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   2015| October-December  | Volume 40 | Issue 4  
    Online since September 3, 2015

 
 
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ORIGINAL ARTICLES
Evaluation of the universal immunization program and challenges in coverage of migrant children in Haridwar, Uttarakhand, India
Latika Nath, Prabhdeep Kaur, Saurabh Tripathi
October-December 2015, 40(4):239-245
DOI:10.4103/0970-0218.164389  PMID:26435596
Background: Studies show that immunization among migrant children is poor. India has a dropout rate of 17.7% between Bacillus Calmette-Guιrin (BCG) and measles (District Level Household Survey (DLHS)-3). Haridwar district had the highest dropout rate of 27.4% from BCG to diphtheria, pertussis, and tetanus (DPT) 3 (DLHS-3) in Uttarakhand. We evaluated the Universal Immunization Programme (UIP) among migrants in Haridwar in two blocks. Materials and Methods: We developed input, process, and output indicators on infrastructure, human resources, and service delivery. A facility, session site and cross-sectional survey of 180 children were done and proportions for various indicators were estimated. We determined factors associated with not taking vaccination using multivariate analysis. Results: We surveyed 11 cold chain centers, 25 subcenters, 14 sessions, and interviewed 180 mothers. Dropouts were supposed to be tracked using vaccination card counterfoils and tracking registers. The dropout rate from BCG to DPT3 was 30%. Lack of knowledge (adjusted odds ratio (AOR) 6.6,95% confidence interval (CI) 2.6-16.7), mother not being decision maker (AOR 4.0,95%CI 1.7-9.2), lack of contact by Accredited Social Health Activist (ASHA; AOR 3.0,95%CI 1.1-7.7), not being given four post-vaccination messages (AOR 7.7, 95% CI 2.9-20.2), and longer duration of stay in Haridwar (AOR 3.0 95% 1.9-7.6) were risk factors for nonimmunization. The reasons stated by mothers included lack of awareness of session site location (67%) and belief that child should only be vaccinated in their resident district (43%). Conclusions: There was low immunization coverage among migrants within adequate supervision, poor cold chain maintenance, and improper tracking of dropouts. Mobile immunization teams, prelisting of migrant children, and change in incentives of ASHAs for child tracking were needed. A monitoring plan for sessions and cold chain needed enforcement.
  6,429 722 10
SHORT COMMUNICATIONS
Hypertension in pregnancy: A community-based study
Bharti Mehta, Vijay Kumar, Sumit Chawla, Sandeep Sachdeva, Debjyoti Mahopatra
October-December 2015, 40(4):273-278
DOI:10.4103/0970-0218.164403  PMID:26435602
Background: Hypertensive disorders during pregnancy occur in women with preexisting primary or secondary chronic hypertension, and in women who develop new-onset hypertension in the second half of pregnancy. The present study was undertaken to study the prevalence and correlates of hypertension in pregnancy in a rural block of Haryana. Materials and Methods: This cross-sectional study was carried out in the all 20 subcenters under Community Health Center (CHC) Chiri, Block Lakhanmajra. All the pregnant women registered at the particular subcenter at a point of time of visit were included in the study. Appropriate statistical tests were used for analysis. Results: A total of 931 pregnant women were included in the present study. Prevalence of hypertension in pregnancy was found to be 6.9%. Maternal age ΃25 years, gestational period ͳ20 weeks, history of cesarean section, history of preterm delivery, and history of hypertension in previous pregnancy were found to be significantly associated with prevalence of hypertension in pregnancy. Conclusion: Nearly one in 14 pregnant women in rural areas of Haryana suffers from a hypertensive disorder of pregnancy. Early diagnosis and treatment through regular antenatal checkup is a key factor to prevent hypertensive disorders of pregnancy and its complications.
  6,322 692 13
CME
Essential medicines: An Indian perspective
Rituparna Maiti, Vikas Bhatia, Biswa Mohan Padhy, Debasish Hota
October-December 2015, 40(4):223-232
DOI:10.4103/0970-0218.164382  PMID:26435594
The concept of defining essential medicines and establishing a list of them was aimed to improve the availability of affordable medicines for the world's poor. Access to essential medicines is a major determinant of health outcomes. Several countries have made substantial progress towards increasing access to essential medicines, but access to essential medicines in developing countries like India is not adequate. In this review we have tried to present the Indian scenario in respect to availability and accessibility of essential medicines over last one decade. To enhance the credibility of Indian healthcare system, procurement and delivery systems of essential medicines have to be strengthened through government commitment, careful selection, adequate public sector financing, efficient distribution systems, control on taxes and duties, and inculcating a culture of rational use of medicines in current and future prescribers.
  5,447 645 15
DHANWANTRI ORATION
Right to health: Challenges and opportunities
Rajesh Kumar
October-December 2015, 40(4):218-222
DOI:10.4103/0970-0218.164379  PMID:26435593
  4,546 491 3
ORIGINAL ARTICLES
An epidemiological study of child marriages in a rural community of Gujarat
Yogita P Pandya, Dinesh J Bhanderi
October-December 2015, 40(4):246-251
DOI:10.4103/0970-0218.164392  PMID:26435597
Context: India has the maximum number of child marriages (CMs; < 18 years) because of the size of its population, and in 47% of all marriages the bride is a child. Children who are married at young age are exposed to multiple risks pertaining to their physical, mental, and social health. Aims: (i) To estimate the prevalence of CM in rural population. (ii) To study the determinants and health effects of CM. (iii) To assess the awareness among the married women regarding the health implications of CM. Settings and Design: Community-based cross-sectional study conducted in Ardi village of Anand district. Materials and Methods: All the married women of the village were surveyed to find out the prevalence of CM. For collection of other relevant information, only those women having a married life of less than 10years were interviewed using semicoded and pretested questionnaire. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) 17.0 software. Statistical Analysis Used: Proportions, ratios, χ2 test, and Fisher's exact test. Results: The prevalence of CM was found to be 71.5%. Caste and spouse's education were revealed as important determinants for CM. CM was found to be significantly associated with mother's age at birth of first child, delayed antenatal care (ANC), spontaneous abortion, preterm delivery, low birth weight (LBW), health problems in new born baby, faulty feeding practices, lack of knowledge regarding family welfare methods, and health implications of CM. Conclusion: Exceptionally high prevalence of CM in rural community and its serious health consequences warrant stricter enforcement of legislation, better educational opportunities for girls, and easy access to quality health services.
  4,523 480 6
EDITORIAL COMMENTARY
Vitamin D deficiency: Is the pandemic for real?
Dheeraj Shah, Piyush Gupta
October-December 2015, 40(4):215-217
DOI:10.4103/0970-0218.164378  PMID:26435592
  4,266 541 9
SHORT COMMUNICATIONS
Prevalence and risk factors of abuse among community dwelling elderly of Guwahati City, Assam
Anku Moni Saikia, Neelakshi Mahanta, Ajaya Mahanta, Ashok Jyoti Deka, Arupjyoti Kakati
October-December 2015, 40(4):279-281
DOI:10.4103/0970-0218.164406  PMID:26435603
Background: In spite of tremendous impact on health, elder abuse is still an underreported and unrecognized issue. Objectives: To assess the prevalence of abuse among community dwelling elderly and to identify the various risk factors. Materials and Methods: This community-based cross-sectional study was conducted in 10 randomly selected wards of Guwahati city. A total of 331 elderly (60 years and above) were interviewed. Abuse was screened by Hwalek-Sengstock Elder Abuse Screening Test (H-S EAST). Results: The study revealed 9.31% prevalence. Neglect was the most common type of abuse reported. Age, sex, socioeconomic status, living status, and functional status were found to be significantly associated with abuse. Conclusion: Abuse is prevalent among elderly population.
  3,327 334 7
ORIGINAL ARTICLES
A comparative evaluation of public health centers with private health training centers on primary healthcare parameters in India: a study by data envelopment analysis technique
Sanjeev Davey, Santosh Kumar Raghav, Jai Vir Singh, Anuradha Davey, Nirankar Singh
October-December 2015, 40(4):252-257
DOI:10.4103/0970-0218.164394  PMID:26435598
Background: The evaluation of primary healthcare services provided by health training centers of a private medical college has not been studied in comparison with government health facilities in Indian context. Data envelopment analysis (DEA) is one such technique of operations research, which can be used on health facilities for identifying efficient operating practices and strategies for relatively efficient or inefficient health centers by calculating their efficiency scores. Materials and Methods: This study was carried out by DEA technique by using basic radial models (constant ratio to scale (CRS)) in linear programming via DEAOS free online Software among four decision making units (DMUs; by comparing efficiency of two private health centers of a private medical college of India with two public health centers) in district Muzaffarnagar of state Uttar Pradesh. The input and output records of all these health facilities (two from private and two from Government); for 6 months duration from 1 st Jan 2014 to 1 st July 2014 was taken for deciding their efficiency scores. Results: The efficiency scores of primary healthcare services in presence of doctors (100 vs 30%) and presence of health staff (100 vs 92%) were significantly better from government health facilities as compared to private health facilities (P < 0.0001). Conclusions: The evaluation of primary healthcare services delivery by DEA technique reveals that the government health facilities group were more efficient in delivery of primary healthcare services as compared to private training health facilities group, which can be further clarified in by more in-depth studies in future.
  3,191 420 4
Three sides of a coin in the life of people living with HIV (PLWH)
Deepika Cecil Khakha, Bimla Kapoor, Manju , Singh K Sharma
October-December 2015, 40(4):233-238
DOI:10.4103/0970-0218.164385  PMID:26435595
Background: Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is a global epidemic, a major challenge as a health care problem of modern times. As the survival of life increases from the time of an HIV-positive diagnosis, growing concern for the quality of the life has been extended. Objectives: To assess and correlate the coping, social support and quality of life. Materials and Methods: A descriptive cross-sectional study was conducted at antiretroviral therapy (ART) clinic of AIIMS, New Delhi. The sample comprised people living with HIV/AIDS (PLWHA) who were seropositive for last six months. The tools used to assess the coping, social support and quality of life were BREF COPE, MOS social support survey and WHO QOL-HIV BREF, respectively. Permission was taken from the authors of the tools. The ethical permission was taken from the center. The coping, social support and quality of life were assessed and their association was observed. Data were analyzed using SPSS 17. Results: The most commonly used coping styles were acceptance and religion. The social support used by most of PLWHA was tangible support and affectionate support, while the least used support was positive social interaction. The lowest quality of life is seen in social relations, followed by physical quality of life. There was positive association seen between coping and quality of life as well as social support and quality of life. Conclusion: There was positive association between coping, social support and quality of life.
  3,071 370 1
Risk factors and hospitalization costs of Dementia patients: Examining race and gender variations
Baqar Husaini, Aashrai S V Gudlavalleti, Van Cain, Robert Levine, Majaz Moonis
October-December 2015, 40(4):258-263
DOI:10.4103/0970-0218.164396  PMID:26435599
Aims: To examine the variation in risk factors and hospitalization costs among four elderly dementia cohorts by race and gender. Materials and Methods: The 2008 Tennessee Hospital Discharged database was examined. The prevalence, risk factors and cost of inpatient care of dementia were examined for individuals aged 65 years and above, across the four race gender cohorts - white males (WM), black males (BM), white females (WF), and black females (BF). Results: 3.6% of patients hospitalized in 2008 had dementia. Dementia was higher among females than males, and higher among blacks than whites. Further, BF had higher prevalence of dementia than WF; similarly, BM had a higher prevalence of dementia than WM. Overall, six risk factors were associated with dementia for the entire sample including HTN, DM, CKD, CHF, COPD, and stroke. These risk factors varied slightly in predicting dementia by race and gender. Hospital costs were 14% higher among dementia patients compared to non-dementia patients. Conclusions: There exist significant race and gender disparities in prevalence of dementia. A greater degree of co-morbidity, increased duration of hospital stay, and more frequent hospitalizations, may result in a higher cost of inpatient dementia care. Aggressive management of risk factors may subsequently reduce stroke and cost of dementia care, especially in the black population. Race and gender dependent milestones for management of these risk factors should be considered.
  2,775 285 5
Sociodemographic parameters of Esophageal Cancer in northwest India: A regional cancer center experience of 10 years
Akhil Kapoor, Vanita Kumar, Mukesh Kumar Singhal, Raj Kumar Nirban, Surender Kumar Beniwal, Harvindra Singh Kumar
October-December 2015, 40(4):264-267
DOI:10.4103/0970-0218.164399  PMID:26435600
Background: Despite various advances in the treatment of Esophageal Cancer (EC), being one of the least responsive tumors to cancer therapy, the overall prognosis remains poor. Therefore, it is significant to understand various sociodemographic factors associated with EC to find out various schemes for primary prevention of the disease. Materials and Methods: This is a retrospective analysis of medical records of the EC patients registered in the regional cancer center of northwest India from January 2003 to December 2012. The site of the disease and the histology were also recorded in addition to the various sociodemographic parameters. Results: Out of 55,742 patients registered in our hospital; 3,667 were diagnosed to have EC. Male:female ratio was 1.15:1. The mean age was 54.6 ± 11.74 years; 66.15% of the patients were illiterate and 48.6% belonged to the low socioeconomic status. Smoking and alcohol consumption were identified as risk factors in 48 and 25.6% of the patients, respectively. Conclusions: The etiology in majority of the patients is linked to tobacco and alcohol, thus, modification of life style with limiting the use of addictions may be an effective strategy in the prevention of this dreaded and mostly incurable disease.
  2,562 306 4
SHORT COMMUNICATIONS
Are we underestimating the real burden of malnutrition? An experience from community-based study
Disha Agarwal, Sunil Kumar Misra, Shailendra Singh Chaudhary, Gyan Prakash
October-December 2015, 40(4):268-272
DOI:10.4103/0970-0218.164401  PMID:26435601
Background: Since the inception of childhood nutritional programs in India, underweight has been taken to judge the nutritional status of children; but is it a true indicator of overall prevalence of malnutrition in a community? Objective: To estimate the overall prevalence of malnutrition by using Composite Index of Anthropometric Failure (CIAF) and to assess its usefulness over various conventional anthropometric indicators among under 5 children residing in Agra city. Materials and Methods: A cross-sectional, community-based study was conducted among under 5 years age children, from June 2012 to July 2013 in an urban slum of Agra. Nutritional status was assessed using anthropometry and clinical examination, and classified as per World Health Organization (WHO) 2006 Growth Standards and CIAF. Results: Of the 458 children studied, 42.8% were underweight, 41.9% had stunting, while 22.7% had wasting. However, 60.04% of children were found to be malnourished as per the CIAF. Unlike three conventional anthropometric indicators of malnutrition, CIAF was observed to have a much consistent association with morbidity like diarrhea episodes in past 3 months (odds ratio (OR) = 2.09), acute respiratory tract infection (ARI) episode in past 3 months (OR = 1.58), and any illness requiring hospitalization (OR = 1.29). Conclusion: The CIAF should supplement the conventional indices of malnourishment, to provide a single, aggregated figure of actual number of undernourished children in a given population.
  2,529 334 10
LETTERS TO EDITOR
An outbreak of cholera due to contaminated water, Medak District, Andhra Pradesh, India, 2013
Ramesh R Allam, Chengappa K Uthappa, Chava Nalini, Prasada R Udaragudi, Geetha P Tadi, Manoj V Murhekar
October-December 2015, 40(4):283-285
DOI:10.4103/0970-0218.164408  PMID:26435605
  2,309 238 6
Health issues among call center employees
Sim Sai Tin, Viroj Wiwanitkit
October-December 2015, 40(4):282-282
DOI:10.4103/0970-0218.164407  PMID:26435604
  1,768 167 -
BOOK REVIEW
An evolving common language in epidemiology
Chandrakant Lahariya
October-December 2015, 40(4):286-286
  954 182 -
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  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007