Admissions to a sick new born care unit in a secondary care hospital: Profile and outcomes.

BACKGROUND: To reduce neonatal mortality in North Bihar, evidence is required about the impact of sick newborn care units (SNCUs) in secondary level hospitals on mortality at the end of the neonatal period. OBJECTIVES: The objective of the study is to assess the profile of neonates admitted to an SNCU and the outcome at the completion of neonatal period. METHODS: A cohort of neonates admitted from March to June 2014 to an SNCU was assessed through family interviews and hospital records. Demographic details (age, sex, and socioeconomic status) and clinical details (antenatal care, birthplace, weight, diagnosis, and family history) were documented. Follow-up was done at discharge or death or referral and the completion of neonatal period. The primary outcome was survival at the completion of neonatal period. Secondary outcomes were case fatality rate at discharge and weight gain. RESULTS: Of 210 neonates assessed, 87.6% (95% confidence interval [CI] 82.4-91.4) survived till the end of the neonatal period. The case fatality rate at the time of discharge was 0.9% (95% CI 0.3-3.4). Majority of the diagnoses were infections, hyperbilirubinemia, and infant of diabetic mother. Mean weight gain at the end of neonatal period (n = 157) was 706 g (P = 0.00). Sex ratio at admission was 567 girls to 1000 boys (95% CI 428/1000-751/1000). No neonate from lower socioeconomic families was admitted. CONCLUSIONS: SNCUs in remote areas can bring down neonatal mortality in North Bihar. Unequal access of SNCUs services to girls and lower socioeconomic groups highlighted the existing barriers which require attention.

Diagnostic pathways and direct medical costs incurred by new adult pulmonary tuberculosis patients prior to anti-tuberculosis treatment - Tamil Nadu, India.

BACKGROUND: Tuberculosis (TB) patients face substantial delays prior to treatment initiation, and out of pocket (OOP) expenditures often surpass the economic productivity of the household. We evaluated the pre-diagnostic cost and health seeking behaviour of new adult pulmonary TB patients registered at Primary Health Centres (PHCs) in Vellore district, Tamil Nadu, India. METHODS: This descriptive study, part of a randomised controlled trial conducted in three rural Tuberculosis Units from Dec 2012 to Dec 2015, collected data on number of health facilities, dates of visits prior to the initiation of anti-tuberculosis treatment, and direct OOP medical costs associated with TB diagnosis. Logistic regression analysis examined the factors associated with delays in treatment initiation and OOP expenditures. RESULTS: Of 880 TB patients interviewed, 34.7% presented to public health facilities and 65% patients sought private health facilities as their first point of care. The average monthly individual income was $77.79 (SD 57.14). About 69% incurred some pre-treatment costs at an average of $39.74. Overall, patients experienced a median of 6 days (3-11 IQR) of time to treatment initiation and 21 days (10-30 IQR) of health systems delay. Age ≤ 40 years (aOR: 1.73; CI: 1.22-2.44), diabetes (aOR: 1.63; CI: 1.08-2.44) and first visit to a private health facility (aOR: 17.2; CI: 11.1-26.4) were associated with higher direct OOP medical costs, while age ≤ 40 years (aOR: 0.64; CI: 0.48-0.85) and first visit to private health facility (aOR: 1.79, CI: 1.34-2.39) were associated with health systems delay. CONCLUSION: The majority of rural TB patients registering at PHCs visited private health facilities first and incurred substantial direct OOP medical costs and delays prior to diagnosis and anti-tuberculosis treatment initiation. This study highlights the need for PHCs to be made as the preferred choice for first point of contact, to combat TB more efficiently.

A community based case control study on determinants of perinatal mortality in a tribal population of southern India.

INTRODUCTION: Perinatal mortality rate has been regarded as an indicator of the quality of prenatal, obstetric and neonatal care in an area, which also reflects the maternal health and socioeconomic environment. The objective of the current study was to identify causes and risk factors for perinatal deaths among the tribal population in Jawadhi Hills, Tamil Nadu, southern India. METHODS: A community-based case control study design was used, where a case was a perinatal death and controls were from a sampling frame of all children who were born alive in the same area ±7 days from the day of birth of the case. The WHO Standard International Verbal Autopsy form was used to arrive at the cause of death. Univariate and multivariate analyses for factors associated with perinatal deaths were done. RESULTS: A total of 40 cases, including 22 early neonatal deaths and 18 stillbirths, and 110 controls were included in the study. Among the perinatal deaths, 40% were born prematurely. Sepsis (17.5%) and birth asphyxias (12.5%) were the major causes of deaths. In the final logistic regression model, parity ≥4 (odds ratio [OR] 5.75 [95% confidence interval (CI) 1.88-17.54]), preterm births (OR 5.62 [95% CI 2.12-16.68]) and time to reach the nearest health facility more than two hours (OR 2.51 [95% CI 1.086.73]) were significantly associated with the perinatal deaths. CONCLUSIONS: Prematurity, poor accessibility and a high parity were significantly associated with perinatal deaths in the tribal population of Jawadhi Hills.

A community health programme in rural Tamil Nadu, India: the need for gender justice for women.

This article highlights the efforts of the Community Health and Development (CHAD) Programme of Christian Medical College to address the issues of gender discrimination and improve the status of women in the Kaniyambadi Block, Vellore, Tamil Nadu, India. The many schemes that are specifically for women and general projects for the community from which women can also benefit represent a multi-pronged approach whose aim is the improvement of women's health, education and employment in the context of community development. However, despite five decades of work with a clear bias in favour of women, the improvement in health and the empowerment of women has lagged behind that achieved by men. We believe this is because the community, with its strong male bias, utilises the health facilities and education and employment programmes more for the benefit of men and boys than women and girls. The article argues for a change of approach, in which gender and women's issues are openly discussed and debated with the community. It would appear that nothing short of social change will bring about an improvement in the health of women and a semblance of gender equality in the region.