Vol 3, Issue 1, Jan-Mar, 2013

Kulkarni et al. investigate the degree of coverage and factors influencing the decision to immunize children in an urban slum area of Mumbai, India. While heartening to know that overall coverage by immunization was about 88%, it provides interesting insight into the reasons why parents fail to get their children immunized. Minor illnesses, lack of awareness about immunization schedules, and economic difficulties emerged as reasons for failure to immunize the child- all of them can be remedied by better health education and follow up. Ghosh et al. reporting health-seeking behavior among mothers in a rural community in Darjeeling district of West Bengal, India echo similar conclusion- awareness through exposure to mass media, socio-economic status, and literacy were key factors that influenced a decision to seek healthcare for their children. Chawda et al. present a similar study, but in female construction workers, wherein, they report that nearly 67% children were underweight and 49% had stunted growth. Kulkarni et al. report that among adult agricultural workers, there was a greater trend to seek healthcare resources offered by government hospitals (48% vs. 28% seeking private medical care). In a country of 1 billion people, this represents a lion’s share of the healthcare responsibility. However, as Thayyil et al. point out in their review article, about 78% of doctors practice in urban areas while over 80% of the total population resides in villages. The reasons behind these are no doubt complex, but steps like creation of a new course aimed at creating practitioners who will serve the rural populace represents a step in the right direction.

Progress of a country comes at a price. With the booming economy, Indians have now more food stuff to eat. Most of the time what we eat and give our children to eat is not healthy. Consequently, a lot more Indian children are becoming overweight like their western counterparts. Approximately 22 million children, under five years of age, are overweight across the world. The worst part is that we do not know for sure what proportion of Indian children are overweight. Different studies in India have shown a wide range of prevalence of childhood obesity. Recent studies have proved beyond doubt that this impending epidemic is not only restricted to the elite children in our country, but has crossed the socioeconomic divide and childhood obesity is on the rise even among the less privileged ones. Recent findings have shown that the propensity to become obese is evident as early as someone is in the uterus. Obesity is the root cause of many chronic diseases. The best way to tackle the obesity epidemic is to lessen its burden in children. The earlier we intervene in a person’s life; the better will be the results, not only for the individual, but for the country as well. Population-based prevention strategies are the best to tackle this epidemic. It seeks to change the social norm by encouraging an increase in healthy behaviour and a reduction in health risk. They involve shifting the responsibility of tackling health risks from the individual to governments and health ministries. Key words: Children, India, metabolic syndrome, obesity

‘Health gaps between countries and among social groups within countries have widened’. Health is a basic need of a human being and access to health is a basic human right. Article 47 of the Indian Constitution enjoins the State to improve the standard of Public Health, as it is one of its primary duties. India, forms 17% of the global population and accounts for 20% of the total global disease burden. There are pronounced disparities existing between the rural and urban areas, as indicated by the infant mortality rates. Eighty-two percent are residing in villages. Seventy-four percent of the doctors live in urban areas, serving only 28% of the population. The people in rural areas are still unable to access the services of doctors. In this scenario the Ministry of Health (MOH) Government of India (GOI) announced the start of a new course, to create a cadre of rural doctors. The article will look at the shortfalls in the rural health of India as well as region- and statewise disparities in health status, health infrastructure, and manpower availability and the study was conducted by a literature review of government reports and published articles. There exist gross disparities between rural and urban areas due to negligence of the rulers. Even after initiation of the National Rural Health Mission (NRHM) greater than two-thirds of the funds fl ow to the urban areas/secondary care. The population based on the 2001 census, shows a shortfall in the rural health infrastructure; Community Health Centers (CHC) — 68%, Primary Health Centers (PHC) — 31%, and Subcenters — (SC) — 29%. The solution by creating a new cadre of doctors without improving facilities in the rural areas or without an equitable distribution of resources is unethical. The scarcity of health manpower in rural areas of India was due to skewed prioritization and distribution of resources. This can be corrected by reversing the urban centric planning and bringing equity in social development. Key words: Access to healthcare, health gap, health manpower, rural healthcare

Background: An ailing, unresponsive health system and the existing social complexities, with considerable contextual differences, are all pervasive in India. In health, these are manifested as differences in morbidity and mortality, severely affecting child health and survival. Objectives: To fi nd out the possible factors affecting the health-seeking behavior of mothers with regard to their children, in a rural community of Darjeeling district, and the reasons for not seeking curative care for perceived sick children. Materials and Methods: A cross-sectional, community-based study among the mothers of the Naxalbari Block was undertaken, using a multistage random sampling technique, from June to August 2011, by using the questionnaire method. A total of 256 mothers (sample size) were studied. Results: Joint family structure, mass media exposure, literacy status, socioeconomic status of mothers, and gender differences among children were found to be significantly associated with the healthcare-seeking behavior of the mothers. Conclusion: Increasing maternal education, intensified awareness generation through the mass media approach, implementing gender-sensitive interventions, and counseling, may have positive implications in future, leading to better health outcomes and favorable health indicators. Key words: Gender differences, health-seeking behavior, mothers

Background: Rabies is a zoonotic disease, transmitted by animal bites, mainly dogs. About 99% of all human deaths from rabies occur in the developing nations. It is invariably fatal if proper treatment is not instituted promptly. One of the important factors associated with successful treatment is the knowledge of the care giver in the proper management of animal bites and rabies vaccination. Objectives: To assess among the interns of R.G. Kar Medical College, Kolkata: • The knowledge of animal bite wound management. • The knowledge of rabies pre and post-exposure prophylaxis (PEP). Materials and Methods: A predesigned and pretested anonymous questionnaire with structured questions on animal bite and pre- and PEP was distributed among the interns of R.G. Kar Medical College in the month of March 2012. Results: Among the total of 80 interns, 56.3% and 72.6% of interns did not categorize bites into single transdermal bite and licks on broken skin as Cat-III wound. 12.5% of interns were aware of the intradermal route of vaccination. Ten percent of interns could correctly describe the PEP management of Cat-I wounds while 31.2% of interns thought it was necessary to add rabies immunoglobulin in Cat-II wounds. Conclusion: The results of the study reveal that there are significant gaps in the knowledge regarding the management of animal bite injuries and immunisation. Key words: Immunization, interns, rabies, rabies immunoglobulin, wound category

Background: Immunization against childhood disease is one of the most cost effective public health interventions available and has saved the lives of millions of children in the past three decades. Immunization also prevents many more millions from suffering debilitating illness and lifelong disability. Achieving and maintaining high level of immunization among children is necessary for the control and elimination of the major preventable diseases of childhood. Objectives: A present study was conducted to assess the immunization coverage and the impact of socio-demographic profile on that in an urban slum area in Mumbai city. Material and Methods: A cross-sectional study was carried out in the field practice area (cheetah camp urban health centre) of the T. N. Medical College, Mumbai during the period of January 2007 to October 2008. A total of 352 children from cheetah camp area in the age group of 12–23 months during the study period were selected by using lot quality technique. Results were analyzed using Statistical Package of Social Sciences (SPSS) version 13.0. Results: In the present study, out of the 352 children taken in to consideration, 55.40% were males and 44.60% were females. The overall coverage of immunization in the urban slum area was 88.07%. The most common reasons for not immunizing the child were: due to the visit to native place/village (14.00%), child was ill, hence not brought (8.20%), unaware of need to return for second and third dose (5.70%), and mother too busy (5.00%). Conclusion: In this study, as the overall coverage of immunization among the urban slum area is good but still it has pockets of non-immunization. Hence, more vigilant surveys should be conducted so that these pockets are identified properly and proper actions can be taken. Key words: Immunization coverage, lot quality technique, primary health care, urban slum

Background: Road transport remains the cheapest way to move goods and services across limitless boundaries in Nigeria. The collapse of the rail and water transport system, and the high cost of air transport have given rise to increasing road transport usage. This increases vulnerability to HIV/AIDS among Heavy Goods Vehicle (HGV) drivers due to long absence from home and constant interaction with the commercial sex workers (CSWs). Objectives: The study was performed to determine the sexual behaviour of HGV drivers while on transit within the inter-state transport corridor of Kaduna State in northern Nigeria. Materials and Methods: A descriptive cross-sectional study was conducted in Marraba–Jos along the Kaduna–Kano transport corridor. A structured questionnaire was used to study age, educational status, knowledge and attitude toward HIV/AIDS, and the sexual behavior of HGV drivers. Results: Three hundred and fifty HGV drivers participated in the study, of whom 273 drivers (78.0%) had excellent knowledge on HIV/AIDS preventive measures and 218 drivers (62.0%) had good attitude toward prevention. Frequency of having sex while on transit varied with 84 respondents (24%) having sex at any available opportunity and 49 (14%) having sex on a daily basis. Three hundred and twenty-two drivers (92.0%) agreed in taking some preventive measure, of which 36.8% made use of condoms. One hundred and sixty-one drivers in the study (46.0%) considered themselves a high-risk group to getting infected and 140 (40.0%) agreed that public discussion on HIV/AIDS will help create the necessary awareness. Conclusion: The knowledge of HIV/AIDS among HGV drivers was found to be high, attitude toward prevention was good, and there was fair appreciation of public health intervention toward combating HIV/AIDS when compared to previous studies done on road transport workers in the country. Key words: Heavy goods vehicle drivers, HIV/AIDS, sexual behavior

Context: Majority of the Indian population lives in rural area, where the main occupation is agriculture. In developing countries, agriculture workers have multitude of health problems, whereas they do not have access to the adequate health care facilities. Aims: The present study was aimed to know the health-seeking behavior of agricultural workers. Settings and Design: This cross-sectional study was done from January 2009 to December 2009 in a rural area of Bhutaramanahatti sub-center (Vantamuri PHC), Belgaum District. Materials and Methods: A total of 400 agricultural workers of age 16-60 years were interviewed in their households/ fields. Data were acquired on a predesigned and pretested questionnaire. Statistical Analysis Used: Percentages and Chi-square test. Results: Among the study participants 55.75% were males and 44.25% were females, with a male to female ratio of 1.25:1. Most of the agricultural workers (89.5%) were Hindus, 10.5% were Muslims, and 47% were illiterates, whereas 38% had passed first to fifth grades, 14.5% had passed sixth to tenth grades, and 0.5% had attended tenth plus. Of the 400 subjects, 295 (73.75%) belonged to Class V socioeconomic status. Overall, 48.75% opted government doctors and 28% opted private doctors as the first priority health care providers for their illness. 37.75% preferred private or AYUSH practitioners and 18.25% opted government doctors in case illness was not cured or they were not satisfied with the treatment given by the first health care provider. Conclusions: The present study reveals that most of the agricultural workers depended on government doctor for their illness. In order to overcome the situation, special health check-up camps need to be conducted with emphasis on improvement of health. Key words: Agricultural workers, health-seeking behavior, occupational health

Aims: To assess the health of children of construction workers with the help of anthropometric measurements and to explore their childcare practices. Settings and Design: Female construction workers and their children of age 12 to 36 months were taken as one study unit. The study had two components. One component deals with anthropometric measurements of the children while a qualitative descriptive exploratory component was used to explore mothers’ perspectives and childcare practices. Methodology: Anthropometric measurements, background information, and living conditions were collected with the help of pre-tested and semi-structured questionnaire. In depth interview technique was used to explore child care practices. Total 14 mothers were interviewed to attain the saturation of responses. “Snow ball” technique was used to recruit children for anthropometric measurements and mothers for in-depth interview. Anthropometric analysis was done in WHO-ANTHRO software v 3.0.1. Content analysis method was used to analyze emerging themes from the interviews. Results: Mean Z scores of weight for age, height for age, and MUAC was less than -1.5. Among the children, 67.2% of children were underweight; 28.4% were wasted while 49.3% were stunted. All mothers believed breast milk to be good for baby for first few months, but only 11% of mothers could practice exclusive breast-feeding. Mothers’ perspectives about childcare shows understanding about importance of breast-feeding, complementary feeding, balanced diet, and vaccination. However, mothers were not able to practice their knowledge in childcare; main reasons were fear of wage loss, unavailability of proper living facilities and influence of labor contractor. Conclusions: The study findings confirm the inequity of health among children of construction workers. Mainstreaming of the workers in unorganized sector and strict legislations ensuring good living conditions are recommended to combat child malnutrition among this group. Key words: Child care practices, child malnutrition, construction workers, unorganized sector, WHO Anthro 2006 standards

Background: India has the largest percentage/number of vitamin A deficient children in the world. However, the effectiveness of a program of vitamin A supplementation at the population level has been rarely examined. We aim to examine the status of vitamin A supplementation among preschool children in India and its association with their socioeconomic and demographic characteristics and the social and economic development level of the State in which they reside. Materials and Methods: Data are from a cross-sectional study of 20,802 children aged 12-35 months whose mothers participated in the National Family Health Survey 3 (NFHS-3) conducted during 2005-2006. The association between the socioeconomic and demographic characteristics of the children, the social and economic development status of the State in which they reside and vitamin A supplementation status was examined by means of unadjusted and adjusted logistic regression models. Results: Only 25% of the children in India received vitamin A supplementation, indicating a poor coverage, and the differences between the States were wide (<10% to >45%). Rural children (OR: 1.20; 95% CI: 1.10-1.30; P < 0.0001) and children of educated mothers (OR: 2.40; 95% CI: 2.04-2.83; P < 0.0001) were more likely to receive vitamin A supplementation than others. Children born in a higher birth order (6+) (OR: 0.54; 95% CI: 0.46-0.63; P < 0.0001) and those residing in states with low levels of social and economic development (OR: 0.51; 95% CI: 0.46-0.57; P < 0.0001) were only about half as likely to receive vitamin A supplementation as their counterparts. Conclusion: The national vitamin A supplementation program in India did not reach a majority of preschool children in 2005. Greater maternal formal education, higher household wealth status and high social development status of their State of residence appears to be an important determinant for receipt of a vitamin A supplementation by preschool children in India. Key words: Children aged 12-35 months, India, logistic regression, NFHS-3, State’s social and economic status, vitamin A supplementation

Background: Hepatitis B infection is the major cause of acute and chronic liver disease, cirrhosis, and hepatocellular carcinoma worldwide and has long been recognized as an occupational hazard among health care workers. Thus, this study was planned to evaluate the coverage of hepatitis B vaccine and to study occupational, epidemiologic, and attitudinal factors in its acceptance among health care workers in a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted among HCWs of MM Institute of Medical sciences and Research, Mullana. A total of 600 health care workers were selected for the study by simple random sampling method. A self designed, semi-structured interview schedule was used to collect data from the participants by interview method. Data on demographic, behavioral, and occupational exposure aspects were also collected. Results: The overall prevalence of hepatitis B vaccination acceptance was 60%. Only 40% of the health workers had received the full three dose vaccination schedule while 20% had received one or two doses, and 40% were unvaccinated. Protection against hepatitis B was cited the most common (54%) reason for taking this vaccine. The most important reasons for not taking the vaccine were negligence (41.6%), whereas the commonest (45%) ground cited for not taking the recommended number of dosage was the lack of knowledge about the total number of doses to be taken for full protection. On multiple logistic regression, vaccine safety (AOR = 6.57, 95% CI = 2.64-16.04) followed by history of exposure to blood (AOR = 5.21, 95% CI = 1.81-16.16) and acceptable knowledge about the disease (AOR = 4.76, 95% CI = 1.13-11.45) were identified as reasons for acceptance of the vaccine. Conclusions: Coverage of complete immunization was low among health care workers. Level of knowledge regarding the disease was also not satisfactory. Education programs should focus on increasing healthcare workers’ perceived severity to occupational exposure to hepatitis B virus and emphasize the safety and effectiveness of the hepatitis B vaccine. Vaccines should be made available free and mandatory in health organizations. Key words: Acceptance, health care workers, hepatitis B vaccination

Introduction: Awareness of learning preferences can have useful learning and teaching implications. However, there is paucity of literature on the learning preferences of clinical students in a medical school. This study uses the VARK questionnaire to explore the learning preferences of the clinical students of Melaka-Manipal Medical College, Malaysia. VARK is an acronym that stands for visual [V], aural [A], reading [R] and kinesthetic [K] sensory modality of learning. Materials and Methods: The study was approved by the College ethical committee. After taking an informed consent, the clinical students participated in the study in April/May 2012 [n = 176]. Instrument: VARK questionnaire Version 7.1 was used and it consisted of 16 multiple choice questions. It was distributed among students in the form of hard copy and they submitted their responses to the VARK questionnaire in a classroom setting. Statistical Analysis: Strong preference was calculated on Microsoft Excel using the VARK guidelines. Likert scale [1 to 5] was used to know their perceptions of their VARK score. Feedback written legibly by the participating students was included in the study [n = 127]. Results: The majority of students [n = 99] were multimodal. Kinesthetic modality was the strongest single preference [n = 35]. Out of 127 feedbacks included in the study, the majority of students [82.7%] agreed with the validity of their VARK score. Conclusion: The majority of clinical students is multimodal in their learning preference and kinesthetic modality is their strongest single preference. Educational Implications: Students can develop learning strategies based on their preferences of learning. Teaching should involve all sensory modality so that all types of students can actively participate in learning session. Students pursuing clinical science can benefit more with the kinesthetic modality of learning. Key words: Clinical students, learning preferences, VARK test

Aims and Objectives: Adverse drug reaction (ADR) may infringe upon compliance, which compromises therapy outcomes in chronic diseases. Our study focused on pharmacovigilance in stigmatizing disease vitiligo, concern with improving disease management incorporating current medical knowledge. Materials and Methods: Therapies in 250 vitiligo cases were scrutinized over period of six months, examining consistency to consensus approach and profiling of the adverse effects. Results: Adverse drug effects occurred in fifth of localized and third of generalized vitiligo patients. Adherence to consensus line of therapy resulted significantly in less adverse effect incidence, and steroid overtreatment was major determinant of risk. Conclusion: Consistency of treatment to consensus approach based on disease extent is prudent to reduce adverse drug effects in vitiligo. Increased vigilance, due psycho-social address, and incorporation of safe and efficacious new immunomodulator drugs is emphasized for consideration toward improved current vitiligo management. Key words: Adverse drug reactions, guideline, pharmacovigilance, vitiligo

Drug reaction with eosinophilia and systemic (DRESS) syndrome is a severe systemic drug reaction with a reported mortality of 10%5. The estimated incidence of this syndrome ranges from 1 in 1000 to 1 in 10,000 drug exposures. The syndrome consists of a severe skin eruption, fever, hematologic abnormalities (eosinophilia or atypical lymphocytes), and internal organ involvement. Here, we report a case of DRESS syndrome in a young male who presented with acute hepatitis. Key words: Drug reaction with eosinophilia and systemic syndrome, drug reaction, hepatitis leflunomide, skin rash

Background: Betel nut (BN) or areca nut (AN) chewing habits on its own or with other ingredients including chewing tobacco are highly prevalent in many South East Asian countries as well as among the migrants from these countries residing around the world. The major alkaloid arecoline in the BN has been found to carcinogenic and to be associated with a range of health risks, including negative effects on pregnancy outcomes. Pregnancy imposes stress on folate stores because of increased requirements for growth of maternal tissues, fetus, and placenta. Folate deficiency during pregnancy is a major public health concern as is associated with many adverse health outcomes including neural tube defects, low birth weight, preterm birth, and delayed maturation of the nervous system, growth retardation, and megaloblastic anemia. Objective: To investigate any association between BN consumption and folate status among pregnant women in rural Bangladesh. Materials and Methods: Data of 730 pregnant women aged 14-50 years from the Maternal and Infant Nutrition Intervention in Matlab (MINIMat) trial in Bangladesh were included in this study. Logistic regression analysis and analyses of covariance (ANCOVA) were used. Results were adjusted for potential confounders. Results and Interpretation: Two-third (63%) of the women consumed BN and 17% had folate deficiency. The women who consumed BN combined with chewing tobacco were 2.57 times more likely to have folate deficiency (OR2.57; 95% CI1.23-5.36; P0.012;) and the women who consumed BN 2-3 times/day were 2.51 times more likely to develop folate deficiency among users (OR 2.51; 95% CI1.07-5.92; P0.035). Mean serum folate levels were significantly lower among BN users as compared to nonusers. Conclusion: The results suggest that betel nut consumption combined with chewing tobacco is associated with lower serum folate level and folate deficiency among pregnant women in rural Bangladesh. Strategies are needed for prevention and control of betel nut consumption in order to prevent adverse health outcomes. Key words: Betel nut, chewing tobacco, folate deficiency, pregnant women

Context: MGMT, is a DNA repair protein involved in removing the mutagenic and cytotoxic adducts from O6-guanine in DNA, which otherwise can lead to the mutation, primarily due to the tendency of O6-methylguanine to pair with thymine during replication, resulting in the conversion of GC to AT pairs, if left unrepaired due to epigenetic silencing of its promoter. Aims: To study the status of MGMT in Kashmiri lung cancer patients Materials and Methods: In this study we analyzed the promoter status of this gene in 50 lung cancer patients using methylation specific-PCR and confirmed by restriction digestion. Results: The promoter was found to be methylated in 52% of the cases, more in male patients (54.2%) than in female patients (46.6%). When stratified according to smoking status, current smokers showed a strong association with methylation (OR = 6.0, P = 0.005) than former and never smokers. We also compared the promoter methylation of the MGMT gene with pesticide exposure, and found that patients with pesticide exposure had statistically significant (OR = 7.7 and P = 0.003) association with promoter methylation. Conclusions: Our results indicate that MGMT promoter methylation is associated with smoking exposure and there appears to be an association of MGMT promoter methylation with pesticide exposure in Kashmiri lung cancer patients. Key words: Kashmiri population, lung cancer, MGMT, NSCLC, pesticide exposure

Background: India is the highest TB burden country in the world and accounts for nearly one fifth (20%) of global burden of tuberculosis. Every year, approximately 1.8 million persons develop tuberculosis, of which about 8,00,000 are infectious and until recently, 3,70,000 cases died of it annually. In India, today, two deaths occur every three minutes from tuberculosis, but these deaths can be prevented with proper care and treatment. Materials and Methods: An interventional study was conducted from January to March 2009 by interviewing 86 final year medical students studying at Rural Medical College, Loni, India. A pre-designed and pre-tested questionnaire was used to collect the pre-workshop and post-workshop data. Questions were based on the knowledge regarding tuberculosis. Results were analyzed statistically using percentage, proportions, and Chi-square test. Results: In this study, about 55 (63.9%) participants correctly specified RNTCP objectives in pre-test, while in post-test, 80 (93.1%) participants could state correct response (P0.0001). In pre-test, 57 (66.3%) participants thought that family member can be a DOTS provider, while during post-test, 80 (93.1%) participants realized that DOTS should not be given by family member (P0.0001). Similarly, highly significant difference in pre- and post-test was observed for DOTS components. Conclusion: Sensitization workshops increase the knowledge of tuberculosis amongst the medical students. RNTCP training should be a part of regular activity of all medical colleges. Key words: Knowledge, medical students, revised national tuberculosis control program, tuberculosis