Health data from diaries used in low-income communities, north India.

OBJECTIVE: To determine the acceptability of keeping a self-written health diary among members of low-income communities, with the aim of generating needed health data. METHODS: We identified three different types of impoverished communities (tribal, inner-city slum and rural) in north India, and conducted a baseline survey to establish the sociodemographic properties of the members of 595 (tribal), 446 (slum) and 51 (rural) households. We designed health diaries with a single page to fill in per month, each with a carbon duplicate, and distributed diaries to willing participants. Health volunteers visited households each month to assist with diary completion and to collect duplicate pages for a period of one year. We compared the frequency of illnesses reported in health diaries with baseline survey data. FINDINGS: A total of 4881 diary users (tribal: 2205; slum: 2185; rural: 491) participated in our project. In terms of acceptability, 49.6% (1093/2205), 64.7% (1413/2185) and 79.0% (388/491) at the tribal, slum and rural sites, respectively, expressed satisfaction with the scheme and a willingness to continue. In the tribal and slum areas, we observed increased reporting of illnesses from health diaries when compared with baseline data. We observed that influenza-like illnesses were reported with the highest frequency of 58.9% (2972/5044) at the tribal site. CONCLUSION: We observed high levels of acceptability and participation among the communities. From our initial field studies, we have observed the benefits to both our study participants (timely preventive education and referrals) and to service providers (obtaining health data to allow improved planning).

Awareness and practices of standard precautions for infection control among nurses in a tertiary care hospital.

Nursing personnel are at a greater risk of acquiring and transmitting blood-borne pathogens. Knowledge about standard precautions and practicing them is very critical in preventing blood borne transmitted infections. This cross sectional hospital-based study sought to assess the level of knowledge and practices regarding standard precautions for infection control amongst nurses and to determine their source of information. In a tertiary care hospital in Delhi, 293 nurses were administered a semi structured questionnaire in December 2011. Questions were asked on knowledge and practices about standard precautions, transmission of blood-borne pathogens, use of gloves, hand washing. Data was entered and analysed in SPSS version 12. The study revealed that the nurses had poor knowledge about standard precautions (97.9%). 189 (64.5%) nurses had inadequate knowledge about the transmission of blood-borne pathogens; more than three-fourth (77.5%) were aware about hepatitis-B vaccine; majority (72.7%) practiced washing soiled hands immediately; and more than half (58.7%) used Gowns and Gloves very often. Refresher training (34.5%) was the major source of information. This study has highlighted major gaps between the knowledge and practices of nurses regarding standard precautions.

Rabies epidemiology and control in India: a review.

Rabies, though a disease of low public health priority, still continues to be a major public health problem in India. In humans, rabies is almost invariably fatal once clinical symptoms have developed. WHO reports around 50 000 rabies deaths every year, out of which 20 000 are estimated to occur in India alone. There is often gross under-reporting of human rabies deaths in India. Despite potent anti-rabies vaccines and immunoglobulins available, rabies is far from control and elimination. An effective strategy for control of rabies takes into account the epidemiology of animal bites, rabies and factors influencing post exposure treatment. Hence it becomes pertinent to review the current status of rabies and strategies for its control in the country. In this article, an attempt has been made to discuss the epidemiology of Rabies, pathogenesis, diagnosis and its prevention and control including the various regimens of anti-rabies vaccines and immunoglobulins available for post-exposure prophylaxis. The importance of primary preventive measures like Animal Birth Control (ABC) and vaccination of dogs has also been highlighted. It is emphasized that rabies should be recognized as priority public health problem and cell culture vaccines should be made available free of cost at all government health facilities. Other important measures include generation of awareness about rabies and first aid of animal bites.

Socio-Demographic, Reproductive and Clinical Profile of Women Diagnosed with Advanced Cervical Cancer in a Tertiary Care Institute of Delhi.

INTRODUCTION: Cervical cancer is one of the leading cancers among Indian women with estimated 123,000 new cases and 67,477 deaths in 2012. Cervical cancer is a multi-etiological disease. Factors such as low socioeconomic status, tobacco use, sexual and reproductive factors, HIV and other sexually transmitted diseases and long-term oral contraceptive use have been suggested as determinants. Assessment of socio-demographic profile and reproductive history gives a better picture of the determinants of cervical carcinoma in low-resource settings. METHODS: This hospital-based cross-sectional study was undertaken at a tertiary healthcare institute at New Delhi, India. Sixty-seven newly diagnosed women with advanced cervical cancer (stage 2B-4B), who were undertaking radio- and/or chemotherapy, were included to assess their socio-demographic, reproductive and clinical profile. RESULTS: The mean age of women at the time of detection of cervical cancer was 52.28 ± 11.29 years (range 30-75 years). More than 60 % of patients were illiterate and belonged to middle socioeconomic status. Thirty-nine percentage of the study subjects had their first sexual experience before 15 years of age. Nearly 54 % women had 5 or more pregnancies. Nearly 73 % of women had all deliveries at home. Majority (69 %) of women had symptoms suggestive of reproductive tract infection. Among them, unusual discharge from vagina (73.13 %) followed by bleeding after menopause (55.10 %) and pain in abdomen (44.77 %) were the most common presenting complaints. Pallor was present in nearly two-third (63.93 %) study subjects. More than half (56.72 %) study subjects had moderate anemia, and 7.46 % had severe anemia before treatment. Mean hemoglobin level of the study subjects was 10.35 ± 1.72 gm% before treatment and 9.69 ± 1.29 gm% after treatment. This difference was statistically significant. Around 97 % of the study subjects had squamous cell carcinoma of the cervix. Majority (53.73 %) of the study subjects were in stage 3B of cervical cancer. Combination of radiotherapy and chemotherapy was the most common (77.67 %) modality of treatment. CONCLUSIONS AND RECOMMENDATIONS: Illiteracy, low socioeconomic status, early sexual debut, high fertility, home delivery, reproductive tract infections, use of insanitary clothes during menstruation and anemia were observed in majority of women with advanced cancer cervix. Presence of these factors indicates possible risk of cervical cancer and should be kept in mind when women seek health services. Early diagnosis through high risk or opportunistic screening and timely management of cervical cancer needs to be ensured for better outcomes.

Quality of Life of Patients with Advanced Cervical Cancer before and after Chemoradiotherapy.

BACKGROUND: Cervical cancer is the most frequently diagnosed cancer among women in India. Understanding quality of life (QOL) in women undergoing chemoradiotherapy for cervical cancer will help in introducing interventions for better care and outcomes in these women. This study assessed QOL before and after chemo radiotherapy in cervical cancer patients. MATERIALS AND METHODS: This followup study covered sixtyseven newly diagnosed women with advanced cervical cancer (stages 2b to 4b). Structured questionnaires (the European Organization for Research and Treatment of Cancer, EORTC QLQC30 and EORTC QLQCX24) were used to assess the change in QOL after 6 months of treatment. RESULTS: The mean age of women at the time of detection of cervical cancer was 52.3±11.29 years (Range 3075 years). Six months survival was 92.53%. The mean global health score of cervical cancer patients after six months of treatment was 59.52, which was significantly higher than the pretreatment score of 50.15 (p=0.00007). Physical, cognitive and emotional functioning improved significantly (p<0.05) after treatment. Fatigue, pain, insomnia and appetite loss improved but episodes of diarrhea increased after treatment. The mean "symptoms score" using EORTC QLQCX24 post treatment was 20.0 which was significantly lower as compared to the pre treatment score 30.0 (p<0.00001). Sexual enjoyment and sexual functioning decreased significantly after treatment. CONCLUSIONS: QOL of newly diagnosed cervical cancer patients improved significantly following chemoradio therapy. Enhancement was also demonstrated on three of the five functional scales of EORTC QLQC30. To further improve QOL, interventions focusing on social and psychological support and physical rehabilitation may be needed.

HPV Vaccination in India: Critical Appraisal.

Cervical cancer is the third most common cancer in women worldwide. The role of human papilloma virus (HPV) in the genesis of cervical carcinoma is well documented. The HPV 16 and 18 are found to be most commonly associated with invasive cervical carcinoma. The advent of cervical carcinoma vaccine has advanced the hopes that eradication of cervical carcinoma might be possible in future. The scenario of prevention of cervical carcinoma is completely different in developed and developing countries. The implementation of the vaccination as a routine in India is still controversial. Here we have tried to critically analyse these issues in Indian context. However it is clear that cervical cancer vaccine is not an immediate panacea and cannot replace the cervical cancer screening which is mandatory in Indian context.