Does blood pressure variability affect the summer associated symptoms amongst females?

INTRODUCTION: Blood pressure usually increases in winter and decreases in summer i.e, shows seasonal variation. In a tropical country like India women often complain off prominent symptoms like dizziness, giddiness, fainting and weakness during summer months. The objective was to study the prevalence of above symptoms which are common during summer and its association with variation in blood pressure among normotensive healthy females aged 18-40 years. METHODS: The present study was carried out on 132 women as a prospective observational study which included 2 home visits to the participants in the two different seasons in the months of May-June (summer) and December-January (winter) based on the data provided by the meteorological department of Government of India. Blood pressure and pulse rate (hemodynamic variables) was measured in these seasons and information was collected on the occurrence of the symptoms in these seasons. RESULTS: There was mean decrease of 11.07 +/- 10.29 mm of Hg in Systolic blood pressure & 6.79 +/-6.88 mm of Hg in diastolic blood pressure in summer as compared to winter. The symptoms in the form of weakness, dizziness and blackout which are generally perceived by women in this area to be due to low blood pressure were observed in 32.6% of the study subjects in summer compared with 2.3% in winter. The difference was statistically highly significant (p < 0.001). There was no significant difference between the mean value of electrolytes, creatinine and urea in the cases and the controls. CONCLUSION: Thus the seasonal variation in blood pressure rather than electrolytes abnormality may be responsible for these symptoms.

Seasonal variation in prevalence of hypertension: Implications for interpretation.

OBJECTIVES: to study seasonal variation in prevalence of hypertension. MATERIALS AND METHODS: the study was carried out in the year 2006, in Gokulpuri, an urban slum located in eastern part of Delhi. 275 females 18-40 years of age were examined in summer. Blood pressure was measured in two seasons, summer and winter. Nutritional status of each individual was assessed by BMI. RESULTS: the prevalence of hypertension based on SBP was 12.72% in summer which increased to 22.22% in winter. The prevalence of hypertension, using DBP criteria increased to more than double (summer vs. winter, 11.27% vs. 26.59%, P< 0.001). Overall prevalence of hypertension (SBP ≥ 140 or DBP ≥ 90 mm of Hg) was 1.9 times during winter compared to summer (P<0.001). Greater increase in prevalence of hypertension during winter among older females and underweight as well as normal females was observed. CONCLUSION: Significant increase in prevalence of hypertension during winter compared to summer indicates need for considering this factor while comparing prevalence reported in different studies as well as interpreting the surveillance data based on repeat surveys.

Utilizing paramedical worker for screening visual status of adults in a village of Delhi.

A community based study in a village of Delhi was carried out during February 2004-May 2005 to assess visual outcomes in population more than 40 years age utilizing a paramedical worker. About 24% of them had sup-optimal vision and were referred to a health centre visited by an ophthalmologist. 78% of those referred, attended the centre and got spectacles/cataract operation as advised indicating effectiveness of screening by a paramedical worker followed by referral. Since the specialist referral service was also available within the same village, very high success rate in the current study may not be replicated to the same extent in other settings.

General practitioners' knowledge of childhood asthma in Delhi, India.

OBJECTIVE: To assess knowledge of childhood asthma among general practitioners (GPs) in Delhi, India. DESIGN: In this cross-sectional study, a total of 157 GPs were interviewed using a validated questionnaire, including six questions of local and social relevance. A response rate of 78.5% was obtained. RESULTS: Although the GPs who participated in the study had adequate knowledge of the importance of appropriate treatment, the safety of inhalers/oral steroids and the role of medicines in the prevention of frequent asthma attacks, the majority lacked knowledge of symptomatology, exercise-induced asthma and inhaled corticosteroids. GPs with >5 years of practice were more likely to have significantly less knowledge about preventive drugs, certain aspects of treatment of acute asthma and misconceptions, such as 'drinking milk increases mucus production' or 'children with asthma should not consume dairy products, chilled drinks, sour or chilled food'. On the other hand, GPs with < or =5 of practice had misconceptions such as 'children with asthma have abnormally sensitive airways' and 'asthmatic children develop dependence on inhalers'. CONCLUSIONS: The gaps in knowledge about asthma and its management highlight the need to design well-structured educational strategies for health professionals.

Incidence of summer associated symptoms, host susceptibility and their effect on quality of life among women 18 to 40 years of age in an urban slum of Delhi.

OBJECTIVES: To study whether individual susceptibility plays a role in the occurrence of summer associated symptoms (dizziness, giddiness, fainting and weakness) among women 18-40 years of age and their effect on the quality of life. METHODS: It was a prospective community based study carried out in an urban slum of Delhi as a follow up of an earlier study. All women who had "given symptoms" during summer in the earlier study and a sample of those who were asymptomatic were included in the current study. Both the groups were studied for the occurrence of "given symptoms" and quality of life during next summer and winter using a pre structured questionnaire and WHOQOL-BREF. RESULTS: Incidence of "given symptoms" during summer was more than three times among women who were symptomatic earlier compared to women who were asymptomatic. The incidence of these symptoms was significantly higher among the former across different age groups and BMI categories. Their physical domain of quality of life was also adversely affected. CONCLUSIONS: Continued high incidence of summer associated symptoms with adverse effect on their physical quality of life, among women who were symptomatic earlier too, points to individual susceptibility rather than random occurrence. This aspect requires for further studies.

Clinicoepidemiological profile and predictors of severe illness in young infants (< 60 days) reporting to a hospital in North India.

OBJECTIVES: To describe the clinical and epidemiological profile of young infants reporting to a hospital and assess previously proposed simple clinical signs for their value in enabling health workers to detect young infants with severe illness warranting hospital admission. METHODS: Observational study of infants less than 2 months of age presenting consecutively to a large public hospital in South Delhi who were evaluated by a health worker (nurse), on a standardized list of signs and symptoms, and the ability of these were evaluated against the need for hospital admission which was assessed by an independent pediatrician. RESULTS: Of the 1624 young infants triaged, 878 were enrolled into the study. Of these 100 (11%) were below 7 days of age, for whom the common reasons for seeking care were jaundice (52%), not feeding well (6%) and fever (5%). The remaining 778 (89%) were 7-59 days of age with respiratory symptoms as the main presenting complaints (29.1%). The primary clinical diagnoses in infants with serious illness needing admission to hospital in the age group <7 days (n = 66) were hyperbilirubinemia (56%) and sepsis (21%). In those between 7-27 days of age (n = 60), primary diagnoses were sepsis (27%), pneumonia (13%), diarrhea, dysentery or dehydration (10%), while in the age group 28-59 days of age (n = 47) pneumonia (40%), sepsis (19%) and diarrhea or dehydration (13%) were the common primary diagnoses. Signs that had at least a prevalence of 5% and were strong predictors for all the age categories studied were history of difficult feeding (OR 6.8 for 0-6 days, 15.1 for 2-27 days and 6.2 for 28-59 days age groups), not feeding well on observation (OR 13.7, 27.6 and 20.9 respectively for the 3 age groups), temperature > 37.5C (OR 21.8, 14.6 and 30.0 respectively for the 3 age groups) and respiratory rate > 60 per minute (OR 6.8, 15.1 and 21.0 respectively for the 3 age groups). Additional strong predictors with > 5% prevalence were history of convulsions (OR 7.9, only in 0-6 day age group), lethargy (OR 26.1, only in 7-27 day age group), and history of diarrhea (OR 3.0 for 2-27 days and 2.2 for 28-59 days age groups). CONCLUSIONS: Simple clinical signs are useful in hands of health worker for identifying neonates with serious illness warranting hospital admission. These will be of use in the further development of clinical algorithms for the national integrated management of childhood illnesses.

Knowledge, attitude and practices regarding tuberculosis and dots among interns in delhi, India.

OBJECTIVE: To assess the knowledge, attitude and practices regarding tuberculosis (TB) and DOTS among young medical graduates (interns). DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Lady Hardinge Medical College and Maulana Azad Medical College, New Delhi, India, during November and December 2002, simultaneously. SUBJECTS AND METHODS: A pre-tested semi-structured questionnaire consisting of 30 items was administered to the young medical graduates/interns posted in different departments. The questions covered mode of transmission, symptoms of pulmonary TB, investigations, short course chemotherapy including DOTS as well as conventional anti-tubercular treatment, special situations, health education and chemoprophylaxis. RESULTS: A total of 287 interns were surveyed. Majority of the study subjects (92.7%) ranked DOTS strategy as more successful for treating tuberculosis in comparison to self-administered therapy. However, a mere 4.2% study subjects were aware of all modes of transmission. One hundred and eighty-nine (65.9%) correctly chose sputum examination for acid fast bacilli as the single most confirmatory test for diagnosing pulmonary TB. The rest either gave incorrect responses (including ELISA-17.0%, PCR-9.8%, X-ray chest-4.2%, ESR-1.7%) or did not respond (1.4%). Only 2.1% marked pyrazinamide and rifampicin as the agents to be avoided in patients with liver disease. One hundred and forty-one different treatment regimens were mentioned in the responses received and of those only 11(7.8%) were scientifically acceptable. CONCLUSION: TB is a major health problem in South-East Asian countries. There is a need for appropriate changes to be made in the undergraduate medical teaching/training curriculum in the concerned countries with regard to TB.

Awareness and perception about tuberculosis in the general population of Delhi.

The present study was conducted to assess awareness and perception regarding tuberculosis among the general population of Delhi. A total of 1008 adults, selected by multistage stratified systematic sampling, were interviewed using a pre-tested proforma. The majority had heard about tuberculosis (99.1%) and most (89.2%) perceived it to be an infectious disease. The correct mode of transmission i.e. airborne (coughing/sneezing) was known to 71.8% study subjects. The majority (90.1%) knew cough as a symptom. Nearly all (98.2%) perceived Tuberculosis to be a preventable disease, citing the treatment of patients as the mainstay of preventing spread of the disease. However, responses like separation of utensils or hospitalisation of the patient to prevent the spread of the disease indicate persistence of stigma and discrimination in a small proportion of the population. There is a need to widen the scope and intensify the information and education being provided to the population based on gaps identified.

Practice and knowledge regarding prevention of tetanus among nursing personnel in Delhi.

A cross-sectional study was conducted in Delhi to assess the practices and knowledge regarding tetanus immunization among nursing personnel. Majority of the study subjects had received their last dose of tetanus toxoid injection only after injury and just 4.4% received it to complete the immunization schedule. More than 12% subjects did not know whether they had received any tetanus toxoid injection or not, another 5.5% had their last dose of tetanus toxoid more than ten years back. As many as 20 (22.2%) subjects stated that TT should be given after every injury. Of the remaining 70 subjects only 22.9% correctly knew why TT was not required. Only one third of the subjects knew the indications of anti tetanus serum.

Newborn care practices in an urban slum of Delhi.

BACKGROUND: Despite efforts by government and other agencies, neonatal morbidity and mortality continues to be high in India. Among other reasons, newborn care practices are major contributors for such high rates. AIMS: To find out the newborn care practices including delivery practices, immediate care given after birth and breast-feeding practices in an urban slum of Delhi. SETTINGS AND DESIGN: Community based, cross-sectional survey in a resettlement colony (a type of urban slum). MATERIALS AND METHODS: Semi-structured, pre-tested schedule was used to interview 82 mothers of newborns in the study area. STATISTICAL ANALYSIS: Data was analyzed using Epi - info version 6.04. Fischer exact test and chi2 test were applied. A P value of less than 0.05 was considered significant. RESULTS AND CONCLUSION: More than half i.e. 26 (56.1%) of home deliveries, which were mostly conducted by dais (24, 91.3%) or relatives in 4 (8.7%) of home deliveries. Bathing the baby immediately after birth was commonly practiced in 38 (82.6%) of home deliveries. Finger was used to clean the air passage in most of the home deliveries (29, 63%). About 61% (28) of home delivered newborns were not weighed at birth. Rooming in was practiced in majority of the cases. A few of home delivered neonates (12) were given injection tetanus toxoid by unqualified practitioners. Use of clip, band or sterile thread to tie the cord and no application to the cord was significantly higher in institutional deliveries. Breast milk as the first feed was significantly more in institutional deliveries. There is an urgent need to reorient health care providers and to educate mothers on clean delivery practices and early neonatal care.

Practices and knowledge regarding prevention of tetanus among doctors in Delhi.

A cross-sectional study was conducted in Delhi to study immunisation practices regarding prevention of tetanus among doctors and their knowledge regarding its prevention. Delhi was divided into five zones, and from each zone two hospitals and five dispensaries were selected, giving due representation agency-wise. All the doctors posted for casualty duty in the selected hospitals, all doctors posted in the selected dispensaries and two private practitioners selected randomly from the nearby area of the selected dispensaries were included in the study. Only 7% of doctors had received their last dose of tetanus toxoid to complete the immunisation schedule and majority had received it following injury. As much as 38.3% of doctors favoured TT after every injury. Out of the remaining who opposed it only 59.5% could provide the correct reason for this. Less than half of the doctors knew the indications of anti-tetanus serum. There is a need for the doctors to take TT immunisation more seriously and adopt recommended immunisation practices, because if they themselves are not following the guidelines, it is likely to be reflected in their advice and motivation to patients.

The impact of an IEC campaign on tuberculosis awareness and health seeking behaviour in Delhi, India.

OBJECTIVE: To study the impact of an intensive IEC campaign regarding the Revised National Tuberculosis Control Programme launched by the Government of Delhi on awareness generation among the general population and improvement in self-reporting by symptomatic cases in Delhi, India. DESIGN: Cross-sectional study. RESULTS: A pilot study wherein 1008 persons selected by systematic random sampling from the general population and 1012 patients selected from symptomatic cases reporting to DOTS centres were interviewed. Among the general population, 716 (71.0%) had been exposed to one or more IEC message through the media. The core message regarding symptoms, diagnosis, treatment centre and free treatment was recalled correctly by 144 (14.3%), 449 (44.5%), 659 (65.4%) and 900 (89.2%), respectively. In the post IEC period, a significant increase (P < 0.01) was seen in individuals self-reporting with symptoms to DOTS centres: the media message reportedly encouraged 36.3% of these to self-report. Prior to the IEC campaign only 49 (9.8%) patients had chosen a DOTS centre as first source of treatment, which increased significantly (P < 0.0001) to 104 (20.4%) post IEC. CONCLUSION: The IEC campaign launched by the Government of Delhi has been effective in raising awareness and improving self-reporting, but it requires intensification with suitable modification to reach all sectors.

Knowledge about tetanus immunization among doctors in Delhi.

BACKGROUND: In spite of the clear-cut guidelines regarding tetanus immunization, we have observed that tetanus toxoid injection is often given after injury without considering previous immunization status. One of the reasons for this could be that the doctors themselves are not aware of the correct immunization schedules against tetanus. AIMS: 1. To assess the knowledge about tetanus immunization in relation to injuries among doctors. 2. To assess their knowledge about tetanus immunization schedules in children, pregnant women and adults. SETTING AND DESIGN: It was a cross-sectional study conducted in Delhi. MATERIALS AND METHODS: After complete enlisting of all the government allopathic hospitals and dispensaries, a representative sample (including private practitioners from the nearby area of selected dispensaries) of doctors was selected. All the doctors were personally contacted and information was collected through a pre-structured self-administered proforma. STATISTICAL ANALYSIS: Data was analyzed using a computer and wherever applicable Chi-square test/Z test or Fishers' Exact test was applied. RESULTS AND CONCLUSION: As many as 38.3% of doctors favored tetanus toxoid injection after every injury. The correct knowledge of immunization against tetanus in children, pregnant women and adults was 75%, 90.8% and 35.8% respectively. The knowledge regarding when to give boosters was even poorer. The present study showed that doctors had poor knowledge about tetanus immunization that needs to be improved.

National Rural Health Mission--a critical review.

National Rural Health Mission is strategic framework to implement the National Health Policy 2002. The scheme of Accredited Social Health Activist is an improvement over the earlier Community Health Guide Scheme. Integration of various health and family welfare programmes will result in economy and allocation of resources as per needs of the districts. Decentralised planning with the involvement of Panchayati Raj Institutions is likely to make health as people's programme. Converging water supply, sanitation, hygiene and nutrition with health planning is a logical step. The proposal to strenthen institutions of primary health care and Community Health Centres as functional Rural Hospitals alongwith introduction of Indian Public Health Standards and accountability of public health institutions to the public is likely to revolutionise the status of health care in rural India.

Increasing access to cataract surgery in a rural area--a support strategy.

The objectives of the study were to elicit the reasons for not undergoing cataract surgery from those having cataract, aged 50 years and above, in a village community and, develop, implement and assess a support strategy for getting cataract surgery done. The leading reasons identified were monetary constraints (18.8%), transport difficulty (17.4%), lack of awareness about cataract in the eyes (17.4%) and lack of escort (14.5%). Based on the identified reasons, patients were transported in groups to a government eye hospital for free surgery after completion of required pre operative formalities at the village health center itself. Out of 65 eligible individuals, 66.2% underwent surgery. The success of the approach was evident by perceived improvement in vision in 88.4% operated patients, occurrence of only few minor complications and a satisfactory hospital experience being reported by all.

A foreign body in the spinal canal. A case report.

An 18-year-old man who presented with weakness in his lower limbs, had an upper motor neurone lesion at the D12-L1 level. At laminectomy two stone-like objects were found which proved to be bundles of tiny pieces of wood. They are thought to have entered the cord through an abdominal penetrating injury sustained six years previously.

Awareness of pulse polio immunisation.

Mass polio immunisation campaign was launched in the national capital territory of Delhi with 2 doses of polio vaccine to be administered to children upto 3 years of age on October and December 4, 1994 respectively. Massive information, education & communication (IEC) efforts through mass media and interpersonal communication preceded the dates of the campaign. A study to assess the awareness of general population was carried out by interviewing 225 adult residents of Delhi using a structured questionnaire. These were drawn by two stage stratified random sampling. Zonewise assembly segments in the first stage and census enumeration blocks in the second stage formed the sampling frame. The study, carried out 3 days prior to date of administration of first dose of oral polio, revealed that 60.4% of population was aware of the programme being launched and 31.6% about aim of the programme. None of the respondents were aware of all the specific parameters put together correctly viz., objective, immunisation days, age group & immunisation status of children. The higher level of awareness was directly proportional to the level of education. The overwhelming success of the programme was indicated by immunisation of > 90% children upto 3 years of age all over Delhi in the first phase of the programme. The key to success of the programme despite low awareness is explained on the basis of unflinching efforts put in by vaccine centre level committees, integrated child development scheme (ICDS) and urban basic service (UBS) functionaries in mobilising people to reach various vaccination centres. Other states planning to launch such mass campaigns should pay attention to social mobilisation in addition to IEC efforts for successful completion of the programme.

Diarrhea management in some Jhuggi clusters of Delhi.

PIP: In India, a survey was conducted of 6285 persons living in 1090 households in the Jhuggi clusters of Sanjay Amar Colony, Hathi Park, and Jai Prakash Colony in New Delhi to identify diarrhea management practices at home and at a health facility and to determine knowledge levels about preparation of oral rehydration solution (ORS) and sugar salt solution (SSS). 183 (2.9%) persons experienced diarrhea in the previous 2 weeks. 68.3% were younger than 5 years old. 13.1% of all diarrhea cases had blood in their stool. Oral rehydration therapy (ORT) was provided to 3.3% in ORS form, 10.4% in SSS form, 5.5% as dal water, and 5.5% as shikanji. Correct preparation of SSS via finger pinch, scoop, or spoon and glasses was performed in 36.6% of households. Only 11.5% could correctly measure the water needed to make 1 liter of ORS. The first action against the diarrhea was often taken on day 2 (13.1%) and day 3 (18%). 55.7% of diarrhea cases sought treatment at a private practice. 7.1% went to a government health facility. 79.1% of cases taken to a medical practitioner received a drug (e.g., antidiarrheals and antimicrobials). Yet, antimicrobials were indicated in only 13.1% of diarrhea cases taken to a health facility. These cases had dysentery. Only 31.3% received ORS or home-available fluids. Government health facilities were more likely to provide ORT than private practitioners (61.5% vs. 27.4%). All diarrhea cases experiencing dehydration received ORT or intravenous fluids. These findings stress the need for reorientation training of physicians on appropriate case management of diarrhea and rational use of drugs in cases of acute diarrhea. Families also need training in correct preparation and use of ORT and in restriction on the use of drugs.^ieng

Knowledge regarding tetanus toxoid immunization among persons attending health mela in Delhi.

Although vaccine against tetanus has been in use for more than two decades, often people are not aware of tetanus immunization schedules and its significance in preventing tetanus. The current cross-sectional study was carried out to (1) assess knowledge about tetanus immunization (in relation to injury) among persons attending a health mela and (2) To assess their knowledge about tetanus immunization schedules in children, pregnant women and adults. Every tenth person above 15 years of age, who came to health post in the mela was interviewed. A total of 231 persons attending a health mela in Delhi in October 2003 were interviewed. About two third of them were males. Majority (55%) were graduates or above. Only half of them indicated that they would give tetanus immunization after an injury, two fifth indicated it after animal bite and only one fourth indicated it after burns. Knowledge was higher among females and with higher education. However, knowledge regarding correct immunization schedules, prevention of tetanus by DPT and when to give booster in case of injury after primary immunization was poor. There is need to create greater awareness among people about immunization against tetanus, duration of immunity and disease prevented by it. This is to ensure immunization when it is needed and avoid unnecessary repeated immunization.