Background: Breastfeeding is the best meal for a new born child. Various initiatives are in place for early initiation of breastfeeding. The effectiveness of these interventions is put to question when a large number of neonates fail to receive breast milk soon after birth. This study analyses the parameters likely to affect the time of onset of breastfeeding and evaluate the scope for interventions. It is important to assess the factors affecting initiation of breastfeeding, determine the relationship of these factors with the time of initiation and to analyse if counselling by health care workers has any benefit on outcome.Methods: This is a hospital based cross sectional observational study in 200 lactating mothers from a pre-designed questionnaire. Main outcome measure- early onset (<1 hour of birth) of breastfeeding.Results: Only 55% neonates included in this study were breastfed within the first 30 minutes. Positive influence for early initiation of breastfeeding was found with non primi mothers aged more than 26 years, with secondary or higher education, who had vaginal birth with institutional delivery. Early oral intake of mother with professional women living in joint family started early breastfeeding. Use of pre lacteal feeds delayed the onset of breastfeeding. Infants fed earlier were males, weight >2.2 kg. Women counselled by health care workers fed their babies earlier.  Conclusions: This study surmises that pre lacteal feeds should be discouraged and active health care workers’ participation should be encouraged for early breastfeeding. Breastfeeding should be initiated as soon as possible for healthy neonatal outcome.

Tetanus is an acute infectious disease, caused by spores of the bacterium Clostridium tetani. The spores are found everywhere in the environment, particularly in soil, ash, intestinal tracts/faeces of animals and humans, on the surfaces of skin and rusty tools like nails, needles, barbed wires, etc. Being very resistant to heat and most antiseptics, the spores can survive for years. Anyone can get tetanus, but the disease is particularly common and serious in new born babies and pregnant women, who have not been sufficiently immunised with Tetanus Toxoid (TT) containing vaccines. The disease remains an important public health problem in many parts of the world, but especially in low income countries or districts, where immunisation coverage is low and unclean birth practices are common. There are no particular diagnostic tests for tetanus, the diagnosis is made clinically. Hence, early identification of cases of tetanus becomes important for early intervention. Herein, the authors reported four cases (1 male and 3 females) of tetanus, with varied clinical manifestations, management and outcome. The patients were diagnosed with severe generalised tetanus, otogenic tetanus, mild generalised tetanus and severe generalised tetanus respectively. The patients were treated with inj. diazepam, inj. tetanus toxoid, inj. methocarbamol. Two of them recovered completely and two could not be revived.