This paper studies the effect of the utilisation of antenatal care services as an indicator of the contraceptive environment and breastfeeding practices on fertility by taking the most recent birth interval as the outcome variable in three selected states of India, namely, Tamil Nadu, Madhya Pradesh and Orissa. Data for the present study have been taken from the National Family Health Survey conducted in the year 1992-93 for the states of Madhya Pradesh, Orissa and Tamil nadu. The study variable is the length of the most recent birth interval, the interval between last and next-to-last birth before the survey. Results shows that there is a strong positive relationship between the utilisation of antenatal services and the socioeconomic background of mothers in terms of literacy, place of residence and standard of living. It has also been found that women utilising antenatal care services have a rather longer birth interval. The use of ANC services motivates pregnant women to deliver in a hospital or at home attended by health professionals. Treating ANC utilisation as the contraceptive enmvironment, we find differential in the length of birth intervals particularly at the moderate level of fertility but not significant in a controlled situation.

Research questions: What is the prevalence of undernourishment among rural pregnant women? 2. What is the overall nutritional status of rural pregnant women? Objectives: first to assess the nutritional status of pregnant women attending rural antenatal clinic. 2. to assess the prevalence of different grades of anemia among rural pregnant women attending the antenatal clinic. 3. to estimate the average weight gain during the course of pregnancy. Study design: Longitudinal descriptive study. Setting: Study was performed at 3 antenatal clinics in Sarojni Ngr. block of Lucknow district. Participants: 400 pregnant women registered and followed up at above mentioned clinics for the study. Study variables: body mass index, vitamines and mineral deficiencies, weight gain, caloric intake, hemoglobin level. Statistical analysis: percentages. Results: overall 23.3 percent women were having BMI<18.5 Kg/m2, 38 percent women were found to be anemic (Hb<11gm/dl) . Average weight gain during pregnancy was recorded to be 6.6 Kg. 29.5 percent women were found to be taking inadequate diet.

Research question: What are drugs used by Female Health Workers for the treatment of pneumonia and common cold? Objectives: 1. To study the pattern of use of drugs with doses and duration for treatment of ARI in children by Female Health Workers. 2.To compare knowledge and practices related to treatment of ARI among trained and untrained (for CSSM) Female Health Workers. Study design: Cross-sectional. Setting and Participants: Female Health Workers from 5 CHCs and 1 Institutional Hospital of Rewa Division. Study Period : August 1998 to August 1999. Sample size:146 female health workers of Rewa Division. Statistical analysis: chi-square test. Results: Data analysis of 146 female health workers interviewed revealed that 49.31 percent health workers advised co-trimoxazole for treatment of pneumonia, out of them only 34.72 percent mentioned proper doses and duration. 50.69 percent FHWs described unjustified combination of antibiotics. 45.89 percent FHWs prescribed steriod drugs and 11.64 percent cough syrups. 63.70 percent FHWs advised antibiotics in common cold.

Resarch questions: What is the duration of lactation amenorrhoea in urban area? 2.What are its determinants? Objectives: To determine the median duration of lactation amenorrhoea and its determinants amongst women in an urban area. Study design : Cross- sectional study . Setting : A resettlement colony of East Delhi. Study Variables: Lactation amenorrhoea in relation to breast feeding and other mother and child variables. Statistical analysis: Chi-square test and multiple logistic regression analysis. Results: The median duration of lactational amenorrhoea was observed to be 8.25 months. The amenorrhoeic status was significantly related to breast feeding and exclusive breast feeding. Conclusions: contraceptive campaigns may be delayed up to 6 months post-partum relating in a longer period of overall protection, first from amenorrhoea and then by contraceptive use.

Research question: what is the status of antenatal care among pregnant women in India? Objective: To assess the stuatus of antenatal care for pregnant women in India Sampling design: WHO 30 cluster survey methodology with certain modifications incorporating information on female literacy and distance of the village has been used. Results: The characteristics of sample households for pregnant women were broadly in proportion to the characteristics of all India population. About 89% of the pregnant women availed antenatal visits of which 62% had received three or more ANC visits . Those recieving second dose of TT or booster dose were about 78% . About 73% of the pregnant women recieved IFA tablets during their pregnancy. About 53% had full package of ANC. The proportion of Institutional deliveries managed by hospitals and health centres was about 41% , it being higher among literate women and in urban areas. Conclusion: The literacy of women is the key to improve antenatal care of pregnant women. Hence efforts should be made to have information, education and communication (IEC) activities targeted to educate the mothers especially in rural areas. The tribal, small and inaccessible villages and the statues of Bihar, Rajasthan, UP, MP and North Eastern states (combined) should be focused and targeted in the RCH programme.

Research question: what is the effect of maternal biosocial determinants on birth weight of the newborn? Hypothesis: Low socio-economic status and illiteracy has a detrimental effect on birth weight of the newborn. Objective: to co-relate maternal age, education, parity and socio-economic status with low birth weight. Study Design: Community based longitudinal study. Participants: 290 pregnant women followed up till delivery. Results: Incidence of low birth weight was higher in teenage pregnancies, with high parity and low socio-economic status. Incidence of low birth weight was also seen to be high in illiterate females. Conclusions: Maternal age, parity and literacy has a significant effect on the birth weight of the newborn.

Research question: whether ICDS has made any long term effects on the behaviour and academic achievements of children in their early school years? Hypothesis: ICDS beneficiaries should have benefitted from the services availed during their pre-school years. Objectives: To assess the academic achievements and general characteristics of past ICDS beneficiaries compared to non beneficiaries. Study design: Cross-sectional Results: Of 1067 children in 7-13 years, 1022(96%) were school going. Twenty one percent children has never attended anganwadis (AWs), whereas 48% had availed services from AWs fairly regularly during their first 6 years of life. Behaviour, general hygiene and academic performance of children who had availed AW services regularly was similar to those who had not availed these services with few differences. Academic achievements of children studying in govt. schools were less than those studying in private schools. Conclusions: ICDS services probably did made impact as beneficiares were atleast competing with non-beneficiaries who were in higher socio-economic status.

Objectives: To assess the validity of SNAP in predicting the outcome in terms of mortality and duration of hospital stay. The study was also undertaken to evolve the best cut-off SNAP scores for predicting mortality in different individual neonatal conditions. Methods: 295 consectivie newborn admitted to NICU during an eleven month period were evaluated with the investigations requaired as per the specifications of SNAP. Neonates who succumed with 24 hrs of admission and thos who were shifted to the NICU for observation purposes were excluded. Conclusions: SNAP is ameasure of illness surity and correlates well with neonatal mortality. SNAP may assist the clinician in explaining tyhe probable outcome and therapeutic intervention needed and the cost of treatment of the parents. SNAP scores>10 in VLBW babies and >15 in others are associated with higher nortality.

Objectives: Cervical cancer is the most important cause of malignancy associated deaths among women in India. Western studies have reported higher risk of abnormal Pap smears in HIV infected women. A large burden of HIV infection and increasing HIV epidemic in India threatens to exacerbate incidence of cerical cancer. Methods: Between June 96 & Sept.99 women attending two STD clinics in Pune were screened for HIV infection, offered STD laboratory diagnosis and treatment and their pap smears were evaluated. Results: Squamous cell abnormality was detected in 10 per cent of HIV sero negative women attending STD Clinics. This proportion was nearly double (19.2% )(Odds ratio-2.14, 95% C.I. 1.03-4,48,P-0.04) in HIV seropositive women. Having more than one life time partners and presence of STDs were also significantly associated with Pap smear abnormality in univariate analysis. In multivariate analysis, women presenting with STD and HIV infection both, were 2.8 times more likely to have inflammatory Pap smear and 3.5 time more likely to have abnormal Pap smear compared to HIV seronegative women presenting without STDs. Conclusion: Pap smear abnormalities were common in women attending STD clinics in Pune. Presence of HIV infection further increased the risk two folds. Therefore, women suffering from STDs should undergo periodic pap smear screening for early detection of cervical abnormalities and should receive appropriate management to reduce morbidity and mortality.

Objectives: Based on the reports of 139 fever related deaths in Jarwal Primary health centre (PHC) of Bahraich district, UP during April to Sept.99 a study was undertaken to explore the possibility of outbreak of Plasmodium falciparum malaria in the area and reasons of outbreak. Methods: The study was undertaken during Sept.-Oct.99 in Bahraich district, UP The study included a parasitological and an entomological survey. Blood slides from fever cases were collected and examined following standard procedures for detection of species and state of parasite. Results: overall slide positivity rate (SPR) was found to be 33.8 with a preponderance of P. falciparum (88.4% ). There was an outbreak of Pf malaria in Jarwal and surrounding areas as well, Foci of P. falciparum malaria were found in Jarwal, Fakharpur and Hazoorpur PHCs around Kaisarganaaj PHC, in addition, P.faciparum cases were also reported from Motipur and Tejwapur.Conclusion: Poor surveillance of affected areas resulting in low annual parasite incidence (API) lack of insecticidal spray in the currently affected PHCs as the API was less than 2 and a incidence (API) and development of resistance in P. falciparum to chloroquine were found as a possible reasons for the outbreak. It is recommended that surveillance be strengthened in all PHCs of Bahraich district to contain further extension of malaria in northeastern UP.