Cost-Effective Recruitment need for 24x7 Paediatricians in the State General Hospitals in Relation to the Reduction of Infant Mortality.

INTRODUCTION: According to World Health Organisation (WHO), improvement of hospital based care can have an impact of upto 30% in reducing Infant Mortality Rate (IMR), whereas, strengthening universal outreach and family-community based care is known to have a greater impact. The study intends to assess how far gaps in the public health facilities contribute towards infant mortality, as 2/3rd of infant mortality is due to suboptimum care seeking and weak health system. AIM: To identify cost-effectiveness of employment of additional paediatric manpower to provide round the clock skilled service to reduce IMR in the present state health facilities at the district general hospitals. MATERIALS AND METHODS: A cross-sectional observational study was conducted in a tertiary teaching hospital and district hospitals of 2 districts (Hooghly and Howrah in West Bengal). Factors affecting infant mortality and shift wise analysis of proportion of infant deaths were analysed in both tertiary and district level hospitals. Information was gathered in a predesigned proforma for one year period by verifying hospital records and by personal interview with service personnel in the health establishment. SPSS software version 17 (Chicago, IL) was used. The p-value was calculated by Fischer exact t-test. RESULTS: Available hospital beds per 1000 population were 1.1. Percentage of paediatric beds available in comparison to total hospital bed was disproportionately lower (10%). Dearth of skilled medical care provider at odd hours in district hospitals resulted in significantly greater infant death (p < 0.0001), but was not seen in tertiary hospital. The investment for appointing four additional paediatricians for round the clock stay duty was found to be cost-effective. CONCLUSION: Provision of round the clock availability of skilled medical care may reduce hospital based infant mortality and it is cost-effective.

Myelomeningocele with hydrocephalus and agenesis of corpus callosum.

A 45-day-old male baby presented with a leaking myelomeningocele and signs of meningitis. A computerised tomographic scan of brain revealed gross supratentorial ventriculomegaly with inflammatory exudates suggestive of intracranial infection. An unexpected association of complete agenesis of corpus callosum was discovered, however it is an incidental finding, a rare combination indeed.

Adolescent health screening questionnaire.

Adolescent screening questionnaire is a set of questions made on determinants of adolescent health and used to screen adolescents exposed to health risk environment to offer preventive and promotional health care . Most evidence based questionnaire (GAPS) was developed by American Medical Association. Subsequently American Academy of Pediatrics (AAP) and Bright Future (BF) developed questionnaire. All of them were developed to serve American and Western society needs. Format of Adolescent Preventive Services (FAPS) questionnaire was prepared by Adolescent Health Clinic of Calcutta Medical College to suit Indian adolescents, having a different cultural background, with technical support from WHO. National consultations on this questionnaire was supported by WHO and GOI. It was field tested and its validity and reliability were assessed among adolescents of six school students. Use of this tool helps identification of adolescents exposed to high-risk environments and use of necessary early intervention to prevent morbidity and mortality in adolescents. The available software version of FAPS can be used in the computer class to screen all school adolescents regularly.

Efficacy of oral rehydration therapy in dehydrating diarrhoea of children.

Establishment of diarrhoea treatment and training units (DTTUs) in all major health facilities for promotion of appropriate oral rehydration therapy (ORT) is an important strategy for control of diarrhoeal diseases (CDD) in children in this country. Univariate analysis of mortality experiences of a random sample of 225 diarrhoea cases among children treated at DTTU in the department of paediatric medicine, RG Kar Medical College, Kolkata revealed that case fatality rate (CFR) of diarrhoea was much higher among children treated with parenteral fluid therapy with or without drugs (20.6% and 20.9% respectively), compared to those treated with oral rehydration solution (ORS) only (0.75%). Certain child care practices, like immunisation, breastfeeding and use of ORS at home also favourably influenced survival of children suffering from diarrhoea. The CFR of diarrhoea cases did not depend on type of diarrhoea or nutritional status of the child. Thus, promotion of correct practice of ORT merits attention through all possible means.