Vol 3, Issue 4, Oct-Dec, 2013

Various health programs addressing noncommunicable diseases (NCDs) have been launched in India. Integration of these health programs will avoid duplication of efforts and will address the problem of NCD prevention in a holistic manner. Integration to address the comorbidity due to communicable diseases and NCDs is also required. Various approaches like disease domain, action level, and system level integration should be tried at state level on pilot basis followed by national level integration. Integration of concepts focusing on public health approach and clinical medicine; allopathic system and other Indian System of Medicine; and involvement of private sector in NCD prevention activities will go a long way in combating the already established epidemic in India. Integrated approaches focusing on population and personal clinical services with health system strengthening may be more appropriate strategy for controlling NCDs in India. Key words: Health system, integration, noncommunicable disease

Oral health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate oral health decisions. The current review is based on some of the extensive literature in health literacy, much of it focused on the intersection of low literacy and the understanding of basic health care information. Health literacy is a non-pharmacological method of managing and preventing diseases. There are three distinct levels in oral health literacy, i.e. functional, interactive and critical. Health literacy is important for all adults, who must be able to read articles and magazines about oral and general health prevention, interpret instructions on prescription bottles and over-the-counter medications, manage the healthcare needs of their children and ageing parents and interpret insurance and Medicare rules, regulations and benefits. There are several factors which impact on low health literacy level in the community. Poor health literacy is considered as a contributor of poor oral health status in an individual, poor heath outcome in a community and health inequalities. The dental profession is indeed changing the tide and now recognizes that several solutions can be implemented to ensure effective communication becomes a national organizational priority to improve oral healthcare. Key words: Health knowledge, health literacy, literacy tools, oral health literacy

Context: Construction industry is one of the stable growing industries of the world and in India it is the largest economic activity after agriculture. Construction workers are at a greater risk of developing certain health disorders and sickness than workers in many other industries. Very little research has been done on the occupational health, hazards and psychosocial problems of these workers especially in Asian countries like India. Aims: The aim of this study is to understand the occupational health problems of construction workers — building and civil, to compare the morbidities among these two categories of workers. Settings and Design: The cross-sectional study was conducted at Kozhikode district of Kerala, India. Materials and Methods: Construction projects were selected by simple random method and all workers (N = 410) were enrolled as study subjects. Data was collected by the team consisting of investigators, doctors and social worker using a pre tested validated structured proforma. Results: Data was collected from 387 (94.4%) workers. Most of them belonged to the young age group (26.8 years). The prevalence of past morbidity like tuberculosis (1%), malaria (13.7%) and jaundice (10.6%), typhoid (3.4%) were higher than the general population in both groups without any statistically significant differences between them. Prevalence of injury was higher among civil work group (17.2% and 6.6%.) Current fever, respiratory infections, eye disease were higher among Group I, skin and musculo-skeletal problems were similar. Conclusions: Measures are needed to improve the work environment of construction workers by ensuring availability of protective gears, sanitation facilities at the sites along with an accessible, accountable occupational health services. Key words: Building and construction workers, occupational health, skin problems, water borne disease, work related injury

Background: Diabetic neuropathy (DN) can affect any part of the nervous system and should be suspected in all patients who have had diabetes for more than 5 years. Family physicians (FPs) can play an important role with the care and education of people with diabetes. They can augment the knowledge and motivate the diabetics to acquire a healthy life style, which would further lead to a good glycemic control providing protection from the chronic complications. Lack of compliance with the guidelines on the part of the diabetic subjects, indicates deficiencies in the FPs’ knowledge, implementation techniques, and attitude problems. Therefore, the present study was conducted to assess FPs’ knowledge, attitude, and practice regarding DN for further educational interventions that will improve their quality of care for diabetic patients in family practice centers. Materials and Methods: The study population was 60 FPs working in family practice centers affiliated to Suez Canal University Hospitals. The questionnaire composed of three groups of questions to collect data for evaluation of knowledge, attitude, and practice; two written patient problems to assess their practice and two questions to assess barriers and recommendations of physicians. To pass the evaluation; 50, 80, and 60% were the cut off points to pass the evaluation for knowledge, attitude, and practice, respectively. Results: 48.3, 66.7, and 43.3% of the evaluated FPs passed the knowledge, attitude, and practice assessment, respectively. Eighty-five percent of physicians felt that they need more knowledge and training in DN management. Physicians’ qualification (P = 0.037) was a significant variable in passing the knowledge test, but qualification and experience years (P = 0.007 and 0.035, respectively) were significant variables in passing the practice test. There was a positive significant (P = 0.021) correlation between practice and knowledge score. Postgraduate knowledge accounts the majority (78.3%) as a source of information about DN. Providing physicians with standardized guidelines (81.7%), continuous medical education seminars (76.7%) and training courses (76.7%) came at the top of physician’s recommendations to improve DN care by FPs. Conclusion: This study has identified the need for improvement in family medicine physician practices for treating and educating diabetics and recommended that awareness and educational programs are necessary to update the FPs on screening, effective treatment of diabetes and prevention of DN. Key words: Attitude, diabetic neuropathy, family physicians, knowledge

Aims Objectives: Aim to fi nd out prevalence of anaemia in adolescent girls and its correlation with demographic factors. Materials and Methods: 1000 adolescent girls were included in study between 12-15 years of age modified kuppuswamy scale were used to classify in socio economic groups. The nutritional status of all girls were analysed .Blood was collected for following indices Hb RDW PCV RBC count. Results: Aamong 1000 adolescent girls 60percent found to be anaemic, 18.4 percent as mild 41.3percent as moderate , and 0.4 percent was having severe anaemia. High prevalence of anaemia was reported among adolescent girls belonging to class III, IV, V as per modified kuppuswamy classification.[1] Thin and severely thin adolescent girls were found to be at higher risk of anaemia. Key words: Adolescent girls, anemia, socio-economic status

Objective: The aim of the study was to fi nd out the sero-prevalence of Hepatitis C infection among blood donors. Materials and Methods: All collected blood bags were screened for anti-hepatitis C virus antibodies (HCV Ab; MicroELISA 3rd generation, J. Mitra) during the study period of 4 years and data were analyzed. Results: A total of 28621 blood donors were screened for transfusion transmissible infections (TTIs) in which 80 donors were positive for Hepatitis C infection, constituted 11% of total sero-reactive donors. In 2009, only 10 cases were sero-reactive while in 2012, 36 cases were sero-reactive for Hepatitis C infection. Conclusions: Hepatitis C infection among blood donors are in rising trends in this study area. Voluntary donors are safer than replacement donors as they have very low sero-prevalence. As these blood donors represent the highly selective community of a general population in most of the countries. So the actual sero-prevalence of hepatitis C infection may be more in the general population. Promoting HCV screening, voluntary blood donation, diagnosis and treatment among blood donors are very important measures to control the transmission of HCV infection, decrease sero-reactive cases and ensure safe blood collection. Key words: Blood donors, hepatitis C infection, sero-prevalence

Introduction: Diabetes Mellitus Type 2 (DM) is a progressive chronic disease which places a significant burden of self-management on the individuals and their families. Negative attitude and lack of social support, particularly from friends and family, are considered the barriers to adherence and self-care. Objective: To assess the initial psychological reaction, attitude and social support in patients of Diabetes Mellitus Type 2. Materials and Methods: A community based prospective follow up study was conducted in rural and urban areas of Delhi. A total of 98 patients, either known diabetics or those after testing positive with blood-test during screening for diabetes, were selected after systematic random sampling and interviewed using pretested pre-designed questionnaire after 4 months of initial screening survey for diabetes. Data was analysed using SPSS software (version 16). Chi-square and fi sher's exact tests were used and accepted statistically significant if P value was less than 0.05. Results: It was found that more rural patients (56, 88.9%) felt disappointed compared to those residing in urban areas (13, 61.9%), when their families denied them from eating prohibited diet (2=13.82, P=0.001). Rural families were reported to be more supportive for food and exercise issue (2=12.51, P=0.001). A higher proportion of patients in urban area (13, 41.9%) compared to rural patients (3, 4.5%) perceived that disease would affect their married life (2=22.15, P=0.001). However, no significant difference in negative attitude and social support was found during the gender, occupation and education status assessment. Conclusion: Psycho-social management of diabetes need to be targeted and addressed. Diabetes management programs should fi nd ways to build and improvise social support for patients. Key words: Rural-urban Delhi, self care, social demographic factors, type 2 diabetic mellitus

Context: The main stay in the management of tuberculosis is its early diagnosis and treatment. Aim: To evaluate the utility of Universal Sample Processing (USP) method, claimed to be more sensitive than direct smear microscopy. Materials and Methods: Sputum samples from 1000 patients with history of cough for more than two weeks, visiting the two RNTCP centers between November 2011 and November 2012, were subjected to direct Ziehl–Neelsen staining and staining after USP method. To fi nd out if there was any difference in the time taken to detect Acid Fast Bacilli (AFB) between the methods, the smears were screened by two trained RNTCP technicians. Sputum samples positive for AFB in the USP method were put up for culture on Lowenstein–Jensen medium to evaluate the suitability of USP method as a pre-treatment procedure before culture. The growth was identified as Mycobacterium tuberculosis (MTB) by the Niacin test. Results: Ninety four samples were positive for AFB by both methods. The USP method did not detect more positives among those which were found negative by direct microscopy. There was no significant difference in the time taken to detect AFB between the methods. Among the 94 smear positive samples subjected to USP method as a pre-treatment procedure, only 40 (42.5%) samples yielded growth of MTB. Conclusions: USP technique did not offer additional advantage over direct microscopy for detection of AFB to diagnose pulmonary tuberculosis. As a pre-treatment procedure, USP method yielded low mycobacterial growth even from those samples positive for AFB by microscopy, making it unsuitable for culture of MTB. Key words: Acid Fast Bacilli, pulmonary tuberculosis, sputum microscopy, Universal Sample Processing (USP) method

Background: Dermatophytosis though trivial, exerts a psychological effect and requires effective treatment which is often costly. Numerous studies on clinicomycological aspects of dermatophytosis have been conducted in different parts of India but no reports are available from the state of Meghalaya. Aims: The study was therefore aimed at determining the prevalence and etiological agents of dermatophytosis amongst the patients attending the Department of Dermatology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) Shillong. Materials and Methods: A total of 259 samples obtained from 237 clinically diagnosed cases of fungal infection of the skin, hair and nails were included. Direct microscopy (Potassium hydroxide (KOH) mount), culture and identification were done according to standard procedures. Results: The major clinical group was found to be Tinea pedis (26.6%) followed by Tinea corporis (18.9%) and Tinea cruris (14.3%). Tinea capitis was predominantly seen in children (72.7%). The maximum cases were seen in the age group of 21-30 years (34.4%) showing a male predominance. Direct microscopy (KOH mount) were positive in 99(38.2%) of the 259 samples whereas; 76 (29.3%) were positive on culture. The predominant dermatophyte species isolated was Trichophyton rubrum (30.3%) followed by Trichophyton mentagrophytes (28.9%). Conclusion: The present study, gives an insight about the etiological agents of dermatophytosis in this part of India. This data provides an assessment of the prevalence and etiological profile which would help in the estimation of the problem and hence in the prevention of dermatophytosis with adequate control measures. Key words: Dermatophytes, tinea, trichophyton

Context: Needle stick injuries (NSIs) are wounds caused by needles in health care setup that accidentally puncture the skin and may result in exposure to blood or other body fluids. NSI is a major occupational health and safety issue faced by health care professionals globally. Nurses have the highest rate of needle stick injury among health care workers. Aims: To determine the prevalence of needle stick injuries (NSIs) among the nurses, to determine the association between NSI and selected variables like age, marital status, years in service, educational qualification and to assess the measures undertaken by the respondents after the NSI. Materials and Methods: A cross sectional study was conducted in a tertiary care hospital in Imphal among nurses from October to November 2011. Self-administered questionnaire was used for data collection. Descriptive statistics were used. Chi square test was used to see the association and a P-value of <0.05 was taken as significant. Results: The prevalence of NSI within the last one year was found to be 28.1% (N=86). Of them 49(46.5%) had two or more NSIs in the last one year. More than half of the NSIs occurred during intravenous (IV) injection, 16.3% during intramuscular (IM) injection and only 1.6% during recapping of the needle. Eighty three (96%) of them did not were gloves during NSI. Forty (46.5%) of them washed the injured part with water and soap as immediate measure. Thirty seven (43%) did not report it. Though 251(82%) knew about the free availability of Post Exposure Prophylaxis (PEP) in the hospital, only 5(5.7%) took PEP. Conclusion: Needle stick injury is an important occupational health hazard among the nurses. Reporting to the concerned authorities, screening after NSI and promotion of safety measures should be greatly encouraged. Key words: Cross-sectional study, needle stick injuries, nurses, post-exposure prophylaxis, prevalence

Prenatal care is commonly understood to have a beneficial impact on pregnancy outcome. Child survival is directly dependent on good maternal health and nutrition. Aim: To study the variation in counseling of prenatal care measures at different sources of care. Materials and Methods: A cohort of 5,380 observations from the New York State Pregnancy Risk Assessment Monitoring System were analyzed to study the relationship between site/source of prenatal care and quality/ content of prenatal care, and the influence of maternal characteristics therewith. Statistical Analysis Software, version 8 (SAS-V8) was used for analysis. Results: The most common source of care was doctor of medicine/health managed care organization (75.89%) followed by hospital clinic (11.22%), community health center (6.5%), health department clinic (4.05%), and others (2.3%). Health department clinic showed a greater prevalence proportion for counseling in all of the fi ve prenatal care measures (talked about breastfeeding, illegal drugs, nutrition, baby’s growth, and smoking) when compared with the remaining four sources of care. Majority of private clinic attendees were whites (87.8%), older mothers (20.7%), and/or high income groups (67.8%). Young mothers preferred visiting health department clinic (22.5%). Average income mothers preferred accessing healthcare from the community health center (26.9%). Conclusion: Variation in quality of care among various sources of care is likely to occur. Maternal characteristics could also influence the selection of source of care. Key words: Maternal characteristics, source of prenatal care, quality of prenatal care

Context: The Workload Indicators of Staffing Need (WISN) human resource planning and management tool, developed by Shipp (1998) and popularized by the World Health Organization (WHO), gives health managers a way to analyze and calculate correct staffing levels in health facilities. In present study, WISN tool was used to assess a District Hospital in terms of staffing of laboratory technicians to understand the staffing need against the existing workload of health system. Aims: To assess the staffing needs of laboratory technicians in District Hospital using WISN method. Settings and Design: Hospital-based cross-sectional study. Materials and Methods: The present study is a cross-sectional survey involving observation, record review, and personal interview. Study was performed in a District Hospital of Madhya Pradesh. There were six laboratory technicians in the District Hospital and all of them were included in the study. The staffing pattern and need of laboratory technicians in District Hospital was estimated and WISN indicators calculated. Statistical Analysis Used: Rate ratio and proportions were calculated using Microsoft Excel 2007. Results: WISN calculation showed that District Hospital in which the study was done requires 16 laboratory technicians in order to provide the volume of health services in its annual statistics in accordance with the professional standards (activity standards) for these services, thus having a shortage of 10 technicians. Conclusion: The laboratory technicians in the District Hospital where study was conducted are constantly under pressure to match the existing workload due to shortage of manpower. Appropriate human resources management and planning can contribute greatly to the improvement of efficiency of their work by ensuring optimum workload. Key words: Health work force, human resource management, workload indicator of staffing need

Introduction: Primary health care is the nucleus of country’s health care delivery system. Bottlenecks in delivery of services at PHC level leads to decreased efficiency of health system and indirectly affects health of the citizens of a country. Keeping these issues in mind a study was carried out with the objectives i)To identify constraints/bottlenecks in implementation of elements of primary health care ii)To fi nd out solutions to address these bottlenecks. Materials and Methods: This crosssectional study was carried out in Cuttack district during Dec 2010 and January 2011 using a semi-structured pre-tested questionnaire. Data regarding various difficulties faced while delivering health care services at PHC was collected from participants attending district level IMNCI (Integrated Management of Neonatal and Childhood Illness) training after getting verbal consent. All 72 respondents who had attended the training during the above mentioned period were included in this study (Medical officer, AYUSH medical officer, Maternal Child Health co-coordinators and Block Programme Officers). Data were analyzed manually using content analysis. Results: Difficulty in vaccine delivery, inadequate infrastructure and lack of sufficient manpower for smooth functioning of JSY, difficulty in card updation and difficulty in retrieval of defaulter of alcoholic TB patients for Directly Observed Treatment Shortcourse (DOTS) are some of the problems identified in general. Conclusion: The study identified the need for strengthening infrastructure and manpower to provide quality care for institutional delivery. It also emphasized the need for construction of more number of sub centre buildings which forms the backbone of rural health care delivery system. Identification of loop holes and bridging the gap by corrective action will make the journey towards Millenium Development Goal (MDG) easier. Key words: Constraints, implementation, national health programme, PHC

Background: Since 2007, Satara district is implementing a voluntary conditional cash transfer scheme named “Second Honeymoon Package” (SHP) for postponement of first pregnancy. This study was undertaken to evaluate it’s effectiveness in preventing pregnancies, utilizing the years for learning or betterment in jobs. Cost-effectiveness analysis was undertaken from government’s viewpoint and that from beneficiary’s viewpoint. Objectives: To perform the economic evaluation of second honeymoon package programme from the perspective of beneficiaries and that of Government of Maharashtra during the defined time horizon. To determine the targets to be achieved so as to make the programme cost- effective. Materials and Methods: This was an evaluation study of a community based interventional programme. This study employed quasi-experimental study design. Economic evaluation was conducted from the perspective of Government of Maharashtra and that of beneficiaries’. Costs and consequences SHP were evaluated in comparison with those of routine family welfare programme. Sensitivity analysis was done using Treeage Pro® version 2009 software. Results: Cost for participation in programme was Rs. 965888/268 person years of productivity. Cost of not participating in the Second honeymoon programme but availing routine family planning services was Rs. 298902/133 person years gained. Rankings analysis showed that no strategies were clearly dominated by any other. Extended dominance report indicates no strategies were eliminated by extended dominance. Incremental cost-effectiveness ratio was Rs.4920/person year of productivity. Conclusions: The SHP is cost effective at high success and productivity rates. The success rate of postponement of first pregnancy was 51.4%. Postponement of pregnancy by 2 years provides 45% chances of productive utilization of time. Key words: Decision analytic modeling, incremental cost eff activeness' ratio, second honeymoon package

Background: Violence is a major public health problem which affects the community and threatens the life of people. Objectives: To estimate the prevalence and different forms of violence among HIV positive young adults taking antiretroviral therapy (ART) in Udupi district. Materials and Methods: A cross-sectional study was carried out among HIV positive young adults (18-35 years) who were aware of their status. The participants were selected from ART Centre of Udupi district adopting convenience sampling. Data were collected from 200 young HIV positive young adults using a predesigned, pre-tested self-administered questionnaire. Results: The overall prevalence of domestic violence was 14.5% and was found to be more among females (17.6%) as compared to males (6.9%). This difference was statistically significant among gender with a P-value <0.05. Among the various forms of violence the prevalence of physical violence was found to be 14.5% with significant difference among gender. Among females who experienced physical violence, husband was perpetrator in 76% cases and among males, parents/relatives as the perpetrator in 75% cases. Around 8.5% of females had experienced sexual violence and husband was perpetrator in 50% of the cases followed by relatives and friend/acquaintance. Conclusion: Physical and sexual violence was found to be more in female HIV positive patients as compared to males. The presence of violence among HIV positive young adults especially among the females demands for the concerted efforts at combating underlying factors leading to violence among this vulnerable group of HIV positive young adults. Key words: ART, HIV positive, physical and sexual violence, young adults

Background: In spite of the numerous chronic diseases that have been linked to obesity, studies focusing on the awareness regarding causes, consequences and strategies to prevent and control of obesity among women are lacking in the literature, especially in developing countries such as India, where obesity is culturally accepted and nurtured and women bearded the highest weight gain in the recent decade. Objective: We explored the awareness regarding causes, consequences and preventive measures of obesity among 325 ever-married aged 20-54 years women with different levels of body mass index (BMI) in the national capital territory of Delhi representing urban India. Materials and Methods: A population based follow-up survey of women systematically selected from the second round of National Family Health Survey (NFHS-2, 1998-99) samples who were re-interviewed after four years in 2003. As a part of qualitative data collection, the respondents were asked to free list open-ended questions on causes, consequences and preventive measures of obesity. Responses were analyzed through Anthropac software package. Results: Over eating was reported as the most important cause of obesity by normal and overweight women whereas obese women reported fried food consumption as the most important cause of weight gain. A few women from each group reported changing lifestyle as a cause of obesity. Also, there were lots of misconceptions about the cause of obesity among women (such as no tension in life, more tension, happiness, constipation, problem in Delhi’s water etc.). In terms of the consequences of obesity, the participants were well aware of the common physical consequences. Normal and obese women reported breathlessness as the most important consequence whereas overweight women reported problem in standing and sitting. Regarding preventive measures, overweight and obese women reported ‘walking’ as most important preventive measure of obesity whereas normal women reported ‘doing exercise’. In addition, ‘dieting’ was reported as the next important preventive measures of obesity by all groups of women. Conclusion: Our study of a fairly large, community based sample of women has shown that women were aware of the complex nature of obesity in terms of causes, consequences and a range of potential solutions. The findings are important for public health interventions in obesity care in India. Implementation of health promotion and health education in the community should use effective school education and mass media programme to raise more awareness of the causes, consequences and preventive measures and hammer misconceptions, to combat the growing level of obesity among Indian women. Key words: Consequences, causes, Delhi, India, obesity, overweight, preventive

Background: Psychiatric morbidity in tuberculosis (TB) patients is well-known and its impact on treatment compliance needs to be evaluated. Objectives: To study psychiatric profile, personality trait of TB patients registered on directly observed treatment-short course (DOTS) and to evaluate their impact on treatment completion and default. Materials and Methods: Psychiatric morbidity and personality traits were assessed by Cornell Medical Index and 16PF personality questionnaire, respectively. Patients with psychiatric comorbidity were randomized into two groups. Group A: DOTS with psychiatric intervention and Group B: DOTS alone. They were followed up till treatment completion. Results: Out of 214 patients registered, 176 (82.2%) had psychiatric comorbidity. 150 (85.2%) had anxiety neurosis, and 26 (14.8%) had depression. On personality assessment, 54.1% were neurotic, 26% introverts, 15.8% extroverts, and 4.1% had other traits. Forty-one (23.3%) patients defaulted. Default rate was low (13.6 vs 33%, P = 0.002) and patient retrieval was good (67 vs 24%, P = 0.01) in group A. Patients with neurotic trait defaulted more (P = 0.006). On multivariate analysis, smoking (odds ratio (OR) = 3.76, 95% confidence interval (CI): 1.7-8.28); alcoholism (OR = 15.4, CI: 6.67-35.72); and neurotic personality (OR = 3.54, CI: 1.61-7.79) were strongly associated with default whereas age, sex, social class, literacy, and psychiatric morbidity type were not. Conclusion: Pretreatment psychological assessment and intervention reduces default rate. Key words: Anxiety neurosis, default, neurotic, treatment compliance

Objective: To investigate the remote management system of osteoporosis community intervention and design the data warehouse. Materials and Methods: The basic principles and methods of data warehouse were applied to the osteoporosis community intervention to build the MySQL 4.5 relational database using PHP as the development tool. A web-based B/S Model remote management system was established for the high risk population of osteoporosis in the community. Results: The system can be used for data management, data query, online analysis, etc., in community health service center, specialist outpatient for osteoporosis, and health administration sectors. Conclusion: The remote management system and data warehouse can provide guidance for policymaking of health administrators, residents health information, and intervention suggestions for general practitioners in community health service centers, patients follow-up information for osteoporosis specialists in general hospitals, as well as large quantities of original research data and preliminary health statistic results. Key words: Community management, data warehouse, information management system, osteoporosis, remote management of osteoporosis

Background: India contributes a large proportion to global under-five child mortality. One of the determinants of child morbidity and mortality is the “child rearing practices.” Socio-economic environment, child rearing practices and nutritional status play a synergistic role. Materials and Methods: Information was collected by exit interviews from married women attending out-patient departments of three primary health centers. Data was collected during December, 2009 using pretested questionnaire Married women in reproductive age group with youngest child in the age group of 1-5 years were eligible for inclusion. To assess the child rearing knowledge and practices (CRKP), a composite score was calculated based on 10 variables and categorized into satisfactory and unsatisfactory. Results: A total of 100 eligible married women were included in the study. About half of the women were in the age group of 25-35 years, 80% belonged to social class V and VI majority (63%) were literate and 70% had ≥2 children. With the increase in literacy status, there was the increase in proportion of women who had satisfactory CRKP and decrease in proportion of women who had given pre-lacteal feed. Among women who had three children, 15 out of 39 (38%) had fully immunized their first child as compared with 25 out of 39 (64%) for the second child and 38 out of 39 (97%) for the third child. Immunization coverage increased as the birth order increased. Conclusion: Mothers’ education has a significant role in determining her child rearing practices, which in turn would lead better child survival. Key words: Child rearing practices, India, maternal education, rural

Context: ‘Adolescence’ is a period of substantial change and hence associated with the risk of many health-related problems. Teachers and grass-root level health service providers i.e. multi-purpose health workers (female/male) are one of the key stakeholders who are to understand and respond to adolescent needs. Aims: To assess knowledge level regarding changes in adolescence among teachers and multi-purpose health workers. Settings and Design: It was a cross-sectional study conducted in rural block in the field practice area attached to Department of Community Medicine, Pt BD Sharma PGIMS Rohtak (India). Materials and Methods: All the 49 multi-purpose health workers (male and female) [ie., MPHW (M and F)] who were working in the study area are those posted at the sub centers, Primary Health Centers, or Community Health Centers for more than six months were included in the study. In addition, four large schools with strength of more than 250 students (two girls and two boys/co-ed Senior Secondary Schools) were randomly selected by lottery technique. All the 94 teachers who were involved in teaching the classes 9-12 in those schools were included in the study. Data were collected on predesigned, pre-tested and semi-structured schedules by conducting face-to-face interviews while maintaining the confidentiality of the responses. Statistical analysis used: Proportions, chi-square test. Results and Conclusion: 68/94 (72.3%) teachers were able to mention at least one sexual change which occur in adolescents. Among the sexual changes, menarche was the most common change familiar to the teachers. 48/49 (97.96%) workers were aware of at least one sexual change. Behavioral changes (emotional/social changes) were the ones which are least conversant to both health workers 10/49 (20.4%) and the teachers 24/94 (25.5%). Key words: Adolescent, awareness, changes, health workers, knowledge, teachers

Background: Prevalence of gastro-esophageal reflux disease (GERD) in all ages has shown an upward trend over the past decades. The reasons for this increase are ill-understood. The data in the pediatric population is limited. Recent studies have linked childhood GERD to adult GERD. This study was conducted to assess the symptoms, risk factors of GERD among the schoolchildren residing in a rural area. Aims: The aim of this study was to fi nd out the prevalence of GERD risk factors among the school children aged 8-17 years and to fi nd any association between body mass indexes, meal pattern and sleep disturbances related to GERD. Materials and Methods: We did a cross-sectional study on 380 school children of 4th-10th standard from 4 schools of Veleru, the Rural Health Center attached to Dr. Pinnamaneni Siddhartha Institute of Medical Sciences. The questionnaire consisted of questions for reflux symptoms, meal pattern and sleep disturbances. Results: The symptoms of reflux like abdominal pain was reported in 7%, heartburn in 1.3%, regurgitation in 2.4%, vomiting in 2.9%, difficulty in swallowing in 2.1%, sore taste in mouth in 0.8% of the children. The risk-factors for reflux like caffeinated drinks were found in 45.3%, very spicy food in 12.1%, heavy meals in 2.4% of the children. Sleep disturbance was seen in 33.4% of the children. Obesity was present in 0.6% of the children. Conclusion: School children should be informed about the symptoms and risk factors of GERD so that healthy dietary habits can be developed at a young age and GERD can be prevented. Key words: Dietary habits, gastro-esophageal reflux disease, school children

Context: WHO estimates that around two billion people are anemic with approximately 50% of all anemia attributable to iron deficiency. Weekly Iron and Folic Acid Supplementation Program is implemented in school, in various countries to reduce prevalence of anemia in adolescents. Aims: To fi nd out baseline prevalence of anemia and its determinants in urban school-going children of Mumbai. Settings and Design: The cross-sectional study was carried out from August to October 2012 on sample size of 385 school children, selected by systematic random sampling of class VI to X of government-aided school. Materials and Methods: After a written-informed consent, students were interviewed by pre-tested, semi-structured questionnaire and then weight and height were recorded. Hemoglobin was estimated by cyanmethemoglobin method using a colorimeter. Data was analyzed by SPSS version 16. Statistical Analysis Used: Proportion, Chi-square test, Co-relation Co-efficient and Unpaired t test. Results: Mean age was 12.9 years with SD of 1.5 years. Overall prevalence of anemia was 53.2% with prevalence in females and males 56.5% and 50%, respectively. Proportion of mild, moderate and severe anemia was 21.6%, 30.9% and 0.8%, respectively. Age was significantly associated and negatively co-related with mean hemoglobin values with highest prevalence in age group of 15 to 19 years. Anemia was significantly associated with attainment of menarche. Practice of eating green leafy vegetables, groundnuts and egg was significantly higher in males as compared to females. Tiredness and palpitation were significantly higher in females as compared to males. Very few students (2.9%) were aware about anemia. Only 75% of the students were willing to consume weekly iron and folic acid supplementation for a year. Conclusions: Both males and females are susceptible to anemia with highest prevalence in age group of 15 to 19 years. Awareness of anemia was very poor in school-going children. Key words: Adolescents, anemia, WIFS program

Background: Subclinical thyroid disorders usually do not produce symptoms of thyroid disease until they turn into over thyroid disease. Thyroid disease is more common in people with diabetes mellitus than in the general population and it is important to detect thyroid disorder before its clinical manifestation. Subclinical hypothyroidism (SCH) can produce dyslipidemia, obesity thus resulting increased predisposition to coronary artery disease. Subclinical hyperthyroidism can aggravate hyperglycemia and impair blood sugar control. Objectives: Our objective is to determine the prevalence of subclinical thyroid disorders in patients with type 2 diabetes mellitus (T2DM) and to analyze the clinical and metabolic profile of patients with this dual endocrine disorder. Methods and Results: One hundred consecutive type 2 diabetic patients without clinical manifestations of thyroid disorders were screened for SCH and subclinical hyperthyroidism using serum free T3, free T4 and thyroid stimulating hormone (TSH) levels. Individuals of subclinical thyroid disease were further screened for thyroperoxidase (TPO) antibodies. SCH was detected in 13% of type 2 diabetic patients and none had subclinical hyperthyroidism in our study. SCH was common among females with type 2 diabetes (84.6%). Elevated TPO antibody levels were present in 84.6% SCH patients. Diabetic retinopathy among SCH patients showed significant association with higher serum TSH levels. Left ventricular diastolic dysfunction was present in 30.8% of SCH patients. Conclusion: SCH is common among type 2 diabetic patients, especially in females. It is most commonly secondary to autoimmune thyroid disease. Microvascular complications are commonly observed in this group of patients with dual endocrinal disorder and treating physician should be aware of the impact and should routinely screen SCH to prevent complications. Key words: Anti-thyroperoxidase antibody, diabetic retinopathy, left ventricular diastolic dysfunction, subclinical hypothyroidism, subclinical hyperthyroidism, type 2 diabetes mellitus

Objectives: To analyze the prescribing pattern and appropriateness of drug treatment of diarrhoea in hospitalized children. The economic burden of the disease and adverse drug reactions (ADRs) occurring during the course of treatment was also studied. Materials and Methods: It was a prospective, observational, single center study undertaken in pediatric inpatients of diarrhea, aged one month to twelve years over a period of eighteen months at a tertiary care teaching hospital in western India. Modified Kunin’s criteria along with the guidelines set by the Indian Academy of Pediatrics (IAP) and WHO were followed for assessing the appropriateness of the antimicrobials prescribed. The adverse drug reactions occurring during course of the treatment were noted and the economic burden of the disease was calculated as direct and indirect costs. Results: A total of 103 patients were enrolled, of whom 45% were in the age group of one month to one year. Diarrhoea with some dehydration was diagnosed in 50.5% patients followed by severe dehydration (34.9%) and no dehydration (14.6%). The number of drugs and antimicrobials prescribed per patient were 7.53±1.87 and 1.92±0.67, respectively. Rehydration fluids (31.6%) and antimicrobials (25.5%) were the commonest drug groups prescribed. Among the antimicrobials, cefotaxime, cotrimoxazole and amoxicillin with clavulanic acid were frequently prescribed. Appropriate antibacterial therapy was given in only 13% of the cases. Only one ADR due to cotrimoxazole was observed. The economic burden of the disease was calculated to be Rs. 3164.81 per patient. Conclusion: Inappropriate use of antimicrobials was seen in the study. Emphasis on proper diagnosis and treatment, education and availability of locally effective guidelines may help in a better and judicious use of drugs in children. Key words: Adverse drug reactions, Diarrhoea, drug utilization, modifi ed Kunin’s criteria, pediatric patients

Low back pain is a major public health problem all over the world. It is generally assumed that overweight, height and low back pain are related. However, the scientific evidence to support this relationship is not fully conclusive. The aim of this study is to estimate the prevalence of low back pain and its association with height, fat distribution, reproductive history and socioeconomic influence. A representative sample of 401 men and 403 women aged 20 years and above were selected and studied. It is found that 28.4% and 52.9% respectively were having low back pain. Height and fat distribution were found to have no association with low back pain. Both men and women, whose household were in the lower socio economic status reported more back pain (Adjusted odds ratio (AOR) for men 1.61, 95% confidence interval (CI): 1.02, 2.55 and AOR for women 1.57, 95% CI: 1.02, 2.34). Men with lower educational qualification reported more back pain (AOR 1.89, 95% CI: 1.08, 3.31). In women, those who have undergone caesarean section (AOR 1.661, 95% CI: 1.02, 2.72) and sterilization (AOR 1.63, 95% CI: 1.09, 2.44) were found to be a positively associated with low back pain. The only socioeconomic link with back pain among women seemed to be manual occupation (AOR 3.33, 95% CI: 1.49, 7.4). The finding confirms the higher burden of back pain on the socially disadvantaged, but cannot yet be explained by known risk factors. Key words: Fat distribution, height, low back pain, reproductive history, socioeconomic class

Context: Most of the sexually transmitted infections (STIs), both ulcerative and non-ulcerative are prevalent in India. However, due to lack of adequate laboratory infrastructure in the country, information regarding STIs lies essentially on syndromic basis. Hence, there is very limited data of laboratory proven STIs. Aims: The aim of this study is to determine the prevalent STI and reproductive tract infection (RTI) in the region and comparison of etiological diagnosis with syndromic approach. Settings and Design: Cross-sectional study. Materials and Methods: A total of 1120 patients attending STI/RTI clinic were included in the study with one or more complaints as enunciated by World Health Organization in its syndromic approach. Depending on syndromic presentation, different samples such as ulcer swabs, genital swabs and blood samples were collected. These samples were processed by the standard guidelines of National AIDS Control Organization. Warts, Molluscum contagiosum and genital scabies were diagnosed clinically. Results: Age of acquiring STI in females (20-24 years) was lower than males (25-44 and more). Vaginal discharge syndrome (90.3%) was most common followed by cervical discharge syndrome (20%). The highest incidence of herpes (14.3%) seen in genital ulcerative diseases but clinically human papilloma virus (16.5%) was common. Overall, Candida was the most common isolates. Bacterial STIs like chancroid (0%) and gonorrhea (0.54%) are showing a declining trend. Laboratory confirmation of syndromic diagnosis was seen in only 409/1120 (36.5%). Conclusions: Viral STIs/RTIs are getting the upper hand over bacterial. Syndromic algorithms have some shortcomings and they need to be periodically reviewed and adapted to the epidemiological patterns of STIs in a given setting. Key words: Genital discharge syndrome, genital ulcerative syndrome, sexually transmitted infection/reproductive tract infection, World Health Organization, Syndromic approach

Scrub typhus is an acute, febrile zoonosis caused by an obligate intracellular bacterium Orientia tsutsugamushi. It is of greatest public health importance in tropical rural Asia. The clinical manifestations of the disease range from sub-clinical to fatal organ failure. The common symptoms are fever, chills, headache, myalgia, dry cough, lymphadenopathy and gastrointestinal disturbances. The first presentation with cutaneous vasculitis and polyarthralgia is rare and unusual. We report a case of scrub typhus that presented with cutaneous vasculitis and polyarthralgia, which is very unusual and patient recovered with doxycycline treatment. Key words: Chigger, eschar, leukocytoclastic vasculitis, Orientia tsutsugamushi, polyarthralgia, Weil-Felix test

Roadside accidents have increased tremendously in the last decade resulting in increased morbidity and mortality both in the developing and developed nations.[1] However, there can be instances where accident happens on the road without any vehicular involvement. The present communication intends to convey one very important incident which throws numerous questions to the administrators, general public, and traffic policy makers. A 42-year-old Sikh male was driving on a two-wheeler in one of the cities of northern India when he suddenly met with an unusual accident. While driving, he started yawning and suddenly he felt something going into his mouth. He hardly had time to react to this strange intrusion when he suddenly felt a stinging sensation in his throat. He stopped his vehicle and tried to fi nd out the cause of the pain in the throat. He felt something moving in his pharyngeal area and asked a passerby to have a look into his throat. Nothing could be seen in the neck region. He started feeling the development of a lump in his throat which was felt to be gradually increasing in the size. An ambulance was called from public helpline number which arrived in 15 minutes. By that time the patient had started developing breathing difficulty and cyanosis.