ABSTRACT
BACKGROUND: Given India's high rate of TB, rising burden of non-communicable diseases (NCDs) and growing elderly population, elderly TB patients may be at higher risk of adverse outcomes including death, loss-to-follow-up (LTFU) and treatment failure. This may call for modifications in their management. This study thus aimed to compare the profile and treatment outcomes between elderly (≥60 years) and non-elderly (15-59 years) TB patients. METHODS: This was a retrospective cohort study using routinely-collected programme data from a chest clinic in Delhi, India. It included all elderly and selected non-elderly TB patients registered for treatment between 2005 and 2010. Data on patients' clinical and demographic characteristics and treatment outcomes were analysed. RESULTS: There were 812 elderly and 1624 non-elderly TB patients. Elderly patients were more likely to be male (63.2% vs 51.1%) and have smear-positive TB (56.0% vs 47.4%). Adverse outcomes were more frequent among elderly patients (adjusted OR 1.9, 95% CI: 1.5-2.4), specifically deaths (adjusted OR 5.0, 95% CI: 3.1-8.1) and lost-to-follow-up (adjusted OR 1.4, 95% CI: 1.0-1.9). CONCLUSIONS: The profile and worse outcomes of elderly Indian TB patients may be indicative of co-existing NCDs. This needs further investigation and likely calls for a more comprehensive and intensive approach to their management.
Subject(s)
Antitubercular Agents/therapeutic use , Health Services Accessibility , Tuberculosis/drug therapy , Tuberculosis/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , India/epidemiology , Male , Mass Screening , Middle Aged , Retrospective Studies , Risk Factors , Sex Factors , Treatment Outcome , Young AdultABSTRACT
BACKGROUND & OBJECTIVES: Janani Suraksha Yojana (JSY), a conditional cash transfer scheme introduced to improve the institutional delivery rates and thereby reduce the maternal and infant mortality was implemented in all States and Union Territories of India from 2007. The present study was carried out to identify the beneficiary level factors of utilization of JSY scheme in urban slums and resettlement colonies of trans-Yamuna area of Delhi. METHODS: A cross-sectional community based survey was done of mothers of infants in the selected areas of the two districts by stratified random sampling on a population proportionate basis. Socio-demographic factors, antenatal services availed and distance of nearest health facility were studied. Outcome variable, a beneficiary, was a woman who had ever interacted with the ASHA of her area during the antenatal period of previous pregnancy and had child birth in an institution. Descriptive tables were drawn; univariate analysis followed by multiple logistic regression was applied for identifying the predictors for availing the benefits. RESULTS: Of the 469 mothers interviewed, 333 (71%) had institutional delivery, 128 (27.3%) had benefited from JSY scheme and 68 (14.5%) had received cash benefits of JSY. Belonging to Hindu religion and having had more than 6 antenatal check ups were the significant predictors of availing the benefits of JSY. CONCLUSION: There is a need to improve the awareness among urban slum population about the utilization of JSY scheme. Targeting difficult to access areas with special measures and encouraging more antenatal visits were essential, prerequisites to improve the impact of JSY.
Subject(s)
Financing, Organized , Infant Mortality , Maternal Mortality , Poverty , Urban Population , Adult , Cross-Sectional Studies , Female , Humans , India/epidemiology , InfantABSTRACT
BACKGROUND: Depression is the most common geriatric psychiatric disorder. Other than organic, socio-demographic factors, have been found to play an important role in mental health. In this study we evaluated the association of some socio-demographic factors with geriatric depression. METHODS: A cross-sectional study was carried out in the Out Patient Department registration area of a tertiary care teaching hospital in Delhi. Questionnaire based interviews were conducted among the elderly people visiting the hospital. A 15-item geriatric depression scale-Hindi was used to assess depression. RESULTS: Six hundred and seventy eight subjects were interviewed. The age of the subjects ranged from 65 to 85 years. About three-fourth of the study population were males. About 61.4% scored positive for depression. Multiple logistic regression analysis revealed that the following were significant (P<0.05) independent predictors of depression: Higher age, low educational status, financial dependence and presence of any chronic health problem. CONCLUSIONS: The present study found that the prevalence of depression among the study subjects was high. Also the independent risk factors found in this study need to be targeted in formulating mental health policy for geriatrics.
ABSTRACT
Medical college faculty, who are academicians are seldom directly involved in the implementation of national public health programmes. More than a decade ago for the first time in the global history of tuberculosis (TB) control, medical colleges of India were involved in the Revised National TB Control Programme (RNTCP) of Government of India (GOI). This report documents the unique and extraordinary course of events that led to the involvement of medical colleges in the RNTCP of GOI. It also reports the contributions made by the medical colleges to TB control in India. For more than a decade, medical colleges have been providing diagnostic services (Designated Microscopy Centres), treatment [Directly Observed Treatment (DOT) Centres] referral for treatment, recording and reporting data, carrying out advocacy for RNTCP and conducting operational research relevant to RNTCP. Medical colleges are contributing to diagnosis and treatment of human immunodeficiency virus (HIV)-TB co-infection and development of laboratory infrastructure for early diagnosis of multidrug-resistant and/or extensively drug-resistant TB (M/XDR-TB) and DOTS-Plus sites for treatment of MDR-TB cases. Overall, at a national level, medical colleges have contributed to 25 per cent of TB suspects referred for diagnosis; 23 per cent of 'new smear-positives' diagnosed; 7 per cent of DOT provision within medical college; and 86 per cent treatment success rate among new smear-positive patients. As the Programme widens its scope, future challenges include sustenance of this contribution and facilitating universal access to quality TB care; greater involvement in operational research relevant to the Programme needs; and better co-ordination mechanisms between district, state, zonal and national level to encourage their involvement.
Subject(s)
Antitubercular Agents/therapeutic use , Extensively Drug-Resistant Tuberculosis/drug therapy , Extensively Drug-Resistant Tuberculosis/epidemiology , Mycobacterium tuberculosis/pathogenicity , Coinfection , Education, Medical , Extensively Drug-Resistant Tuberculosis/complications , Extensively Drug-Resistant Tuberculosis/microbiology , Extensively Drug-Resistant Tuberculosis/physiopathology , HIV Infections/complications , HIV Infections/epidemiology , Humans , IndiaABSTRACT
During the period immediately after marriage, women are neither assessed for their reproductive health nor given any intervention for the same. A community based longitudinal study was done to assess the status of reproductive health of newly married women in which 71 newly married women were followed for 9 months. Mean age at marriage was 20.24 (19.74-20.74) years. 76.06% were anemic. With time, proportion reporting menstrual complaints and RTI symptoms increased significantly (P<0.05). 29 (40.85%) reported menstrual complaints and 22 (30.99%) RTI symptoms. Only 14 (19.72%) subjects used contraceptive methods. 79% conceived within 9 months of marriage. Only 25% pregnancies got registered in first trimester. Reproductive and nutritional status of the newly married women was unsatisfactory.
Subject(s)
Contraception/statistics & numerical data , Menstruation Disturbances/epidemiology , Patient Acceptance of Health Care , Pregnancy Rate , Refugees/statistics & numerical data , Spouses , Adolescent , Anemia/epidemiology , Female , Health Surveys , Humans , Incidence , India/epidemiology , Longitudinal Studies , Pregnancy , Prenatal Care/statistics & numerical data , Urban Population , Women's Health , Young AdultABSTRACT
OBJECTIVE: To study the impact of wholesome mid day meal (MDM) program run by an NGO on the growth of the primary school students in rural area of Mathura district. METHODS: This intervention study involved children enrolled in Government run rural primary schools in Mathura district in Uttar Pradesh from March 06 through August 07. A wholesome, nutritionally balanced MDM provided by an NGO for the students in the 6 primary schools was selected as intervention group. Control group consisted of children in 8 schools which received locally prepared MDM by village panchayats. Height, weight, change in height/month, change in weight/month, prevalence of protein-energy malnutrition and prevalence of signs of vitamin deficiencies, were measured. RESULTS: Food was provided for 221 days in one year. Within group and between groups repetitive measures were compared using generalized estimating equation (GEE). Within both intervention and control groups height and weight had significantly increased (p < 0.05), while there was no significant difference between the groups. There was no change in prevalence of malnutrition within either of the groups. Reduction in vitamin A deficiency signs was 38% more in intervention group (p < 0.001). Prevalence of Vitamin D deficiency reduced by 50% more in intervention group. No such differences between groups were observed for vitamin B complex and vitamin C. CONCLUSIONS: MDM provided by the NGO has no better impact on growth of the primary school children, however, it reduced prevalence of vitamin deficiency significantly in comparison to the MDM run by Village Panchayats.
Subject(s)
Avitaminosis/prevention & control , Child Nutrition Disorders/prevention & control , Food Services , Health Promotion , School Health Services , Avitaminosis/epidemiology , Body Height , Body Weight , Child , Child Nutrition Disorders/epidemiology , Child, Preschool , Female , Growth , Humans , India/epidemiology , Male , Organizations , Prevalence , Protein-Energy Malnutrition/epidemiology , Protein-Energy Malnutrition/prevention & controlABSTRACT
This study was carried out to find out the impact of a specially designed preventive intervention on menstrual and sexual hygiene practices and incidence of RTI/STI among the newly married women. A community based intervention study with controls was conducted in two resettlement colonies of Delhi. Total 74 subjects in intervention group and 71 subjects in the control group were studied. Each subject was followed up for 9 months every three monthly. The intervention package included education about menstrual and sexual hygiene, RTI/STIs and contraceptive usage, and packets of condoms. RTI/STI was diagnosed using syndromic approach. Only 2 and 8 subjects in the intervention and control group respectively used condoms (p>0.05 after adjustment). Practice of washing genitals improved in the intervention group (p<0.05 both with and without adjustment). 19 (25.68%) women in intervention and 22 (30.99%) in the control group (p=0.478) reported RTI/STI symptoms during study period; after adjusting for other variables OR=0.37 (p=0.007). 57.89% of RTI/STI patients consulted doctor in intervention group as compared to 18.18% in control group (p<0.05). Increasing awareness and providing intervention at the very beginning of sexual life of newly married women can modify some of the high risk behaviors and thus reduce the risk of acquiring RTI/STIs.
Subject(s)
Condoms , Health Education , Health Knowledge, Attitudes, Practice , Hygiene , Sexually Transmitted Diseases/prevention & control , Female , Humans , India , Marital Status , Patient Acceptance of Health Care , Poverty , Reproductive Tract Infections/diagnosis , Sexually Transmitted Diseases/diagnosis , Urban Population , Women's HealthABSTRACT
Diabetes was estimated to be responsible for 109 thousand deaths, 1157 thousand years of life lost and for 2263 thousand disability adjusted life years (DALYs) in India during 2004. However, health systems have not matured to manage diabetes effectively. The limited studies available on diabetes care in India indicate that 50 to 60% of diabetic patients do not achieve the glycemic target of HbA1c below 7%. Awareness about and understanding of the disease is less than satisfactory among patients, leading to delayed recognition of complications. The cost of treatment, need for lifelong medication, coupled with limited availability of anti-diabetic medications in the public sector and cost in the private sector are important issues for treatment compliance. This article attempts to highlight the current constraints in the health system to effectively manage diabetes and the need for developing workable strategies for ensuring timely and appropriate management with extensive linkage and support for enhancing the availability of trained manpower, investigational facilities and drugs.
ABSTRACT
A population-based cross-sectional inquiry was carried out in Delhi to assess the practice of fetal sex determination, sex-selective abortions and awareness about the related law. A total of 1514 respondents, selected through multistage cluster sampling from all across Delhi, were interviewed using a pretested, semistructured questionnaire. Legal awareness (73.6%) was significantly better among the male and urban respondents. Only 39 (2.6%) of the respondents had ever gone for fetal sex determination. In 17 (43.6%) of them, it was done in spite of being aware of its unlawfulness, and in 33 (84.6%), the couple had one or more living male children. Frequency of fetal sex determination was comparable for slum and urban areas. Fifty-six additional cases of fetal sex determination, occurring in the neighbourhood of the respondents, were also reported. A total of 28 cases of female feticide were reported. Awareness about the illegality of fetal sex determination has improved, compared with the 1997-1998 data collected from East Delhi (55.3-73.6%). However, this comparison also shows a marginal increase in the practice of fetal sex determination (2.1-2.6%). In all cases of feticide, a qualified doctor was involved. A number of couples abandoned the abortion plan midway, even after detecting that the fetus was female, and there were occasional cases where the doctor refused to abort the female fetus.
Subject(s)
Abortion, Induced/legislation & jurisprudence , Abortion, Induced/statistics & numerical data , Sex Preselection , Social Control, Formal , Adult , Female , Humans , India/epidemiology , Male , Maternal Health Services/statistics & numerical data , Population Surveillance/methods , Pregnancy , Surveys and Questionnaires , Urban Health Services/statistics & numerical dataABSTRACT
OBJECTIVE: To assess the immunization coverage of BCG, DPT, OPV, Measles, MMR and Hepatitis B vaccines in two urbanized villages of East Delhi and study the factors affecting the coverage. METHODS: Children of age 24-47 months were selected using systematic random sampling. Information on socio-demographic factors and immunization status was obtained by house-to- house visit. Immunization coverage of all vaccines was computed and analysis of association between immunization coverage and socio-demographic factors was done. RESULTS: The coverage levels were 82.7% for BCG, 81.5% for DPT/OPV 1, 76.8% for DPT/OPV 2, 70.7% for DPT/OPV 3 and 65.3% for measles vaccine. It was 41.4% and 41.6% for DPT booster and MMR vaccine. Higher education of mother (OR=1.96) and father (OR=1.80), father's occupation (OR=1.86), residential status (OR=1.76), place of birth (OR=2.64) and presence of immunization card (OR=5.8) were significant determinants for complete immunization on univariate analysis. On regression analysis mother's education (OR=1.43), presence of immunization card OR=2.05 and place of birth (OR=3.80) remained significant. CONCLUSION: Immunization evaluation surveys have shown a wide variation across regions, states and different strata of the society.
Subject(s)
Communicable Disease Control/organization & administration , Diphtheria-Tetanus-Pertussis Vaccine/administration & dosage , Immunization Programs/organization & administration , Urban Health , Vaccination/trends , Analysis of Variance , BCG Vaccine/administration & dosage , Chi-Square Distribution , Child, Preschool , Cross-Sectional Studies , Developing Countries , Educational Status , Female , Health Knowledge, Attitudes, Practice , Humans , India , Infant , Logistic Models , Male , Program Evaluation , Risk Assessment , Socioeconomic Factors , Urban Population , Vaccination/standardsABSTRACT
The burden of diabetes mellitus across the world especially in India is substantial, and much of the morbidity and mortality is due to development of diabetic complications. Control of blood glucose is important to reduce occurrence of these complications. Measurement of glycated haemoglobin values provides valuable information about long term glycemic control, and is recommended for routine monitoring by several clinical guidelines on diabetes. Monitoring and appropriate management have been shown to improve outcomes in patients with diabetes in other parts of the world. However, the adoption of glycated hemoglobin as part of routine monitoring of diabetes patients in India will need to answer issues of availability, affordability and accessibility.
Subject(s)
Diabetes Complications/prevention & control , Diabetes Mellitus, Type 2/blood , Glycated Hemoglobin/analysis , Health Services Accessibility/organization & administration , Public Health , Blood Glucose/analysis , Chronic Disease , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/economics , Guideline Adherence , Health Services Accessibility/economics , Humans , IndiaABSTRACT
Despite achieving the goal of national elimination of leprosy, it remains a serious public health problem in the high prevalence states of Uttar Pradesh, Bihar and Orissa. A significant percentage of newly detected cases are Multibacillary. It underscores the importance of developing a more effective strategy to combat the disease in high prevalence pockets of the country. A glance into sociodemographic profile of the leprosy patients of one the high prevalence states might help in understanding the current ground situation better. A questionnaire based study was conducted at health care center of two districts of Uttar Pradesh (Rampur and Moradabad). Data on demographic profile of leprosy patients attending these centers were collected. The leprosy patients were more frequently males (63.8%). The duration of time before presentation was significantly longer for semiskilled workers (Kuppuswami Scale classification), p = 0.029. Patients with multibacillary disease were younger (mean age 31.04 yrs) as compared to paucibacillary leprosy (mean age 38.7yrs), p value = 0.041. These observations suggests that a specific population based approach is required to detect new cases early. Certain groups of the population might benefit from active surveillance.
Subject(s)
Leprosy/epidemiology , Leprosy/microbiology , Mycobacterium leprae , Adolescent , Adult , Aged , Aged, 80 and over , Child , Demography , Female , Humans , India/epidemiology , Male , Middle Aged , Occupations/statistics & numerical data , Surveys and Questionnaires , Time FactorsABSTRACT
Hypogonadism in male patients with Leprosy is common and may identify patients with future risk for bone loss and osteoporosis. In the present study, we evaluated gonadal function in 71 male patients with Leprosy both clinically and by estimation of serum testosterone levels. The patients belonged to selected rural areas of Uttar pradesh, with majority aged less than 50 yrs (74.6%), Hindus (66.7%), illiterate (60.9%), and of low socioeconomic status (58% with per capita income < Rs.500 per month). Most patients had multibacillary Leprosy (83.1%), duration less than 2 years (75.4%) and had received antileprosy drugs for less than a year (95.6 %). Seven patients (9.9%) had clinical features of hypogonadism such as gynaecomastia, decreased sexual hair and infertility. Serum testosterone levels, estimated in 31 of the patients, revealed low values in 25.8% (8/31) patients (Mean 4.65+/-3.37 ng/ml). Age, duration of Leprosy and socioeconomic status but not type of Leprosy or treatment duration affected hypogonadism significantly. The results of the present study indicate a high frequency of hypogonadism among rural male Leprosy patients that warrants routine screening to identify patients at risk for osteoporosis and possible prevention with testosterone replacement therapy.
Subject(s)
Hypogonadism/complications , Leprosy/epidemiology , Testosterone/blood , Adolescent , Adult , Humans , Hypogonadism/blood , India/epidemiology , Leprostatic Agents/administration & dosage , Leprosy/blood , Leprosy/complications , Leprosy/drug therapy , Male , Middle Aged , Risk Factors , Rural Health , Socioeconomic FactorsABSTRACT
OBJECTIVE: Social factors and prevalent norms in the community determine the proportion of teenage pregnancy in the community. In the light of high risk associated with teenage pregnancy, the socio-cultural determinants, which influence the conception among teenagers in Nepal, need to be understood. These determinants may be modified by suitable interventions to reduce teenage pregnancy. Aim of this study was to examine the socio-cultural determinants of teenage pregnancy in eastern Nepal. METHODS: A case-control study design was selected for comparing the education, economic status, family support and freedom towards conception among teenagers as compared to higher age group women. RESULT: Seventy adolescent pregnant women were compared with seventy primigravida women in the 20 to 29 years age group. The teenage pregnant women were less educated, had poor economic background, more likely to have accidental pregnancies as compared to the other group and more likely to have love marriages. Husbands were more likely to decide about continuation of pregnancy. They had less psychological and social support from the family. CONCLUSION: Marriage at young age and pregnancy during teens are associated with less social acceptance and poor support in the family.
Subject(s)
Pregnancy in Adolescence , Social Class , Adolescent , Adult , Case-Control Studies , Contraception/psychology , Educational Status , Female , Health Knowledge, Attitudes, Practice , Humans , Nepal/epidemiology , Pregnancy , Risk Factors , Social Support , Socioeconomic FactorsABSTRACT
The study was undertaken with the objective of observing operational aspects of 609 pulse polio booths established during Intensified Pulse Polio Campaign in East Delhi on National Immunisation Days (NID) during 2001-2002 through well designed format. The average number of persons present on duty at polio booths was 3.73 against a recommendation of 4 per booth. All the booths had vaccine carriers but some of them were not following the guidelines laid for maintaining the cold chain. One sixth "(15.4%)" of the booths needed fresh supplies of vaccine carrier. There is need for deployment of motivated trained manpower at polio booths to ensure the success of Pulse Polio Campaign. Maintenance of cold chain and quality assurance of vaccine administered to children in the field remain a challenge. More than half (55.7%) booths did not have any volunteer. Absence of volunteers from the community in more than half of the booths warrant for strengthening the linkages between the governmental agencies and the community.
Subject(s)
Immunization Programs/organization & administration , Poliomyelitis/prevention & control , Volunteers , Evaluation Studies as Topic , Humans , India , Poliovirus Vaccine, Oral , Urban PopulationABSTRACT
387 mothers in Mehrauli block of Delhi were interviewed regarding their knowledge, attitudes, beliefs and practices regarding measles. 98.4% enumerated one or the other symptoms, fever being the commonest. 77.5% were aware of the infectious nature and 97% had favourable attitude regarding feeding the child during measles. The commonest foodstuff given was cowmilk and khichdi. 95.1% of the respondents intended to apply local herbs on eruptions. There was a variety of local medicines for home treatment and Laung, Tulsi leaves and Kishmish being the practice in descending order of preference. 98.4% respondents favoured giving special nutritional care during the attack of measles to their children.
Subject(s)
Health Knowledge, Attitudes, Practice , Measles/physiopathology , Mothers/psychology , Rural Population , Adult , Child , Diet , Female , Humans , India , Measles/therapySubject(s)
Pregnancy Complications/epidemiology , Pregnancy in Adolescence/statistics & numerical data , Adolescent , Adult , Case-Control Studies , Female , Gestational Age , Humans , Infant, Newborn , Nepal/epidemiology , Pregnancy , Pregnancy Outcome , Prenatal Care/statistics & numerical data , Risk FactorsABSTRACT
A number of surveys, small or large, have been undertaken by various agencies for coverage evaluation of immunization programs. The most commonly used design is the WHO-30 cluster sampling method. Other new methods are the Institute for Refresh Medical Statistics (IRMS) New Delhi method and the lot quality assurance sampling method. This paper describes the National Immunization Day (NID) method to evaluate the immunization coverage of the Expanded Program on Immunization (EPI) vaccines in the Sunsari district of Nepal. A total number of 3,332 respondents (69.4% females and 30.6% males) were interviewed regarding the immunization status of their children during NID. The children with complete immunization (BCG, measles and three doses of DPT and OPV) were 65.7%. The individual coverage by EPI vaccines (except OPV III and measles) was more than 80%. The result shows that there is positive relationship between immunization coverage and educational level of the respondents.