Anthropometric surrogates for screening of low birth weight newborns: a community-based study.

In developing countries, where about 75% of births occur at home or in the community, logistic problems prevent the weighing of every newborn child. This study compares various anthropometric surrogates for identification of low birth weight neonates. A longitudinal community based study was done in an urban resettlement colony and 283 singleton neonates within 7 days of birth were examined for the anthropometric measurements such as head, chest, mid upper arm circumference and foot length as a screening tool for low birth weight. Chest circumference measured within 7 days of birth appeared to be the most appropriate surrogate of low birth weight with highest sensitivity (75.4%), specificity (78.4%), and positive predictive value (48.9%) as compared with other anthropometric parameters. Low birth weight neonates in absence of weighing scales can be early identified by using simple anthropometric measurements for enhanced home-based care and timely referral.

Relevance of tumor angiogenesis patterns as a diagnostic value and prognostic indicator in oral precancer and cancer.

Tumor angiogenesis occurs by recruitment of endothelial cell precursors or by sprouting of existing capillaries, which differ from the normal vasculature by having an altered morphology that can be exploited for diagnosis and as a prognostic indicator. Improved technologies have propelled diagnosis into a new era. These technologies have to be used with great precision. The diagnosis of a dysplastic premalignant lesion of the oral mucosa cannot be based solely on clinical findings. Therefore histologic evaluation of a representative biopsy specimen is necessary. Accurate judgment of the proper site for biopsy is essential for reaching a correct diagnosis. The aim of this report is to analyze the vascular patterns with the help of direct oral microscopy and the technique of stereo-optical microscopy in the oral cavity to select biopsy sites, and compare the outcome of a directed biopsy with that of biopsy specimens obtained from sites selected solely on the basis of clinical criteria. The study sample comprised 50 oral mucosal lesions. A statistically significant difference was noted between samples judged to be microscopically representative sites. We conclude that this method would aid in early and better diagnosis and treatment planning of oral premalignant and malignant lesions by assessing the various vascular patterns in the mucosa.

Does blood pressure variability affect the summer associated symptoms amongst females?

INTRODUCTION: Blood pressure usually increases in winter and decreases in summer i.e, shows seasonal variation. In a tropical country like India women often complain off prominent symptoms like dizziness, giddiness, fainting and weakness during summer months. The objective was to study the prevalence of above symptoms which are common during summer and its association with variation in blood pressure among normotensive healthy females aged 18-40 years. METHODS: The present study was carried out on 132 women as a prospective observational study which included 2 home visits to the participants in the two different seasons in the months of May-June (summer) and December-January (winter) based on the data provided by the meteorological department of Government of India. Blood pressure and pulse rate (hemodynamic variables) was measured in these seasons and information was collected on the occurrence of the symptoms in these seasons. RESULTS: There was mean decrease of 11.07 +/- 10.29 mm of Hg in Systolic blood pressure & 6.79 +/-6.88 mm of Hg in diastolic blood pressure in summer as compared to winter. The symptoms in the form of weakness, dizziness and blackout which are generally perceived by women in this area to be due to low blood pressure were observed in 32.6% of the study subjects in summer compared with 2.3% in winter. The difference was statistically highly significant (p < 0.001). There was no significant difference between the mean value of electrolytes, creatinine and urea in the cases and the controls. CONCLUSION: Thus the seasonal variation in blood pressure rather than electrolytes abnormality may be responsible for these symptoms.

Seasonal variation in prevalence of hypertension: Implications for interpretation.

OBJECTIVES: to study seasonal variation in prevalence of hypertension. MATERIALS AND METHODS: the study was carried out in the year 2006, in Gokulpuri, an urban slum located in eastern part of Delhi. 275 females 18-40 years of age were examined in summer. Blood pressure was measured in two seasons, summer and winter. Nutritional status of each individual was assessed by BMI. RESULTS: the prevalence of hypertension based on SBP was 12.72% in summer which increased to 22.22% in winter. The prevalence of hypertension, using DBP criteria increased to more than double (summer vs. winter, 11.27% vs. 26.59%, P< 0.001). Overall prevalence of hypertension (SBP ≥ 140 or DBP ≥ 90 mm of Hg) was 1.9 times during winter compared to summer (P<0.001). Greater increase in prevalence of hypertension during winter among older females and underweight as well as normal females was observed. CONCLUSION: Significant increase in prevalence of hypertension during winter compared to summer indicates need for considering this factor while comparing prevalence reported in different studies as well as interpreting the surveillance data based on repeat surveys.

Utilizing paramedical worker for screening visual status of adults in a village of Delhi.

A community based study in a village of Delhi was carried out during February 2004-May 2005 to assess visual outcomes in population more than 40 years age utilizing a paramedical worker. About 24% of them had sup-optimal vision and were referred to a health centre visited by an ophthalmologist. 78% of those referred, attended the centre and got spectacles/cataract operation as advised indicating effectiveness of screening by a paramedical worker followed by referral. Since the specialist referral service was also available within the same village, very high success rate in the current study may not be replicated to the same extent in other settings.

General practitioners' knowledge of childhood asthma in Delhi, India.

OBJECTIVE: To assess knowledge of childhood asthma among general practitioners (GPs) in Delhi, India. DESIGN: In this cross-sectional study, a total of 157 GPs were interviewed using a validated questionnaire, including six questions of local and social relevance. A response rate of 78.5% was obtained. RESULTS: Although the GPs who participated in the study had adequate knowledge of the importance of appropriate treatment, the safety of inhalers/oral steroids and the role of medicines in the prevention of frequent asthma attacks, the majority lacked knowledge of symptomatology, exercise-induced asthma and inhaled corticosteroids. GPs with >5 years of practice were more likely to have significantly less knowledge about preventive drugs, certain aspects of treatment of acute asthma and misconceptions, such as 'drinking milk increases mucus production' or 'children with asthma should not consume dairy products, chilled drinks, sour or chilled food'. On the other hand, GPs with < or =5 of practice had misconceptions such as 'children with asthma have abnormally sensitive airways' and 'asthmatic children develop dependence on inhalers'. CONCLUSIONS: The gaps in knowledge about asthma and its management highlight the need to design well-structured educational strategies for health professionals.

Problems related to menstruation amongst adolescent girls.

OBJECTIVE: To study the types and frequency of problems related to menstruation in adolescent girls and the effect of these problems on daily routine. METHODS: Girls in the age group 13-19 years who had had menarche for at least one year at the time of study. 198 adolescent girls have been studied. Data was collected by personal interviews on a pre-tested, semi-structured questionnaire. The questions covered menstrual problems, regularity of menses in last three cycles of menstruation and the effect of these problems on the daily routine. Analysis was done using SPSS version 12. Percentages were calculated for drawing inferences. RESULTS: More than a third (35.9%) of the study subjects were in the age group 13-15 years followed by 17-19 years, 15-17 years respectively. Mean age of study participants was calculated to be 16.2 years. Dysmenorrhea (67.2%) was the commonest problem and (63.1%) had one or the other symptoms of Pre-menstrual syndrome (PMS). Other related problems were present in 55.1% of study subjects. Daily routine of 60% girls was affected due to prolonged bed rest, missed social activities/commitments, disturbed sleep and decreased appetite. 17.24% had to miss a class and 25% had to abstain from work. Mothers and friends were the most common source of information on the issue. CONCLUSION: Screen adolescent girls for menstruation related problems and provide them with counseling services and relevant information on possible treatment options. Besides, there is a need to emphasize on designing menstrual health programmes for adolescents.

Incidence of summer associated symptoms, host susceptibility and their effect on quality of life among women 18 to 40 years of age in an urban slum of Delhi.

OBJECTIVES: To study whether individual susceptibility plays a role in the occurrence of summer associated symptoms (dizziness, giddiness, fainting and weakness) among women 18-40 years of age and their effect on the quality of life. METHODS: It was a prospective community based study carried out in an urban slum of Delhi as a follow up of an earlier study. All women who had "given symptoms" during summer in the earlier study and a sample of those who were asymptomatic were included in the current study. Both the groups were studied for the occurrence of "given symptoms" and quality of life during next summer and winter using a pre structured questionnaire and WHOQOL-BREF. RESULTS: Incidence of "given symptoms" during summer was more than three times among women who were symptomatic earlier compared to women who were asymptomatic. The incidence of these symptoms was significantly higher among the former across different age groups and BMI categories. Their physical domain of quality of life was also adversely affected. CONCLUSIONS: Continued high incidence of summer associated symptoms with adverse effect on their physical quality of life, among women who were symptomatic earlier too, points to individual susceptibility rather than random occurrence. This aspect requires for further studies.

Awareness and perception about tuberculosis in the general population of Delhi.

The present study was conducted to assess awareness and perception regarding tuberculosis among the general population of Delhi. A total of 1008 adults, selected by multistage stratified systematic sampling, were interviewed using a pre-tested proforma. The majority had heard about tuberculosis (99.1%) and most (89.2%) perceived it to be an infectious disease. The correct mode of transmission i.e. airborne (coughing/sneezing) was known to 71.8% study subjects. The majority (90.1%) knew cough as a symptom. Nearly all (98.2%) perceived Tuberculosis to be a preventable disease, citing the treatment of patients as the mainstay of preventing spread of the disease. However, responses like separation of utensils or hospitalisation of the patient to prevent the spread of the disease indicate persistence of stigma and discrimination in a small proportion of the population. There is a need to widen the scope and intensify the information and education being provided to the population based on gaps identified.

Clinicoepidemiological profile and predictors of severe illness in young infants (< 60 days) reporting to a hospital in North India.

OBJECTIVES: To describe the clinical and epidemiological profile of young infants reporting to a hospital and assess previously proposed simple clinical signs for their value in enabling health workers to detect young infants with severe illness warranting hospital admission. METHODS: Observational study of infants less than 2 months of age presenting consecutively to a large public hospital in South Delhi who were evaluated by a health worker (nurse), on a standardized list of signs and symptoms, and the ability of these were evaluated against the need for hospital admission which was assessed by an independent pediatrician. RESULTS: Of the 1624 young infants triaged, 878 were enrolled into the study. Of these 100 (11%) were below 7 days of age, for whom the common reasons for seeking care were jaundice (52%), not feeding well (6%) and fever (5%). The remaining 778 (89%) were 7-59 days of age with respiratory symptoms as the main presenting complaints (29.1%). The primary clinical diagnoses in infants with serious illness needing admission to hospital in the age group <7 days (n = 66) were hyperbilirubinemia (56%) and sepsis (21%). In those between 7-27 days of age (n = 60), primary diagnoses were sepsis (27%), pneumonia (13%), diarrhea, dysentery or dehydration (10%), while in the age group 28-59 days of age (n = 47) pneumonia (40%), sepsis (19%) and diarrhea or dehydration (13%) were the common primary diagnoses. Signs that had at least a prevalence of 5% and were strong predictors for all the age categories studied were history of difficult feeding (OR 6.8 for 0-6 days, 15.1 for 2-27 days and 6.2 for 28-59 days age groups), not feeding well on observation (OR 13.7, 27.6 and 20.9 respectively for the 3 age groups), temperature > 37.5C (OR 21.8, 14.6 and 30.0 respectively for the 3 age groups) and respiratory rate > 60 per minute (OR 6.8, 15.1 and 21.0 respectively for the 3 age groups). Additional strong predictors with > 5% prevalence were history of convulsions (OR 7.9, only in 0-6 day age group), lethargy (OR 26.1, only in 7-27 day age group), and history of diarrhea (OR 3.0 for 2-27 days and 2.2 for 28-59 days age groups). CONCLUSIONS: Simple clinical signs are useful in hands of health worker for identifying neonates with serious illness warranting hospital admission. These will be of use in the further development of clinical algorithms for the national integrated management of childhood illnesses.

Knowledge, attitude and practices regarding tuberculosis and dots among interns in delhi, India.

OBJECTIVE: To assess the knowledge, attitude and practices regarding tuberculosis (TB) and DOTS among young medical graduates (interns). DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Lady Hardinge Medical College and Maulana Azad Medical College, New Delhi, India, during November and December 2002, simultaneously. SUBJECTS AND METHODS: A pre-tested semi-structured questionnaire consisting of 30 items was administered to the young medical graduates/interns posted in different departments. The questions covered mode of transmission, symptoms of pulmonary TB, investigations, short course chemotherapy including DOTS as well as conventional anti-tubercular treatment, special situations, health education and chemoprophylaxis. RESULTS: A total of 287 interns were surveyed. Majority of the study subjects (92.7%) ranked DOTS strategy as more successful for treating tuberculosis in comparison to self-administered therapy. However, a mere 4.2% study subjects were aware of all modes of transmission. One hundred and eighty-nine (65.9%) correctly chose sputum examination for acid fast bacilli as the single most confirmatory test for diagnosing pulmonary TB. The rest either gave incorrect responses (including ELISA-17.0%, PCR-9.8%, X-ray chest-4.2%, ESR-1.7%) or did not respond (1.4%). Only 2.1% marked pyrazinamide and rifampicin as the agents to be avoided in patients with liver disease. One hundred and forty-one different treatment regimens were mentioned in the responses received and of those only 11(7.8%) were scientifically acceptable. CONCLUSION: TB is a major health problem in South-East Asian countries. There is a need for appropriate changes to be made in the undergraduate medical teaching/training curriculum in the concerned countries with regard to TB.

Practice and knowledge regarding prevention of tetanus among nursing personnel in Delhi.

A cross-sectional study was conducted in Delhi to assess the practices and knowledge regarding tetanus immunization among nursing personnel. Majority of the study subjects had received their last dose of tetanus toxoid injection only after injury and just 4.4% received it to complete the immunization schedule. More than 12% subjects did not know whether they had received any tetanus toxoid injection or not, another 5.5% had their last dose of tetanus toxoid more than ten years back. As many as 20 (22.2%) subjects stated that TT should be given after every injury. Of the remaining 70 subjects only 22.9% correctly knew why TT was not required. Only one third of the subjects knew the indications of anti tetanus serum.

Practices and knowledge regarding prevention of tetanus among doctors in Delhi.

A cross-sectional study was conducted in Delhi to study immunisation practices regarding prevention of tetanus among doctors and their knowledge regarding its prevention. Delhi was divided into five zones, and from each zone two hospitals and five dispensaries were selected, giving due representation agency-wise. All the doctors posted for casualty duty in the selected hospitals, all doctors posted in the selected dispensaries and two private practitioners selected randomly from the nearby area of the selected dispensaries were included in the study. Only 7% of doctors had received their last dose of tetanus toxoid to complete the immunisation schedule and majority had received it following injury. As much as 38.3% of doctors favoured TT after every injury. Out of the remaining who opposed it only 59.5% could provide the correct reason for this. Less than half of the doctors knew the indications of anti-tetanus serum. There is a need for the doctors to take TT immunisation more seriously and adopt recommended immunisation practices, because if they themselves are not following the guidelines, it is likely to be reflected in their advice and motivation to patients.

Newborn care practices in an urban slum of Delhi.

BACKGROUND: Despite efforts by government and other agencies, neonatal morbidity and mortality continues to be high in India. Among other reasons, newborn care practices are major contributors for such high rates. AIMS: To find out the newborn care practices including delivery practices, immediate care given after birth and breast-feeding practices in an urban slum of Delhi. SETTINGS AND DESIGN: Community based, cross-sectional survey in a resettlement colony (a type of urban slum). MATERIALS AND METHODS: Semi-structured, pre-tested schedule was used to interview 82 mothers of newborns in the study area. STATISTICAL ANALYSIS: Data was analyzed using Epi - info version 6.04. Fischer exact test and chi2 test were applied. A P value of less than 0.05 was considered significant. RESULTS AND CONCLUSION: More than half i.e. 26 (56.1%) of home deliveries, which were mostly conducted by dais (24, 91.3%) or relatives in 4 (8.7%) of home deliveries. Bathing the baby immediately after birth was commonly practiced in 38 (82.6%) of home deliveries. Finger was used to clean the air passage in most of the home deliveries (29, 63%). About 61% (28) of home delivered newborns were not weighed at birth. Rooming in was practiced in majority of the cases. A few of home delivered neonates (12) were given injection tetanus toxoid by unqualified practitioners. Use of clip, band or sterile thread to tie the cord and no application to the cord was significantly higher in institutional deliveries. Breast milk as the first feed was significantly more in institutional deliveries. There is an urgent need to reorient health care providers and to educate mothers on clean delivery practices and early neonatal care.

The impact of an IEC campaign on tuberculosis awareness and health seeking behaviour in Delhi, India.

OBJECTIVE: To study the impact of an intensive IEC campaign regarding the Revised National Tuberculosis Control Programme launched by the Government of Delhi on awareness generation among the general population and improvement in self-reporting by symptomatic cases in Delhi, India. DESIGN: Cross-sectional study. RESULTS: A pilot study wherein 1008 persons selected by systematic random sampling from the general population and 1012 patients selected from symptomatic cases reporting to DOTS centres were interviewed. Among the general population, 716 (71.0%) had been exposed to one or more IEC message through the media. The core message regarding symptoms, diagnosis, treatment centre and free treatment was recalled correctly by 144 (14.3%), 449 (44.5%), 659 (65.4%) and 900 (89.2%), respectively. In the post IEC period, a significant increase (P < 0.01) was seen in individuals self-reporting with symptoms to DOTS centres: the media message reportedly encouraged 36.3% of these to self-report. Prior to the IEC campaign only 49 (9.8%) patients had chosen a DOTS centre as first source of treatment, which increased significantly (P < 0.0001) to 104 (20.4%) post IEC. CONCLUSION: The IEC campaign launched by the Government of Delhi has been effective in raising awareness and improving self-reporting, but it requires intensification with suitable modification to reach all sectors.

Infant feeding - an evaluation of text and taught.

OBJECTIVE: Study was conducted to 1) assess knowledge of doctors, medical interns and nurses/ANMs regarding exclusive breast-feeding, management of common problems related to breast feeding and appropriate complementary foods 2) review the above aspects in books commonly read by medical and nursing students. METHODS: Cross-sectional study conducted in the department of Community Medicine, Maulana Azad Medical College, New Delhi during a seven-month period on 93 interns, 58 medical officers and 44 nurses/ Auxillary Nurse Midwives (ANMs) with the help of a pre-tested structured multiple choice questionnaire and review of some commonly read books of Pediatrics, Community Medicine and Nursing. RESULTS: The concept of 'exclusive breast-feeding' was clear to most health personnel but the fact that water should also not be given was not clear in the books reviewed. The books also lacked emphasis on management of common lactation problems and this was also seen in the knowledge of the health personnel. CONCLUSION: As inappropriate feeding practices are widely prevalent, knowledge of large proportion of health personnel is incorrect and commonly read books are inadequate on this issue, there is need for greater emphasis on this in books and training sessions.