Population prevalence of congenital disabilities among children aged 0-2 years resident in urban slums of Pune, India.

Background: Non-fatal birth defects and developmental disabilities are the most important causes of congenital disabilities in young children. This study was performed to determine the prevalence of congenital disabilities among children aged 0-2 years resident in urban slums of Pune. Methods: In 2016, using a random sampling method, 840 children from 28 registered slums located in each of the 14 wards of Pune city, India, were included in the study. Data on congenital disabilities and the clinical diagnosis responsible for the disability were collected. Data were also collected on selected risk factors for these conditions and current treatment through a structured questionnaire. Descriptive analysis was used to describe relationships among variables. Pearson's chi-square test was used to determine associations, and the level of significance was established at P<0.05. Associations between outcomes of interest and risk factors were expressed as Odds Ratios (OR) at 95% Confidence Interval (CI). Results: In this age group, the prevalence of congenital disability was 1.67% (95% CI 0.91-2.78) (14/840). The prevalence of clinically diagnosed birth defects was 1.19% (95% CI 0.57-2.18) (10/840). The prevalence of developmental disabilities was 0.48% (95% CI 0.13-1.21) (4/840). Children with birth defects were more likely to be premature (P=0.045, OR=4.34, 95% CI=1.03-18.28) and low birth weight (P=0.003, OR=10.41, 95% CI=2.21-48.38). Only seven out of 14 children with birth defects and developmental disabilities were taken for treatment after the initial diagnosis. Conclusion: Birth defects and developmental disabilities are prevalent conditions. Community awareness, provision of appropriate medical and habilitation care, as well as screening and early intervention for these conditions are essential to prevent morbidities and ameliorate disabilities.

Respectful maternity care in the achievement of universal health coverage.

The attainment of universal health coverage (UHC) is incomplete without achieving respectful maternity care (RMC). While planning for UHC, the need and importance of RMC should be considered. In India, the government has started a health scheme on UHC, namely the Ayushman Bharat Scheme. RMC being an important component of UHC, if not achieved, will result in failure to achieve UHC in the true sense.

Respectful maternity care and breastfeeding.

Respectful maternity care and its effect on breastfeeding is not widely explored. Disrespect and abuse affect the health of the mother and the newborn, affect lactogenesis and negatively influence breastfeeding. This has serious short-term and long-term ill effects. Separation of the mother and the newborn result in failure to establish early breastfeeding. Interventions, policies and programs should be developed to address the issues pertaining to respectful maternity care. This will not only help in breastfeeding but will also safeguard the fundamental rights of the mother and the child.

Respectful maternity care: A national landscape review.

Respectful maternity care is a fundamental right of every childbearing woman. It contributes to ensuring a positive outcome for mothers as well as newborns, and aims to address health inequalities. However, studies have reported a high prevalence of disrespect and abuse in India, and have shown that the quality of care has been overlooked at all levels including research, policy, programme and practice. The lack of respectful maternity care results in failure in accessing institutional services. Thus, it is essential to design context-specific and evidence-based interventions as well as formulate policies and programmes to reduce disrespectful maternity care.

Factors relating to hospitalisation and economic burden of paediatric constipation in the state of Victoria, Australia, 2002-2009.

AIM: Constipation is common, with severe symptoms requiring hospitalisation. Constipation can be a primary (present at admission and requires treatment or investigation) or principal (first listed) diagnosis for hospitalisation. In the USA, constipation is the second most common ambulatory care digestive diagnosis with total costs >US$1.7 billion/year. Incidence of hospitalisation for constipation in children peaks at toilet-training age. This study determined the burden of paediatric constipation to hospital care in Victoria, Australia. METHOD: The Victorian Admitted Episodes Dataset was analysed retrospectively, examining hospital admissions with a primary diagnosis of constipation in the 7-year period 2002/2003 to 2008/2009. RESULTS: For children, constipation was recorded as a primary diagnosis in 8688 admissions (3.6/1000 of population). In-hospital prevalence was ∼1.0%. Mean length of stay was 4.4 days (median 1.0, range 0-993, standard deviation 16.7). There were 1121 readmissions in 668 children. Average treatment cost was A$4235/admission (median A$1461, range A$0-$278 816), with annual costs of ∼A$5 505 500. Children in the highest socio-economic area had ∼50% fewer admissions (P < 0.0001). Predictors of readmission included age 10-18, male gender, rural residence, severe socio-economic disadvantage, public hospital, planned admission, longer length of stay and association with other medical conditions. CONCLUSIONS: This study identified that constipation in children is a significant cost burden in Victoria (costing public hospitals ∼A$5.5 million/year). Hospitalisation in Victoria is 10-fold higher than in the USA with 10% readmissions within a month. We conclude that strategies aimed at reducing hospitalisation for constipation could result in significant savings for the paediatric public health system in Victoria, Australia.

Potentially avoidable hospitalisation for constipation in Victoria, Australia in 2010-11.

BACKGROUND: When primary care of constipation fails, the patient may need emergency hospitalisation for disimpaction. This study aimed to provide population-based data on the number of unplanned admissions and the cost to the healthcare system for constipation in Victoria, Australia in financial year 2010-11. METHODS: The Victorian Admitted Episodes Dataset was examined to find the number of emergency hospital separations coded as constipation (ICD-10-AM Code K390). An estimate of costs was determined from the number of weighted inlier equivalent separations (WIES) multiplied by the WEIS price, used by the Victorian Government for funding purposes. RESULTS: There were 3978 emergency separations for constipation in Victoria in 2010-2011, 92% in public hospitals. Fifty-five percent were female and 38% > 75 years old. One third stayed overnight and 1/3 more than 1 day. The emergency bed day rate was 7.1 per 10,000 of population. The estimate of cost, based on WEIS, was approximately $8.3 million. Potential savings could be made by reducing the number of separations in 6 Local Government Areas (LGAs). CONCLUSIONS: This study shows that the burden (in number of admissions, emergency bed days and overall direct costs) in managing emergency admissions for constipation in Victoria, Australia, is very significant and likely to be similar in other developed countries. Improved primary healthcare and alternative ways to achieve faecal disimpaction without emergency admission could save the public health system a proportion of this $8.3 million.

Toxic epitheliopathy from a single application of preservative free oxybuprocaine (0.4%) in a patient with Sjogren's syndrome.

Topical ocular anaesthetic agents are frequently used for ophthalmic diagnosis and surgery. While corneal complications following long-term use or misuse of local anaesthetic solutions have been described, toxic epitheliopathy after a single application of six drops of preservative free oxybuprocaine is rare. In order to increase the awareness of this ocular complication, we report such a case in a patient with Sjogren's syndrome who presented for elective cataract surgery. We outline the mechanisms proposed to explain the ocular toxic effects of oxybuprocaine and discuss the management principles in preventing this complication in the context of Sjogren's syndrome.

Small area analysis of ambulatory care sensitive conditions in Victoria, Australia.

Ambulatory care sensitive conditions (ACSCs) are used as a measure of access to primary health care. The purpose of this study was to identify factors associated with variation in ACSC admissions at a small area level in Victoria, Australia. The study was ecologic, using Victorian Primary Care Partnerships (PCPs) as the unit of analysis. Data sources were the Victorian Admitted Episodes Dataset, census data from the Australian Bureau of Statistics, and the Victorian Population Health Survey. Age- and sex-adjusted total ACSC admission rates were calculated, and weighted least squares multiple linear regression was used to examine the associations of total ACSC admission rates by various predictor variables. Key variables were categorized into 1 of 4 framework components for analyzing access and use of health care services: predisposing, enabling, need, or structural. Enabling characteristics explained 61.70% of the variation in ACSC admission rates across PCPs. Socioeconomic characteristics (income, education) and percentage with poor self-rated health were important factors in explaining variations in ACSC admissions at a small area-level [R(2)=0.77]. Community-level variables differentially affect access to primary health care, with significant variation by socioeconomic status. This analytical approach will assist researchers to identify community-level predicators of access across populations at locations, including factors that may be affected by policy change.

Patient characteristics associated with hospitalisations for ambulatory care sensitive conditions in Victoria, Australia.

BACKGROUND: Ambulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable with the application of preventive care and early disease management, usually delivered in a primary care setting. ACSCs are used extensively as indicators of accessibility and effectiveness of primary health care. We examined the association between patient characteristics and hospitalisation for ACSCs in the adult and paediatric population in Victoria, Australia, 2003/04. METHODS: Hospital admissions data were merged with two area-level socioeconomic indexes: Index of Socio-Economic Disadvantage (IRSED) and Accessibility/Remoteness Index of Australia (ARIA). Univariate and multiple logistic regressions were performed for both adult (age 18+ years) and paediatric (age <18 years) groups, reporting odds ratios (OR) and 95% confidence intervals (CI) for a number of predictors of ACSCs admissions compared to non-ACSCs admissions. RESULTS: Predictors were much more strongly associated with ACSCs admissions compared to non-ACSCs admissions in the adult group than for the paediatric group with the exception of rurality. Significant adjusted ORs in the adult group were 1.06, 1.15, 1.13, 1.06 and 1.11 for sex, rurality, age, IRSED and ARIA variables, and 1.34, 1.04 and 1.09 in the paediatric group for rurality, IRSED and ARIA, respectively. CONCLUSIONS: Disadvantaged paediatric and adult population experience more need of hospital care for ACSCs. Access barriers to primary care are plausible causes for the observed disparities. Understanding the characteristics of individuals experiencing access barriers to primary care will be useful for developing targeted interventions meeting the unique ambulatory needs of the population.