Birth preparedness and complication readiness among women of Bankura District, West Bengal.

BACKGROUND: Birth preparedness and complication readiness (BPCR) is the process of planning for normal birth and anticipating the actions needed in case of an emergency which is critical in averting maternal morbidity and mortality. OBJECTIVES: To find out awareness and practices regarding BPCR among pregnant and recently delivered women in Bankura, West Bengal. MATERIALS AND METHODS: A cross-sectional, community-based study was carried out among 120 pregnant women and 235 recently delivered women. Information on sociodemographic variables as well as awareness and practices regarding BPCR were collected through semi-structured interview. For statistical analysis Z-test was used. RESULTS: The majority of respondents (69.3%) had registered for antenatal care within the first 12 weeks of their pregnancy and 74.0% of the recently delivered women had four or more antenatal check-ups and 81.3% had institutional delivery. The BPCR index of pregnant women and recently delivered women was 45.2 and 59.0, respectively, whereas BPCR index of the total was 52.1. CONCLUSION: Although the BPCR indicators are satisfying, the health system should use the opportunity during visits to health institutions to increase awareness among the pregnant women and her family on how to plan for the pregnancy and identify danger signs.

A study on utilization of Janani Suraksha Yojana and its association with institutional delivery in the state of West Bengal, India.

BACKGROUND: India launched the Janani Suraksha Yojana (JSY) on the principles of conditional cash transfer providing monetary incentive to needy women to improve access to institutional childbirth. OBJECTIVES: This study was conducted among JSY-eligible women who delivered between April 2012 and June 2012 to assess the utilization of cash incentives toward institutional delivery, along with other associated factors influencing institutional delivery. METHODS: It was a cross-sectional, descriptive study conducted between July 2012 and May 2013 on 946 women selected through stratified random sampling of subcentres from better and worse performing districts of West Bengal. RESULTS: 74.7% of the study population was JSY-eligible. 90.2% of those who took three antenatal check-ups (ANCs) and 36.8% JSY-noneligible women received cash. Government institutions were preferred for childbirth among all groups irrespective of JSY eligibility, receipt of cash, and number of antenatal visits. Overall, 78.8% opted for institutional delivery if they had received cash, which was significantly more than those who did not (64.5%). JSY-eligible women were 1.5 times more likely to deliver in government institutions compared to JSY-noneligible women. With no incentive, the likelihood of institutional delivery was halved. The distance of a 24 Χ 7 delivery hub beyond 5 km (74.8% vs. 81.8%), the religion of Islam (62.7% vs. 83.2%), and multiparity (63.9% vs. 83.6%) were significant deterring factors. CONCLUSION: Despite some inclusion and exclusion errors, cash incentive under JSY was associated with increased institutional delivery, especially in government institutions though there were other factors influencing the decision as well.

Goiter prevalence, urinary iodine, and salt iodization level in sub-Himalayan Darjeeling district of West Bengal, India.

National iodine deficiency disorders control program needs to be continuously monitored. Hence, a cross-sectional study was conducted during the period from April-May 2011 to assess the prevalence of goiter, status of urinary iodine excretion (UIE) level and to estimate iodine content of salts at the household level in Darjeeling district, West Bengal. Study subjects were 2400 school children, aged 8-10 years selected through "30 cluster" sampling methodology. Goiter was assessed by standard palpation technique, UIE was estimated by wet digestion method and salt samples were tested by spot iodine testing kit. Overall goiter prevalence rate was 8.7% (95% confidence intervals = 7.6-9.8) and goiter prevalence was significantly different with respect to gender. Median UIE level was 15.6 mcg/dL (normal range: 10-20 mcg/dL). About 92.6% of the salt samples tested had adequate iodine content of ≥15 ppm. Findings of the present study indicate that the district is in a transition phase from iodine-deficiency to iodine sufficiency.

Are institutional deliveries promoted by Janani Suraksha Yojana in a district of West Bengal, India?

'Janani Suraksha Yojana (JSY)' was implemented in India to promote institutional deliveries among the poorer section of the society. A cross-sectional study was conducted in Bankura district among 324 women who delivered in last 12 months selected through 40 cluster technique to find out institutional delivery rate, utilization of JSY during antenatal period and relation between cash benefit under JSY during antenatal period and institutional delivery. Overall institutional delivery rate was 73.1% and utilization of JSY among eligible women was 50.5%. Institutional delivery (84.0%), consumption of 100 iron-folic acid tablets (46.0%) and three or more antenatal check-ups (91.0%) were better in women who received financial assistance from JSY during antenatal period than other women. After adjustment for socio-demographic factors, JSY utilization came out to be significantly (P=0.031) associated with institutional deliveries. The study showed that cash incentive under JSY in antenatal period had positive association on institutional deliveries.

Clinico-epidemiological profile of chronic suppurative otitis media patients attending a tertiary care hospital.

The cross-sectional study was conducted to assess the clinico-epidemiological profile, perceptions and clinical profile of the chronic suppurative otitis media (CSOM) patients in a tertiary care hospital. A pretested questionnaire was used containing open questions and the patients were assessed clinically. Most patients (31.2%) were from 0-10 years age group and were males (58.8%). Majority of them (96%) lived in "kuccha" houses/slums, 76.8% practised unhygienic ear pricking, 36.8% poured oil in their ears, 70.8% bathed in ponds/rivers, 52.8% had ear discharge for more than 1 year. Among the respondents, 17.2% knew that CSOM was contagious, 24% thought CSOM ran in family, 20% knew CSOM is preventable. There was low threat perception and long time to seek care. Patients mostly presented with earache, deafness and discharge, most had deafness and safe variety of CSOM. More than half had comorbidities. Most of the previous study findings corroborated with the present study. Here was a substantial delay between the onset and treatment seeking due to lack of awareness and low threat perception. Pain and complications were the triggers for care-seeking. Education about the disease, strengthening the frontline workers and good referral system are suggested.

Enduring starvation in silent population: a study on prevalence and factors contributing to household food security in the tribal population in Bankura, West Bengal.

BACKGROUND: Strengthening food security enhancement intervention should be based on the assessment of household food security and its correlates. OBJECTIVES: The objective was to find out the prevalence and factors contributing to household food security in a tribal population in Bankura. METHODS: A cross-sectional study was conducted among 267 tribal households in Bankura-I CD Block selected through cluster random sampling. Household food security was assessed using a validated Bengali version of Household Food Security Scale-Short Form along with the collection of information regarding the monthly per capita expenditure (MPCE), total to earning member ratio, BPL card holding, utilization of the public distribution system (PDS) and receipt of any social assistance through a house-to-house survey. RESULT AND CONCLUSION: Overall, 47.2% of study households were food secure whereas 29.6% and 23.2% were low and very low food secure, respectively. MPCE ≥ Rs. 356, total to earning member ratio ≤ 4:1, regular utilization of PDS, and nonholding of the BPL card were significantly related with household food security.

Limited access to iodized salt among the poor and disadvantaged in North 24 Parganas district of West Bengal, India.

Iodine deficiency is endemic in West Bengal as evident from earlier studies. This community-based, cross-sectional descriptive study was conducted in North 24 Parganas district during August-November 2005 to assess the consumption of adequately-iodized salt and to ascertain the various factors that influence access to iodized salt. In total, 506 households selected using the multi-stage cluster-sampling technique and all 79 retail shops from where the study households buy salt were surveyed. The iodine content of salt was tested by spot iodine-testing kits. Seventy-three percent of the households consumed salt with adequate iodine content (> or = 15 ppm). Consumption of adequately-iodized salt was lower among rural residents [prevalence ratio (PR): 0.8, 95% confidence interval (CI) 0.7-0.9], Muslims (PR: 0.8, 95% CI 0.7-0.9), and households with monthly per-capita income of < or = US$ 10 (PR: 0.7, 95% CI 0.6-0.8). Those who heard and were aware of the risk of iodine-deficiency disorders and of the benefit of iodized salt were more likely to use appropriate salt (PR: 1.2, 95% CI 1.1-1.3). Those who were aware of the ban on non-iodized salt were more likely to consume adequately-iodized salt (PR: 1.1, 95% CI 1.01-1.3). The iodine content was higher in salt sold in sealed packets (PR: 2.9, 95% CI 1.8-4.8) and stored on shelves (PR: 1.6, 95% CI 1.3-2.0). Seventy-two percent of the salt samples from the retail shops had the iodine content of > or = 15 ppm. The findings indicate that elimination of iodine deficiency will require targeting the vulnerable and poor population.

Awareness and perception of mothers about functioning and different services of ICDS in two districts of West Bengal.

Integrated Child Development Services, a national programme of the Government of India has health, nutrition, and pre-school education components of services. To ascertain awareness, perception of mothers about functioning and different services of ICDS a cross-sectional community based study was conducted between June to September 2007 in Howrah and Purulia districts of West Bengal. A total of 1235 mothers were included as study subjects. As per opinion of the mothers 73% AWCs opened regularly, behaviour of the AWWs was friendly (71.6%) and 63% mothers opined that ICDS is beneficial to their children. 84.2% mothers were aware of any ICDS services. Quantity and quality of supplementary food was acceptable to 88% and 72.7% mothers respectively. 79.2% and 87.5% mothers did not receive any advice on child feeding and growth chart. Making beneficiaries aware about services by targeted interventions will ensure better utilization of ICDS.

A study on care seeking behavior of chest symptomatics in a slum of Bankura, West Bengal.

A cross-sectional, community based study was undertaken in Patpur slum of Bankura to determine the prevalence of chest symptomatics, their health care seeking Behavior and its correlates. Prevalence of chest symptomatics (cough for 3 weeks or more) was found to be 5.5%, three fourths of whom sought relief from a health care provider. Among them, 70.8% did so within 2 weeks, median being 7 days. No preference for either government or private health care provider was seen in first visit, where the major reason for choosing facilities was advice by family & friends (43.8%). Most of the chest symptomatics (75%) were retained in the same facility. Shift from private to government facility for subsequent visits (33.3%) was higher than from government to private facility (16.7%). The main reason (50%) for changing health facility was expectation for better service.

Goitre prevalence, urinary iodine and salt iodisation level in a district of West Bengal, India.

OBJECTIVES: We carried out a study to assess the prevalence of goitre, measure urinary iodine excretion (UIE) levels and to estimate salt iodine content at the household level in Howrah district of West Bengal, India. STUDY DESIGN: This is a Cross-sectional descriptive study conducted in September-December 2006. SETTING: Primary schools located in 30 clusters (villages and wards) randomly selected through 30 cluster sampling methodology. PARTICIPANTS: 2400 school children, aged 8-10 years. Indicators: The indicators used in this study to assess for IDD were recommended by the WHO/UNICEF/ICCIDD. Goitre was assessed clinically by the standard palpation technique. The urinary iodine excretion level was analyzed by the wet digestion method. Salt samples consumed at the household level were collected and tested by the spot iodine testing kit to measure iodine content. RESULTS: The Total Goitre Rate (TGR) was 13.7% (95% CI = 12.3-15.1%). Grade 1 was 11.4% and Grade 2 (visible goitre) was 2.3%. The TGR was influenced by the age and sex factors but not by religion and residence. The median urinary iodine excretion level was 13 microg/dL (normal range: 10-20 microg/dL) and none had a value less than 5 microg/dL. There was significant negative correlation between UIE levels and the age and place of residence factors. Almost 80% of salt samples tested had adequate iodine content (>or= 15 ppm). Consumption of iodized salts was lower among Hindus and in rural area. CONCLUSION: In conclusion, the Howrah district is in a transition phase from iodine deficiency to iodine sufficiency.

Persistence of iodine deficiency in Gangetic flood-prone area, West Bengal, India.

In 2000, India revoked the ban on production and sale of non-iodised salt. We conducted a study in the north 24 Parganas district in the state of West Bengal to assess the prevalence of goitre, status of urinary iodine excretion (UIE) level and to estimate iodine content of salts at the household level. We surveyed 363 school children aged eight to ten years selected using a multistage cluster sampling technique. We estimated goitre prevalence and urinary iodine excretion (UIE) using methods and criteria recommended by the World Health Organization. We estimated the iodine content of salt samples collected from the households of the study subjects using spot iodine testing kit. Of the 363 children, 73 (20%) had goitre. The median UIE was 160 micro g/l (normal: > or =100 micro g/l) and only 6% children had a level below 50 micro g/l. Only 253 of 363 salt samples (70%) were sufficiently iodised. The combination of high goitre prevalence with normal median urinary excretion indicates that the North 24 Parganas district is in transition from iodine deficient to iodine sufficient state. However, the persistence of non-iodised salt consumption indicates that an intensification of universal salt iodisation program is needed. In 2000, India revoked the ban on production and sale of non-iodised salt. We conducted a study in the north 24 Parganas district in the state of West Bengal to assess the prevalence of goitre, status of urinary iodine excretion (UIE) level and to estimate iodine content of salts at the household level. We surveyed 363 school children aged eight to ten years selected using a multistage cluster sampling technique. We estimated goitre prevalence and urinary iodine excretion (UIE) using methods and criteria recommended by the World Health Organization. We estimated the iodine content of salt samples collected from the households of the study subjects using spot iodine testing kit. Of the 363 children, 73 (20%) had goitre. The median UIE was 160 micro g/l (normal: > or =100 micro g/l) and only 6% children had a level below 50 micro g/l. Only 253 of 363 salt samples (70%) were sufficiently iodised. The combination of high goitre prevalence with normal median urinary excretion indicates that the North 24 Parganas district is in transition from iodine deficient to iodine sufficient state. However, the persistence of non-iodised salt consumption indicates that an intensification of universal salt iodisation program is needed.

Assessment of iodine deficiency disorders in Purulia district, West Bengal, India.

Iodine deficiency disorders IDD are major public health problems in India, including West Bengal. Existing programme to control IDD needs to be continuously monitored through recommended methods and indicators. The objective of this study was to assess the prevalence of goitre, status of urinary iodine excretion UIE level and to estimate iodine content of salts at the household level in Purulia district, West Bengal. A school-based, cross-sectional study was conducted during June-September 2005; among 2,400 school children, aged 8-10 years. The "30 cluster" sampling methodology and indicators for assessment of IDD, as recommended by the joint WHO/UNICEF/ICCIDD consultation, were utilized for the study. Goitre was assessed by standard palpation technique, urinary iodine excretion was analyzed by wet digestion method and salt samples were tested by spot iodine testing kit. The total goitre rate TGR was 25.9% (95% Cl=24.1-27.1%) with grade I and grade II (visible goitre) being 19.5% and 6.4% respectively. Goitre prevalence did not differ by sex but significant difference was observed in respect of age. Median urinary iodine excretion level was 9.25 microg/dl and 31.6% children had value less than 5 microg/dl. Only 33.4% of the salt samples tested had adequate iodine content of > or = 15 ppm, High goitre prevalence (25.9%) and median urinary iodine (9.25 microg/dl) below normal range indicate existence of current iodine deficiency in Purulia district. The district is still in the iodine-deficient state. Moreover, salt iodisation level far below the recommended goal highlights IDD as major public health problems in the district. Intensified information, education and communication activities along with sustained monitoring are urgently required.

A comparative study of common ear morbidity pattern among the primary school children of an urban slum of Kolkata and rural area of Hooghly.

A cross-sectional, clinical and epidemiological study was undertaken among 627 primary school children (rural 145, urban 482) to compare the common ear morbidity pattern between an urban slum of kolkata and a rural area of Hooghly. Middle ear pathology was found to be present in 20% and 12.6% among rural and urban students respectively. Cerumen in the external auditory canal was the commonest clinical finding in both the areas and was found to be present in 35.86% of rural and 30.70% of urban population respectively. Smoke nuisance, bathing in open ponds and overcrowding were some of the predisposing factors causing ear diseases, like chronic suppurative otitis media and serous otitis media.

Availability and use of emergency obstetric care services in four districts of West Bengal, India.

Process indicators have been recommended for monitoring the availability and use of emergency obstetric care (EmOC) services. A health facility-based study was carried out in 2002 in four districts of West Bengal, India, to analyze these process indicators. Relevant records and registers for 2001 of all studied facilities in the districts were reviewed to collect data using a pre-designed schedule. The numbers of basic and comprehensive EmOC facilities were inadequate in all the four districts compared to the minimum acceptable level. Overall, 26.2% of estimated annual births took place in the EmOC facilities (ranged from 16.2% to 45.8% in 4 districts) against the required minimum of 15%. The rate of caesarean section calculated for all expected births in the population varied from 3.5% to 4.4% in the four districts with an overall rate of 4%, which is less than the minimum target of 5%. Only 29.9% of the estimated number of complications (which is 15% of all births) was managed in the EmOC facilities. The combined case-fatality rate in the basic/comprehensive EmOC facilities was 1.7%. Major obstetric complications contributed to 85.7% of maternal deaths, and pre-eclampsia/eclampsia was the most common cause. It can be concluded that all the process indicators, except proportion of deliveries in the EmOC facilities, were below the acceptable level. Certain priority measures, such as making facilities fully functional, effective referral and monitoring system, skill-based training, etc., are to be emphasized to improve the situation.

Iodine deficiency disorders among school children of Malda, West Bengal, India.

A community-based, cross-sectional study was conducted among 2,392 school children, aged 8-10 years, in Malda district of West Bengal, India, in January 2001 to assess their iodine status. The children were selected through a multistage 30 cluster-sampling technique to determine the status of iodine deficiency disorders (IDD) using recommended quantifiable indicators. The prevalence of goitre was assessed clinically using the standard palpation method by the teachers of Community Medicine, and a total goitre rate of 11.3% was found with no significant gender difference (p>0.05). Urinary iodine excretion (UIE) levels of 341 study subjects, selected through systematic random sampling, were analyzed by the wet digestion method to determine biochemical iodine deficiency by the teachers of Biochemistry Department. The median UIE was 15 mcg/dL, and no child had UIE value less than 5 mcg/dL. Iodine content of 1,060 salt samples tested with spot-testing kit revealed 85.1% with adequate iodine content of > or = 15 ppm. The finding of 11.3% of total goitre rate but with no evidence of current iodine deficiency (median UIE 15 mcg/dL) indicates that the Malda district is in the transition phase from iodine-deficient to iodine-sufficient.