Capacity Assessment of District Health System in India on Services for Prevention and Management of Infertility.

BACKGROUND: Infertility is a neglected service component in the public health-care system in India. OBJECTIVES: This study aims to assess the availability and practices on prevention and management services for infertility in the district health system. METHODOLOGY: A cross-sectional survey of selected health facilities and the staff from 12 district hospitals (DHs), 24 community health centers (CHCs), 48 primary health centers (PHCs), and 48 subcenters was conducted using qualitative and quantitative methods. Interviewed staff included 26 gynecologists; 91 medical officers; 91 auxiliary nurse midwife; 67 laboratory technicians; and 84 accredited social health activist workers. RESULTS: The findings indicate that adequate staff was in place at more than 70% of health facilities, but none of the staff had received any in-service training on infertility management. Most of the DHs had basic infrastructural and diagnostic facilities. However, the majority of the CHCs and PHCs had inadequate physical and diagnostic facilities related to infertility management. Semen examination service was not available at 94% of PHCs and 79% of CHCs. Advanced laboratory services were available in <42% at DHs and 8% at CHCs. Diagnostic laparoscopy and hysteroscopy were available in 25% and 8% of DHs, respectively. Ovulation induction with clomiphene was practiced at 83% and with gonadotropins at 33% of DHs. CONCLUSION: The district health infrastructure in India has a potential to provide basic services for infertility. With some policy decisions, resource inputs and capacity strengthening, it is possible to provide advanced services for infertility in the district health system.

A study on morbidity pattern of child labourers engaged in different occupations in a slum area of Calcutta.

A cross-sectional study of 150 child labourers engaged in different occupations in a slum area of Calcutta was conducted to assess their health and nutritional status. Most (88%) of them had some type of morbidity. Female child workers (95.5%) suffered more than the males (84.7%). Most prevalent morbidities among the child labourers were seen as pallor (49.3%) followed by pediculosis (48%), dental caries (28.6%), malnutrition (22.6%), worm infestation (20.6%) and scabies (16.6%). Garage workers were observed to suffer less from any type of morbidity except pallor which may be attributed to lead exposure. Rag-pickers had significantly (p < 0.05) more risk of developing worm infestation, scabies and pediculosis whereas domestic helpers had significantly (p < 0.05) more risk of developing pediculosis. Occupational hazards were also studied but excepting pallor in garage workers and scabies in rag-pickers, nothing could be documented.

An accident-risk assessment study of temporary piece rated workers.

An occupational injury surveillance study (record study of five years duration) was conducted involving the workers of a fertilizer producing industry in eastern India to assess whether the risk of occupational accidents in temporary piece rated workers was higher in comparison to the permanent time rated workers. At the same time, to collect the personal details of the workers who have worked in the industry in the study period, an interview was also conducted. Mean age of temporary piece rated workers and permanent time rated workers were (35.9 +/- 12.5) and (35.3 +/- 11.4) respectively. Distribution of other variables like nature of work, level of education, experience, habits were also very similar between the two worker groups. Accident incidence rate, accident frequency rate and accident severity rate were found to be significantly higher in temporary piece rated workers. This difference was more prominent in case of time-loss accidents than in no time-loss accidents. Relative risk has varied from 2.3 to 18.0 in case of time-loss accidents. In case of no time-loss accidents, it has varied from 1.1 to 2.6. When relative risk is considered after taking both types of accidents together, it has ranged from 1.2 to 3.5. This study concluded that the temporary piece rated workers are more vulnerable to occupational accidents.