Little Doctors: Agents of change in Indian rural communities.

The child-to-child approach to health advocacy is one that draws on the strengths and agency of children to make a positive impact within their communities. The approach has been popularly used for health education in low- and middle-income countries. This article describes the 'Little Doctors' program that implemented the child-to-child approach in the towns of KC Patty and Oddanchatram, located in remote hilly regions of Tamil Nadu, India starting in 1986 to train middle- and high school children to respond to diseases prevalent in their communities along with practices for preventative measures. The program involved sessions that used a combination of creative instructional methods to engage students and provided take-home messages for them to act on with their families and community. The program was successful in creating a creative learning environment for children, offering a shift from the traditional methods of classroom instruction. Students who successfully completed the program were awarded certificates as 'Little Doctors' in their communities. Although the program did not conduct formal evaluations of the program effectiveness, students reported successfully recalling complex topics such as early signs of diseases like tuberculosis and leprosy that were prevalent in the community during the time. The program experienced several challenges and had to be discontinued despite its continued benefits to the communities.

Elastography: a surrogate marker of renal allograft fibrosis - quantification by shear-wave technique.

PURPOSE: Renal fibrosis is the most common cause of allograft failure in kidney transplantations. Evaluation of renal abnormalities has progressed considerably over the past years. Currently, the diagnosis of intrarenal fibrosis and quantification of its development with non-invasive assessment tools is possible. This may help in early detection of renal allograft dysfunction. This study sought to assess the efficacy of 2D real-time shear-wave elastography (SWE) in the quantitative measurement of renal allograft dysfunction. METHODS: A total of 172 patients were included in our study. SWE was performed in all these patients just before renal allograft biopsy. The cortical elasticity was assessed and described in terms of Young's modulus (kPa). Banff histopathological grading obtained from transplant kidney tissue biopsy was taken as the reference standard. The potential correlation between SWE scores and Banff classification was performed. RESULTS: There was a significant correlation between the Banff grade and mean SWE score, with a correlation coefficient of 0.665 (p < 0.001). The individual correlation coefficients of interstitial fibrosis and tubular atrophy with mean SWE score stood at 0.667 and 0.649 respectively (p < 0.001). The correlation of resistive indices was insignificant when compared to mean polar SWE score in respective poles and the Banff grading of fibrosis. CONCLUSIONS: Renal stiffness quantified by 2D SWE showed significant correlation with histopathological renal fibrosis. Thus, the study suggests that shear-wave elastography could be used as a surrogate marker for early detection of renal fibrosis.

Reasons for default from treatment of chronic illnesses in a primary healthcare program in rural Tamil Nadu.

Chronic illnesses are an increasing cause of morbidity and mortality in rural India. Many patients default from treatment, and exploring their reasons for the same may suggest strategies to improve service accessibility and acceptability. A qualitative study was conducted of 22 patient interviews, six key informant interviews, and two patient focus group discussions for investigating the reasons for default at the KC Patty Primary Health Centre and surrounding villages in Kodaikanal Taluk, Dindigul district, Tamil Nadu. The reasons included money or transport difficulties, frequent travel, feeling healthy, focus on work, fear of scolding from clinic staff, medication side effects, preference for alternative therapy, and depression. Some reasons were only divulged after an extended discussion. Support from families and village-level health workers (VLHWs) were also identified as important. Recommendations include more open and patient communication between health workers and defaulting patients, in addition to recruitment of more VLHWs.

Bacterial orbital cellulitis - A review.

Infections of orbit and periorbita are frequent, leading to significant morbidity. Orbital cellulitis is more common in children and young adults. At any age, infection from the neighboring ethmoid sinuses is a likely cause and is thought to result from anatomical characteristics like thin medial wall, lack of lymphatics, orbital foramina, and septic thrombophlebitis of the valveless veins between the two. Other causes are trauma, orbital foreign bodies, preexisting dental infections, dental procedures, maxillofacial surgeries, Open Reduction and Internal Fixation (ORIF), and retinal buckling procedures. The septum is a natural barrier to the passage of microorganisms. Orbital infections are caused by Gram-positive, Gram-negative organisms and anaerobes in adults and in children, usually by Staphylococcus aureus or Streptococcus species. Individuals older than 15 years of age are more likely to harbor polymicrobial infections. Signs include diffuse lid edema with or without erythema, chemosis, proptosis, and ophthalmoplegia. It is an ocular emergency requiring admission, intravenous antibiotics, and sometimes surgical intervention. Computed tomography (CT) and magnetic resonance imaging (MRI) are the main modalities to identify the extent, route of spread from adjacent structures, and poor response to intravenous antibiotics and to confirm the presence of complications. If orbital cellulitis is secondary to sinus infection, drainage of pus and establishment of ventilation to the sinus are imperative. Loss of vision can occur due to orbital abscess, cavernous sinus thrombosis, optic neuritis, central retinal artery occlusion, and exposure keratopathy, and possible systemic sequelae include meningitis, intracranial abscess, osteomyelitis, and death. The article was written by authors after a thorough literature search in the PubMed-indexed journals.

"How often? How much? Where from?" knowledge, attitudes, and practices of mothers and health workers to iron supplementation program for children under five in rural Tamil Nadu, south India.

Iron deficiency anemia (IDA) affects 70% of under-5 children in India. The primary prevention strategy is regular iron supplementation. Little is known about what helps families adhere to daily iron supplementation. Our study explored the knowledge, attitudes, and practices of mothers and village health workers (VHWs) involved in a community health program in one hill district of Tamil Nadu. We conducted 30 semistructured interviews and 3 group discussions involving mothers, VHWs, and community stakeholders. Knowledge of IDA was widespread, yet no children were receiving the iron supplementation as recommended. The main determinants to adherence included the perception of its need, the ease of access, and the activity of VHWs. Preventive care requiring daily supplements is challenging. Our study suggests that increasing community awareness of mild anemia, simplifying dosage instructions, and further strengthening the supportive environment for VHWs would help in reducing the prevalence of IDA.