashtra, India: a cross-sectional survey

ObjectiveIron-deficiency anaemia (IDA) is the most common nutritional disorder observed in adolescent girls in India. Our aim was to investigate the prevalence and risk factors associated with IDA in rural Maharashtra, India, to address current evidence gaps. Study designCross-sectional survey. MethodsThe study recruited 13- to 17-year-old adolescent girls living in 34 villages of Osmanabad district. Data were collected on individual health, dietary, sociodemographic factors, and anthropometric measurements were taken. Haemoglobin (Hb) levels were measured using Sahli's haemometer. Logistic and linear regressions were used to identify risk factors associated with IDA and Hb levels, respectively. ResultsAmong 1010 adolescent girls (response rate 97.5%), the mean Hb was 10.1 g/dl (standard deviation = 1.3), and 87% had anaemia (Hb < 12 g/dl). The prevalence of mild (11.0–11.9 g/dl), moderate (8.0–10.9 g/dl) and severe (Hb ≤ 7.9 g/dl) anaemia was 17%, 65% and 5%, respectively. Anaemia likelihood increased significantly with age (odds ratio (OR): 1.41 per year, 95% confidence interval (CI): 1.17–1.70). Factors associated with decreased anaemia risk were mid-upper arm circumference (MUAC) ≥22 cm (OR: 0.51, 95% CI: 0.31–0.82), ≥3 days/week consumption of fruit (OR: 0.35, 95% CI: 0.23–0.54) or rice (OR: 0.39, 95% CI: 0.17–0.91), and incomplete schooling (OR: 0.47, 95% CI: 0.24–0.91). In the final model lower age, MUAC and fruit consumption were significantly associated with Hb level. ConclusionAnaemia prevalence was extremely high among adolescent girls in rural areas of Maharashtra. Whilst we identified risk factors that could be used for targeting interventions, there is urgent need of comprehensive preventative interventions for the whole adolescent girl population.

Comparison of the NBM 200 non-invasive haemoglobin sensor with Sahli's haemometer among adolescent girls in rural India

Objective: The study objective was to compare haemoglobin measurements between the NBM 200 (non-invasive haemoglobin sensor) and Sahli’s hemometer in adolescent girls in a rural Indian setting. Methods: Participants included girls aged between 13 to 17 years from 34 villages in Tuljapur and Lohara blocks of Osmanabad district, Maharashtra, India. Haemoglobin (Hb) measurements from the non-invasive sensor (NBM 200) were compared with measurements obtained from Sahli’s hemometer using Bland-Altman plot, Spearman correlation coefficient, sensitivity, specificity, and area under the receiver operating characteristic curve analysis (AUROC). Results: Paired measurements from both methods were obtained from 766 adolescent girls (N=766). Haemoglobin levels estimated by Sahli’s hemometer ranged from 5.0 g/dL to 14.0 g/dL (mean: 10.1 g/dL, standard deviation (SD): 1.41), whereas measurements obtained from the NBM 200 ranged from 9.5 g/dL to 15.2 g/dL (mean: 12.8 g/dL, SD: 1.42). The Bland-Altman analysis indicated a mean difference of -2.70 g/dL (95% Confidence Intervals: -2.84 to -2.55) demonstrating an overestimation of Hb measurement by the NBM 200 compared to the Sahli’s hemometer measurements. The NBM 200 showed low sensitivity (23.6%) and moderate specificity (61.8%) for the diagnosis of anaemia. The AUROC score was 0.43 indicating an underestimation of anaemia in our study population by the NBM 200. Conclusion: Haemoglobin measurements obtained from the NBM 200 were consistently higher leading to an underestimation of anaemia prevalence compared with Sahli’s hemometer estimates among adolescent girls in India.

Supply Side School Interventions for Girls in India, Effectiveness and Labour Market Outcomes Evidence from a Natural Experiment

In this paper we analyse the joint impact of two supply side school interventions (NPEGEL & KGBV) in India, aimed at improving girls schooling outcomes at the elementary level, on the probability of primary and upper primary completion and on changes to the reported usual principal status with regard to attending educational institution for girls in rural areas. We exploit the regional variation with regard to programme implementation in order to estimate the causal impact of the treatment using a triple difference in difference and difference in difference methodology. Our results suggests that exposure to both the programmes is associated with an increase in the probability of primary as well as upper primary completion and attending educational institution. Additionally, we examine the impact of this increase in participation in schooling by girls in 6-14 age group on labour force participation for rural (uneducated) women in the age group 25 to 59 years on account of within household substitution with regard to responsibility of performing domestic tasks. The recent fall in rural female labour force participation, despite the economic growth, in India have found little consensus on the explanations for the same in the literature. Using programme exposure as an instrumental variable we find a negative effect of a greater participation in school by girls on labour force participation for women, while a positive effect on participation in domestic tasks for the same. Compared to the descriptive explanations presented in the past literature our result on the other hand focuses on causal mechanism instead.

Parallelism and meaning: Understanding molas as twinned pairs

For over 100 years, Kuna Indian women and girls have sewn and worn the mola blouse as part of their dress ensemble. On the front and back of the blouses are mola panels, conceived and created as a pair. The pair of mola panels may be nearly identical or different. The relationship between a pair of mola panels is discussed in terms of the impact on the designs of Kuna culture and ethnoaesthetic criteria, especially layering, filler techniques, symmetry and colour preferences, as well as sewing techniques and material usage. Aspects of Kuna sociality, cosmology and verbal oratory are explored. In most cases it is possible to establish a thematic relationship between the back and front mola panels of a mola blouse. An object-based material culture approach contributes to an enhanced understanding of the complexities of mola making, including the technical skills required to design and manipulate layers of cloth. The importance of understanding mola panels as twinned pairs is highlighted by evaluating individual panels in pairs based on the examination of mola collections from six museums. This research also provides practical information for museum curators and others to establish which individual mola panels in collections may constitute a pair, originating from the same mola blouse.

Age of Onset of Puberty in Apparently Healthy School Girls from Northern India.

To determine the age of pubertal onset and menarche in school-going girls, and to assess the impact of obesity on pubertal timing. Cross-sectional. Seven schools across Delhi, India. 2010 school girls, aged 6-17 years. Anthropometric measurement and pubertal staging was performed for all subjects. Menarche was recorded by status quo method. Body mass index was used to define overweight/obesity. Serum gonadotropins and serum estradiol were measured in every sixth participant. Age at thelarche and menarche analyzed for entire cohort and stratified based on body mass index. Median (95% CI) ages of thelarche, pubarche and menarche were 10.8 (10.7-10.9) y, 11.0. y (10.8-11.2) y and 12.4 y (12.2-12.5) y. Overweight/obese girls showed six months earlier onset of thelarche and menarche than those with normal BMI (P<0.05). Serum gonadotropins did not vary significantly in overweight/obese subjects. The study provides the normative data for pubertal growth in Indian girls. Pubertal onset occurs earlier in overweight and obese girls.

Overweight and low height in children of urban, rural and indigenous communities

Changes in lifestyle have led to an increase of overweight in the juvenile population. However, there are limited studies about this topic in relation to an indigenous population. The aim of this study is to verify the overweight and height defi cit in children aged 8 and 9 years, of both sexes, from urban, rural and indigenous communities of the city of Nova Laranjeiras in the State of Parana. The 277 (148 boys) students were divided into three groups: rural (n = 100), urban (n = 99) and Indian communities (n = 78). The measurements taken were body mass (kg), height (m) and body mass index. The statistics method was an analysis of covariance and chi-square test (P <.05). Among the 277 schoolchildren, the prevalence of overweight was 14.6% in the rural area, 27.1% in urban area and 30.3% in the indigenous area in boys, and 15.7% in rural areas, 17.6% in urban and 20% in Indian girls. There was no difference in the frequency of overweight among groups for both sexes. The prevalence of height defi cit was different between the groups; it was higher in indigenous children than urban and rural children. Among the Indians, 42.4% of boys and 51.1% girls had low stature. Only indigenous children were overweight and of low height, while being prevalent in 15.1% of boys and 11.1% girls. Low stature is frequent in indigenous populations, and it would be ideal to have more research to identify its causes and consequences. Children showed high rates of overweight in all regions, demonstrating that poor eating habits and a sedentary lifestyle are not only characteristics of urban centres.

Clitoral length and anogenital ratio in Indian newborn girls

To generate normative data on clitoris length, anogenital distance and anogenital ratio in Indian newborns. Cross-sectional study. Neonatal unit of a tertiary care teaching hospital in Kolkata. 378 female neonates, who were hemo-dynamically stable without critical illness or chromosomal anomaly, and without any vulval hematoma or genital abnormalities. Measurements were recorded using a digital vernier caliper between 24-72 hours. Infant was held in position by an assistant, while the investigator measured clitoral length by gently retracting the labia majora. Anogenital distance (centre of the anus to posterior convergence of the fourchette) and anogenital ratio (anogenital distance divided by the distance from centre of the anus to base of the clitoris) was also measured. Gestational age- and birthweight-wise normative values of clitoral length, anogenital distance and anogenital ratios. Mean clitoral length was 3.1 (1.54) mm for the whole cohort while anogenital distance and anogenital ratio were 10.2 (2.78) mm and 0.34 (0.07) mm, respectively. The gestation age-wise percentile charts of clitoral length, anogenital distance and anogenital ratio have been generated. There was no correlation between clitoral length and gestational age, body length, head circumference and birth weight. Correlations were also weak for anogenital distance. The normative values generated can serve as reference standard in the assessment of clitoromegaly, ambiguous genitalia, virilizing effects and suspected in utero androgen exposure.

Malnutrition Status of Adolescent Girls in India: A Need for the Hour

Malnutrition Status of Adolescent Girls in India: A Need for the Hour

Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis

ObjectivesTo assess the status of menstrual hygiene management (MHM) among adolescent girls in India to determine unmet needs.DesignSystematic review and meta-analysis. We searched PubMed, The Global Health Database, Google Scholar...

Abstract P039: American Indian Youth Wellness Initiative

American Indian youth have the highest prevalence of obesity of all ethnic groups in the U.S. Obese individuals are at higher risk for cardiovascular disease, high blood pressure, dyslipidemia, type 2 diabetes mellitus and stroke. Reducing childhood obesity will require effective prevention strategies that focus on environments and promotion of physical activity and a healthy diet. Objective: To understand trends in the prevalence of obesity and severe obesity among American Indian tribal youth during the past 20 years. Methods: Participants included American Indian boys and girls aged 10-15 years from 14 different tribes in the Southwest, primarily Arizona, who attended a 1-week residential summer wellness camp from 1995 to 2015. Height and weight were measured on the first day of camp; sex- and age-specific body mass index (BMI) percentile and BMI z-score were computed using CDC SAS code. Obesity in childhood is defined by age- and sex-specific BMI percentile greater than or equal to the 95th percentile; severe obesity is defined as BMI ≥ 120% of the 95th percentile of BMI-for-age or as BMI ≥ 35.0 kg/m2. Chi-square tests and two-sample t-tests were used to determine the effects of sex and time on obesity and severe obesity. The significance threshold was set at p &lt; .05. Results: Our sample was comprised of 354 youth, 154 males (43.5%) and 200 females (56.5%), aged 12.7 ± 1.6 years (mean ± SD). Across the 20-year period, the prevalence of obesity was 80.2% (284 of 354) overall, and was greater in males (85.7%; 132 of 154) than females (76.0%; 152 of 200, p = 0.02). Likewise, the prevalence of severe obesity was greater in males (65.6%; 101 of 154) than females (50.0%; 100 of 200, p = 0.003) and was 56.8% (201 of 354) overall. The mean BMI-for-age percentile and z-score were 94.5 ± 11.9 and 2.05 ± 0.71, respectively; BMI z-score was higher in males (2.17 ± 0.7) than in females (1.96 ± 0.7, p = 0.004). There were no clear trends in obesity among our American Indian youth campers from 1995 to 2015, but the prevalence was high in all years (range 62.5 - 95.0%; 10 of 16 youth in 2011 - 19 of 20 youth in 2003). Conclusions: Throughout the 20-year period, there was consistently a high prevalence of obesity and severe obesity among American Indian tribal youth. Boys displayed a higher prevalence and severity of obesity relative to girls. Given the strong association between obesity in youth and the risk for chronic disease, our results underscore the critical need to intervene early in regards to establishing healthy eating and exercise behaviors among American Indian youth.

Classrooms as radical spaces of possibilities

ABSTRACTThis article provides a brief snapshot of a girls school in Northern India called Prerna. Girls in India are unwanted, unequal and unsafe. Every year a million of them are killed in the womb. One third of the world's child brides (read ‘girl slaves’) are in India. They live their lives in a grim, complex context where, gender, poverty and caste intersect. They face domestic violence and sexual abuse regularly. Many of them are forced into child labour at home and outside. Succeeding in this grim context, Prerna demonstrates how girls need not drop out because they are girls. Schools can indeed defeat the social obstacles to girls' education if it is so committed and engages actively to counter the gender-based factors that keep girls out of school in order to ‘keep in’ girls who are in danger of being ‘pulled’ or ‘pushed’ out. The uniqueness of the Prerna programme is that it puts an empowerment course with a strong focus on the critical study of institutionalised gender power relations in society, in the official curriculum and time table. It does not treat empowerment work as an extra curricular or after-school activity. Most importantly it demonstrates that classrooms can be transformed into ‘radical spaces of possibility’ (bell hooks) when the curriculum is centred on students' lives and its challenges.

A study on the prevalence of thinness and obesity in school going adolescent girls of Kashmir Valley

Background: A vast majority of girls in India are suffering from either general or specific morbidities. Under nutrition and obesity are important nutritional problems in adolescents. In Indian adolescents the prevalence of under nutrition is 53.1% in males and 39.5% in females. In India the prevalence of obesity is also increasing with 8.3% in adolescent boys and 5.5% in adolescent girls. This is especially seen in the urban affluent class because of unhealthy eating, consumption of junk and fast foods and also due to changing lifestyles and physical inactivity. Adolescent girls constitute a socially disadvantageous group in our society. Methods: A cross sectional study design was adopted and the study was conducted in randomly selected schools in three districts of Kashmir Valley during April 2014 to March 2015. A total of 428 girls in the age group of 12 to 18 years were included in the study. Data was collected using a pre-tested and pre-structured proforma which included assessment of the dietary habits, anthropometric measurements and general physical examination of the study participants. Results: The prevalence of thinness in the study population was 35.70% and was significantly associated with SES, mother’s literacy and mother’s occupation (p value <0.001,0.039 and <0.001 respectively).The prevalence of overweight was 7.20% .It was observed that age, SES and residence had a significant association with the prevalence of overweight (p value 0.010, <0.001 and 0.001 respectively). The prevalence of overweight by WHR was 4.40% and that of obesity was 3.30%. Conclusions: Thus it is concluded from this study that a considerable proportion of adolescent girls suffered from thinness and obesity. We recommend that requisite measures be taken to address these concerns as this group constitutes a sizeable proportion of the Indian mothers of our future generation and their well-being is critically important for improving the nutritional health of women of the nation.

Awareness and perception regarding PCPNDT Act and gender preference among mothers of under-five attending immunization clinic

Background: Falling sex ratio is signaling precipitation of demographic catastrophe in India. Female feticide, male child preference, and gender inequities are to be blamed. Objective: To study awareness and perception regarding Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act among mothers of under-five attending immunization clinic and gender preference among them. Materials and Methods: A Cross-sectional study was carried out among 200 mothers of under-five attending immunization clinic at Government Medical College, Nagpur, during April–June 2014. Data were collected by interview using semistructured pro forma after obtaining written consent of mothers. Data were presented in percentage, mean, range with SD, and X2-test as test of significance. Result: Majority of mothers 150 (75%) were aware about decreasing girls in India. One hundred and sixty-one (80.5%) mothers were aware about prenatal sex determination, and 61 (30.5%) knew that sonography is used for this purpose. Awareness about PCPNDT Act was 65%. Awareness was significantly associated with higher education, upper socioeconomic class, and working status. Although 85 (42.5%) mothers knew that punishment under PCPNDT is in the form of jail or monetary fine, none were aware about the correct penalty. Of 83 mothers desirous of more children, 33 (40%) preferred to have male child; while only 14 (17%) had preference for a female child. Preference for male child was significantly associated with the birth of previous female child. Conclusion: Awareness regarding PCPNDT Act is high among those with higher education, upper socioeconomic class, and working mothers. Preference for male child is significantly associated with the birth of previous female child.

Study of adherence and effect of iron and folic acid supplement on haemoglobin level among adolescent girls in rural area

Background: The NFHS-3 data suggests that anaemia among adolescent Indian girls (15–19 years) is 56%. The control of anaemia in adolescent girls can be more easily achieved if a satisfactory iron status can be ensured in this important phase of life. This study estimated the prevalence of anaemia among adolescent girls, their adherence and compliance to IFA and studied effect of IFA supplementation on haemoglobin level of adolescent girls. Methods: Community based cross-sectional study was carried out among 378 adolescent girls during June 2012 to May 2013 by house to house survey. All the relevant information was collected in predesigned proforma. The clinical examination, anthropometric examination and by Sahli’s haemoglobin meter, estimation of haemoglobin were done. Participants were given iron and folic supplementation for 45 days at the time of home visit and subsequently for another 45 days. Adherence to IFA was assessed through pill count. Results: Prevalence of anaemia in the adolescent girls was found to be 68.5%. Majority of girls were having mild anaemia. Before intervention the mean haemoglobin was 10.61±1.32 and after intervention it was 11.02±1.06 (p=0.001). Adherence to treatment was found in 85.19% of study participants. Conclusion: Prevalence of anaemia among adolescent females was high in rural study area. The declining trend was observed in grades of anaemia, there was conversion of moderate anaemia to mild anaemia and non-anaemia which was significant. The mean haemoglobin levels were increased after supplementation of IFA in study participants.

Enteric Coated Iron Folic Acid Tablets: Compromised Efficacy at Cost of Safety

Iron is essential for the synthesis of hemoglobin in erythrocytes and its deficiency can causes Anemia. An estimated 1.62 billion people are suffering from Anemia worldwide with its highest prevalence in developing countries specially India. Therefore, Government of India has started a strategic nutritional and weekly iron folic acid supplementation (WIFS) program to reduce its prevalence and severity among Indian women and adolescent girls. WIFS supplementation mainly includes either sugar coated ferrous sulfate (red tablet) or enteric coated ferrous sulfate tablets (blue tablets) as a prime dosage form to serve the people. Comparing these two dosage forms, conventional oral preparation of Ferrous Sulfate (sugar coated tablets) can cause dose related gastrointestinal side effects such as nausea, constipation, anorexia, heart burn, vomiting, diarrhea and approximately 25% of patients experiencing these side effects, whereas, there is some evidence that enteric-coated or delayed release Ferrous Sulfate preparations may reduce these gastrointestinal discomforts and could be more effective considering absorption of iron along the entire intestine, primarily in the duodenum and the jejunum, but, several reported case studies have been published so far which dictated that dissolution of iron formulation in acidic media such as gastric juice helps in its absorption and indicating better treatment outcomes with sugar coated tablets. Moreover, by passing the dissolution of iron tablets in gastric juice via enteric coating may results in its poor absorption. Hence, efficacy of iron supplement is being compromised at cost of safety (to avoid side affects) by formulating into enteric coated tablets. This review will focuses on information on burden of Anemia in India and various reported case studies which showed that sugar coated ferrous sulfate tablets might not be interchangeable with enteric coated ferrous sulfate tablets with compromised efficacy.

Social Withdrawal and Social Anxiety in Relation to Stylistic Parenting Dimensions in the Indian Cultural Context

The purpose of the study was to examine associations between composite parenting behaviors’ (parenting styles and dimensions) and social withdrawal and social anxiety. Participants of the study were 227 girls in India with age ranging from 6-11 years. The parents completed the parenting styles and dimension questionnaire and girls completed Social anxiety scale for children while the parents/teachers completed the Teacher report syndrome scale for social withdrawal behavior in girls. Pearson’s product moment correlations were done to study the associations between parenting behaviors’ and social anxiety and social withdrawal respectively. A standard multiple regression analysis was used with social withdrawal and social anxiety as dependent variables. Correlational results indicated that authoritarian, uninvolved parenting styles and physical coercion, verbal hostility, non-reasoning and indifference parenting dimensions are positively correlated with social anxiety and socially withdrawn behaviors’. Authoritative style, and parental dimensions of connection, regulation and autonomy granting are inversely correlated with social anxiety and socially withdrawn behaviors’ Results from multiple regression analyses indicated that uninvolved, non- reasoning, neglect and reject parenting dimensions positively predicted social anxiety and social withdrawal in girls, while authoritative style and connection parenting dimensions inversely predicted social withdrawal and social anxiety among girls. The present findings suggest the positive contribution of authoritative, connection stylistic dimensions in amelioration of social emotional problems among girls and inverse contribution of uninvolved, non-reasoning, neglect, reject parenting styles and dimensions in exacerbation of social anxiety and socially withdrawn behaviors’ in girls in the Indian cultural context.

Primary Dysmenorrhea and Menstrual Symptoms in Indian Female Students: Prevalence, Impact and Management.

Background:Dysmenorrhea is the most common gynecological problem among females and it is defined as cramping pain in the lower abdomen occurring just before or during menstruation. Menstrual symptoms are a broad collection of affective and somatic concerns that occur around the time of menses. The effect and importance of dysmenorrhea is very wide, therefore managing the problem is important.Objective:To ascertain the prevalence, and impact of primary dysmenorrhea in student girls and their management behaviors.Methods and Materials:A Cross-sectional study was conducted on 1000 healthy females aged 11-28 years. Standardized Self-reporting questionnaires were used to obtain relevant data. Pain intensity was assessed by using the Numerical Pain Scale (NPS). Data was analyzed by SPSS version 16.Results:Prevalence of dysmenorrhea was 70.2%. Majority of the subjects experienced pain for one or 1-2 days during menstruation. 23.2% of the dysmenorrheic girls experienced pain for 2-3 days. The most common symptom in both dysmenorrheic and non dysmenorrheic girls during the menstrual periods was tiredness and second most prevalent symptom was back pain.Females experiencing mild pain on an average absented for one and half day a month while 2.1±1.2 and 2.5±1.3 days for those who experienced moderate and severe forms of dysmenorrhea respectively. A small proportion of girls sought pharmacological management (25.5%) and 83.2% depended on non-pharmacological methods. Only 14.2% had sought medical advice.Conclusion:Sub optimal use of the medical advice and the barriers to seek medical attention by dysmenorrheic females need exploration. It is important that health education on puberty and menstruation is regarded as inadequate for many girls in India.

Immunogenicity and HPV infection after one, two, and three doses of quadrivalent HPV vaccine in girls in India: a multicentre prospective cohort study

SummaryBackgroundAn increase in worldwide HPV vaccination could be facilitated if fewer than three doses of vaccine are as effective as three doses. We originally aimed to compare the immunogenicity and frequency of persistent infection and cervical precancerous lesions caused by vaccine-targeted HPV after vaccination with two doses of quadrivalent vaccine on days 1 and 180 or later, with three doses on days 1, 60, and 180 or later, in a cluster-randomised trial. Suspension of the recruitment and vaccination due to events unrelated to our study meant that some enrolled girls could not be vaccinated and some vaccinated girls received fewer than the planned number of vaccinations by default. As a result, we re-analysed our data as an observational cohort study.MethodsOur study was designed to be done in nine locations (188 clusters) in India. Participants were unmarried girls aged 10–18 years vaccinated in four cohorts: girls who received three doses of vaccine on days 1, 60, and 180 or later, two doses on days 1 and 180 or later, two doses on days 1 and 60 by default, and one dose by default. The primary outcomes were immunogenicity in terms of L1 genotype-specific binding antibody titres, neutralising antibody titres, and antibody avidity after vaccination for the vaccine-targeted HPV types 16, 18, 6, and 11 and incident and persistent infections with these HPVs. Analysis was per actual number of vaccine doses received. This study is registered with ISRCTN, number ISRCTN98283094; and with ClinicalTrials.gov, number NCT00923702.FindingsVaccination of eligible girls was initiated on Sept 1, 2009, and continued until April 8, 2010. Of 21 258 eligible girls identified at 188 clusters, 17 729 girls were recruited from 178 clusters before suspension. 4348 (25%) girls received three doses, 4979 (28%) received two doses on days 1 and 180 or later, 3452 (19%) received two doses at days 1 and 60, and 4950 (28%) received one dose. Immune response in the two-dose HPV vaccine group was non-inferior to the three-dose group (median fluorescence intensity ratio for HPV 16 1·12 [95% CI 1·02–1·23] and for HPV 18 1·04 [0·92–1·19]) at 7 months, but was inferior in the two-dose default (0·33 [0·29–0·38] for HPV 16 and 0·51 [0·43–0·59] for HPV 18) and one-dose default (0·09 [0·08–0·11] for HPV 16 and 0·12 [0·10–0·14] for HPV 18) groups at 18 months. The geometric mean avidity indices after fewer than three doses by design or default were non-inferior to those after three doses of vaccine. Fewer than three doses by design and default induced detectable concentrations of neutralising antibodies to all four vaccine-targeted HPV types, but at much lower concentration after one dose. Cervical samples from 2649 participants were tested and the frequency of incident HPV 16, 18, 6, and 11 infections was similar irrespective of the number of vaccine doses received. The testing of at least two samples from 838 participants showed that there was no persistent HPV 16 or 18 infections in any study group at a median follow-up of 4·7 years (IQR 4·2–5·1).InterpretationDespite the limitations imposed by the suspension of the HPV vaccination, our findings lend support to the WHO recommendation of two doses, at least 6 months apart, for routine vaccination of young girls. The short-term protection afforded by one dose of HPV vaccine against persistent infection with HPV 16, 18, 6, and 11 is similar to that afforded by two or three doses of vaccine and merits further assessment.FundingBill & Melinda Gates Foundation.

Menarche and Menstruation in Rural Adolescent Girls in Maharashtra, India

Background: Menarche and menstrual experiences play a critical role in adolescent girls’ life. These not only significantly influence their sexual and reproductive health but also possess much social and educational impact. This study qualitatively explores the perceptions, practices and experiences related to menarche and menstruation among rural Indian adolescent girls which has been less studied in the past literature. Methods: A convenience sampling method was used to select 32 adolescent girls (eight girls who did not reach menarche and 24 girls who attained menarche) from rural Maharashtra in India. Information about the perceptions, practices and experiences of menarche and menstruation among the participants was obtained through focus group discussions and was analyzed using thematic analysis. Findings: Most of the participants, especially girls without menarche lacked adequate knowledge about menstruation and its processes. All communications regarding menstruation were between friends, whereas mothers were found to be playing a limited role. Some of the girls were using sanitary pads, while most girls still use old cloths. Financial concerns and difficulty in obtaining sanitary pads were major obstructions for their use. Lack of awareness and appropriate care for menstrual morbidities were reported among these girls, which put impact on their educational attainment. Conclusions: Suitable strategy needs to be developed for providing correct knowledge about menstruation among adolescent girls, such as inclusion of adolescent friendly services in school curriculum and training of mothers and teachers to provide friendly counselling to the girls. Further, menstrual pad vending machines could be installed in schools and colleges, for easy access of sanitary pads at subsidized rate. Special care and support during menstruation can prevent several adverse events from occurring in adolescent girls’ lives.