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   2012| April-June  | Volume 37 | Issue 2  
    Online since May 12, 2012

 
 
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ORIGINAL ARTICLES
A study to evaluate the effect of nutritional intervention measures on admitted children in selected nutrition rehabilitation centers of Indore and Ujjain divisions of the state of Madhya Pradesh (India)
Gunjan Taneja, Sanjay Dixit, AK Khatri, Veena Yesikar, Deepa Raghunath, Sanjay Chourasiya
April-June 2012, 37(2):107-115
DOI:10.4103/0970-0218.96096  PMID:22654284
Backgound: The state of Madhya Pradesh has 1.3 million severely malnourished children. Nutrition rehabilitation centers (NRCs) were started in the state to control severe malnutrition and decrease the prevalence of severe malnourished children to less than 1% among children aged 1-5 years. Materials and Methods: The present study was conducted from November 2008 to October 2009; 100 children admitted to seven different NRCs in Indore and Ujjain divisions of Madhya Pradesh were observed during their stay at NRCs and the follow-up period to analyze the effect of interventional measures on select anthropometric indicators. Mothers of the children were interviewed on health issues and therapeutic feeding practices at the NRCs using a predesigned and pretested interview schedule. Results: The study group consisted of 48 boys and 52 girls; 60% were between 13 and 36 months of age. 93 children were analyzed for anthropometric indicators following a dropout rate of 7%. A statistically significant difference was obtained between the weight of children at admission and discharge (t=14.552, P<0.001); difference of mid upper arm circumference (MUAC) at admission and discharge was statistically significant (t=9.548, P<0.001). The average weight gain during the stay at the centers was 9.25 ± 5.89 g/kg/day. Though the number of severe malnourished children decreased from 85 to 43 following the stay at NRCs (χ2 = 44.195, P<0.001); 48.78% of the children lost weight within 15 days of discharge from the NRCs. Dropout rates of 9.89%, 23.07%, 42.65%, and 61.76% for the study group were obtained during the follow-up period of 6 months for the four follow-up visits conducted 15 days, 1, 3, and 6 months after discharge. The mothers of the children lacked adequate information on health issues and composition and preparation of therapeutic diets at the centers. Conclusion: The NRCs were effective in improving the condition of admitted children, but the effects were not sustained following discharge due to high drop-out rate and lack of adequate parental awareness. There is an urgent need to link these centers with community-based models for follow-up and improve health education measures to maintain the gains achieved.
  10,281 733 25
An epidemiological study of mental disorders at Pune, Maharashtra
Balbir S Deswal, A Pawar
April-June 2012, 37(2):116-121
DOI:10.4103/0970-0218.96097  PMID:22654285
Background: The WHO Global Burden of Disease study estimates that mental and addictive disorders are among the most burdensome in the world, and their burden will increase over the next decades. The mental and behavioral disorders account for about 12% of the global burden of disease. However, these estimates and projections are based largely on literature review rather than cross-national epidemiological surveys. In India, little is known about the extent, severity and unmet need of treatment mental disorders. Thus, there was a need to carry out rigorously implemented general population surveys that estimate the prevalence of mental disorders among urban population at Pune, Maharashtra. The study attempted to address unmet need and to form a basis for formulating the mental health need of the community. Objective: The study was undertaken to estimate the lifetime prevalence and 12 month prevalence of specific mental disorders in urban population, socio-demographic correlates of mental disorders and to assess the service utilization in individuals with mental disorders. Materials and Methods: The study was undertaken among adults aged 18 years and above living in house hold and in geographical area of Pune , Maharashtra. A minimum sample of 3000 completed interviews was planned using representative probabilities to population size (PPS) sampling method which ensured equal probability for every eligible member. Data listing was obtained from Census Office from recent census of 2001 data. The face to face interviews were undertaken in homes using fully structured interview schedule of World Mental Health Survey Initiative duly revised Version of WHO- Composite International Diagnostic Interview (CIDI 3.0) by trained investigators. Clinical reappraisal was carried out using Schedules for Clinical Assessment in Neuropsychiatry (SCAN) among ten percent of diagnosed cases selected randomly. Data were entered into DDE (Blaize Software) and analyzed using SPSS software package. Results: Overall lifetime prevalence of mental disorders was found to be 5.03%.Rates among males (5.30%) were higher as compared to females (4.73%). Among the diagnostic group , depression(3.14%) was most prevalent followed by substance use disorder (1.39%) and panic disorder (0.86%). Overall 12 month prevalence of mental disorder was found to be 3.18% which was 3.47% among males and 2.85% among females. Prevalence of depression (1.75%) was the most 12-month mental disorder, followed by substance use mental disorder (0.99%) and panic disorder (0.69%).Lifetime and twelve month prevalence of any mental disorder was the highest among employed group, followed by home makers and depression was more among married, followed by separated/divorced/widowed group and the least in unmarried group in the study. Treatment gap due to low prescription received indicated the most of the ill person did not acknowledge their need for treatment or do not received the appropriate care. Conclusion: The figure of 5.03% prevalence of diagnosable psychiatric disorders in adult population points to the great need to increase the prevention strategies both at primary and secondary level to overcome the disability and economic loss to society due to mental disorders.
  6,680 696 6
SHORT COMMUNICATIONS
Factors affecting the performance of undergraduate medical students: A perspective
Ananya Mandal, Arijit Ghosh, Gairik Sengupta, Tapas Bera, Nina Das, Subir Mukherjee
April-June 2012, 37(2):126-129
DOI:10.4103/0970-0218.96104  PMID:22654287
Context: Performance of medical students in developing nations like India is perceived to have largely declined. Aims: We attempted to assess the reasons behind such trends. Settings and Design: Students in their third year of medical study were given a predesigned, pretested structured and validated questionnaire that they filled in anonymously. The key areas assessed were concentration, interest and understanding of the subject and other perceived causes of poor performance. Tests for descriptive statistics were applied for evaluation. Results and Conclusions: One hundred and fifty students participated in the study. Fifty-five (36.66%) students performed poorly. Male gender, inability to clear the previous professional examination at the first attempt, difficulty in understanding medium of instruction, self-assessed depression, sleep disorders and perceived parental and peer pressure and dissatisfaction with career choice were significantly linked with poor performance (P<0.05 for each factor). Socioeconomic status and regularity in class were not linked to academic performance.
  5,326 546 13
ORIGINAL ARTICLES
Alcohol Use and STI among men in India: Evidences from a national household survey
Arvind Pandey, Ram Manohar Mishra, Dandu CS Reddy, Mariamma Thomas, Damodar Sahu, Deepak Bharadwaj
April-June 2012, 37(2):95-100
DOI:10.4103/0970-0218.96094  PMID:22654282
Background: Alcohol use has been found to correlate with risky sexual behavior as well as with sexually transmitted infections (STI) among populations with high-risk behavior in India. Objective: To examine the correlates of alcohol use and its association with STI among adult men in India. Materials and Methods: Data from a national representative large-scale household sample survey in the country were used. It included information on sociodemographic characteristics and alcohol use as a part of substance use. Clinical as well laboratory testing was done to ascertain the STI. Results: The overall STI prevalence among adult males was found to be 2.5% (95% confidence interval (CI): 1.9-3.1). Over 26% adult men were found to have been using alcohol in the study population. It was higher among men who were illiterate and unskilled industrial workers/drivers. The men who consumed alcohol had higher prevalence of STI (3.6%; 95% CI: 2.9-5.1) than those who did not consume alcohol (2.1%; 95% CI: 1.5-2.6). The degree of association between alcoholism and STI was slightly reduced after adjusting for various sociodemographic characteristics (adjusted odds ratio: 1.5; 95% CI: 0.9-2.3; P=0.06). Conclusions: The findings of present study suggest integrating alcohol risk reduction into STI/HIV prevention programmes.
  4,545 407 2
LETTERS TO EDITOR
The current seroprevalence of Hepatitis C virus in a Tertiary Care Centre in Vellore, Tamil Nadu
V Gowri, C Chandraleka, R Vanaja
April-June 2012, 37(2):137-137
DOI:10.4103/0970-0218.96110  PMID:22654292
  4,636 238 4
ORIGINAL ARTICLES
Estimating the burden of disease from unsafe injections in India: A cost-benefit assessment of the auto-disable syringe in a country with low blood-borne virus prevalence
Savanna Reid
April-June 2012, 37(2):89-94
DOI:10.4103/0970-0218.96093  PMID:22654281
Background: Unsafe medical injections are a prevalent risk factor for viral hepatitis and HIV in India. Objectives: This review undertakes a cost-benefit assessment of the auto-disable syringe, now being introduced to prevent the spread of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV). Materials and Methods: The World Health Organization methods for modeling the global burden of disease from unsafe medical injections are reproduced, correcting for the concentrated structure of the HIV epidemic in India. A systematic review of risk factor analyses in India that investigate injection risks is used in the uncertainty analysis. Results: The median population attributable fraction for hepatitis B carriage associated with recent injections is 46%, the median fraction of hepatitis C infections attributed to unsafe medical injections is 38%, and the median fraction of incident HIV infections attributed to medical injections is 12% in India. The modeled incidence of blood-borne viruses suggests that introducing the auto-disable syringe will impose an incremental cost of $46-48 per disability adjusted life year (DALY) averted. The epidemiological evidence suggests that the incremental cost of introducing the auto-disable syringe for all medical injections is between $39 and $79 per DALY averted. Conclusions: The auto-disable syringe is a cost-effective alternative to the reuse of syringes in a country with low prevalence of blood-borne viruses.
  4,434 421 17
Mass drug administration coverage evaluation survey for lymphatic Filariasis in Bagalkot and Gulbarga districts
Prakash Kurubarahalli Patel
April-June 2012, 37(2):101-106
DOI:10.4103/0970-0218.96095  PMID:22654283
Background: Lymphatic filariasis (LF) is endemic in 83 countries and territories, with more than a billion people at risk of infection. In view with the global elimination, mass drug administration (MDA) with single dose of diethylcarbamazine and albendazole tablets was carried out for the eligible population in Bagalkot and Gulbarga districts. Objective: Assess coverage of MDA against LF in Bagalkot and Gulbarga districts. Materials and Methods: In this cross-sectional coverage evaluation survey, one urban and three rural clusters were selected randomly in each district. The data were collected in a pretested performa, computed and analyzed using SPSS-10 to calculate frequencies and proportions. Results: A total of eight clusters in two districts resulted in a total study population of 1,228 individuals. The overall compliance rate in Bagalkot district was 78.6% and in Gulbarga district it was only 38.8%. The prime reason for noncompliance was fear of side effects and not received tablets. Conclusion: There is an urgent need for more effective drug delivery strategies to improve the compliance in both the districts.
  4,271 425 9
DHANVANTARI ORATION - 2012
Nexus of poverty, energy balance and health
CP Mishra
April-June 2012, 37(2):71-78
DOI:10.4103/0970-0218.96083  PMID:22654278
Since the inception of planning process in India, health planning was an integral component of socio-economic planning. Recommendations of several committees, policy documents and Millennium development goals were instrumental in development of impressive health infrastructure. Several anti-poverty and employment generation programmes were instituted to remove poverty. Spectacular achievements took place in terms of maternal and child health indicators and expectancy of life at birth. However, communicable diseases and undernutrition remain cause of serious concern and non-communicable diseases are imposing unprecedented challenge to planners and policy makers. Estimates of poverty based on different criteria point that it has remained a sustained problem in the country and emphasizes on revisiting anti-poverty programmes, economic policies and social reforms. Poverty affects purchasing power and thereby, food consumption. Energy intake data has inherent limitations. It must be assessed in terms of energy expenditure. Energy balance has been least explored area of research. The studies conducted in three different representative population group of Eastern Uttar Pradesh revealed that 69.63% rural adolescent girls (10-19 years), 79.9% rural reproductive age group females and 62.3% rural geriatric subjects were in negative energy balance. Negative energy balance was significantly less in adolescent girls belonging to high SES (51.37%), having main occupation of family as business (55.3%), and highest per capita income group (57.1%) with respect to their corresponding sub-categories. In case of rural reproductive age groups, this was maximum (93.0%) in SC/ST category and least (65.7%) in upper caste group. In case of geriatric group, higher adjusted Odd's Ratio for negative energy balance for subjects not cared by family members (AOR 23.43, CI 3.93-139.56), not kept money (AOR 5.27, CI 1.58-17.56), belonging to lower and upper middle SES by Udai Pareekh Classification (AOR 3.73, CI 1.22-11.41), with lowest per capita income (AOR 15.14, CI 2.44-94.14) and in age group >80 years (AOR 5.76, CI 1.03-32.39). Of those in negative energy balance, 70.21% rural adolescent girls and 7 out of 10 geriatric subjects (activity based) were victims of CED. Extent of undernutrition and CED in rural reproductive age group females were more in those caste groups where energy deficit was also of higher magnitude. Energy balance must be visualized giving due consideration to the importance of exercise on human health. The evidence thus generated needs to be translated to the masses based on principles of translational research.
  4,288 313 8
CME
Protein conjugate polysaccharide vaccines: Challenges in development and global implementation
Manisha Nair
April-June 2012, 37(2):79-82
DOI:10.4103/0970-0218.96085  PMID:22654279
Pneumonia and meningitis caused by Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis are among the leading causes of under five mortality and morbidity. Polysaccharide vaccines to prevent these infections are available since 1980s, but these are not effective in infants and children who are the common targets; therefore, protein conjugated were developed. The aim of this article is to understand the need for peumococcal protein conjugate vaccines, the challenges related to their development and global implementation, and the impact of these vaccines on global child health. Challenges in development of new vaccines are as follows:
  1. While pneumonia is a major threat in developing countries, available vaccine 7-valent pneumococcal conjugate vaccine (PCV7) protects against only 30% of invasive disease.
  2. Serogroup B of Neisseria meningitidis causes 32% of the cases in the USA and 45-80% or more in Europe. Due to similarity of its capsular polysaccharide with the cell surface glycoprotein on fetal brain tissue, developing a vaccine against this bacterium remains a challenge.
Challenges in implementation are as follows:
  1. Replacement by nonvaccine serotypes;
  2. capsule switching;
  3. time duration of the antibody protective effect following vaccination;
  4. costs of the vaccines, programme costs, lack of knowledge of the disease burden, and targeting population groups for vaccination.
  3,906 290 8
ORIGINAL ARTICLES
Impact of policy initiatives on civil registration system in Haryana
Pravin Kumar Singh, Manmeet Kaur, Nidhi Jaswal, Rajesh Kumar
April-June 2012, 37(2):122-125
DOI:10.4103/0970-0218.96100  PMID:22654286
Background: Despite the existence of Registration of Birth and Death Act (1969), Civil Registration System (CRS) in India registered only 68.3% of the births and 63.2% of the deaths. Hence, National Population Policy (2000) emphasized the need to improve registration of vital events. In 2005, Haryana initiated policy changes to enhance registration of vital events. We evaluated the impact of these policy changes on CRS in 2009. Materials and Methods: Records and reports of CRS were reviewed. On the basis of the birth and deaths reported by the Sample Registration System, the proportion of births and deaths registered by CRS were estimated using the projected population from 2001 Census. Results: Before 2005, Police Stations were the registration centers in rural Haryana. On 1 st January 2005, the birth and death registration was made the responsibility of Primary Health Centers (PHCs). Medical Officers at PHCs were designated as Registrar and Pharmacists as Sub-Registrar of Births and Deaths. Auxiliary Nurse Midwife and Anganwadi Workers facilitated the registration. Till 2004, the registration of births was stagnant at the level of 70% for several years, which increased to 95% by 2009. Similarly registration of death events increased from 73.5% to 92.1%. Conclusion: Haryana state is still to achieve complete registration of births and deaths, but certainly shift of registration from police to health department has strengthened the CRS.
  3,938 198 9
VIEW POINT
Institutionalization of the NACP and Way Ahead
AM Kadri, Pradeep Kumar
April-June 2012, 37(2):83-88
DOI:10.4103/0970-0218.96088  PMID:22654280
In India, HIV prevention and control activities started way before the reporting of the first case of HIV infection. On reporting of evidences of HIV infection from different parts of the country and varied groups, Government launched the National AIDS Control Program (NACP). The program was launched on the foundation of early interventions and Mid-Term Plan, which evolved in three phases over the period of eighteen years. With progression of time, epidemiological situation changed and knowledge/capacity to tackle HIV improved. In the course of the evolution, NACP has moved from the centrally controlled program to district driven. Also different strategies were inducted/refined and many important institutes like Task Force, a high-powered National AIDS Committee, National AIDS Control Board, National AIDS Control Organization, State AIDS Control Societies, Project Support Units/Project Management Units, National Council on AIDS, Department of AIDS Control, Technical Support Unit, District AIDS Prevention and Control Unit (DAPCU) were created. Currently program is implemented vertically with good impetus and is able to contain the spread of HIV in India. For enhancing the effectiveness and sustainability, future of the NACP is strongly linked with the well-performing DAPCU and good synergy/integration with General Health System. HIV/AIDS epidemic in India has entered into the third decade. Evidences show that this epidemic in India is of concentrated type and characterized by the heterogeneity, following the type 4 pattern, where the epidemic shifts from the most vulnerable populations [such as female sex workers, men who have sex with men, injecting drug users to bridge populations (clients of sex workers, sexually transmitted infection patients, partners of drug users, long route truck drivers, short stay cyclical single male migrants], then to the general population and from urban centers to rural areas (ruralization of epidemic) with increasing involvement of youth and women (feminization of epidemic).
  3,458 244 1
EDITORIAL
Universal access to health care for all: Exploring road map
Dinesh Agarwal
April-June 2012, 37(2):69-70
DOI:10.4103/0970-0218.96081  PMID:22654277
  2,771 430 4
SHORT COMMUNICATIONS
Perceptions of medical students about their educational environment in community medicine in a medical college of coastal Karnataka
B Unnikrishnan, T Rekha, P Prasanna Mithra, Nithin Kumar, B Reshmi
April-June 2012, 37(2):130-132
DOI:10.4103/0970-0218.96106  PMID:22654288
  2,461 359 5
LETTERS TO EDITOR
Association of adiposity with pulse pressure amongst Gujarati Indian adolescents
Sreedhar Krishna
April-June 2012, 37(2):133-134
DOI:10.4103/0970-0218.96107  PMID:22654289
  2,103 139 -
H1N1 newer vaccine usage: Experiences from Karnataka state
V Narayana Holla, Sagar Borker
April-June 2012, 37(2):134-136
DOI:10.4103/0970-0218.96108  PMID:22654290
  2,075 160 2
Different routes of administration of cell culture rabies vaccines
Sanjeev M Chaudhary
April-June 2012, 37(2):136-136
DOI:10.4103/0970-0218.96109  PMID:22654291
  1,895 182 -
OBITUARY
Rest in Peace, Friend

April-June 2012, 37(2):138-138
  1,371 105 -
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  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007