Malnutrition-free India: Dream or reality.

In spite of great efforts done by the Government of India to tackle the problem of malnutrition, proportion of population normal on nutrition scale has been stationary; nearly half of them have been a victim of under- and over-nutrition. Over a period, undernutrition has declined but this has been compensated by overnutrition. Hidden hunger is a still an unfinished agendum. The achievement of food grain security at the national level did not percolate down, and households' food insecurity and level of chronic food insecurity are still high. High economic growth rates have failed to improve food security in India. There is a need and scope for organizational, financial, and managerial reforms in this direction. The repercussion of malnutrition is not limited to physical deterioration, but it also affects the psychological level of victims. The legislative, service, and educational approaches should be optimized to fulfill the dream of malnutrition-free India.

Bacteriophages Can Make a Difference in Water Quality: Evidence From a Community-Based Study From North India.

Background and objectives Diarrhoea is a preventable and treatable faecal-oral disease. Despite significant inputs from the health and non-health sector in the treatment and prevention of diarrhoea, it remains a significant contributor to under-five-years children mortality and exerts profound effects on their growth and development. Bacteriophage has the potential to prevent diarrhoea. Bacteriophage status may influence the extent of diarrhoea. The objectives of the study were a) to assess the bacteriophage status and quality of water based on the Most Probable Number (MPN) count in the drinking water of under-five years children, and b) to find the association of the extent of diarrhoea with the bacteriophage status and quality of drinking water of under-five-years children in rural areas of Varanasi. Methods This is a community-based cross-sectional study done in the Chiraigaon community development block in a rural area of Varanasi. Water samples were collected and analysed in the Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi. Results The result of the study was that bacteriophage is present in 118 samples of water, whereas bacteriophage for Escherichia coli (E. coli), Klebsiella, and Vibrio were present in the drinking water of 81.1%, 53.8%, and 25.8% of under-five-years children, respectively. The water quality was highly satisfactory in 41.7% of samples and unsatisfactory in 15.2% of samples (p<0.004). All samples with highly satisfactory water quality had bacteriophages. Diarrhoea was present in 57.14% of samples without bacteriophage and 24.5% in samples with bacteriophage (p<0.01). The unadjusted odds ratio is 4.09. Interpretation and conclusions The odds of diarrhoea are four times higher in the water sample without bacteriophage than in the water sample in which bacteriophage is present. Bacteriophage study in preventing diarrhoea in children under five and health risk assessment call for focus.

Treatment seeking in reproductive age women with RTIs/STIs: a community based cross-sectional study.

The socio-cultural and economic contexts in developing countries influence the epidemiology or STIs and helps in making them an important public health priority. This study was carried out to explore the health care seeking pathway of the women suffering from RTls/STls. influence or major socio-demographic variables on treatment seeking pattern. This cross sectional study was carried out comprising or eight hundred reproductive age (15-49 years) women selected following a multistage sampling procedure. The information pertaining to health seeking behaviour were collected from them using a pre-designed pretested interview schedule. Quantum of RTIs/STIs in the study group was estimated and symptomatics were asked specially about time lag between appearance of symptoms and seeking acre; reason for not seeking care; outcome of treatment they have taken if any. Out of total 359 subjects with symptoms of RTls/STls only about one-third (37.3%) had sought treatment. Only a few (4.5%) had sought treatment within 1 month of appearance of symptoms. Considering it to be physiological about half of the subjects (45.3%) did not seek treatment. The treatment seeking pattern was highly associated with the level of education (p = 0.000). Reluctance in seeking treatment, delay in its initiation, prelerence for unqualified practitioners in first consultation and significant association between education and treatment seeking pattern emphasize BCC and service provision for control and prevention of RTls/STls.

Everything is not on track in management of diarrhoea in under-five children: Evidence from rural area of India.

CONTEXT: Diarrhea is one of the leading causes of death and morbidity in under-five children. Effective management can significantly influence survival of children with diarrhea. OBJECTIVES: This study was carried out to assess extent of diarrhea, its source of treatment, and type of therapy. SETTINGS AND DESIGN: This snapshot study was conducted in rural setting of India. METHODS AND MATERIAL: This study was conducted on 217 under-five children selected through multistage sampling procedure. STATISTICAL ANALYSIS USED: Statistical association of diarrhea with age and gender of children was established by computing Chi-square. RESULTS: Period prevalence (Recall period 2 weeks of visit) of diarrhea in rural under-five children was 35.9% (95%C.I. 29.3-42.2%). Highest prevalence in age group 0-12 months (47.8%) and lowest in 49-59 months (18.2%). Number of episode per child is 1.08. Diarrhea was watery in 69.4%. Quacks were treatment provider for 36.4% cases. In 17.6% episodes, no treatment was taken. Only 9.4% episodes were treated in government facilities. For the treatment of diarrhea, antibiotic was used in 71.8% cases, ORS use was 33.3% cases, and zinc was used 21.8% of diarrhea episodes. CONCLUSIONS: Diarrhea is a significant problem in under-five children from a rural area of India. In spite of existence of National Program for Control of Diarrheal Diseases (NPCDD) since four decades, management of diarrhea is not on track. Focusing on primary care provision to under-five children can help in bringing the management of diarrhea on track.

Ocular cysticercosis at a teaching hospital in Northern India.

BACKGROUND: Ocular cysticercosis (OC) is common in tropical countries. This study aimed to analyze the clinical presentation patterns, management and treatment outcomes of OC cases seen at a teaching hospital in North India. METHODS: This study took place between March 2014 and February 2019. A total of 36 patients with OC were analyzed to determine clinical presentation and outcomes. RESULTS: Of the 36 patients, 13 (36.11%) were male and 23 (63.89%) were female. The most frequently affected age group was 10-29 years (n = 22; 61.11%). All of the patients had unilateral lesions, with involvement of the left eye in 22 (61.11%) and the right in 14 (38.89%). The majority of cases were isolated to the ocular region; however, five (13.89%) demonstrated neural involvement as well. In terms of cyst location, 15 (41.67%) were orbital, 13 (36.11%) were subconjunctival and four each (11.11%) were intraocular or on the eyelid. The most common clinical presentations were subconjunctival masses or proptosis in 13 each (36.11%) and periorbital swelling in 12 (33.33%). Most patients received medical treatment (n - 23; 63.89%), while the others required surgical excision. Recurrence was noted in seven patients (19.44%), of which three underwent surgery while the rest were treated medically. Two patients (5.56%) developed phthisis. CONCLUSIONS: In this study, OC cysts were more often orbital or subconjunctival compared to findings reported from Western countries. In addition, a female preponderance was noted in contrast to previously reported findings. Advanced radioimaging is crucial to ensure early diagnosis and treatment.

The epidemiology of ocular trauma in Northern India: A teaching hospital study.

AIM: The aim was to determine the epidemiology of ocular trauma in a large teaching hospital in northern India over 4 years from 2010 to 2014. MATERIALS AND METHODS: This prospective, hospital-based, observational study was conducted at the Ophthalmology and Emergency Outpatient Departments of S. S. Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from March 2012 to February 2016. Detailed history was taken with special consideration to time, place and session of trauma, mode of injury, and type and nature of traumatic agent. All patients were thoroughly examined as per the standard clinical procedures to identify the type, extent, and severity of injury and impact on ocular structure and vision. Follow-up period was 6 months. Statistical analysis was based on age, sex, residence, marital status, occupation, per capita income, type of trauma and nature of damage, etc. RESULTS: Out of 402 patients, 293 (72.9%) were male and 109 (27.1%) were female. Overall male-to-female sex ratio was 2.7:1. Patients were aged between 2 and 70 years (mean: 26.48 ± 15.88, median: 23 years). The most vulnerable age group was 6-15 years (24.38%) followed by 16-25 years (23.88%). Maximum patients belonged to rural background (61.94%). The extent of ocular trauma was 3.93% (95% confidence interval: 3.23-4.63). Majority of participants were single (78.11%) and rest were married. About 112 (27.9%) participants were illiterate and 24.4% had primary education only. One hundred and eighty-eight (46.8%) participants belonged to lower and lower middle socioeconomic status. The cases were clustered in Rs. 1000-5000 per capita income. Most of the injuries occurred in summer season (46.18%) and in afternoon between 12.00 and 17.59 h (48.8%). Majority of trauma occurred away from home (66.20%) mainly on street (28.6%) and playground (9.2%). The most common injury was nonoccupational (82.3%) including sports related (23.9%) and road traffic accident (23.6%). Mechanical injuries were accounted for 89.3% of all eye injuries, and most common source was wooden object (24.9%) followed by metallic objects (20.9%). Traumatic agents were blunt and sharp in 56% and 17% of cases, respectively. Majority of traumatic agents were solid (82.1%). Seven percent of victims were drowsy during trauma and 98.4% of participants were not using any protective device at the time of injury. In 60.7% of cases, time elapsed between injury and treatment was between 1 and 24 h. Around 44.5% had isolated ocular trauma and rest 55.5% were polytrauma cases. Three hundred and sixty-eight (91.5%) participants had unilateral involvement and 8.5% had bilateral involvement. Almost 52.8% had injuries of adnexa and 32.8% had globe injuries. More than half of the study participants had ≥3 ocular structure involvement. After 6 months, 14.8% of the right eyes and 25.5% of the left eyes showed poor outcome. CONCLUSION: This study highlights epidemiology of ocular trauma in northern India. Mass health education and awareness about risk of ocular trauma, morbidity caused by delayed presentation, and need to adopt safety or preventive strategies should be focused, especially during travel, playground, and at workplace.

Prevalence and spectrum of hypertension in a rural area.

AIMS AND OBJECTIVES: The objective of the study was to find the prevalence and spectrum of hypertension in a rural area of Varanasi, India. MATERIALS AND METHODS: This was a cross sectional study carried on 3600 subjects > or = 30 years of age and residents of three villages around Varanasi. The period of study was from April 2002 to January 2003. RESULTS: The overall prevalence of hypertension 13.6%.As much as 25.05% of the total subjects were in the category of High Normal. Among the hypertensives 80.5% had Stage 1 hypertension. With advancing age the prevalence of hypertension increased significantly. CONCLUSION: It is alarming to note that 1/4th of the study subjects had blood pressure in the range of High Normal and are a potential risk group. Of the hypertensive, 80% had Stage 1 hypertension which can be prevented and normalised by adopting lifestyle modification.

Nutritional status of adolescent girls of a slum community of Varanasi.

In order to assess nutritional status of adolescent girls of a slum community of Varanasi and factors influencing them, this study was carried out on 70 girls belonging to the age group 13 to 18 years. The study subjects were selected from Sunderpur, an urban community of Varanasi, by adopting appropriate sampling methodology. The approach adopted for the study was a cross sectional one. The tools in the study were pre-designed and pre-tested schedule, weighing scale, steel anthoropometric rod and measuring tape. The techniques of the study included interview method, clinical examination and anthropometry. In all, 70.0% adolescent girls had BMI < 20%; 51.43% study subjects were suffering from Chronic Energy Deficiency (CED). Stunting (Height for age alpha 90%) was present in 10% of adolescent girls. Their average Weight, Height, MAC were 83.45%, 93.08% and 82.05% of the corresponding estimated reference values. Significant association of common parameters (viz., age, caste, income, type of family, working and literacy status) with nutritional status of study subjects was not observed in this study. However, lesser undernutrition in large families (> 6) indicated role of familial support in prevention of undernutrition in adolescent girls.

Energy balance of adolescent girls in rural area of Varanasi.

Although several studies have been undertaken on dietary intake of adolescent girls, studies on their energy expenditure and thereby energy balance are few. In order to explore these aspects, this community based cross-sectional study was done on 270 adolescent girls of a rural area of Varanasi, selected by adopting appropriate sampling technique. Nutritional status of study subjects was assessed on the basis of BMI. Their energy intake was computed by 24 hours recall oral questionnaire method. Estimation of energy expenditure was based on physical activity which was noted by 24 hours activity recall questionnaire method. Average energy intake (1609.42 +/- 528.87 kcal/day) of the study subjects was less than their mean energy expenditure (1896.19 kcal/day). Their energy expenditure was significantly influenced by several factors (e.g. age, caste, type of family, etc.) As much as 69.63%, subjects were in negative energy balance. Majority of subjects belonging to lower (79.37%) and middle (75.19%) SES were in the negative energy balance. Negative energy balance has been significantly less in subjects belonging to high SES, having main occupation of the family as business and high per capita income groups with respect to their corresponding subcategories. In all 68.52% study subjects had BMI < 18.5 kg/m2. Majority (91.11%) of adolescent girls had rate of energy expenditure > 1.4. Under nutrition was significantly (p<0.05) more in subjects with rate of energy expenditure > 1.4 (i.e. 70.33%) than in subjects with rate of energy expenditure < or = 1.4.

MCH record maintenance at primary health centre level.

Scrutiny of MCH records of 1977-78 and 1988 at PHC level revealed glaring deficiencies in their maintenance e.g. missing of entries., duplicate entries etc. Extent of supervision of service records was extremely low. Record linkages could be poorly established and thus present mechanism of health care delivery could not ensure continuity of care. The level of record maintenance has almost remained same over a decade period. This can be avoided by modifying the information system, making records at the PHC level simple, action oriented with built in system of evaluation and involving community in its maintenance and utilisation.

A study on some diarrhoea related practices in urban Mirzapur.

In an operational research on the improvement of sanitation and water supply by an Indo-Dutch project at Mirzapur, UP, diarrhoeal morbidity was taken as an intermediate outcome variable for measuring the impact of the proposed intervention. In this study 350-410 under-five children were selected from 200 urban families of 3 slums and surveyed during 3 different seasons for 2 weekly recall of morbidity, treatment and feeding practices during diarrhoea. The prevalence of diarrhoea varied between 8.7% to 33%. Breast feeding was not restricted while other forms of feeding was continued in 57.1% to 66.3% of cases. Use of ORT increased significantly from 0% to 39.62% possibly as a result of health education. Reorientation of private practitioners to avoid use of unnecessary drug is suggested.

PIP: In 1988, researchers conducted an operations research study of an improved sanitation and water supply project which included health education in the slums of Sabari, Armanganj, and Katwaru Ka Pura in Mirzapur, Uttar Pradesh in India to examine diarrhea related practices. Diarrhea prevalence was significantly higher in the rainy season than either the summer or winter months (32.3% vs. 12.9% and 8.65% respectively; p.001). Drugs were used significantly more often in the rainy season (97.65%) than in the winter and summer months (67.86% and 81.63% respectively; p.001). Private practitioners treated most cases of diarrhea regardless of the season (94.1% in rainy season, 53.6% and 75.5% in winter and summer months respectively). On the other hand, government health facilities treated relatively few cases (3.5%, 17.9%, and 0 respectively). Use of home available fluids increased significantly from 0-39.62% (p.001). So did use of oral rehydration packets 2.7-32%; p.001). The researchers accredited this improvement to educational activities. Women tended to continue breastfeeding and giving other foods to children during diarrheal episodes. Nevertheless there was room for improvement. These results revealed the need for educational efforts to encourage caretakers to use home available fluids and oral rehydration solution and to reorient private practitioners to avoid using drugs and to use oral rehydration therapy.

Estimating true burden of disease detected by screening tests of varying validity.

Timely and accurate information on disease load is essential for planning health programs. Unfortunately, complexity, cost and need of skilled personnel limit the use of screening tools of high validity in developing countries. The disease load estimated with tools of low validity differs considerably from true disease load, particularly for diseases of extreme levels of prevalence/incidence. A tool of 70% sensitivity and specificity may yield a prevalence/incidence rate of 34% (CI: 32.23-35.67%) for a disease whose true rate is only 10.0% (CI: 8.94-11.06%). We proposed a procedure to derive the true estimate in such cases, based on the concepts of sensitivity and specificity of a diagnostic/screening test. It is applied on two sets of real data--one pertaining to incidence rate of low birth weight (LBW) and the other to prevalence rate of obesity--where multiple screening tests of varying validity were used to estimate the magnitude. Different screening tests yielded widely varying incidence/prevalence rates of LBW/obesity. The prevalence/incidence rates derived by using the proposed estimation procedure are similar and close to the true estimate obtained by screening tests considered as gold standard. Further, sample size determined on the basis of the results of a tool of low validity may be either larger or smaller than the required sample size. Estimation of true disease load enables determination of correct sample size, thus improving the precision of the estimate and, in some instances, reducing the cost of investigation.

Nexus of poverty, energy balance and health.

Since the inception of planning process in India, health planning was an integral component of socio-economic planning. Recommendations of several committees, policy documents and Millennium development goals were instrumental in development of impressive health infrastructure. Several anti-poverty and employment generation programmes were instituted to remove poverty. Spectacular achievements took place in terms of maternal and child health indicators and expectancy of life at birth. However, communicable diseases and undernutrition remain cause of serious concern and non-communicable diseases are imposing unprecedented challenge to planners and policy makers. Estimates of poverty based on different criteria point that it has remained a sustained problem in the country and emphasizes on revisiting anti-poverty programmes, economic policies and social reforms. Poverty affects purchasing power and thereby, food consumption. Energy intake data has inherent limitations. It must be assessed in terms of energy expenditure. Energy balance has been least explored area of research. The studies conducted in three different representative population group of Eastern Uttar Pradesh revealed that 69.63% rural adolescent girls (10-19 years), 79.9% rural reproductive age group females and 62.3% rural geriatric subjects were in negative energy balance. Negative energy balance was significantly less in adolescent girls belonging to high SES (51.37%), having main occupation of family as business (55.3%), and highest per capita income group (57.1%) with respect to their corresponding sub-categories. In case of rural reproductive age groups, this was maximum (93.0%) in SC/ST category and least (65.7%) in upper caste group. In case of geriatric group, higher adjusted Odd's Ratio for negative energy balance for subjects not cared by family members (AOR 23.43, CI 3.93-139.56), not kept money (AOR 5.27, CI 1.58-17.56), belonging to lower and upper middle SES by Udai Pareekh Classification (AOR 3.73, CI 1.22-11.41), with lowest per capita income (AOR 15.14, CI 2.44-94.14) and in age group >80 years (AOR 5.76, CI 1.03-32.39). Of those in negative energy balance, 70.21% rural adolescent girls and 7 out of 10 geriatric subjects (activity based) were victims of CED. Extent of undernutrition and CED in rural reproductive age group females were more in those caste groups where energy deficit was also of higher magnitude. Energy balance must be visualized giving due consideration to the importance of exercise on human health. The evidence thus generated needs to be translated to the masses based on principles of translational research.