Evaluation of integrated Child Development Services program in Gujarat, India for the years 2012 to 2015.

BACKGROUND: The Integrated Child Development Services (ICDS) scheme has been operational for more than three decades in India. OBJECTIVE: To evaluate the various aspects of the ICDS program in terms of inputs, process and outcome (coverage), utilization, and issues related to the ICDS program. METHODS: A total of 130 Anganwadi centers (AWCs) were selected including 95 AWCs from rural areas and 35 AWCs from urban areas from April 2012 to March 2015, from 12 districts of Gujarat and the union territory of Diu. Information was collected for infrastructure, baseline characteristics of AWWs, provision, coverage and utilization of various ICDS services, and various issues related to program operation. RESULTS: A majority of pregnant (94.7%) and lactating (74.4%) mothers, and adolescent girls (86.6%) were availing ICDS services. In 96.9% of the AWCs, a growth chart was available and 92.3% AWWs were using it accurately. A total of 14.9% children were underweight including 13.5% moderately and 1.4% severely malnourished children. Two-third (66.2%) children were covered by supplementary nutrition (SN). Only 14.6% of the AWCs reported 100% preschool education (PSE) coverage among children. More than half (55.4%) of the AWCs reported an interruption in supply during the last 6 months. Various issues were reported by AWWs related to the ICDS. CONCLUSION: The study has reported gaps in terms of infrastructure facility, different trainings, coverage, supply, and provision of SN, status of PSE activities in AWCs, and provision of different services to the beneficiaries.

Evaluation of National Leprosy Eradication Program after Integration into General Health System in Rajkot District, Gujarat from 2003 to 2014.

BACKGROUND: National Leprosy Eradication Program (NLEP) was launched in 1983 with the goal of elimination of leprosy as a public health problem. AIM: To evaluate the NLEP performance after integration into general health system from April 2003 to March 2014. MATERIAL AND METHODS: A retrospective record based study was conducted by obtaining data from Rajkot district leprosy center. Prevalence rate (PR), new case detection rate (NCDR), proportion of female cases, child cases, multibacillary (MB) cases, Grade II disability among new cases and release from treatment (RFT) cases were evaluated from April 2003 to March 2014 and analyzed by using Chi-square for trend analysis test. RESULTS: The PR of leprosy per 10,000 populations was significantly declined (P < 0.001) from 0.44 in 2003-2004 to 0.15 during March 2014. Reduction in NCDR trend was statistically significant (P < 0.001). The proportion of female cases among newly detected cases showed fluctuation from 36.23% in 2003-2004 to 37.10% in 2013-2014 (P > 0.05). The proportion of child cases also showed significantly declining trend from 12.08% in 2003-2004 to 6.70% in 2013-2014 (P < 0.05). Significant number of MB cases decreased from 122 (2003-2004) to 69 (2013-2014) (P < 0.001). Grade II disability proportion was 1.45% in the year 2003-2004, increased to 5.2% in 2009-2010 and then again decreased to 3.4% in 2013-2014 (P > 0.05). Proportion of patients RFT showed fluctuation from 66.66% (2003-2004) to 45.68% (2009-2010) and then 64.66% (2013-2014) (P < 0.001). CONCLUSION: The NLEP is having a favorable impact on the problem of leprosy by maintaining the elimination level of leprosy in Rajkot district over a decade.

Evaluation of Integrated Child Development Services program in Gujarat, India.

OBJECTIVE: To evaluate Integrated Child Development Services (ICDS) program in terms of infrastructure of Anganwadi centers, inputs, process, coverage and utilization of services, and issues related to program operation in twelve districts of Gujarat, India. DESIGN: Facility (Anganwadi) based study. SETTING: Twelve districts of Gujarat, India (April 1, 2012 to March 31, 2013). PARTICIPANTS: ICDS service providers (60 Anganwadi workers from 46 rural and 14 urban Anganwadi centers) and their beneficiaries. MAIN OUTCOME MEASURES: Coverage of supplementary nutrition, pre-school education, immunization and referral services. RESULTS: Supplementary nutrition coverage was reported in 48.3% in children. Interruption in supply of supplementary nutrition during last six months was reported in 61.7% Anganwadi centers. Only 20% centers reported 100% pre-school education coverage among children. Immunization of all children was recorded in only 10% Anganwadi centers, while in 76.7% centers, no such records were available. Regular health checkup of beneficiaries was done in 30% centers. Referral slips were available in 18.3% Anganwadi centers and referral of sick children was done from only 8.3% centers. CONCLUSIONS: There are program gaps in coverage of supplementary nutrition in children, its regular supply to the beneficiaries, in pre-school activities coverage, recording of immunization, and regular health check-up of beneficiaries and referral of sick children.

Characteristics of Hospitalized Patients with Severe and Non-Severe Pandemic Influenza A (H1N1) in Saurashtra Region, India (Two Waves Analysis).

BACKGROUND: In India, the first case of 2009 pandemic influenza A (H1N1) virus infection was reported in May 2009 and the same in Saurashtra region in August 2009. We describe the epidemiology and factors associated with severe and non-severe cases of 2009 influenza A (H1N1) infection reported in the Saurashtra region. MATERIALS AND METHODS: From September 2009 to January 2011, we reported 511 patients who were infected with 2009 influenza A (H1N1) virus and admitted in different hospitals of Rajkot city. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) testing was used to confirm infection. Factors associated with severe cases were determined by comparing with non-severe cases. RESULTS: Out of 511 patients, 140 had severe disease (requiring intensive care or died) and 371 non-severe diseases (admitted in wards and survived). Median age of 30 years; median time of 5 days from onset of illness to diagnosis, and 4 days median time was reported for hospital stay among severe disease patients. More than half (60.7%) were females. Out of the patients with severe disease, 52.1% patients residing in urban area (OR = 1.68, CI = 1.13-2.49). Significant association was reported among severe disease patients for delayed referral from general practitioner/physician after initial treatment. All patients received antiviral drug, however, only 27.1% received within 2 days of illness. Presence of coexisting condition (pregnancy (OR = 0.19, CI = 0.08-0.48) was strongly associated with severe disease. CONCLUSION: Delayed referral from general practitioner/physician, duration of antiviral treatment, presence of coexisting condition (i.e., pregnancy) were responsible for intensive care or mortality among severe influenza A (H1N1) illness.

Clinical and epidemiological characteristics of 2009 pandemic influenza A in hospitalized pediatric patients of the Saurashtra region, India.

BACKGROUND: The first case of 2009 pandemic influenza A or H1N1 virus infection in India was reported in May 2009 and in the Saurashtra region in August 2009. We describe the two waves clinicoepidemiological characteristics of children who were hospitalized with 2009 influenza A infection in the Saurashtra region. METHODS: From September 2009 to February 2011, we treated 117 children infected with 2009 influenza A virus who were admitted in different hospitals in Rajkot city. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) test was used to confirm infection, and the clinico-epidemiological features of the disease were closely monitored. RESULTS: In the 117 patients, with a median age of 2 years, 59.8% were male. The median time from onset of the disease to influenza A diagnosis was 5 days, and that from onset of the disease to hospitalization was 7 days. The admitted patients took oseltamivir, but only 11.1% of them took it within 2 days after onset of the disease. More than one fourth (29.1%) of the admitted patients died. The most common symptoms of the patients were cough (98.3%), fever (94.0%), sore throat and shortness of breathing. Pneumonia was detected by chest radiography in 80.2% of the patients. CONCLUSIONS: In children with infection-related illness, the survival rate was about 71% after oseltamivir treatment. The median time for virus detection with real-time RT-PCR is 5 days. Early diagnosis and treatment may reduce the severity of the disease.

Clinico-epidemiological features of the hospitalized patients with 2009 pandemic influenza A (H1N1) virus infection in Saurashtra region, India (September, 2009 to February, 2010).

BACKGROUND: The first case of 2009 pandemic influenza A (H1N1) virus infection in India was reported in May, 2009 and in Saurashtra region in August, 2009. We describe the clinico-epidemiological characteristics of patients who were hospitalized with 2009 influenza A (H1N1) infection in Saurashtra region. MATERIALS AND METHODS: From September, 2009 to February, 2010, we observed 274 persons infected with 2009 influenza A (H1N1) virus who were admitted in different hospitals in Rajkot city. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection; the clinico-epidemiological features of the disease were closely monitored. RESULTS: Of 274 patients, median age was 29.5 years, and 51.5% were males. Only 1.1% patients had recent travel history to infected region. Median time of five days was observed from onset of illness to influenza A (H1N1) diagnosis, while median time of six days reported for hospital stay. All admitted patients received oseltamivir drug, but only 16.1% received it within two days of onset of illness. One fourth of admitted patients were expired. The most common symptoms were cough (96.7%), fever (92%), sore throat and shortness of breathing, and coexisting conditions including diabetes mellitus (9.9%), hypertension (8.8%), chronic pulmonary diseases (5.5%) and pregnancy (5.5%) (P<0.05). Pneumonia was reported in 93% patients with chest radiography. CONCLUSION: We have demonstrated that infection-related illness affects both children and adults with survival of 74% patients. The median time from onset of illness to virus detection with use of real-time RT-PCR is five days. Pregnancy is found as a significant (P<0.05) risk factor for severe disease.

Iodine deficiency disorders in 6-12 years old rural primary school children in Kutch district, Gujarat.

OBJECTIVE: To compare prevalence of goitre in primary school children; to determine median urinary iodine concentration in children; and, to assess level of salt iodization at retail trader level. DESIGN: 30 cluster survey study. SETTINGS: Primary schools of Kutch district, Gujarat, India. METHODS: Total 70 students including five boys and five girls from 1st to 7th standard, present in class on the day of visit were selected randomly for Goitre examination (n=2100). Urine sample was collected from one boy and one girl from each standard in each cluster. From the community, 28 children, including two boys and two girls from each standard in the same age group were examined, and salt samples were tested from their households. From each village, one retail shop was visited and various salts available were purchased and tested for iodine on the spot with spot kit. RESULTS: Goitre prevalence of 11.2% was found among primary school children (grade 1- 8.6% and grade 2-2.6%). As the age increased, the Goitre prevalence also increased except in age group of 8 years. Median urinary iodine excretion level was 110 µg/L. Iodine level more than 15 ppm was found in 92.3% salts samples tested at the household level. CONCLUSION: Present study showed mild goitre prevalence in primary school children in Kutch district of Gujarat.

Hospitalizations associated with 2009 influenza A (H1N1) and seasonal influenza in Saurashtra region, India.

INTRODUCTION: This study investigated the clinico-epidemiological characteristics of patients who were hospitalized with 2009 pandemic H1N1 influenza virus infection and seasonal influenza in the Saurashtra region of India. METHODOLOGY: From September 2009 to February 2010, a total of 773 patients with influenza virus attending different hospitals in Rajkot city were studied. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection; the clinico-epidemiological features of the disease were closely monitored. RESULTS: Of the 733 patients, 35.4% (274/773) were cases of 2009 pandemic H1N1 influenza and 64.6% (499/773) were cases of seasonal influenza. Of the 274 patients with 2009 pandemic H1N1 influenza, the median age was 29.5 years, and 51.5% were males. Only 1.1% positive patients had recent travel history to an infected region. A median time of five days was observed from onset of illness to influenza A (H1N1) diagnosis, and a median time of six days was reported for hospital stay. All admitted influenza A (H1N1) patients received Oseltamivir drug, but only 16.1% received it within two days of onset of illness. One fourth of the admitted positive patients died. The most common symptoms were cough, fever, sore throat, and shortness of breath. The coexisting conditions were diabetes mellitus, hypertension, chronic pulmonary diseases, and pregnancy (p = 0.001). Chest radiography revealed 93% of the positive patients had pneumonia. CONCLUSION: The clinical course and outcomes of the 2009 pandemic (H1N1) influenza virus are comparable to those of the currently circulating seasonal influenza, with high mortality in influenza A (H1N1) patients.