Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411013EnglishN2018July10HealthcareDental Caries Status of 3-6 Years Old Children in Biratnagar, Nepal: A Cross- Sectional Study English0104Deep Jitendra MeisheriEnglish Ashiwn DevasyaEnglish Bhushan BhattaraiEnglish Ravi AcharyaEnglishBackground: Dental caries persists as one of the most prevalent chronic diseases among children worldwide. In preschool age children, this form of dental caries is termed as Early Childhood Caries (ECC). The objective of this study is to determine the frequency of dental caries among preschool children of Biratnagar, Nepal. Methods: A cross-sectional study of 1382 preschool children was conducted in Biratnagar, Nepal. Children were randomly selected from government run preschools in Biratnagar. Children between 3-6 years age group were assessed for dental caries. Data was analyzed using SPSS version 16.0 software. Results: Out of the 1382 children examined, 894(64.86%) had caries out of which 501(56.04%) were males and 393(43.95%) females. The overall mean deft for ECC was 2.93±2.17 ranging from 0-16. Severe-ECC was present in 39.59% (354 out of 894) of caries positive children. Dental plaque was present in 931(67.36%) children. 279(20.18%) children had poor oral hygiene. Conclusion: More than half of the preschool children had early childhood caries. Association between age of the child, dental plaque and poor oral hygiene has been established. There is an urgent need for preventive and curative oral health programs for children in Nepal. EnglishDental caries, Preschool children, ECC, s-ECC, NepalIntroduction: Dental caries persists as one of the most prevalent chronic diseases among children worldwide. Dental caries also interferes with the healthy life of both children and adolescents. Dental caries is defined as a multifactorial microbial disease characterized by demineralization of the inorganic and destruction of the organic substance of the tooth.[1] Dental caries in preschool age children is termed as Early Childhood Caries (ECC).  According to American Academy of Pediatric Dentistry (AAPD), ECC is defined as the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in a child 71 months of age or younger. In children younger than 3 years of age, any sign of smooth surface caries is indicative of severe early childhood caries (s-ECC). [1, 2] Children with ECC and s-ECC have a poor quality of life due to pain, premature loss of teeth, malnutrition, distress and functional restrictions. [3] The incidence of dental caries among preschool children of developed countries has been declining. However, 90% of preschool children in Asia are affected by dental caries. [4] There is a lack of definite data on incidence of ECC and s-ECC at both national and local levels in the city of Biratnagar, Nepal. Therefore the aim of the present study is to measure the incidence of dental caries among 3-6 years old children of Biratnagar, Nepal.  Methods: A cross sectional study was conducted in Biratnagar, Nepal during the period of Jan-April, 2018. The study was conducted after approval from institutional ethical review committee. Informed consent explaining the nature of the study was obtained from the parents and headmasters of the schools.3-6 years old children of both genders from government run preschools were included in the study. Children above 6 years of age having at least one permanent tooth or suffering from  periodontal conditions or any systemic disease or were absent on the day of examination were excluded from the study. A total of 1382 children attending government run preschools were clinically examined for diagnosis of ECC and s-ECC according to deft index. The WHO criterion was used for diagnosis of dental caries.[4] The presence of dental plaque and assessment of oral hygiene was assessed solely through visual examination without using any universally accepted index system as it was not the prime objective of the study. Caries severity was assessed via deft index by categorizing the score into very mild (1 tooth), mild (2-3 teeth), moderate (4-5 teeth) and severe (more than 6 teeth). The examination of the children was done by single calibrated examiner with the child seated in a normal chair or in knee to knee position depending on the behavior of the child. The examination was carried out using sterilized mouth mirror and explorer in natural light. In questionable cases the tooth was marked as sound. No radiographs were taken. SPSS version16.0 software was used to enter and analyze the data. Chi-square test and ANOVA were used to find significance. P value of Englishhttp://ijcrr.com/abstract.php?article_id=2500http://ijcrr.com/article_html.php?did=2500 AAPD: Policy on Early Childhood Caries: Classifications, consequences, and preventive strategies. Reference manual, 2011; 34(6): 50. Milnes AR. Description and epidemiology of nursing caries. J Public Health Dent 1996; 56(1):38–50. Pahel BT, Rozier RG, Slade GD. Parental perceptions of children’s oral health: the Early Childhood Oral Health Impact Scale (ECOHIS). Health Qual Life Outcomes 2007; 5:6.  Du RY, Mcgrath C, Yiu, CKY, King NM. Health- and oral health –related quality of life among preschool children with cerebral palsy. Qual Life Res 2010; 19(9):1367-1371. Kassebaum,N.J.;Bernabé,E.;Dahiya,M.;Bhandari,B.;Murray,C.;Marcenes,W.Globalburdenofuntreated caries: A systematic review and metaregression. J. Dent. Res. 2015, 94, 650–658.  Kumarihamy, S.L.; Subasinghe, L.D.; Jayasekara, P.; Kularatna, S.M.; Palipana, P.D. The prevalence of early childhood caries in 1–2 years olds in a semi-urban area of Sri Lanka. BMC Res. Notes 2011, 4, 336. Abdullah S, Qazi HS, Maxood A: Dental caries status in 6–9 years old children. Pak Oral Dent J 2008, 28:107–112.  Stella YLK, Petersen PE, Pine CM, Borutta A: Health-promoting schools: an opportunity for oral health promotion. Bull WHO 2005, 83:677–685. Currie C, Hurrelmann K, et al: Health and health behaviors among young people. Copenhagen; WHO regional office for Europe; 2000 WHO policy series. Health policy for children and adolescents, (1). International report. http://www.euro.who.int/__data/assets/pdf_file/0006/119571/E67880.pdf. Accessed on 30th April 2011.  Pitts NB, Chestnutt IG, Evans D, White D, Chadwick B, Steele JG, et al: The dentinal caries experience of children in the United Kingdom, 2003. Brit Dent J 2006, 200:313–320. Hugoson A, Koch G, Helkimo AN, Lundin SA: Caries prevalence and distribution in individuals aged 3–20 years in Jonkoping, Sweden, over a 30-year period (1973–2003). Int J Paediatr Dent 2008, 18:18–26. 6. Wyne AH: Caries prevalence, severity, and pattern in preschool children. J Contemp Dent Pract 2008, 3:024–031. Mahejabeen R, Sudha P, Kulkarni SS, Anegundi R: Dental caries prevalence among preschool children of Hubli: Dharwad city. J Indian Soc Pedod Prev Dent 2006, 24:19–22.  Charani A, Mohsin S, Sufia S, Khan AA: Prevalence of early childhood caries among 3-5-year old children of Clifton, Karachi. J of Pak Dent Assoc 2011, 20:89–92.  Sufia S, Chaudhry S, Izhar F, Syed A, Mirza BA, Khan AA: Dental caries experience in preschool children: is it related to a child’s place of residence and family income? Oral Health Prev Dent 2011, 9(4):375–379.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411013EnglishN2018July10HealthcareValidated RP-HPLC Method for Quantification of Paclitaxel in Human Plasma – Eliminates Negative Influence of Cremophor El English0510Hindu KalluruEnglish Vinodhini C.English Satish Srinivas K.English Surulivel Rajan M.English Chitra K.English Mangathayaru K.EnglishBackground: Literature reports innumerable methods for quantification of paclitaxel in biological matrices. Most of these involve complicated extraction procedures like solid phase extraction, separate procedure for elimination of interference of Cremophor El, advanced and expensive instruments. Objectives: The objective of the present research work is to develop and validate a simple, rapid, sensitive, economic and reproducible reverse phase – high performance liquid chromatography method for the estimation of paclitaxel concentration in human plasma that eliminates negative influence of Cremophor El on recovery of paclitaxel. Methods: Chromatographic separation of paclitaxel was carried out using C18 column (150 × 4.6 mm i.d., 4μm particle size, Waters, Australia) with 60% acetonitrile, 40% of 10mM ammonium acetate buffer solution and 0.1% formic acid as a mobile phase at a flow rate of 1.0mL/min at ambient temperature. Validation was performed as per ICH Q2 guidelines. Results: In this system the retention time was 3min. The detection limit was 5ng/mL and limit of quantification with reproducibility was 15ng/mL. Plasma samples were extracted using single solvent (tertiary – Butyl Methyl Ether) liquid- liquid extraction with a recovery of 96-99%. Robustness of the method was established with variation in flow rate, detection wave length and mobile phase composition. Stability of paclitaxel during the study period was studied and found to be stable. Conclusion: The developed method is easy to perform, quick, reproducible with good recovery without negative influence of Cremophor El and applicable to quantify paclitaxel in regular clinical practice for individualization of the therapies. EnglishPaclitaxel, Cremophor El, Single solvent extraction, BioanalyticalPaclitaxel is a very effective antineoplastic agent used in the treatment of ovarian, breast, cervix and non-small cell lung cancers (1). Paclitaxel was the first taxane derivative isolated from the bark of Taxusbrevifoliain the year 1971 (2) and being marketed from 1993 (3). It is a complex, hydrophobic molecule administered in a solution of Cremophor-EL (Cr El) and dehydrated alcohol in the ratio of 1:1. Neutropenia, myelosuppression, gastrointestinal ailments, alopecia are the common adverse effects of paclitaxel treatment. Peripheral neuropathy is the major adverse effect of paclitaxel and increases with increasing cumulative dosage (2). Moreover, Cr El is widely known to cause severe hypersensitivity reactions requiring premedication (4). It is well recognized that there is inter and intraindividual variability in pharmacokinetic characteristics of paclitaxel. Currently body surface area (BSA) is used in the dosing of paclitaxel, leading to significant interindividual differences in plasma concentrations and risk of severe and treatment limiting adverse effects (5, 6). Quantification of paclitaxel in the blood or plasma samples is necessary to establish pharmacokinetic parameters that can assess inter and intraindividual variability, thereby making necessary dose adjustments to improve therapeutic efficacy and minimizing the adverse effects (7). It is also reported that Cr El has a negative impact on the reproducibility of bioanalysis of paclitaxel due to entrapment of paclitaxel in the micelles of Cr El (8), and various methods are used to nullify the effect of Cr El on quantification of paclitaxel (9). Therefore, it is necessary to develop a rapid, simple, sensitive, economic and reproducible method to quantify plasma concentrations of paclitaxel in regular clinical practice to promote individualization of treatments. Till date several methods have been reported for the quantification of paclitaxel in biological matrices using various techniques like high performance liquid chromatography (HPLC), liquid chromatography-tandem mass spectroscopy (LC-MS), micellarelectrokinetic chromatography (MEKC), capillary electrophoresis, immune assays etc (10-12). Most of these methods require tedious, complicated extraction procedures like solid phase extraction (SPE), advanced and expensive instruments like LC-MS which are not available in many hospitals, diagnostic and research labs.     We herewith report on our development of a rapid, simplified, economic and sensitive method of paclitaxel quantification in human plasma by liquid-liquid extraction for application in clinical sample analysis.  METHODS Instruments and Reagents The HPLC system - LC- 2010 (Shimadzu Corporation, Kyoto, Japan) liquid chromatographic quaternary auto sampler pump model equipped with UV-Visible detector, Class VP software. C18 HPLC column with 150×4.6mm (i.d) with particle size of 4µm (Waters, Australia),  universal guard column with 20×3.9mm i.d and UV detector (Shimadzu), Ultra sonicator (PCI analytics, Vertex enterprises, India), Milli Q water system, Micro centrifuge and vortex shaker. Paclitaxel (>99% purity) was purchased from Sigma-Aldrich, India. Paclitaxel formulation (Taxeleon 30mg/5mL) was kindly gifted by Neon Laboratories, Mumbai. Acetonitrile, t-butyl methyl ether (t-BME), methanol of HPLC grade, ammonium acetate and formic acid of analytical grade were used. Deionized water purified from Milli-Q water system was used throughout the study. Drug free plasma was obtained from healthy volunteers in our laboratory. Preparation of stock solution Stock solution of paclitaxel was prepared by dissolving 10mg of paclitaxel in 10mL of acetonitrile. This stock solution was further diluted for the preparation of working standard solutions with diluent (Acetonitrile and water in 1:1 ratio) to get the concentration range of 6ng/mL to 6µg/mL. Blood sampling This method development is a part of pharmacokinetic drug interaction study in cancer patients and has been approved by Institutional ethics committee of our institution (IEC No: IEC-NI/16/Mar/51/16). Blood samples from six cancer patients receiving 260mg of Paclitaxel were collected after procuring signed written informed consent. All the blood samples were collected in heparinized vacutainers. Plasma samples were separated from the whole blood by centrifuging at 3000 rpm for 10min and were stored in refrigerator at -80°C until analysis. Sample Pretreatment About 500µL of patient plasma was extracted with 1mL of t-BME twice and vortexed for 1 min. After centrifugation at 2000 rpm for 10 min, the organic layer was transferred into a 10 mL beaker. The t-BME extract was evaporated to dryness, residue was reconstituted with 1mL of diluent and filtered through 0.22 µ pore size nylon membrane filters, about 20 µL of the sample was applied to HPLC analysis as per the proposed chromatographic conditions (13). HPLC Conditions Chromatographic separation of paclitaxel was performed using C18 column (150×4.6mm i.d., 4µm particle size, Waters, Australia) with 60% acetonitrile, 40% 10mM ammonium acetate buffer solution and 0.1% formic acid as mobile phase ata flow rate of 1.0 mL/min at ambient temperature. The detection wavelength was 230 nm. Detector output integration was carried using Class VP software to determine peak areas. Validation The validation was performed as per ICH Q2(R1) guidelines (14). Calibration curves of paclitaxel were developed using drug free plasma samples spiked with known concentration of paclitaxel standard. The detection limits were calculated from the calibration curve. Intra and inter-day method precision, accuracy, recovery, stability and robustness were assessed using spiked plasma samples with 6-60000 ng/mL paclitaxel standard solution. The recovery was calculated as the difference in the peak area between standard and that spiked to plasma sample. Statistical methods: The data was statistically treated using Microsoft excel 2010. Statistical methods like relative standard deviation, percentage and coefficient of determination (r2) were used. RESULTS Linearity and detection limits The limit of detection was found to be 5 ng/mL and limit of quantification that can be reliably and reproducibly measured is 15 ng/mL. Linearity of detector response was assessed for extracted plasma standards over the range of 6-6000 ng/mL with an r2 value of 0.9998 (Table I). For 0.5 mL aliquots of plasma samples, linearity was satisfactory between 6 and 6000 ng/mL. Precision Assay precision was found to be satisfactory in the concentration range of 6-6000 ng/mL. The intraday and interday precision was assessed using six replicates of three concentrations 60, 600, 6000 ng/mL and the relative standard deviation was found to be < 0.7% for intraday and < 3% for interday precision (Table II). Formulation Assay Accuracy of the method was established by quantification of paclitaxel in the pharmaceutical dosage form (Taxeleon 30 mg/5mL, Neon laboratories) in the concentration range of 6-60000 ng/mL. The results shows that the peak shape is symmetrical with a good baseline and there was strong correlation between the standard solutions and pharmaceutical dosage form solutions with respect to retention time and peak area. The assay performance data are presented in Table II. Recovery Recovery of paclitaxel was estimated by using spiked plasma samples of 500 µL with standard solutions of known concentrations, extraction of plasma samples as per the sample pretreatment procedure, analyzing and comparison of peak areas of paclitaxel standard and extracted plasma samples. Recovery of paclitaxel measured in triplicates at three concentrations (60 ng, 600 ng and 6 µg/mL) was in the range of 96-99% (Table II). Selectivity and Specificity Chromatograms of blank plasma, paclitaxel standard in diluent, paclitaxel extracted from patient plasma are illustrated in the Fig 1.  The results of extraction from plasma and standard reveal a symmetrical peak shape and good baseline resolution of paclitaxel. Interference due to plasma matrix components was not observed during the analysis. Using this system, the retention time for paclitaxel was 3 min and the runtime for total analysis of each run was efficiently maintained for 5 min. It is also observed that there is no interference of endogenous peaks, peak shape and retention time being the same for paclitaxel standard in diluent, paclitaxel formulation and extracted plasma samples. Stability of paclitaxel The stability of paclitaxel standard solution and extracted plasma were assessed for 6h to determine the optimum requirements for processing and storage during the analysis (Table III). We found that paclitaxel was quite stable in room temperature and at 4°C for the assay duration. Robustness Three chromatographic conditions (Detection wavelength, Flow rate and composition of mobile phase) were altered deliberately at a range of ± 2% and under each condition samples were analyzed to estimate the paclitaxel content. The results reveal that the values were in the acceptance limits of 98-102% with %RSD (Relative Standard Deviation)of less than 2% (Table IV). Effect of Cremophor El on paclitaxel analysis It is reported that the bioanalysis of paclitaxel reproducibility is negatively affected by Cr El (9). However, no such effects were observed in our study. This may be due to liquid-liquid extraction with t-BME, that nullifies the ion suppression effects caused by Cr El (15). DISCUSSION The limit of detection and limit of quantification of the current developed method is sensitive enough to carry out the clinical studies/pharmacokinetic studies of paclitaxel for 24 h. These are equal to the methods using sophisticated solid phase extraction (10). The value of regression coefficientr2=0.9998 confirmed the linear relationship between the concentration of the drug and area of the peak. This method is precise enough to perform continuous and regular quantification of paclitaxel in human plasma. The minimal variation in %RSD for interday and intraday precision indicates the complete harmony among repeated injection, repeated analysis, intraday and interday study. The strong correlation between the standard solutions and pharmaceutical dosage form with respect to retention time and peak area establishes the accuracy of the method. The proposed method of analysis was highly selective and specific as peaks of the analyte in spiked plasma and patient plasma were well resolved. Separation of peaks was confirmed by using blank plasma, plasma spiked with analyte and patient plasma containing analyte along with other drugs. The recovery of paclitaxel was efficient and equal to the costly SPE techniques which were used in other methods (10). The minor deliberate changes made in various experimental parameters did not significantly affect the peak area, recovery of the analyte indicating the robustness of the developed method. The stability of paclitaxel in various conditions has been well studied. In this method stability of paclitaxel in standard solutions and extracted from plasma was assessed for 5 h both at room temp (bench-top) and under refrigeration at 4°C to establish the stability of the analyte during the process of analysis. The %RSD values shows that there were no considerable changes in their concentration after 5 h indicating that samples are stable during analysis. The extraction solvent used in this method t-BME can eliminate the negative influences caused by the Cr El that are reported in other methods (9). This method was a part of pharmacokinetic drug interaction study of paclitaxel in breast cancer patients. It was successfully applied for quantification of paclitaxel in human plasma and pharmaceutical dosage form. The method is sensitive enough to quantify paclitaxel in the samples upto 24 h of intravenous administration.   CONCLUSION The current developed RP-HPLC method for quantification of paclitaxel in human plasma is rapid, economic, sensitive and reproducible without negative influence of Cr El. Limit of quantification of this method was 15 ng/mL, making it applicable for clinical pharmacokinetic studies of paclitaxel. A number of methods have been described earlier for quantification of paclitaxel in various biological matrices using various techniques including HPLC. The later involve longer run times, usage of costly SPE procedures and methods to reduce the influence of CrEl. The method described here is equally sensitive yet simpler, using single solvent extraction procedure and having a short retention time of 3 min. Mobile phase composition, sample extraction using t-BME and the use of C18 (15× 4.6 cm i.d, 4 µm particle size) column have attributed to the sensitivity, precision, reproducibility and shorter retention time of the method, which makes it a very practical method to use. ACKNOWLEDGEMENTS Our sincere thanks toNeon laboratories, Mumbai for gifting paclitaxel formulation (Taxeleon 30mg/5mL). FUNDING Our sincere thanks to the management, Sri Ramachandra University for supporting the research work in the form of GATE Young Faculty Research Grant for the year 2016-17 (Grant no – 54/Dean/2016)     Englishhttp://ijcrr.com/abstract.php?article_id=2501http://ijcrr.com/article_html.php?did=2501(1)      Huizing MT, Misser VH, Pieters RC, ten Bokkel Huinink WW, Veenhof CH, Vermorken JB, et al. Taxanes: A New Class of Antitumor Agents.Cancer Investigations1995; 13 (4): 381–404. (2)     Jordan MA, Wilson L. Microtubules and Actin Filaments: Dynamic Targets for Cancer Chemotherapy. Current Opinion in Cell Biology 1998; 123–130. (3)      Jordan MA, Wilson L. Microtubules as a Target for Anticancer Drugs. Nature Reviews Cancer 2004; 4 (4): 253–265. (4)      Gligorov J, Lotz JP. Preclinical Pharmacology of the Taxanes: Implications of the Differences. Oncologist 2004; 9 Suppl 2 (suppl 2): 3–8. (5)      Steed H, Sawyer MB. Pharmacology, Pharmacokinetics and Pharmacogenomics of Paclitaxel. Pharmacogenomics2007; 8 (7): 803–815. (6)      Gerritsen-van Schieveen P, Royer B. Level of Evidence for Therapeutic Drug Monitoring of Taxanes. Fundamentals and Clinical Pharmacology2011; 25 (4): 414–424. (7)      Krens SD, McLeod HL, Hertz DL. Pharmacogenetics, Enzyme Probes and Therapeutic Drug Monitoring as Potential Tools for Individualizing Taxane Therapy. Pharmacogenomics 2013; 14 (5): 555–574. (8)      Sparreboom A, Zuylen L Van, Brouwer E, Loos WJ, Bruijn P De, Gelderblom H et al. Cremophor EL-Mediated Alteration of Paclitaxel Distribution in Human Blood?: Clinical Pharmacokinetic Implications.Cancer Research 1999; 1454–1457. (9)      Andersen A, Warren DJ, Brunsvig PF, Aamdal S, Kristensen GB, Olsen H. High Sensitivity Assays for Docetaxel and Paclitaxel in Plasma Using Solid-Phase Extraction and High-Performance Liquid Chromatography with UV Detection. BMC Clinical Pharmacology 2006; 6 (1): 2. (10)HendrikxJJMA, Rosing H, SchinkelAH, Schellens JHM, Beijnen JH. Quantification of Taxanes in Biological Matrices: A Review of Bioanalytical Assays and Recommendations for Development of New Assays. Bioanalysis 2014; 6 (7): 993–1010. (11)    Palmas RA, Monteiro J, Fresco P. Analytical Methods for Taxanes Quantification in Diluted Formulations and Biological Samples and Their Applications in Clinical Practice. International Journal of Pharmacy and  Pharmaceutical Sciences 2014; 6 (6): 17–23. (12)    Khan I, Iqbal Z, Khan A, Hassan M, Nasir F, Raza A et al. A simple, rapid and sensitive RP-HPLC-UV method for the simultaneous determination of sorafenib and paclitaxel in plasma and pharmaceutical dosage forms: Application to pharmacokinetic study. J Chromatogr B Analyt Technol Biomed Life Sci., 2016;DOI: 10.1016/j.jchromb.2016.08.029. (13) Yonemoto H, Ogino S, Nakashima MN, Wada M, Nakashima K. Determination of Paclitaxel in Human and Rat Blood Samples after Administration of Low Dose Paclitaxel by HPLC-UV Detection. Biomedical Chromatography 2007; 21: 310-317. (14)https://www.gmp-compliance.org/guidelines/gmp-guideline/ich-q2r1-validation-of-analytical-procedures-text-and-methodology (Last accessed: October 28, 2017) (15) Bhaskar V. 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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411013EnglishN2018July10HealthcareWomen in Child Care and Early Education: Truly Nontraditional Work English1113Asha MenonEnglishThe field of child care and early childhood has been viewed historically as ‘women’s work’ and shares the typical characteristics of low compensation, limited requirements, incoherent career ladder, and high turnover. The connection between women and children, rooted in biology, the sociology of the family, and the historical perceptions of men and women, perpetuates the idea that the care and early education of children belong to women. Furthermore, the conventional wisdom that by and large women naturally love and want to do and are able to care not only for their own children, but all children. This view describes the root of a pervasive problem, not just for persons in the child care and early education field, but also for the nation as a whole. At a time when the number of women, including mothers with young children, entering the labor market is expanding rapidly, the need for child care and early education programs in centers and homes is also growing. It is time to examine in more detail the underlying assumptions about child care and education as women’s work and to emphasize the claim that such work is valuable, worthy and essential to the growth and development of children, to the health and stability of the family, and to the success and expansion of the nation’s economy. EnglishChild care, Traditional work, Nontraditional workIntroduction Child care and early education programs offer more than “child’s play”. The field serves multiple roles in the development of an expanded female work force and has a major impact on every segment of the society: children, parents, families, public/private schools, employers and governments at all levels. Child care and early education is needed for all children of all ages and categories and for various time periods ( Kaul, 1999). The level of quality of child care and early education is a serious concern, poor care is detrimental to children and quality care is expensive. Not only is it true that parents can’t work without child care and early education programs. Parents cannot work effectively if their children are not cared properly- absenteeism, tardiness, reliability and productivity are affected by a family’s child care and early education arrangements. The perception of women and children determines to a great extend the treatment received from the society at large, attitudes that tend to perpetuate the pattern of diminished value and limited opportunities for resource allocation. As long as the field of child care and early education is viewed as traditional women’s work, the characteristics of women’s work will apply: low salaries, scant benefits, limited access to training and high job turnover. Young women in urban India are working in ever larger numbers. Every 1 out of 4 women between the age of 20 and 34 years was working in 2016; compared to merely one in 10 seven years before, as per the latest data from India Human Development surveys (2017). This is a remarkable jump in employment. The single most critical factor that will enable young women to continue working is adequate, reliable and affordable childcare. There is strong evidence from other countries that government policies that support early education and childcare increase labor force participation of women and reduces gender gaps. Traditionally, grandparents have been the primary source of childcare in India. Increased labor mobility in recent years has resulted in young families moving away from their native places. The consequent loss of proximity to grandparents means a loss of childcare as well. Traditional and Non-traditional Work for Women Child care and early education is defined as traditional because 97% of child care and early educators are female; women are the mothers who have had the biological and historical responsibility for the basic care of children. However, child care and early education and family child care are burdened by the traditional / non-traditional dichotomy. Working with young children is often perceived as similar to mothering and something instinctive and enjoyable to women. This view is perpetuated by government, the broader community, and, sometimes, educators themselves. A society’s beliefs are grounded on basic beliefs about the characteristics of human nature and relationships. Some assumptions in child care and early education to be examined include: Women can naturally care for their children and the children of others and should do it with little or no remuneration. Even women who have little or no education and work experience, little orientation toward the future, limited resources in the home, no experience of training for working with children in groups who are not their children are presumed capable of working effectively in child care and early education programs. On the other hand, it is also believed by many that women on welfare are not interested in or capable of working in the child care and early education field. Like most assumptions, neither is completely true. Traditional jobs for women are viewed as negative: low compensation, limited advancement and high turnover. Traditional women’s work with its many restrictions and limitations would require no pre-service and in-service training and education; there would be no reason to improve oneself if there is nowhere to go. Non-traditional jobs for women are viewed as positive: higher compensation (salary and benefits), advancement opportunities (career ladder), and low turnover based on commitment and job satisfaction. Therefore pre-service and in-service training for the work is important and necessary. Women and the work they do are based on societal, familial, professional and personal assumptions. Women, especially poor women and mothers are silently expected to be dependent on a male, father or husband. Related characteristics-Work is characterized by belief in the need to improve and expand commitment to efficacy and effectiveness, reliability, stability, business abilities, and to continued growth through reading and reflecting, workshops and conferences, courses and degree programs. In the Indian context the role of women in the development of the childcare and early education field has been frequently invisible or minimized. Although the field was and is dominated by women, in the earliest days the founders and leaders were mostly men.  Child care and early education has developed into a complex field in which multiple groups become interrelated over time in terms of long days and extended years (OECD 2009). With growing urbanization and increase in women’s participation in the work force across the country among all socio-economic groups, there has been a sea change in social structures and practices in the last few decades (Swaminathan, 1993). A significant indicator of this change has been the emergence of the nuclear family, a change which has converted child rearing from what was traditionally a shared responsibility into the sole responsibility of the young parents. This responsibility is often further delegated. While in the higher income brackets children are often left with paid surrogate care givers, in the lower socioeconomic communities the responsibility of care giving get loaded on to the older sisters, thus keeping them often out of school and robbing them of their childhood. As a result, given the constant pressures and challenges of day -to day- existence in today’s complex society, the possibilities of “informal early care and education’ for the young child at home is becoming less of a reality. It was this changing social context, over the years, which laid the seeds for the introduction of the concept of Early Child hood Care and Education (ECCE) in our country. Barriers inherent in professional roles for women A women’s well-being directly affects her family’s and nation’s health, productivity and stability in many ways. But often women receive little care and support, control few resources and at the same time shoulder multiple burdens and suffer many kinds of discrimination.  The women who work in non-traditional jobs must rely on women in traditional jobs, i.e., child care.  Non-traditional jobs require preparation and training and commitment to work in order to remain competitive and eligible for promotions. Barriers inherent in professional roles for women are as follows: Social/Cultural: Women are socialized for limited work levels, often have unsupportive family and friends, feel the negative attitudes of coworkers, lack self confidence and assertiveness, have limited experience with tools and mechanical operations. Education and Training: Women often have limitations about getting an appropriate education, knowing about advancement techniques, having support services (child care is always seen as a support service for working mothers). Paraphrasing Pogo: We have seen the enemy and it is us. That is, women themselves sell themselves short, do not protest low wages and limited or no benefits, do not clamor and work for better conditions, do not make every effort to get additional experience, education and exposure to professional colleagues (mentor, teachers, etc) Conclusions As long as childcare and early education is perceived as a traditional field for women, some women will be restricted in or prevented from entering the field. The paradigm shift from traditional to nontraditional is difficult, even for women themselves. The resistance to, even the refusal to, change is largely because of the need to change attitudes towards power, control, comfort levels, taking risks and being liked, valued and cared for over against being disliked, devalued and abandoned or ignored. More needs to be done; we need to become advocates for providing opportunities for women’s full economic, political, professional and personal development. Pay special attention to policies affecting women in general and low-income women in particular. Address multiple issues pertaining to the rights of all women’s work and children’s play. Explore one’s own perceptions and expectations about work and about women’s work. There is a need to identify and align with organizations that promote the well-being and self sufficiency of all citizens, including women and children. We also need to contribute resources, energy, and skills to women work and children’s play. Englishhttp://ijcrr.com/abstract.php?article_id=2502http://ijcrr.com/article_html.php?did=2502 Department of Women and Child Development (2016). Annual Report Kaul, V (1999). Early Childhood Care and Education in the Context of EFA. Paper Prepared for the Government of India. Education for All: The Year 2000 Assessment Report. New Delhi. Menon-Sen, K., Shiva Kumar, A. K. (2001). Women in India: How free? How equal? New Delhi, India: United Nations Development Assistance Framework. Swaminathan. M (1993). Current Issues in Early Childhood Care and Education . In T.S.Saraswati and Kaur.B(Eds) Human Development and Family Studies in India. An Agenda for Research and Policy. New Delhi.Sage Publications. OECD (2009), Promoting pro-poor growth: Employment, OECD Publishing, Paris. UNESCO (2012). Gender?sensitivity: a training manual for sensitizing educational managers, curriculum and material developers and media professionals to gender concerns.