Urban Lucknow Research Articles

The Epidemiology of Rheumatic Diseases in India

Epidemiological studies, referred to as the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) studies, have been conducted under the aegis of the International League against Rheumatism and the World Health Organization to evaluate the epidemiology of rheumatic and musculoskeletal (RMSK) diseases in India. These COPCORD studies conducted in rural Bhigwan and urban Pune in Maharashtra, rural Calicut and rural Trivandrum in Kerala and rural and urban Lucknow in Uttar Pradesh, along with data from the Global Burden of Diseases study have helped to understand the burden of rheumatic diseases in the community. Based on these studies, RMSK diseases, which are amongst the top 25 causes of disability in the Indian population, are prevalent in nearly 25%–30% of the Indian population. The common rheumatic diseases in the community are soft tissue rheumatism, neck and back pain, fibromyalgia and unspecified pains and osteoarthritis (most commonly affecting the knee). These diseases most commonly affect young persons between the third to the fifth decade of life, more often affect females, are prevalent in both rural and urban populations, and account for considerable disability in up to one-fifth of individuals leading to loss of livelihood and dependence on others for self-care. Community-based national healthcare programs to manage RMSK diseases at the community level are urgently needed. There also remains an unmet need to train more doctors to diagnose and manage rheumatic diseases at the primary, secondary and tertiary levels of care.

Gestational glucose intolerance (GGI) and gestational diabetes mellitus (GDM) among antenatal women attending urban community health centers of Lucknow: A cross-sectional study.

Gestational diabetes mellitus (GDM) is an emerging public health concern in India, which has detrimental effects on both the mother and the baby. The data on prevalence of GDM was unavailable at secondary urban health facilities, from where a majority of pregnant women seek antenatal services, and the following study identifies this burden. A cross-sectional study was conducted from May 2019 to June 2020 among pregnant women attending the antenatal outpatient department (OPD) at secondary level health facilities in urban Lucknow. A semi-structured interview schedule was administered to the study subjects for collecting the relevant information and 75 g of oral glucose tolerance test was performed irrespective of the meal. The cut-off points taken for the diagnosis of GDM and gestational glucose intolerance (GGI) was as per the guidelines of the Ministry of Health and Family Welfare for diagnosis of GGI/GDM. The overall prevalence of GDM and GGI in the study was 11.6% and 16.8%, respectively. Three-fourth of the women (22/29) were diagnosed with GDM in the second trimester of pregnancy. The prevalence of GDM (16.7%) was significantly higher in pregnant women aged more than 25 years and in those who were overweight. Mean birth weight (3.2 ± 8.1 kg) of the babies was significantly higher in the women with GDM. Among the fetal complications was respiratory distress observed among 28 pregnant women and 31% of them had GDM and this was statistically significant. The prevalence of GGI and GDM was found 16.8% and 11.6%, respectively. Gestational age, pre-pregnancy weight, pre-pregnancy BMI, weight gain during the pregnancy, family history of diabetes. PCOS, macrosomia and GDM in prior pregnancies was found to significant with GDM in the study.

Spatially Resolved Distribution, Sources, Exposure Levels, and Health Risks of Heavy Metals in

In the present study, a total of 64 road dust samples were collected from five different functional areas (residential, commercial, parks, high-traffic, and industrial) in urban Lucknow to assess the accumulation, distribution, and health risk of heavy metals (HMs) (i.e., Fe, Mn, Zn, Cu, Pb, Cd, As, Cr and Ni). Acid digestion methods were used to analyze HMs, followed by inductively coupled plasma-mass spectrometry (ICPMS). The ascending frequency of HMs was Cd < As < Ni < Cr < Pb < Cu < Zn < Mn < Fe for all different functional areas. Almost all HMs exceed the limits of Indian natural soil background values (INSB) across all functional areas. The pollution assessment results reveal that the urban road dust of Lucknow is highly enriched with Zn and Pb, causing deterioration of dust quality. The spatial distribution of HMs shows that road dust found in the central and southwestern zones of the Lucknow urban area are more contaminated than in other areas. The ecological risk assessment demonstrates that Cd was the highest risk contributor, followed by Pb, Zn and Cu. The result of the health risk assessment i.e., the cumulative hazard index (HI) and the cumulative lifetime cancer risk (LCR), reveal that children (mean HIchildren = 1.26, LCRchildren = 0.000187) are more vulnerable to HM exposure than adults (HIadults = 0.14, LCRadults = 0.0000804). For carcinogenic and non-carcinogenic risk, ingestion appears to be the major pathway of HM exposure in both age groups. It is alarming that all studied four carcinogenic HMs were found in concentrations higher than 1 × 10−6 (the permissible limit for humans). This indicates slight chances of developing cancer for both age groups in all functional areas.

Prevalence and predictors of hypertension among adults of urban Lucknow, India: A community-based study

Background and Objective: Hypertension is an important public health problem in both economically developing and developed countries. In India, recent community surveys have reported that the prevalence of hypertension has risen among urban and rural inhabitants. This study was conducted to find out the prevalence of hypertension and to identify the risk factors among adults residing in urban areas of Lucknow. Materials and Methods: The cross-sectional field study involved a survey of 300 respondents, aged 18 years and above using the stratified random sampling and probability proportionate to size technique. A study tool which contained risk factor questionnaire and physical measurements of height, weight, and blood pressure were used to collect the data. Data analysis was performed using the SPSS version 16. The Chi-squared test and logistic regression analysis were used to analyze the data. Results: The prevalence of hypertension was 14.67% among urban adults. Hypertension was significantly higher among individuals aged >40 years and those who consumed tobacco products. A higher proportion of the hypertensives belonged to the illiterate category. There was a significant difference in hypertension prevalence in different education classes. Respondents living in overcrowded houses had higher odds of having hypertension than those not experiencing overcrowding. Conclusion: Age, education, and overcrowding were independent risk factors of hypertension. Prevention measures targeting the modifiable risk factors associated with hypertension should be taken.

Drinking water hygiene practices in caregivers of under 6 year children: a cross sectional study in urban Lucknow, India

Background: Safe drinking water is the basic necessity for humans. Due to water borne diseases, most of the children get malnourished. The present study was conducted to know about knowledge and practices on drinking water hygiene and to find the association between knowledge and drinking water hygiene practices among caregivers of under 6 year children.Methods: It is a community-based cross-sectional study conducted in the field practice area of a medical college in urban Lucknow. We included 250 respondents in our study. The data were analyzed using Institutional SPSS-24.0 (IBM Corp., Chicago, USA).Results: The present study showed that about 91.6 percent of study participants showed concern about safe drinking water hygiene. About 90.8 percent of study participants thought that water container needs cleaning and about 95.6 percent thought that water container needs covering. Surprisingly 65.6 percent of the participants did not use any type of water purification method. People thought that they should use drinking water purification methods, but in reality, much less percentage (34.4%) of people in the study uses any type of purification method (p&lt;0.001).Conclusions: Although most of the participants showed their concern about safe drinking water hygiene, purification, etc., most of them still do not use any purification methods putting their children are at risk of many diseases.

Higher mental functioning in dementia: A status assessment

Background: Of the higher mental functions, certain deteriorate earlier than others. The relative deterioration of the different higher mental functions in dementia patients would be of interest to investigate. Aim: We intended to study the status of higher mental functioning in dementia patients. Materials and Methods: Household screening of a randomly selected ward, Musahebganj of urban Lucknow generated 1,216 elderly people aged >55 years. After taking the informed consent to participate in the study, all the subjects were screened using the Mini Mental Status Examination (MMSE) for cognitive disorders. Age and education specific cut-off criteria were used to find out MMSE positive subjects. MMSE positive subjects were assessed in detail using the Cambridge Examination for Mental disorder in the Elderly-Revised instrument. Result: Fifty patients were diagnosed to have dementia as per the international classification of diseases-10 criteria. The study demonstrated that the higher mental functioning especially visual reasoning, ideational fluency, and memory are maximally affected in dementia patients. Conclusions: The deterioration in higher functioning is usually seen in dementia. The mental functioning relates with each other and is interrelated, leading to overall deterioration.

A Study of Consumption of Iodized Salt among Households of District Lucknow, India

Iodine deficiency is the world's single greatest cause of preventable mental retardation. Universal Salt Iodization is a safe, cost-effective and sustainable strategy to ensure sufficient intake of iodine by all individuals. In Uttar Pradesh only 42.5% households are using cooking salt which was iodized at the recommended level. The present study was conducted to asses the pattern of consumption of iodized salt and the awareness about health benefits of iodized salt among households in Lucknow. A cross sectional study was conducted in rural and urban Lucknow in 400 households selected using PPS technique and were interviewed using predesigned oral questionnaire and household salt was tested for Iodine content by kit. It was observed that 257(64.2%) households were using salt of iodine content of >15ppm, 135(31.8%) were using salt with inadequate iodine content and 8(4%) households were consuming salt with no iodine. On multivariate analysis high social class, literacy status, exposure to mass media was significantly associated with consumption of adequately iodized salt. 62% of the people surveyed knew iodine deficiency results in goiter, iodization of salt as an important attribute to the quality of salt was found only in 11.2% respondents. It is recommended better IEC is the need of the hour to improve consumption of appropriately iodized salt.

Effects of Lifestyle habits on the prevalence of obesity among school going adolescents residing in urban Lucknow

Background: Sedentary behaviour is related to the prevalence of obesity among school going adolescents. Lifestyle habit among adolescents is one of the factors related to the occurrence of obesity which is an important public health issue. Aims & Objectives: To assess the factors associated with the prevalence of obesity among school going adolescents. Materials and Methods: This was a cross sectional descriptive study of 680 school going adolescents, aged 10-19 years. Participants were enrolled by using multi stage random sampling technique. Predesigned and pretested schedule was used to elicit information on lifestyle habits that included eating food with family, consumption of breakfast, frequency of eating fast food, aerated drinks in a week, modes of transport used, participation and duration of hours spent in active sports, time spent in watching television and anthropometric variables. Age and gender specific percentile growth charts of 2007 (WHO) was used as reference to classify subjects as obese. Results: About 71.5 percent of adolescents used to eat food with family which was significantly (p=0.0001) associated with the low prevalence of overweight. The percentage of overweight was higher among those who ate fast food daily. The primary predictors for overweight in our study were eating food with family, mode of transport used and duration of watching television. Multivariate logistic regression revealed that the prevalence of overweight was 3.06 times higher among those who used public/private transport respectively than who walked [OR: 3.06 (95% CI: 1.87-5.02)]. Conclusion: The lifestyle habits of adolescents that included eating food with family, frequency of eating fast food & aerated drinks, modes of transport used, duration & participation in active sports and time spent in watching television showed the association with prevalence of overweight. Therefore there is an urgent need to educate parents and teachers regarding healthy lifestyle and healthy eating behaviour of the adolescents.

Assessing the magnitude, distribution and determinants of catastrophic health expenditure in urban Lucknow, North India

IntroductionTo assess the magnitude, distribution, and determinants of catastrophic health expenditures (CHE) of households in urban Lucknow, North India. MethodsA cohort of 400 households was selected by 2-step cluster sampling and baseline demographic survey was done followed by two six-monthly health surveys. CHE was defined as health expenditures ≥10% of household's capacity to pay, measured by non-subsistence spending. ResultsFrom December 2011 to June 2012, 157/400 (39.25%) households reported ≥1 episodes of illness, with households suffering sickness in the first survey at increased risk for it in the second (Crude Odd's Ratio = 3.33, 95% CI: 2.02–5.45; p value <0.0001). Mean sickness days without hospitalization were 13.13 ± 36 per household. In 24 (6%) households, there was ≥1 hospitalization. Health expenditure was entirely met through out of pocket payments (OOP). CHE occurred in 45 (11.25%) households, with statistically significant differences across per capita income quintiles (p = 0.036) and 60% falling in the lower two. On logistic regression model, adjusting for per capital income quintile, CHE was associated with hospitalization (Adjusted OR = 100, 95% CI: 25.00–333.33; p < 0.0001) and >13 sickness days without hospitalization (Adjusted OR = 4.21, 95% CI: 1.862–9.524; p = 0.001). ConclusionsSince not only hospitalization but also prolonged sickness days without hospitalization was associated with increased risk of CHE, and since almost half the households have sickness, steps should be taken to protect all households from financial hardship through tax based health financing, social health insurance or other forms of prepayment, as currently all health expenses were met through OOP payments.

Breastfeeding practices for newborns among urban poor in Lucknow, northern India: A prospective follow-up study

ObjectivesTo describe evidence-based WHO-defined (exclusive, predominant, partial, never breastfed) breastfeeding patterns and the factors associated with them for neonates among urban poor in Lucknow, northern India. MethodsThis prospective follow-up study was conducted at two urban public hospitals at Lucknow. Neonates who did not have any morbidity or congenital malformation and were residents of Lucknow were enrolled within 48 h of birth and followed-up once at six weeks at the outpatients' clinic or home to assess established (voluntary) breastfeeding pattern. ResultsA total of 1020 neonates were enrolled from March 2007 to April 2008. Follow-up information on established breastfeeding pattern was available for 937 (91.8%) of the enrolled neonates. Rate of exclusive breastfeeding during the neonatal period was 26.4%, predominant breastfeeding was 28.7%, partial breastfeeding was 40.1%, and no breastfeeding was 4.7%. Potentially harmful weaning materials (animals' milk (35.8%), formula feeds (17.6%), water (48.1%) and other substances (teas/herbal drinks/juices/soups/rice water/mashed banana/etc (9.9%)) were being fed to 74% (95% CI: 70.7%–76.3%) of the neonates.Neonates born to mothers with no formal education, fathers with no formal education, whose mothers had fewer (<3) antenatal care visits, were born in Muslim families, were slum residents or were from low socio-economic status were significantly (p < 0.05) less likely to be exclusively breastfed than their counterparts. ConclusionThe proportion of neonates being exclusively breastfed was low at 26.2% (95% CI: 23.7%–29.4%). There is a need for promotion of exclusive breastfeeding for all newborns in urban Lucknow, northern India.

Estimation of out of pocket direct and indirect medical expenditure and spending burden ratio across income quintiles in urban Lucknow, India

BackgroundHealth insurance in India is almost non-existent. Therefore all expenses incurred during illnesses are borne directly by the family and accurate estimates are not available. The primary objective of the study was to assess the proportion of households who incur out of pocket medical expenditure due to sickness of family members in an urban area in India. Secondary objectives were to quantify the direct and indirect medical expenditure incurred by families in the last 3 months and to assess the spending burden ratio (ratio of total medical expenditure to family income) among income quintiles. MethodsThis was a community based cross sectional study conducted in randomly selected administrative wards in Lucknow city, northern India. ResultsFrom December 2011 to March 2012, 400 families, having 2343 members were recruited from 16 wards. Mean family size was 5.86 members (SD = 2.13 members) and mean family income was INR 9622.25 (SD = 11,323.01) (US $1 = INR 50 approximately in mid-2012). In last 3 months, 115 households (28.75 percent) sought medical care for illness in one or more family members. Mean direct medical expenditure was INR 3406 (SD = 4657), mean indirect medical expenditure was INR 1449 (SD = 2685) and mean total medical expenditure was INR 6590 (SD = 13,333). The spending burden ratio in the lowest and highest income quintile was 0.57 ± 0.82 and 0.15 ± 0.30 respectively (p value = 0.024). ConclusionsSince more than one-fourth of households incur medical expenditure which are paid out of pocket from family income, and since the spending burden ratio is statistically significantly higher in the lowest income quintile when compared to highest, there is a need for introduction of health insurance of some sort for the urban population. This is especially needed for the poorer sections, with provision to absorb the indirect medical expenses if possible.

Odds ratio of risk factors for oral submucous fibrosis in a case control model

Our aim was to calculate the odds ratio (OR) of various epidemiological, social, behavioural, and dietary risk factors for oral submucous fibrosis in a population-based case control study. We did this in rural and urban Lucknow by organising oral health camps in the community, where a total of 3136 subjects were enrolled. Panmasala, a dry commercial preparation containing areca nut, slaked lime, catechu, and condiments, with or without tobacco, was the most important aetiological factor for the disease. The 95% confidence interval (CI) of the OR for tobaccoless panmasala ranged from 4.77 to 6.88 and for tobacco panmasala from 4.55 to 9.71. OR using multivariate analysis was 14.09 for tobaccoless panmasala and 5.39 for tobacco panmasala. Patients who use panmasala are at high risk of developing oral submucous fibrosis.

Diabetes mellitus: A risk factor for cognitive impairment amongst urban older adults

Background:Studies reported in relation to diabetes mellitus and cognitive impairment are inconclusive. Diabetes mellitus is a wide spread physical illness amongst older adults. The study explores whether, it leads to cognitive impairment amongst older adults in comparison to those without diabetes mellitus.Materials and Methods:Study sample consisted of 900 subjects fulfilling the inclusion/exclusion criteria out of 1067 elderlies aged 55 years and above residing in a randomly selected ward of urban Lucknow. Pathological investigation was done on all elderlies to rule out diabetes mellitus. Out of 900 subjects 145 were found to have Diabetes Mellitus and rests 755 were without diabetes mellitus. These subjects were further divided into two groups: (i) with and (ii) without cognitive impairment based on detailed assessment of Mini Mental State Examination positive subjects by Cambridge Examination for Mental Disorders of the Elderly- Revised (CAMDEX-R). International Classification of Diseases-10th revision criteria were used to make diagnosis. Data analysis was done calculating odds ratio, Chi square, and percentages.Results:Diabetes mellitus was found to be prevalent is 13.7% and 16.9% amongst older adults aged 55-59 years and 60 years and above respectively. Odds ratio 1.3 with CI 95% indicates that subjects with diabetes mellitus is 1.3 times at more risk to develop cognitive impairment amongst urban older adults than non-cognitively impaired subjects. But differences on Chi square test were found to be insignificant.Conclusion:There is a weak association between diabetes mellitus and cognitive impairment amongst urban older adults.

SP4-34 Factors associated with qualified medical care for sick neonates among urban poor in Lucknow, northern India

IntroductionThis study assessed factors associated with qualified medical care-seeking (QMC) for sick neonates among urban poor.MethodsThe study was conducted at an urban Reproductive and Child Health (RCH) center and free...

Cognitive Dysfunction in Normally Aging Urban Older Adults: A Community-based Study

Background:Does cognitive screening rule out impairment of different cognitive functions of older adults in India? This study is an attempt to explore these issues.Materials and Methods:Study sample consisted of 89 Mixed version of Mini Mental State Examination and Hindi Mental State Examination (Mixed MMSE) negative older adults aged ≥60 years. Subjects giving informed consent for the study were recruited using inclusion/exclusion criteria from a randomly selected ward of urban Lucknow as consecutive series. Semi-structured proforma of sociodemographic details and Mixed MMSE were administered. Subjects scoring above 23 on Mixed MMSE and not having any significant physical illness in past one year which affects the activity of daily living were considered as normally aging older adults. These normally aging older adults (89) were further assessed on Brief Cognitive Rating Scale to identify level of cognitive functioning on different domains. Appropriate statistical test was used for data analyses using Statistical Package for Social Sciences (SPSS) 12.0 version.Results:Maximum normally aging older adults (51.7%) has mild level of objective dysfunction in “orientation” followed by “concentration” (22.5%). Significantly (P<0.05) higher number of normally aging males had objective dysfunction in “orientation” and in “functioning/self-care” in comparison with females. Similarly, significantly (P<0.05) higher number of subjects aged 70 years or more had subjective dysfunction on “recent and past memory” in comparison with those in 60 to 69 years of age.Conclusion:Normally ageing subjects had objective cognitive dysfunction in the areas of “orientation” and “concentration” and “functioning/self care.” It was found in more older adults with increasing age.

Effect of behaviour change communication on qualified medical care‐seeking for sick neonates among urban poor in Lucknow, northern India: a before and after intervention study

To assess the impact of a behaviour change communication (BCC) intervention on qualified medical care-seeking for sick newborns in urban Lucknow, northern India. Before and after intervention study conducted at two urban public hospitals at Lucknow. Neonates who did not have any morbidity or congenital malformation and were residents of Lucknow were enrolled within 48 h of birth and followed once between 6 and 8 weeks at the outpatients' clinic or home to assess the primary outcome measure which was qualified medical care-seeking for any neonatal illness. Mothers in the after-intervention phase received BCC intervention at enrolment, targeted at identification of danger signs of neonatal illnesses and promotion of qualified medical care-seeking. Analysis was by intention to treat. In the before-intervention phase, 510 neonates were enrolled (from March 2007 to August 2007) and 481 (94.3%) were followed up. In the after-intervention phase, 510 neonates were enrolled (September 2007-April 2008) and 490 (96.1%) were followed up. Neonatal morbidity was 50.3% (242/481) and 44.3% (217/490) in before and after intervention phases, respectively. Qualified medical care-seeking for neonatal illnesses was significantly higher among mothers after-intervention (OR = 2.12; 95% CI = 1.42-3.16; P = 0.0001). Since the behaviour change intervention package led to significant improvement in qualified medical care-seeking for sick newborns, this may be tested for effectiveness in other settings and considered for scaling up here, with rising proportion of institutional deliveries.

Care-seeking behavior and out-of-pocket expenditure for sick newborns among urban poor in Lucknow, northern India: a prospective follow-up study

BackgroundThe state of Uttar Pradesh, India accounts for one-quarter of India's neonatal deaths and 8 percent of those worldwide. More than half (52%) of these deaths occur due to infections. In order to achieve Millennium Development Goal-4 of reducing child mortality by two-thirds by the year 2015, it is important to study factors which affect neonatal health. In Uttar Pradesh there is meager data for spending on health care in general and neonates in particular.MethodsThe study was conducted at an urban Reproductive and Child Health (RCH) center and a District hospital. Neonates were enrolled within 48 hours of birth and were followed-up once at 6 weeks ± 15 days at the OPD of the respective hospitals or at home. This study assessed (1) distribution of neonatal illnesses and different health providers sought (2) distribution of out-of-pocket expenditures by type of illness and type of health provider sought (3) socio-economic distribution of neonatal illnesses, care-seeking behavior and out-of-pocket expenditures. Per-protocol analysis was performed.ResultsFive hundred and ten neonates were enrolled and 481(94.4%) were followed-up. Parents of 50.3% (242/481) neonates reported at least one symptom of illness. Of these 22.3% (107/481) neonates had illnesses with at least one reported Integrated Management of Neonatal and Childhood Illnesses (IMNCI) danger sign. Among IMNCI illnesses, point prevalence of septicemia was 6.2% and pneumonia was 5.2% while among non-IMNCI illnesses point prevalence of upper respiratory infection was 9.5%, and diarrhea was 7%. Community based non-government dispensers (NGDs) were leading health providers (37.6%). Mean monthly income of families was 2804 Indian Rupees (INR) (range: 800 to 14000; n = 510), where US$ 1 = 42 INR. Mean out-of-pocket expenditure on neonatal illness was 547.5 INR (range: 1 to 15000; n = 202) and mean out-of-pocket expenditure for hospitalization was 4993 INR (range: 41 to 15000; n = 17). All hospitalizations were for IMNCI illnesses. Neonates from lower income strata were less likely to receive any medical care (p < 0.0001) and were also less likely to be seen by a Government provider (p = 0.03).ConclusionSince more than half of the neonates have morbidity and out-of-pocket expenditure on neonatal illnesses often exceeds the family income of the lower strata of the low income group in the community, there is a need to either introduce health insurance scheme or subsidize health care for them. Also, since NGDs, half of which could be unqualified are leading health providers, qualified medical care-seeking for sick newborns should be promoted in urban Lucknow.

Symptom-specific care-seeking behavior for sick neonates among urban poor in Lucknow, Northern India

To assess symptom-specific care-seeking practices for newborns and behavioral factors associated with them to inform strategies to enhance newborn care seeking in urban Lucknow, Northern India. This was a prospective follow-up study of consecutive 326 neonates delivered at an urban reproductive and child health (RCH) center. Focused Group Discussions (n=5) were also conducted in urban slums (n=3) at the RCH center (n=1) and at a district hospital (n=1). Overall, 326 neonates were recruited within 48 h of birth and 289 (88.7%) were followed up at 6 weeks (+/-15 days) at home. Parents of 51.2% (148/289) neonates reported at least one symptom of illness. Among these, 27.3% (79/289) neonates had at least one reported Integrated Management of Neonatal and Childhood Illnesses (IMNCI) danger sign, of which 15 (18.9%) did not receive any modern medical care, 5(33.3%) of which were dead by early infancy. Care seeking from unqualified providers (spiritual/traditional) was 33.3% (3/9) for persistent diarrhea and 23.5% (4/17) for pneumonia. Qualitative data from Focused Group Discussions showed that when pictures of some danger signs were shown like sunken eyes, reduced skin turgor, chest in-drawing and bulged fontanel, care seeking for these as well as fast breathing were influenced by 'local beliefs', which considered them to be untreatable by modern medicines alone. Thus, care seeking from multiple providers and use of traditional/home remedies delayed appropriate and timely medical care seeking. Almost half of the neonates had an illness symptom of which half had an IMNCI danger sign, of which one fifth did not receive medical care. Therefore, there is an urgent need to introduce a locally modified community IMNCI program here, for promoting care seeking from qualified providers for sick neonates.

Fertility and Family Planning in Urban Lucknow: A Bench Mark Survey

A benchmark survey of fertility and family planning was carried out in Uttar Pradesh and findings here report for Lucknow only. If it is assumed that most of the population growth is the result of the difference between birth and death rates the factors related to and influencing this were the focus of the survey. They included the demographic factors of: sex ratio of females/1000 males; age at marriage; universality of marriage; marital fertility; incidence of separation and widowhood; and the socioeconomic factors of education; household income and occupation; religion; social practices which influence the birth interval; and the use of contraception. The survey showed that education level and literacy are increasing and are doing so more quickly among females. The proportion of married women was higher than of married men but the proportion of men employed (71%) was considerably higher than that for women (7%) in the same category (15 and up). The estimated total fertility rate was 6.5 children and it was found that the age specific fertility rate rises early and sharply forming a plateau between ages 25-29 with a sharp decline after age 30 and with fertility reaching an almost insignificant level after age 35. Fertility during the first 10 years of marriage seems to be about the same irrespective of age at marriage. Male sterilization proved to be the widest known contraceptive method and awareness of conventional methods was quite low--only 18%. Although 65% of the couples knew about family planning 65% had never used any method and 75% were currently nonacceptors. This sample revealed that 25% were currently practicing contraception and 10% had been but chose to discontinue. The average acceptor was 33.2 years. Gains in birth control will come through an increased job market better education for women and delayed age at marriage as well as improved family planning programs.