Birthing practices of traditional birth attendants in south Asia in the context of training programmes

Traditional Birth Attendants (TBA) training has been an important component of public health policy interventions to improve maternal and child health in developing countries since the 1970s. More recently, since the 1990s, the TBA training strategy has been increasingly seen as irrelevant, ineffective or, on the whole, a failure due to evidence that the maternal mortality rate (MMR) in developing countries had not reduced. Although, worldwide data show that, by choice or out of necessity, 47 percent of births in the developing world are assisted by TBAs and/or family members, funding for TBA training has been reduced and moved to providing skilled birth attendants for all births. Any shift in policy needs to be supported by appropriate evidence on TBA roles in providing maternal and infant health care service and effectiveness of the training programmes. This article reviews literature on the characteristics and role of TBAs in South Asia with an emphasis on India. The aim was to assess the contribution of TBAs in providing maternal and infant health care service at different stages of pregnancy and after-delivery and birthing practices adopted in home births. The review of role revealed that apart from TBAs, there are various other people in the community also involved in making decisions about the welfare and health of the birthing mother and new born baby. However, TBAs have changing, localised but nonetheless significant roles in delivery, postnatal and infant care in India. Certain traditional birthing practices such as bathing babies immediately after birth, not weighing babies after birth and not feeding with colostrum are adopted in home births as well as health institutions in India. There is therefore a thin precarious balance between the application of biomedical and traditional knowledge. Customary rituals and perceptions essentially affect practices in home and institutional births and hence training of TBAs need to be implemented in conjunction with community awareness programmes.

Introduction : the South Asia Infant Feeding Research Network (SAIFRN)

The South Asia Infant Feeding Research Network (SAIFRN) was established in 2007 to foster and coordinate a research partnership among South Asian and international research groups interested in infant and young child feeding. SAIFRN has brought together a mix of researchers and program managers from Bangladesh, India, Nepal, Pakistan, and Sri Lanka together with international partners from Australia. As the first activity, SAIFRN conducted a series of analyses using Demographic and Health Surveys of Bangladesh, Nepal, and Sri Lanka and the National Family Health Survey of India. The results highlight that most indicators of infant and young child feeding in these four countries have not reached the targeted levels. The rates vary considerably by country, and the factors associated with poor feeding practices were not always consistent across countries. Driven by the ultimate goal of improved child survival in the region, SAIFRN wishes to expand its partnerships with governmental and nongovernmental organizations that share common interests both within and outside the South Asia region. In the future, SAIFRN hopes to provide more opportunities to researchers in the region to improve their skills by participating in capacity-building programs in collaboration with international partner institutions, and looks forward to liaising with potential donors to support such activities.

Prevalence and trends of the diabetes epidemic in South Asia : a systematic review and meta-analysis

Background Diabetes mellitus has reached epidemic proportions worldwide. South Asians are known to have an increased predisposition for diabetes which has become an important health concern in the region. We discuss the prevalence of pre-diabetes and diabetes in South Asia and explore the differential risk factors reported. Methods Prevalence data were obtained by searching the Medline® database with; ‘prediabetes’ and ‘diabetes mellitus’ (MeSH major topic) and ‘Epidemology/EP’ (MeSH subheading). Search limits were articles in English, between 01/01/1980–31/12/2011, on human adults (≥19 years). The conjunction of the above results was narrowed down with country names. Results The most recent reported prevalence of pre-diabetes:diabetes in regional countries were; Bangladesh–4.7%:8.5% (2004–2005;Rural), India–4.6%:12.5% (2007;Rural); Maldives–3.0%:3.7% (2004;National), Nepal–19.5%:9.5% (2007;Urban), Pakistan–3.0%:7.2% (2002;Rural), Sri Lanka–11.5%:10.3% (2005–2006;National). Urban populations demonstrated a higher prevalence of diabetes. An increasing trend in prevalence of diabetes was observed in urban/rural India and rural Sri Lanka. The diabetes epidemicity index decreased with the increasing prevalence of diabetes in respective countries. A high epidemicity index was seen in Sri Lanka (2005/2006–52.8%), while for other countries, the epidemicity index was comparatively low (rural India 2007–26.9%; urban India 2002/2005–31.3%, and urban Bangladesh–33.1%). Family history, urban residency, age, higher BMI, sedentary lifestyle, hypertension and waist-hip ratio were associated with an increased risks of diabetes. Conclusion A significant epidemic of diabetes is present in the South Asian region with a rapid increase in prevalence over the last two decades. Hence there is a need for urgent preventive and curative strategies .

Education : South Asia

South Asia, a source of great literary and literacy traditions and a generator of great philosophies, also contains a large percentage of illiterate people, the majority of them women. South Asia includes India, Pakistan, Bhutan, Nepal, Sri Lanka, Bangladesh, Burma and Afghanistan. The progress of these countries is dependent on female literacy because health, hygiene, and nutrition problems can be partly overcome through educating women. “Illiteracy is closely related to underdevelopment and poverty, and the elimination of illiteracy represents an essential condition for the development and well-being of peoples and nations" (UNESCO PROAP, 1989: II ). In South Asia, women constitute nearly two- thirds of illiterate adults. There is an inherent contradiction in the region between modern amenities, modern educational systems, and advanced communication systems, on the one hand, and the high level of illiteracy and significant backwardness, on the other.

Prevalence, trends and associated socio-economic factors of obesity in South Asia

Aim Worldwide obesity levels have increased unprecedentedly over the past couple of decades. Although the prevalence, trends and associated socio-economic factors of the condition have been extensively reported in Western populations, less is known regarding South Asian populations. Methods A review of articles using Medline with combinations of the MeSH terms: 'Obesity', 'Overweight' and 'Abdominal Obesity' limiting to epidemiology and South Asian countries. Results Despite methodological heterogeneity and variation according to country, area of residence and gender , the most recent nationally representative and large regional data demonstrates that without any doubt there is a epidemic of obesity, overweight and abdominal obesity in South Asian countries. Prevalence estimates of overweight and obesity (based on Asian cut-offs: overweight ≥ 23 kg/m(2), obesity ≥ 25 kg/m(2)) ranged from 3.5% in rural Bangladesh to over 65% in the Maldives. Abdominal obesity was more prevalent than general obesity in both sexes in this ethnic group. Countries with the lowest prevalence had the highest upward trend of obesity. Socio-economic factors associated with greater obesity in the region included female gender, middle age, urban residence, higher educational and economic status. Conclusion South Asia is significantly affected by the obesity epidemic. Collaborative public health interventions to reverse these trends need to be mindful of many socio-economic constraints in order to provide long-term solutions.

Diabetes mellitus in South Asia : scientific evaluation of the research output

BACKGROUND: Diabetes in South Asia represents a different disease entity in terms of its onset, progression, and complications. In the present study, we systematically analyzed the medical research output on diabetes in South Asia. METHODS: The online SciVerse Scopus database was searched using the search terms "diabetes" and "diabetes mellitus" in the article Title, Abstract or Keywords fields, in conjunction with the names of each regional country in the Author Affiliation field. RESULTS: In total, 8478 research articles were identified. Most were from India (85.1%) and Pakistan (9.6%) and the contribution to the global diabetes research output was 2.1%. Publications from South Asia increased markedly after 2007, with 58.7% of papers published between 2000 and 2010 being published after 2007. Most papers were Research Articles (75.9%) and Reviews (12.9%), with only 90 (1.1%) clinical trials. Publications predominantly appeared in local national journals. Indian authors and institutions had the most number of articles and the highest h-index. There were 136 (1.6%) intraregional collaborative studies. Only 39 articles (0.46%) had >100 citations. CONCLUSIONS: Regional research output on diabetes mellitus is unsatisfactory, with only a minimal contribution to global diabetes research. Publications are not highly cited and only a few randomized controlled trials have been performed. In the coming decades, scientists in the region must collaborate and focus on practical and culturally acceptable interventional studies on diabetes mellitus.

How widespread is Parthenium hysterophorus and its biological control agent Zygogramma bicolorata in South Asia?

Parthenium hysterophorus is a weed of global significance causing severe economic, environmental, human and animal health problems in Asia, Africa, Australia and the Pacific. In South Asia, P. hysterophorus occurs in India, Pakistan, Sri Lanka, Bangladesh and Nepal. A host-specific leaf-feeding beetle Zygogramma bicolorata from Mexico was introduced into India in 1984, as a biological control agent for P. hysterophorus. In this study, a GIS-based distribution map of P. hysterophorus and its biological control agent Z. bicolorata in South Asia based on meta-analysis is presented. The map highlights the limited published information on P. hysterophorus incidence in many of the states and territories in India, as well as in neighbouring Bangladesh, Bhutan, Nepal and Pakistan. Incidence of Z. bicolorata was recorded as three distinct clusters, covering many states in India. In Pakistan, Z. bicolorata was recorded in the Punjab region bordering India. A CLIMEX model based on the current distribution of Z. bicolorata in India suggests that the geographic range of this agent in India and Pakistan can extend to other P. hysterophorus-infested areas in the region. The CLIMEX model also suggests that all of Bangladesh and Sri Lanka, and parts of Nepal are climatically suitable for Z. bicolorata.

Weed control in dry direct-seeded rice using tank mixtures of herbicides in South Asia

Dry direct-seeded rice (DSR) faces with complex weed problems particularly when farmers missed pre-emergence herbicide applications. Thus, an effective and strategic weed control in DSR is often required with available options of post-emergence herbicides. In such situations, tank mixtures of herbicides may provide broad spectrum weed control in DSR. Field experiments were conducted in the wet seasons of 2013 and 2014 to study weed control in response to tank mixtures of herbicides currently applied in DSR in South Asia. Results revealed that the tank mixtures of the currently available herbicides (azimsulfuron plus bispyribac or fenoxaprop, bispyribac plus fenoxaprop, and azimsulfuron plus bispyribac plus fenoxaprop; all applied as post-emergence) rarely resulted in antagonistic effects. Highest weed control efficiency (∼98%) was recorded with the tank mixture of azimsulfuron plus bispyribac plus fenoxaprop during both the years. This treatment also produced highest grain yield (7.2 t ha−1 in 2013 and 7.9 t ha−1in 2014), which was similar to the grain yield in the plots treated with the tank mix of azimsulfuron plus fenoxaprop, pendimethalin (applied as pre-emergence) followed by (fb) bispyribac, pendimethalin fb fenoxaprop, as well as pendimethalin fb azimsulfuron. Plots treated with the post-emergence application of single herbicide (i.e., azimsulfuron, bispyribac, or fenoxaprop) had lower grain yield (3.0–5.2 t ha−1 in 2013 to 3.5–6.1 t ha−1in 2014) than all the sequential herbicide treatments and tank mixtures (azimsulfuron plus fenoxaprop and azimsulfuron plus bispyribac), owing to a broad spectrum weed control. The study suggested that if farmers missed the pre-emergence application of herbicides (e.g., pendimethalin) due to erratic rains or due to other reasons, good weed control and high yield can still be obtained with tank mix applications of azimsulfuron plus fenoxaprop or azimsulfuron plus bispyribac plus fenoxaprop in DSR.

Molecular phylogeny and biogeography of langurs and leaf monkeys of South Asia (Primates: Colobinae)

The two recently proposed taxonomies of the langurs and leaf monkeys (Subfamily Colobinae) provide different implications to our understanding of the evolution of Nilgiri and purple-faced langurs. Groves (2001) [Groves, C.P., 2001. Primate Taxonomy. Smithsonian Institute Press, Washington], placed Nilgiri and purple-faced langurs in the genus Trachypithecus, thereby suggesting disjunct distribution of the genus Trachypithecus. [Brandon-Jones, D., Eudey, A.A., Geissmann, T., Groves, C.P., Melnick, D.J., Morales, J.C., Shekelle, M., Stewart, C.-B., 2003. Asian primate classification. Int. J. Primatol. 25, 97–162] placed these langurs in the genus Semnopithecus, which suggests convergence of morphological characters in Nilgiri and purple-faced langurs with Trachypithecus. To test these scenarios, we sequenced and analyzed the mitochondrial cytochrome b gene and two nuclear DNA-encoded genes, lysozyme and protamine P1, from a variety of colobine species. All three markers support the clustering of Nilgiri and purple-faced langurs with Hanuman langur (Semnopithecus), while leaf monkeys of Southeast Asian (Trachypithecus) form a distinct clade. The phylogenetic position of capped and golden leaf monkeys is still unresolved. It is likely that this species group might have evolved due to past hybridization between Semnopithecus and Trachypithecus clades.

Molecular systematics and conservation of the langurs and leaf monkeys of South Asia

Numerous morphology-based classification schemes have been proposed for langurs and leaf monkeys of South Asia but there is very little agreement between them. An incorrect classification scheme when used as a basis for biogeographic studies can support erroneous hypotheses. Further, lack of taxonomic resolution will also confound conservation efforts, given that conservation biologists use traditional morphology-based-classification schemes to prioritize species for conservation. Here, I have revisited recent molecular phylogenetic studies done on langurs and leaf monkeys of South Asia. Results from these studies are in turn used to derive a rational and scientific basis for prioritizing species for conservation. Molecular data support the classification of langurs of the Indian subcontinent-Hanuman, Nilgiri and purple-faced langurs-in the genus Semnopithecus, whereas Phayre's leaf monkey along with other Southeast Asian leaf monkeys form another distinct clade (Trachypithecus). The phylogenetic position of capped and golden langurs remains unresolved. Molecular data suggest that they are closely related to each other but this group might have evolved through past hybridization between Semnopithecus and Trachypithecus. Additionally, genetic data also support the splitting of the so-called Hanuman langurs into at least three species. The scores for taxonomic uniqueness of langurs and leaf monkeys of South Asia were revised using this molecular phylogeny-based classification. According to the revised scores, Phayres leaf monkey and golden langur are priority species for conservation followed by capped and Nilgiri langurs.

Community-based Natural Resource Management: Issues and Cases from South Asia

Community-based natural resource management (CBNRM) is the joint management of natural resources by a community based on a community strategy, through a participatory mechanism involving all legitimate stakeholders. The approach is community-based in that the communities managing the resources have the legal rights, the local institutions and the economic incentives to take substantial responsibility for sustained use of these resources. This implies that the community plays an active role in the management of natural resources, not because it asserts sole ownership over them, but because it can claim participation in their management and benefits for practical and technical reasons1–4. This approach emerged as the dominant conservation concept in the late 1970s and early 1980s, of the disillusionment with the developmental state. Governments across South and South East Asia, Africa and Latin America have adopted and implemented CBNRM in various ways, viz. through sectoral programmes such as forestry, irrigation or wildlife management, multisectoral programmes such as watershed development and efforts towards political devolution. In India, the principle of decentralization through ‘gram swaraj’ was introduced by Mahatma Gandhi. The 73rd and 74th constitution amendments in 1992 gave impetus to the decentralized planning at panchayat levels through the creation of a statutory three-level local self-government structure5,6. The strength of this book is that it includes chapters by CBNRM advocates based on six seemingly innovative initiatives being implemented by nongovernmental organizations (NGOs) in ecologically vulnerable regions of South Asia: two in the Himalayas (watershed development programme in Lingmutechhu, Bhuthan and Thalisain tehsil, Paudi Grahwal District, Uttarakhand), three in semi-arid parts of western India (watershed development in Hivre Bazar, Maharashtra and Nathugadh village, Gujarat and water-harvesting structures in Gopalapura, Rajasthan) and one in the flood-plains of the Brahmaputra–Jamuna (Char land, Galibanda and Jamalpur districts, Bangladesh). Watersheds in semi-arid regions fall in the low-rainfall region (500–700 mm) and suffer the vagaries of drought 2–3 years in every five-year cycle. In all these locations, the major occupation is agriculture, most of which is rainfed or dry. The other two cases (in Uttarakhand) fall in the Himalayan region (temperate/sub-temperate climate), which has witnessed extensive deforestation in the last century and is now considered as one of the most vulnerable locations in South Asia. Terraced agriculture is being practised in these locations for a long time. The last case (Gono Chetona) falls in the Brahmaputra–Jamuna charlands which are the most ecologically vulnerable regions in the sub-continent with constantly changing landscape. Agriculture and livestock rearing are the main occupations, and there is substantial seasonal emigration for wage labour by the adult males. River erosion and floods force the people to adopt a semi-migratory lifestyle. The book attempts to analyse the potential as well as limitations of NGOdriven CBNRM endeavours across agroclimatic regions of South Asia with emphasis on four intrinsically linked normative concerns, namely sustainability, livelihood enhancement, equity and demographic decentralization in chapters 2–7. Comparative analysis of these case studies done in chapter 8, highlights the issues that require further research while portraying the strengths and limits of NGO-driven CBNRM. In Hivre Bazar, the post-watershed intervention scenario is such that farmers often grow three crops in a year – kharif bajra, rabi jowar and summer vegetable crops. Productivity has increased in the dry lands due to improvement in soil moisture levels. The revival of johads in Gopalpura has led to the proliferation of wheat and increased productivity. In Lingmuteychhu, productivity gains have also arisen, but more due to the introduction of both local and high-yielding, new varieties as opposed to increased water availability. In the case of Gono Chetona, improvements have come due to diversification of agriculture; for example, the promotion of vegetable gardens. CBNRM interventions in most cases have also led to new avenues of employment and income generation. The synthesis shows that CBNRM efforts have made significant contributions to livelihood enhancement and only limited gains in terms of collective action for sustainable and equitable access to benefits and continuing resource use, and in terms of democratic decentralization, contrary to the objectives of the programme. Livelihood benefits include improvements in availability of livelihood support resources (fuelwood, fodder, drinking water), increased productivity (including diversification of cropping pattern) in agriculture and allied activities, and new sources of livelihood. However, NGO-driven CBNRM has not met its goal of providing ‘alternative’ forms of ‘development’ due to impediments of state policy, short-sighted vision of implementers and confrontation with the socio-ecological reality of the region, which almost always are that of fragmented communities (or communities in flux) with unequal dependence and access to land and other natural resources along with great gender imbalances. Appalling, however, is the general absence of recognition of the importance of and the will to explore practical ways to bring about equitable resource transfer or benefit-sharing and the consequent innovations in this respect that are evident in the pioneering community initiatives such as pani panchayat, etc. Pertaining to the gains on the ecological sustainability front, Hivre Bazar and Thalisain initiatives through active participation of villagers have made significant regeneration of the water table within the village, and mechanisms such as ban on number of bore wells, the regulation of cropping pattern, restrictions on felling of trees and free grazing to ensure that in the future, the groundwater is neither over-exploited nor its recharge capability impaired. Nevertheless, the longterm sustainability of the interventions in the case of Ghoga and Gopalpura initiatives as the focus has been mostly on regeneration of resources, and less on regulating the use of regenerated resources. Further, in Lingmuteychhu and Gono Chetona, the interventions are mainly household-based and the focus has been less explicit on ecological components. The studies demonstrate the livelihood benefits to all of the interventions and significant variation in achievements with reference to sustainability, equity and democratic decentralization depending on the level and extent of community participation apart from the vision of implementers, strategy (or nature of intervention shaped by the question of community formation), the centrality of community formation and also the State policy. Case studies show that the influence of State policy is multi-faceted and often contradictory in nature. This necessitates NGOs to engage with the State in a much more purposeful way than in an ‘autonomous space’. Thus the role of NGOs in CBNRM is complementary, wherein they provide innovative experiments that the State can learn. This helps in achieving the goals of CBNRM through democratic decentralization. The book addresses the vital issues related to natural resource management and interests of the community. Key topics discussed throughout the book are still at the centre of the current debate. This compilation consists of well-written chapters based on rigorous synthesis of CBNRM case studies, which will serve as good references for students, researchers and practitioners in the years to come.

Multi-decadal variation of the net downward shortwave radiation over south Asia: The solar dimming effect

The solar radiation flux at the earth's surface has gone through decadal changes of decreasing and increasing trends over the globe. These phenomena known as dimming and brightening, respectively, have attracted the scientific interest in relation to the changes in radiative balance and climate. Despite the interest in the solar dimming/brightening phenomenon in various parts of the world, south Asia has not attracted great scientific attention so far. The present work uses the net downward shortwave radiation (NDSWR) values derived from satellites (Modern Era Retrospective-analysis for Research and Applications, MERRA 2D) in order to examine the multi-decadal variations in the incoming solar radiation over south Asia for the period of 1979-2004. From the analysis it is seen that solar dimming continues over south Asia with a trend of -0.54 Wm(-2) yr(-1). Assuming clear skies an average decrease of -0.05 Wm(-2)yr(-1) in NDSWR was observed, which is attributed to increased aerosol emissions over the region. There is evidence that the increase in cloud optical depth plays the major role for the solar dimming over the area. The cloud optical depth (MERRA retrievals) has increased by 10.7% during the study period, with the largest increase to be detected for the high-level (atmospheric pressure P < 400 hPa) clouds (31.2%). Nevertheless, the decrease in solar radiation and the role of aerosols and clouds exhibit large monthly and seasonal variations directly affected by the local monsoon system, the anthropogenic and natural aerosol emissions. All these aspects are examined in detail aiming at shedding light into the solar dimming phenomenon over a densely populated area. (C) 2011 Elsevier Ltd. All rights reserved.

Role of orography in modulating space-time scales of convection over South Asia

Propagation of convective systems in the meridional direction during boreal summer is responsible for active and break phases of monsoon over south Asia. This region is unique in the world in its characteristics of monsoon variability and is in close proximity of mountains like the Himalayas. Here, using an atmospheric general circulation model, we try to understand the role of orography in determining spatial and temporal scales of these convective systems. Absence of orography (noGlOrog) decreased the simulated seasonal mean precipitation over India by 23 % due to delay in onset by about a month vis-a-vis the full-mountain case. In noGlOrog, poleward propagations were absent during the delayed period prior to onset. Post-onset, both simulations had similar patterns of poleward propagations. The spatial and temporal scales of propagating clouds bands were determined using wavelet analysis. These scales were found to be different in full-mountain and no-mountain experiments in June-July. However, after the onset of monsoon in noGlOrog, these scales become similar to that with orography. Simulations with two different sets of convection schemes confirmed this result. Further analysis shows that the absence (presence) of meridional propagations during early (late) phase of summer monsoon in noGlOrog was associated with weaker (stronger) vertical shear of zonal wind over south Asia. Our study shows that orography plays a major role in determining the time of onset over the Indian region. However, after onset, basic characteristics of propagating convective systems and therefore the monthly precipitation over India, are less sensitive to the presence of orography and are modulated by moist convective processes.

Variability of cloud liquid water and ice over South Asia from TMI estimates

In this study, the Tropical Rainfall Measurement Mission based Microwave Imager estimates (2A12) have been used to compare and contrast the characteristics of cloud liquid water and ice over the Indian land region and the ocean surrounding it, during the premonsoon (May) and monsoon (June-September) seasons. Based on the spatial homogeneity of rainfall, we have selected five regions for our study (three over ocean, two over land). Comparison across three ocean regions suggests that the cloud liquid water (CLW) over the orographically influenced Arabian Sea (close to the Indian west coast) behaves differently from the CLW over a trapped ocean (Bay of Bengal) or an open ocean (equatorial Indian Ocean). Specifically, the Arabian Sea region shows higher liquid water for a lower range of rainfall, whereas the Bay of Bengal and the equatorial Indian Ocean show higher liquid water for a higher range of rainfall. Apart from geographic differences, we also documented seasonal differences by comparing CLW profiles between monsoon and premonsoon periods, as well as between early and peak phases of the monsoon. We find that the CLW during the lean periods of rainfall (May or June) is higher than during the peak and late monsoon season (July-September) for raining clouds. As active and break phases are important signatures of the monsoon progression, we also analysed the differences in CLW during various phases of the monsoon, namely, active, break, active-to-break and break-to-active transition phases. We find that the cloud liquid water content during the break-to-active transition phase is significantly higher than during the active-to-break transition phase over central India. We speculate that this could be attributed to higher amount of aerosol loading over this region during the break phase. We lend credence to this aerosol-CLW/rain association by comparing the central Indian CLW with that over southeast Asia (where the aerosol loading is significantly smaller) and find that in the latter region, there are no significant differences in CLW during the different phases of the monsoon. While our hypothesis needs to be further investigated with numerical models, the results presented in this study can potentially serve as a good benchmark in evaluating the performance of cloud resolving models over the Indian region.