Prevalence of low birth weight and its determinants in an urban resettlement area of Delhi.

Birth weight remains an important factor affecting infant and child mortality. Many factors influence the occurrence of low birth weight (LBW). The present study was conducted to study the prevalence and determinants of LBW in an urban resettlement area of Delhi. A baseline survey was done to enroll all pregnant women in the area. These women were followed up every month till outcome. The prevalence of LBW was 39.1%. Occurrence of LBW was related to age, parity, weight and height of the mother. In multiple logistic regression analysis, mother's weight and parity alone emerged as significant variables. On further analysis, on adjusting for age, parity and birth weight were associated for the 20-35-year age group only. Thus, prevalence of LBW remains high in the urban under privileged of Delhi; maternal age, parity and weight and height are important determinants. Increasing age of first birth to more than 20 years can minimize effect of primi parity.

Is education a determinant of knowledge about malaria among Indian tribal population?

Malaria is a major public health problem in tribal villages of India, where 8% of the country's population lives. Literacy level among tribal population is very low. This study aims to examine the relation between education status and knowledge about malaria among Indian tribal communities. 125 randomly selected tribal respondents from one tribal village each of 17 states were administered a close ended questionnaire by trained interviewers to assess their knowledge about various aspects of malaria. Effect of educational status on the level of knowledge was analyzed using chi square test. Stratified analysis was performed using Mantel Haenszel chi square test to eliminate gender bias. 2125 respondents', randomly selected from 17 tribal villages in as many states, findings were analyzed. Fifty seven percent male and 72% female respondents were illiterate. Only 2% respondents had college level education. Educated females were more knowledgeable than their male counterparts. Mantel Haenszel chi square analysis showed that educated respondents were more knowledgeable than the illiterates, after adjusting for sex of respondents. However, there was gross lack of knowledge regarding diagnosis and treatment of malaria and use of insecticides irrespective of gender and educational status. Improvement in literacy status of tribal population will help in increasing awareness about malaria. Opportunities for disseminating information about various aspects of malaria should be utilized during treatment of malaria cases by health workers.

Sexual behavior of drug-users: is it different?

BACKGROUND: Across the world, drug-users (DU) have been shown to be at greater risk of contracting and transmitting sexually transmitted diseases and HIV infection. However, in the metropolitan cities of India, where drug-use patterns may uniquely vary between injection and noninjection, depending on drug availability, little is known about the risk behavior of drug-users. OBJECTIVE: The objective of the study was to find out whether drug-users are more likely to practice high-risk sexual behavior compared to non-drug users. METHODS: The sexual behavior of 70 drug-users, selected by snowball sampling, was compared with 128 age- and economic status-matched controls (non-drug-users), randomly selected from the same community. RESULTS: Seventy-eight percent sexually active drug-users and 43% sexually active non-drug-users had multiple sex partners (P < 0.02). The average number of sex partners was significantly higher among the drug-users (P = 0.05). Anal intercourse was practiced by 25.7% drug-users and 8.6% non-drug-users (OR = 3.7; P < 0.01). The drug-users were 6.7 times more likely to visit commercial sex workers (P < 0.0001). Sexually transmitted disease prevalence was higher among the drug-users (P < 0.003). CONCLUSIONS: Notwithstanding the small sample size, this study shows that drug-users practice high-risk sexual behavior more frequently. Interventions, in the form of awareness generation and prevention education programs, are required in order to reduce risk of sexually transmitted diseases and HIV transmission among drug-users.

Training interns in population-based research: learners' feedback from 13 consecutive batches from a medical school in India.

OBJECTIVES: To document learners' feedback on an educational intervention to provide interns with a hands-on learning experience in population-based research. DESIGN: Cross-sectional inquiry using a structured tool. SETTING: A medical school in India. SUBJECTS: 306 interns from 13 consecutive groups in a 3-month posting. MAIN OUTCOME MEASURES: Interns' participatory involvement in each of the nine units of learning. RESULTS: In six out of the total of nine units of learning, nearly 70% of the students rated their participatory involvement at 3 points or above (on a 5-point rating scale). This rating was 4 or 5 (good or maximal) for 50% or more students with regard to identification of research questions, review of literature, data analysis and interpretation, and for 65.4% students in data collection. However, in the last two units, on writing the research report and its presentation, a large proportion of students rated their participatory involvement as minimal or unsatisfactory (38.9% and 46.4%, respectively). For 91.2% of students, this was the first hands-on experience of any type of population-based research. When the students were asked to identify the most important factor which hampered learning during the present exposure, 54.2% of them reported that it was the unsuitable timing of the exposure, since their priority during internship was the entrance examination for postgraduate courses. CONCLUSIONS: This study empirically demonstrates that with some extra effort from teachers, interns can be exposed to a hands-on learning experience in population-based research, on a systematic basis, without additional resources.

Long-term nutritional effects of ICDS.

Nutritional status of 1243 children (636 boys and 607 girls) in the age group of 7-13 years was assessed in relation to utilisation of Integrated Child Development Services (ICDS) during their childhood. All the houses in every 10th Anganwadi selected by systematic random sampling were surveyed in the ICDS project, Nand Nagri in East Delhi. Information regarding utilisation of ICDS facilities, sociodemographic details, general awareness etc. was collected by interview technique and anthropometric and clinical examination of every child was done and Anganwadi attendance score was calculated for each child. It was found that most of the children were non-beneficiaries (59.1%). On univariate analysis Anganwadi attendance score, age, sex of the child and education status of the father showed statistically significant association (p < 0.005) with malnutrition. On Multiple logistic regression analysis higher age (OR 1.4155 for grade 1 malnutrition and 1.6913 for grade 4 malnutrition) and being female (OR 1.5214 for Grade 4 malnutrition) remained significant risk factors for development of malnutrition for all grades. Anganwadi attendance score did not show any statistically significant association for decreasing the risk of getting malnourished for any grades of malnutrition in 7-13 years age group. There is special need to take special care for girls as well as to continue the special nutrition care even at an higher age. More in depth studies are needed so as to formulate effective nutritional policies for children.

HIV/AIDS related knowledge, risk perception, attitude and sexual behavior of working women staying in hostels.

HIV infection poses a formidable threat to women's health. Already, in India, women account for 21.3% of all AIDS cases. In metropolitan cities women living alone in hostels and having independent income, may have a liberal life style and chances of practising high risk sexual behaviour is greater. This study was conducted to assess the risks and risk perception of such women. Among eighty-nine hostel residents, AIDS awareness was 92.1%. Very few respondents had adequate knowledge about modes of transmission and methods of prevention. Risk perception was poor, however high risk behaviour was less commonly practised by this group.

Assessment of availability and working components of school health services in Delhi.

A total of 204 schools of different types and geographical zones were surveyed. Principals of the selected schools were interviewed to generate data regarding availability and working components of school health during last one year. School health services were non existent in 56 (27.45%) of the total schools and in another 27%, the visits made by school health team were only three or less during last one year. The situation was much better in NDMC and MCD schools but in Govt. of Delhi group, 40 of the 82 schools did not have any school health services. In most of the schools having some form of school health services (govt. or private), all the essential areas of health appraisal viz. anthropometry, general health check-up, vision testing, ENT check-up and dental examination were covered. In 21.62% of such schools no health education activity was done by the school health team. Even in the schools having some form of school health services, referral-follow up system did not seem to be working well. In this situation health check-ups merely satisfy administrative requirements and end up with some data for storage. School health services in Delhi, like other health services, are administered through multiple agencies with somewhat overlapping areas and responsibilities. This has more disadvantages than benefits. An integration of various school health schemes in Delhi with uniform system and standards should be attempted.

Structural and organizational features of school health schemes in Delhi.

The magnitude of work and existence of multiple agencies makes the task of providing school health services to all pupils of the State of Delhi with uniform standards, a very complex job. The present article looks at the matter from the provider's end, illustrates the structural and organizational features of various school health schemes in Delhi and tries to come out with some suggestions for improvement. This study was based on qualitative research methods. Besides the three major agencies involved i.e. Govt. of Delhi, MCD and NDMC, a host of private and other agencies were also contributing significantly in covering a total of approx. 3700 schools with around 19 lakh children. Organizational and other features of school health services varied widely according to the providing agency. There is a need for integration between various school health schemes in Delhi. Since MCD school health scheme appeared to be better organized, its features can be adopted while developing uniform standards. About the components of services, promotive inputs and follow-up of health appraisals are the areas that need to be strengthened. Proper maintenance of cumulative health records, central documentation and timely dissemination of reports are also equally important and need strengthening.

Measles, immunisation and disease: rapid epidemiological assessment in two trans-Yamuna villages of Delhi.

A community investigation was conducted in 2 villages of east Delhi, having 15,000 population. Ten per cent households were selected from both the villages by systematic random sampling and all the under 3-year children in selected households were included in the study. A total of 126 under 3-year children from 360 households were investigated. Total children immunised against measles were 86. Most of the 86 immunised children were vaccinated between 9 and 11 completed months. Of the 80 children aged 12 months or above, 12(15%) were unimmunised. Main reason behind non-immunisation was parental apathy. Of the total 126 surviving under 3-year children, 12(9.52%) had a history of probable measles. Two of these children had already measles before they could be eligible for measles vaccination as per the current schedule.

Impact of a multi-method promotional package on awareness and knowledge about STD and AIDS among the trainees of an industrial training institute in a resettlement colony of Delhi, India.

To design and apply a multi-method promotional package for enhancing awareness and knowledge on STD and AIDS among ITI trainees, and evaluate its impact, an intervention study, using pre and post assessment of the subjects for comparison was carried out. The study was carried out in the Industrial Training Institute (ITI), in a resettlement colony of Delhi. Urethral/vaginal discharge, genital ulcer and pain on micturition were identified as symptoms of STD by a significantly higher number of respondents in the post package sample. A sizable number of subjects included inguinal swelling and lower abdominal pain also as STD symptoms. The IEC intervention showed a significant improvement in knowledge about all four major routes of transmission of HIV/AIDS. Using condoms and avoiding sex with Commercial Sex Workers were reported as measures to prevent STD/AIDS by a significantly higher number of subjects after the intervention. A sizable number of subjects also included other measures (using safe blood/not sharing needles etc.) as well. There was a significant decline in the subjects preferring self treatment or treatment from a chemist shop in case one suffered with an STD. A significant increase was observed in those preferring treatment from govt. facilities or private allopathic doctors. However, the intervention did not seem to result in preference for alternative systems of medicine. The study demonstrated that exposure to intensive promotional intervention, even for a brief period can significantly raise awareness and knowledge of young people even on sensitive topics like STD and AIDS.

Pattern and distribution of ocular morbidity in primary school children of rural Delhi.

A total of 679 primary school children drawn from developed southern parts and underdeveloped eastern parts of Delhi were examined for ocular morbidity. Their age range was 5-15 years and both sexes had almost equal representation. The prevalence of eye diseases was relatively high. Over 40 percent of all the children studied had one or more ocular problems. Trachoma (18%) was the most common ocular morbidity followed by vitamin A deficiency (10.6%), visual acuity < 6/9 (7.4%) and apparent/latent squint (7.4%). In most of these eye disorders, the majority of the children came from the underdeveloped eastern parts of Delhi. Ocular morbidity seems to be unevenly distributed in rural Delhi with a significantly worse picture in the underdeveloped eastern parts, across the river 'Yamuna'. Though blinding trachoma may cease to be a major problem in India, the country continues to have endemic pockets of its non-blinding form. One puzzling observation was that children with protein-energy malnutrition (PEM) did not show any specific vulnerability to ocular diseases. In fact, those with normal weight-height index were having a higher share of eye diseases. Though this issue needs to be explored further in the light of biological plausibility, it appears that children who do not have PEM are also exposed to ocular diseases at least with comparable risk.

Perceptions of teachers regarding sex education in National Capital Territory of Delhi.

A cross sectional study was conducted to find out the knowledge and attitudes of school teachers regarding sex education. Information was collected from 476 senior secondary school teachers belonging both to the government and public schools, selected randomly in National Capital Territory of Delhi using pre-tested close ended questionnaires. A majority of school teachers (73%) were in favour of imparting sex education to school children. Regarding contents of sex education, 90% agreed to the inclusion of reproductive anatomy, physiology including menstruation and birth control measures like condoms and oral pills. However, a majority of school teachers did not want sex education to include topics like abortion, premarital sex and masturbation etc. Fourteen years of age was considered to be the most appropriate for imparting sex education by 28.6% of school teachers. School teachers and doctors were considered by 69.4% and 63.6% of the respondents respectively to be the most appropriate persons for providing sex education.

Process evaluation of pulse polio immunisation in Delhi.

The aim of the study was to assess the functional aspects and the staffing at Pulse Polio immunisations posts. Interns and medical students conducted the survey in eighty seven pulse polio immunisation posts scattered all over National Capital Territory of Delhi on 18th January 1997. A pre-tested structured format containing information pertaining to dose utilisation and staffing was filled. Number of children given pulse polio was on an average 459.2 per immunisation post (474.7 rural, 516.35 slums and 435.0 urban). Average number of neonates (below one month) per immunisation post given polio drops was 5.1 (1.1%). The break-up for rural area, slums and urban area was 3.0 (0.63%), 6.7 (1.30%) and 4.9 (1.13%) respectively. By 12 pm, 67.8% and by 2 pm 88.7% of the doses had been administered. Staffing at most of the immunisation posts was adequate for all categories of staff except doctors (0.48 per booth).

Breast feeding patterns in an urban resettlement colony of Delhi.

Studies on duration and patterns of breast feeding based on recall may lead to a bias about the exact feeding status. The present study was designed to overcome this bias using the 'current status analysis method'. Mothers of 650 infants from 0 to 12 months of age attending a Health Centre were interviewed about the current feeding patterns of the infants and other socioeconomic variables. Month-wise prevalence of feeding patterns was determined. It was observed that breast feeding was maintained at a high level (more than 90%) throughout infancy while exclusive breast feeding showed a rapid decline. At 1 month, 74% and at 4 months, 46% of infants were exclusively breast-fed. The median duration of exclusive breast feeding was 3.83 months. Mothers with lesser education and lower family income were more likely to exclusively breast feed (p < 0.05). The time interval between birth and first breast feed was 24-48 hours in most (48.9%) of the infants. Majority (76.9%) of the infants received pre-lacteal feeds. Hospital-born infants received their first feed earlier and were less likely to receive pre-lacteal feeds as compared to those born at home (p < 0.001). Thus, the practice of exclusive breast feeding has to be promoted amongst pregnant and lactating mothers by health personnel. Also knowledge regarding infant feeding has to be imparted in schools and colleges.

Knowledge, attitude and practices related to dengue in rural and slum areas of Delhi after the dengue epidemic of 1996.

To assess the knowledge and attitudes about dengue and practice of prevention followed by the residents of a rural area and an urban resettlement colony of East Delhi, an interview based cross sectional KAP study was undertaken in Jan 97 to Feb 97, a few months after the dengue epidemic in rural area and urban areas of East Delhi. A pre-structured and pre-tested format containing the relevant questions was administered to the subjects. A total of 687 subjects (334 rural and 353 urban) were interviewed. Nearly four fifth (82.3%) of these were aware of Dengue. Audiovisual media was the most common source of information in both the areas. Knowledge about the disease was fair to good. Fever was the commonest symptom of the disease known to 92% urban and 83% rural respondents followed by symptoms of bleeding and headache. Mosquito was known to spread the disease to 71% rural and 89% urban respondents. More than two third respondents in urban and two fifth in rural areas had used some method of mosquito control or personal protection during the epidemic.

PIP: This study evaluated the knowledge, attitude and practices concerning dengue and the practice of prevention in the rural and urban resettlement areas of New Delhi during January-February 1997, after the 1996 dengue epidemic. A pre-structured and pre-tested format was used by physicians to interview 334 rural and 353 urban residents (n = 687) who visited health centers. A high level of dengue awareness (87.3%) was observed among the respondents who can be attributed to the health education and information campaign of the audiovisual media and health care personnel. Knowledge about dengue was fair to good particularly among urban residents. 92% urban and 83% rural residents reported fever as the most common symptom, followed by bleeding and headache. About 71% rural and 89% urban respondents claimed mosquitoes as the source of the disease and used some method of mosquito control or protection during the epidemic. It has been suggested that prevention of dengue must start within the locality to ensure that the people are receptive to the messages and to make desired behavioral changes easier to adopt.

Measles, immunisation and disease: situation analysis in a resettlement area of northern India.

India has a goal of covering all infants with measles immunization between 9-12 months. The present study was conducted in a resettlement area of east Delhi, with a population of nearly one lac, to assess the extent of measles immunization and infection among children aged under three years. All the 21 blocks of the area were covered and 10% households were selected by systematic random sampling from each of the blocks to provide 944 households and 517 under-3 children, who were individually examined by a doctor. Two hundred and eighty one children aged 12 months or above were immunized at or after 9 months giving a coverage of 74.14%. Among the immunized children 7.78% and 8.36% were vaccinated before and after the recommended age-range (9-12 months) respectively. One fifth of the children aged 12 months or above were not immunized against measles at all. Among the surviving under-3 children, no child suffered measles before 6 months but 11.86% of the children had measles between 6-8 months. Six children were vaccinated even after measles episode and seven children had measles even after immunization. Systematic community contact and special attention to resistant and hostile parents is important in order to accomplish 100% coverage. In view of the sizeable proportion of measles infection among the age group of 6-8 months, there is a case for bringing forward the recommended age for measles immunization, if we are to eradicate the disease.

Knowledge of fresh medical graduates about immunization: impact of posting in community medicine.

Immunization being the most cost effective health intervention rightly forms an integral part of MCH health activities spectrum. Of late medical colleges in the country are directly involved from the planning to evaluation stages in the immunization programmes in their respective catchment areas. Immunization knowledge of 91 interns during their course of involvement in community work, was tested on the first day and last day of their three months posting in the Community Medicine Department. The study showed positive impact of training in the Department of Community Medicine on the performance levels of interns. This was found mainly attributable to effective interaction of interns with the community in the field and taking independent decisions as per the case requirements.

Childbirth spacing in a rural community of Delhi: profile in various marriage cohorts by decades.

Complete retrospective fertility histories of 843 ever married women of two villages in Delhi, obtained through house to house survey, were analysed to study various marriage cohorts by decades for trends of child birth spacing over a period of 60 years from 1921 to 1980. Spacing between consummation of marriage and first child birth gradually declined over the last 6 decades. For all other subsequent livebirths remained constant at an average of nearly 30 months. Irrespective of the reasons for such a trend, much more efforts are required to be put in to increase child spacing.

PIP: From March 1982 to April 1983, researchers from the University College of Medical Sciences in Delhi, India interviewed at least 843 women = or 15 years old and married between 1921-1980 from 2 villages near Delhi about their birth history and year of marriage. There were 3736 live births among the 843 women. 98.8% of the women married between 1921- 1970 had children. Only 182 of the 256 women married between 1971-1980 had already borne children. The spacing between consummation of marriage and the birth of the 1st child (1st birth order) decreased steadily over the 6 decades. For example, the average spacing fell from 44.86 months (1921-1930) to 40.11 (1951-1960) to 28.82 (1971-1980). During this time frame, the mean age at marriage rose gradually, but the mean age for 1st birth did not change. For each decade except 1971- 1980, the spacing for the 1st birth order remained significantly more than most of the other birth orders in that decade. The mean birth interval for all the marriage cohorts stood at 30 months. The average spacing of all births for the 1971-1980 marriage cohort was significantly lower than those of the 5 previous decades (p.05), however. This could be a result of the decline in breast feeding and sexual abstinence in urban areas of India. This trend appears to counteract the efforts of family planning programs. The results of this study indicate that the National Family Welfare Programme must more actively promote child spacing as a means to reduce family size.