The need to focus on medical education in rural districts of India.

Background: . Globally, India has the highest number of medical colleges followed by Brazil and China. The density of physicians in rural India was 3 per 10 000 population against 13 per 10 000 in urban areas. Worldwide, studies show that medical schools play an important role in overcoming the shortage of physicians locally. Hence, we studied the distribution of medical colleges in India and reviewed the shortage of established and new medical colleges in rural districts with the year 2000 as baseline. Methods: . We used the database of the Medical Council of India as on 27 April 2017; and Census 2011 data, based on the percentage of rural/urban population, for the classification of districts (rural/urban). All the 640 districts were included with 1210.9 million population. Results: . Of the 480 rural districts in India, only 132 (27.5%) had a medical college. Jharkhand, Jammu and Kashmir and Arunachal Pradesh had no medical colleges in rural districts. Madhya Pradesh, Uttar Pradesh, Bihar, Assam, Punjab, Uttarakhand, Haryana and Rajasthan had <30% of rural districts with a medical college. Of the 286 new medical colleges established since 2000 in India, 130 (45.5%) were in rural districts with uneven distribution with lower percentage of new medical colleges in states with predominance of rural population. Conclusion: . There is an overall shortage of medical colleges in rural districts of India. Paradoxically, the trend of uneven rural-urban distribution continues among the newly opened medical colleges as well.

Treatment of pediatric diarrhea: a simulated client study at private pharmacies of Ujjain, Madhya Pradesh, India.

INTRODUCTION: In low- and middle-income countries such as India, private pharmacies play an important role in medical treatments, offering advice for common illnesses such as diarrhea and respiratory tract infections. There is a need to explore the details of the dispensing practices at the private pharmacies in low- and middle-income countries. METHODOLOGY: The present study used simulated client methodology to assess the actual dispensing practices for patients with pediatric diarrhea at private pharmacies in an urban setting of an Indian province. RESULTS: This study identified 164 private pharmacies (84.10%) in the study setting that engaged in the practice of dispensing prescription drugs without prescriptions. Only about 40% asked clients if they had a prescription from a doctor. The average duration of consultations at the pharmacies was 1.3 minutes (range, 0.5-6 minutes). The dispensing of drugs was not in compliance with the recommended guidelines and regulations. The most commonly dispensed drugs were antibiotics (40.24%); of these, quinolones either alone or in combination with imidazoles were the most frequently dispensed. The other commonly dispensed drugs were antimotility drugs (31.10%) and Lactobacillus acidophilus (probiotics; 23.17%). The drugs were dispensed in inappropriate doses due to the absence of indications. CONCLUSIONS: Overuse and misuse of all these prescription drugs dispensed by pharmacies pose significant issues, such as resistance, dangerous side effects, and high costs. At the same time, the pharmacies did not dispense recommended drugs such as oral rehydration solution and zinc, which they are authorized to dispense without a prescription.

Mapping private pharmacies and their characteristics in Ujjain district, Central India.

BACKGROUND: In India, private pharmacies are ubiquitous yet critical establishments that facilitate community access to medicines. These are often the first points of treatment seeking in parts of India and other low income settings around the world. The characteristics of these pharmacies including their location, drug availability, human resources and infrastructure have not been studied before. Given the ubiquity and popularity of private pharmacies in India, such information would be useful to harness the potential of these pharmacies to deliver desirable public health outcomes, to facilitate regulation and to involve in initiatives pertaining to rational drug use. This study was a cross sectional survey that mapped private pharmacies in one district on a geographic information system and described relevant characteristics of these units. METHODS: This study of pharmacies was a part of larger cross sectional survey carried out to map all the health care providers in Ujjain district (population 1.9 million), Central India, on a geographic information system. Their location vis-à-vis formal providers of health services were studied. Other characteristics like human resources, infrastructure, clients and availability of tracer drugs were also surveyed. RESULTS: A total 475 private pharmacies were identified in the district. Three-quarter were in urban areas, where they were concentrated around physician practices. In rural areas, pharmacies were located along the main roads. A majority of pharmacies simultaneously retailed medicines from multiple systems of medicine. Tracer parenteral antibiotics and injectable steroids were available in 83.7% and 88.7% pharmacies respectively. The proportion of clients without prescription was 39.04%. Only 11.58% of staff had formal pharmacist qualifications. Power outages were a significant challenge. CONCLUSION: This is the first mapping of pharmacies & their characteristics in India. It provides evidence of the urban dominance and close relationship between healthcare provider location and pharmacy location. The implications of this relationship are discussed. The study reports a lack of qualified staff in the presence of a high proportion of clients attending without a prescription. The study highlights the need for the better implementation of regulation. Besides facilitating regulation & partnerships, the data also provides a sampling frame for future interventional studies on these pharmacies.

A Study of Morbidity Pattern in Street Sweepers: A Cross-sectional Study.

BACKGROUND: Street sweepers play an important role in maintaining the health and hygiene within the cities. This job exposes the street sweepers to a variety of risk factors such as dust, toxins and diesel exhaust pollution, which make them vulnerable to develop certain occupational diseases. Therefore, it was thought necessary to study the morbidity profile in this occupational group. OBJECTIVES: To study the prevalence of morbidities among street sweepers and comparison group. STUDY DESIGN: A cross-sectional study with a comparison group. STUDY SETTING: Nagpur Municipal Corporation, Nagpur. SUBJECTS: THE STUDY INCLUDED TWO GROUPS: (1) A study group comprising 273 street sweepers. (2) A comparison group comprising 142 class IV workers working in the office buildings of Nagpur Municipal Corporation, Nagpur. MATERIALS AND METHODS: A pretested proforma was used to record the necessary information such as clinical history, sociodemographic factors, findings of clinical examination and investigations performed. RESULTS AND CONCLUSIONS: THE IMPORTANT MORBIDITIES DETECTED AMONG STREET SWEEPERS WERE THE FOLLOWING: anemia (20.5%), hypertension (9.5%), upper respiratory tract infections (URTI) (7.3%) and chronic bronchitis (5.9%). In the comparison group, important morbidities detected were the following: anemia (20.4%), hypertension (11.3%), hyperacidity (9.9%), URTI (7.0%) and refractive error (7.0%). Chronic bronchitis was detected in two subjects (1.4%) of the comparison group. The prevalence of chronic bronchitis was significantly high among street sweepers than that of subjects of the comparison group. Therefore, it is recommended that further studies with a larger sample size be undertaken to identify the factors responsible for higher prevalence of chronic bronchitis among the street sweepers.