Background: In India, poor feeding practices in early
childhood contribute to the burden of malnutrition and
infant and child mortality.
Objective. To estimate infant and young child feeding
indicators and determinants of selected feeding practices
in India.

Methods: The sample consisted of 20,108 children
aged 0 to 23 months from the National Family Health
Survey India 2005–06. Selected indicators were examined
against a set of variables using univariate and
multivariate analyses.

Results: Only 23.5% of mothers initiated breastfeeding
within the first hour after birth, 99.2% had ever
breastfed their infant, 89.8% were currently breastfeeding,
and 14.8% were currently bottle-feeding. Among
infants under 6 months of age, 46.4% were exclusively
breastfed, and 56.7% of those aged 6 to 9 months received
complementary foods. The risk factors for not exclusively
breastfeeding were higher household wealth index
quintiles (OR for richest = 2.03), delivery in a health
facility (OR = 1.35), and living in the Northern region.
Higher numbers of antenatal care visits were associated
with increased rates of exclusive breastfeeding (OR for
≥ 7 antenatal visits = 0.58). The rates of timely initiation
of breastfeeding were higher among women who were
better educated (OR for secondary education or above =
0.79), were working (OR = 0.79), made more antenatal
clinic visits (OR for ≥ 7 antenatal visits = 0.48), and
were exposed to the radio (OR = 0.76). The rates were
lower in women who were delivered by cesarean section
(OR = 2.52). The risk factors for bottle-feeding included
cesarean delivery (OR = 1.44), higher household wealth
index quintiles (OR = 3.06), working by the mother
(OR=1.29), higher maternal education level (OR=1.32),
urban residence (OR=1.46), and absence of postnatal
examination (OR=1.24). The rates of timely complementary
feeding were higher for mothers who had more
antenatal visits (OR=0.57), and for those who watched
television (OR=0.75).

Conclusions: Revitalization of the Baby Friendly Hospital
Initiative in health facilities is recommended. Targeted
interventions may be necessary to improve infant
feeding practices in mothers who reside in urban areas,
are more educated, and are from wealthier households.

Infant and young child feeding indicators and determinants of poor feeding practices in India : secondary data analysis of National Family Health Survey 2005–06

W an estimated incidence in highincome countries of 12–19 cases per 100,000 population per year, viral meningitis is almost 3-fold more frequent than bacterial meningitis. Non-polio enteroviruses (NPEV) are the main cause of viral meningitis worldwide, and young age is an important epidemiological risk factor. Although the acute phase is often mild, NPEV infections can cause severe central nervous system (CNS) disease and result in fatal outcome. Transmission of enteroviruses (EVs) occurs mainly via the fecal-oral route and to a lesser extent by respiratory droplets. Therefore, enhancing hand hygiene can diminish viral spread. Although the peak seasonality occurs in summer and fall in temperate climates, enteroviral infections occur perennially in tropical and subtropical areas. Improved molecular typing and several EV surveillance programs (primarily geared toward the detection of poliovirus outbreaks) have led to higher detection rates of enteroviral infections worldwide. Currently, there are more than 100 serotypes of NPEV identified that are subdivided into 4 species (A to D). Since the 1970s, there have been a number of reports of NPEV outbreaks with human EV 71 (EV71) with sometimes fatal outcomes especially in eastern Europe and the Asia-Pacific region. The World Health Organization reports more than 2000 deaths of an estimated 6 million infections. There are large differences in the case fatality rate between the different outbreaks, which might be related to differences in the pathogenic effect on the CNS of different genogroups of EV71. In this review, typical CNS manifestations of EVs and recent outbreaks in children are summarized, and diagnostic tools and possible treatment and prevention strategies are presented.

Enterovirus Infections of the Central Nervous System in Children: An Update.

Echoviruses, a serotype of enteroviruses, infect millions of people globally and there is no specific drug treatment or vaccine available for its management. The screening of medicinal plants used locally for the treatment of infectious diseases, can provide a reliable option in the discovery of potent therapeutic compounds. This study was carried out to investigate the antiviral activities of 27 medicinal plant extracts, belonging to 26 different plant species, selected from Nigerian ethnobotany, against echovirus 7, 13 and 19 serotypes (E7, E13 and E19, respectively). The plants were macerated in methanol and the cytotoxicities of the crude extracts were evaluated on the rhabdomyosarcoma cell line using the MTT assay. The antiviral activity of the plant extracts and fractions against echoviruses (E7, E13, and E19) was determined using the neutralisation assay, an assay that measures the inhibition of cytopathic effect on cell culture. The crude extract of Macaranga barteri leaves had the highest cytotoxicity with CC50 value of 0.27 μg/mL. This was followed by Crinum jagus (9.88 μg/mL) and Terminalia ivorensis (12.14 μg/mL). The antiviral screening showed that ten out of the 27 crude plant extracts tested were active on E7 and E19, inhibiting the cytopathic effect of the virus in tissue culture. None of the extracts inhibited the cytopathic effect caused by E13 serotype. Amongst the active plant extracts, the methanol extract of M. barteri leaves had the highest antiviral activity on both E7 and E9 with IC50 values of 0.028 and 0.0017 ng/mL, respectively, followed by the Ageratum conyzoides extract (0.208 μg/mL, E7; 0.006 μg/mL, E19) and Mondia whitei extract (0.038 μg/mL, E7; 0.005 μg/mL, E19). Amongst the fractions of M. barteri, the DCM fraction was most the active and selective on E7 (IC50 = 0.0075 ng/mL; SI = 19,896.54) and E19 (IC50 = 0.0175 ng/mL; SI = 8581.24). Our research has demonstrated that Macaranga barteri extracts has potent antiviral activity against echoviruses E7 and E19, and our findings suggest that this extract may have potential as a therapeutic agent in the treatment of enteroviral infections.

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In vitro antiviral activity of twenty-seven medicinal plant extracts from Southwest Nigeria against three serotypes of echoviruses.

Viruses are a common cause of central nervous system (CNS) infections with many host, agent, and environmental factors influencing the expression of viral diseases. Viruses can be responsible for CNS disease through a variety of mechanisms including direct infection and replication within the CNS resulting in encephalitis, infection limited to the meninges, or immune-related processes such as acute disseminated encephalomyelitis. Common pathogens including herpes simplex virus, varicella zoster, and enterovirus are responsible for the greatest number of cases in immunocompetent hosts. Other herpes viruses (eg, cytomegalovirus, John Cunningham virus) are more common in immunocompromised hosts. Arboviruses such as Japanese encephalitis virus and Zika virus are important pathogens globally, but the prevalence varies significantly by geographic region and often season. Early diagnosis from radiographic evidence and molecular (eg, rapid) diagnostics is important for targeted therapy. Antivirals may be used effectively against some pathogens, although several viruses have no effective treatment. This article provides a review of epidemiology, diagnostics, and management of common viral pathogens in CNS disease.

https://journals.sagepub.com/doi/pdf/10.1177/1179573517703342

Management of Viral Central Nervous System Infections: A Primer for Clinicians.

Enteroviruses are single-stranded positive-sense RNA viruses that primarily cause self-limiting gastrointestinal or respiratory illness. In some cases, these viruses can invade the central nervous system, causing life-threatening neurological diseases including encephalitis, meningitis and acute flaccid paralysis (AFP). As we near the global eradication of poliovirus, formerly the major cause of AFP, the number of AFP cases have not diminished implying a non-poliovirus etiology. As the number of enteroviruses linked with neurological disease is expanding, of which many had previously little clinical significance, these viruses are becoming increasingly important to public health. Our current understanding of these non-polio enteroviruses is limited, especially with regards to their neurovirulence. Elucidating the molecular pathogenesis of these viruses is paramount for the development of effective therapeutic strategies. This review summarizes the clinical diseases associated with neurotropic enteroviruses and discusses recent advances in the understanding of viral invasion of the central nervous system, cell tropism and molecular pathogenesis as it correlates with host responses.

Molecular Pathogenicity of Enteroviruses Causing Neurological Disease.

Enteroviruses (EVs) have emerged as one of the important etiological agents as a causative organism for encephalitis, especially in children and adults. After the first report of EV encephalitis cases in 1950s, there have been increasing reports of regular outbreaks of EV encephalitis worldwide. Enteroviruses are RNA viruses of the family Picornaviridae that consists of more than 100 serotypes, which are characterized by a single positive-strand genomic RNA. The clinical features are pleomorphic and can be accompanied by mucocutaneous manifestations or isolated encephalitis only. The incidence of encephalitis in EV infection is reported to be about 3% and is associated with high mortality and morbidity. A number of newer therapeutic agents have been used in EV encephalitis with variable results. This review will focus on clinical features, pathophysiology, and newer treatment modality in EV encephalitis.

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Enteroviral encephalitis in children: clinical features, pathophysiology, and treatment advances

The epidemic of obesity along with hypertension (HTN) and cardiovascular disease is a growing contributor to global disease burden. The prevalence of HTN and pre-hypertension in children has been rising steadily over the decades to nearly 4% and 10% respectively [1,2]. Paediatric hypertension is one of the strongest predictor of adult hypertension, which increases the cardiovascular mortality risk in adults [3]. Obesity in childhood is found to be associated with hypertension, dyslipidemia, impaired glucose metabolism and other metabolic and physical consequences like left ventricular hypertrophy, nonalcoholic steatohepatitis, obstructive sleep apnea, orthopedic problems, and psychosocial problems. A literature review found that the risk of adult obesity is at least twice as high for obese children as for non-obese children, as about a third of obese preschool children were obese as adults, and about half of obese school-age children were obese as adults [4]. Adults who have been obese as children may have an even greater prevalence of risk factors for CVD, including hypertension and dyslipidemia, compared with those who had normal weight as children. It has also been shown that childhood obesity and central adiposity increased the risk for the metabolic syndrome in adulthood [5].

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Childhood Obesity and Hypertension

Intermittent incontinence of urine in a sleeping child who has previously been dry for less than 6 months without any other lower urinary tract symptoms is considered to be primary monosymptomatic nocturnal enuresis (PMNE). Although, most children outgrow PMNE with age, the psychological impact on the child warrants parental education and patient motivation and treatment. Motivational therapy, alarm therapy and drug therapy are the mainstay of treatment. Motivational and alarm therapy have better success rates than drug therapy alone. Desmopressin is the commonly used first-line drug and is best for short-term relief. Other drugs such as anti-cholinergics, imipramine and sertraline are used in resistant cases. This review focuses on the assessment and treatment of PMNE.

Advances in the management of primary monosymptomatic nocturnal enuresis in children.

Introduction: Caudal block analgesia is administered to lower the requirements of systemic and inhaled anesthetic drugs during hypospadias surgery. However, recent reports, all clustered in a short time-span have generated controversial and mutually opposing results while evaluating caudal block as an independent risk factor for urethroplasty-related complications after hypospadias repair. There is no consensus statement on the role of caudal block analgesia in formation of urethrocutaneous fistula (UCF) after hypospadias surgery. We performed a systematic review and meta-analysis of the studies evaluating the relative rates of UCF formation after hypospadias surgery in patients who were administered caudal block analgesia versus in those who were not. Methods: Electronic searches were performed using PubMed, PubMed Central, Google Scholar, Ovid, and the Cochrane library. Statistical analysis was performed using a fixed-effect model, odds ratios, risk ratios (RR), and heterogeneity (I2) were calculated. Funnel plot was used to assess for publication bias. Results: Seven studies with 1706 patients were included. Caudal block analgesia is associated with a significantly higher risk of UCF formation (RR: 1.81; 95% confidence interval [CI]: 1.30–2.53), (P = 0.0004) and other urethroplasty-related complications (RR 2.01; 95% CI: 1.48–2.74), (P Conclusions: In patients undergoing hypospadias repair, administration of caudal analgesia is associated with a higher risk of UCF formation and other urethroplasty-related complications.

Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis.

Objective To study and profile complementary feeding practices and their determinants among children 6-23 months of age in an outpatient hospital setting in Central India: A cross-sectional study. Method Total 464 Children, 6-23 months of age, visiting Well baby clinic and Immunization center at AIIMS Bhopal during February 2015 to June 2016, where parents had given consent for participation in the study were included. Children with congenital malformations affecting feeding, cerebral palsy, known chronic systemic diseases, were excluded. Result Breastfeeding was initiated within 1 hour in 59.5%. Complementary feeds were given in 84% of children 6-8 month of age. Minimal dietary diversity as determined by WHO was received by 57% of children while minimal meal frequency was present in 86%. Minimal acceptable diet was received by 58% of children. Breastfeeding was continued in 86% children at 1 year of age and 41% children at 2 years of age. Bottle feeding was present in 26% of children. Multivariate regression analysis was done to correlate minimum acceptable diet and various variables affecting the feeding habits. Higher maternal education (adjusted OR: 4.03; 95% CI: 2.35-6.89) and income group (adjusted OR: 2.03; 95% CI: 1.11-3.72) were found to be significant. Joint families had better feeding practices when compared to nuclear families (adjusted OR: 1.72; 95% CI: 1.12-2.64). Homemaker mothers were able to feed their children in more appropriate way (adjusted OR: 3.33; 95% CI: 1.17-6.62). Conclusion Well-educated homemaker mother, higher income group, and joint families help in establishing better complementary feeding habits in children less than 2 years. An understanding of the prevalent practices will be helpful in identification of areas that need to be focused upon and reemphasized during counseling the caregivers of the young children to improve their nutritional status, which will also reduce the burden of disease at primary care.

Complementary feeding practices and their determinants among children 6-23 months of age in an outpatient hospital setting in Central India: A cross-sectional study.

Shikha Jain

Papers

Enteroviral encephalitis in children: clinical features, pathophysiology, and treatment advances

Childhood Obesity and Hypertension

Advances in the management of primary monosymptomatic nocturnal enuresis in children.

Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis.

Complementary feeding practices and their determinants among children 6-23 months of age in an outpatient hospital setting in Central India: A cross-sectional study.