Clinical Profile and Outcome of Organophosphorus Poisoning in a Tertiary Hospital.

Organophosphorus compound (OPC) poisoning is common in Bangladesh. The toxicity of the agent and paucity of appropriate medical services has resulted in high mortality rates. To find out the clinical profile and outcome of OPC poisoning patients is the main aim of my study. This descriptive cross-sectional study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Bangladesh from September 2016 to November 2018. In this study, mean age of the study subjects was 25.90±11.24 years. Males (70.8%) were predominant than female (29.2%). In this study, most of the poisoning was done by ingestion (98.3%) and only two (1.7%) by inhalation. Regarding features, most muscarinic effect was constricted pupil and bronchospasm (65.0%). Common nicotinic effect was fasciculation (25.0%) and central effect was headache (61.67%). Mean amount of OPC ingestion was 26.30±17.24 ml in this study. Regarding circumstances of poisoning, familial disharmony (38.3%) and quarrel with other family members (37.5%) were the major reason followed by failure of personal affairs (15.0%) and other reasons (9.2%). Regarding complications, aspiration pneumonia was found in 6.7% cases, cardiac arrhythmia was in 6.7% cases and intermediate syndrome was in 1.7% cases. Most of the study subjects (95.0%) recovered fully. Most of the patients were from rural area. Suicidal was the common motive and familial disharmony and quarrel with other family members are the common circumstances of poisoning. Mortality rate was 5.0%.

Increasing knowledge of home based maternal and newborn care using self-help groups: Evidence from rural Uttar Pradesh, India.

BACKGROUND: In India, pregnant women and recently delivered mothers of marginalized communities in Uttar Pradesh (UP) remain un-reached by frontline-health-workers. In these communities, self-help groups (SHGs) have the potential to reach these women with knowledge of home-based maternal and newborn care (HBMNC). OBJECTIVE: The study examines the feasibility of SHGs to improve knowledge of HBMNC. The study identifies the facilitating factors and barriers to knowledge change. METHODS: A panel study with a quasi-experimental design was conducted in Jhansi, UP. Peer educators, called Swasthya Sakhi, of the SHGs of the experimental area were trained on how to conduct discussions on HBMNC topics. Both at baseline and endline 233 women from the experimental area and 237 women from the comparison area were interviewed to measure their knowledge change in HBMNC topics. The net-effect of the intervention was examined using difference-in-difference (DID) analysis with propensity-score-matching (PSM) controlling for the effect of background characteristics of the participants from two study areas. Generalized-estimating-equation (GEE) was used to identify the facilitating factors and barriers to the knowledge change. RESULTS: The findings show significant net-increases in women's knowledge for most of the HBMNC topics including danger signs for a pregnant mother and a newborn child, even after controlling for the background characteristics of the participants. The most significant determinant of the increase of knowledge was the women's education. CONCLUSION: Findings from the study showed SHGs can increase HBMNC knowledge among women. However, studies with longer duration are required to examine the scalability and sustainability of the intervention.

Mobile Phone Messaging to Husbands to Improve Maternal and Child Health Behavior in India.

Over 90% of households in rural Uttar Pradesh, the most populous state of India, have at least one mobile phone. However, ownership of mobile phone among women is quite low. Implementation research was conducted in Uttar Pradesh to examine (a) whether providing information on selected maternal and child health (MCH) behaviors to a husband's mobile phone would enhance the man's knowledge and lead to discussions in their family, and (b) whether such discussions would help in the adoption of healthy practices. The m-Health intervention included biweekly voice messages in local language (Hindi) on MCH topics to the mobile phone of pregnant women's husbands. Using a quasi-experimental design, after four months of the m-Health intervention, in 2014, 881 husbands and 956 women from the study area were interviewed. Husbands' knowledge, controlling for their socio-demographic characteristics, were significantly higher among the listeners of the messages than the non-listeners. Multivariate logistic regression analysis showed that if husbands discussed the messages with family members, the odds of wives' practicing health behaviors improved significantly for three behaviors. These include one antenatal checkup in last trimester of pregnancy (odds ratio 1.72, p < 0.05), receiving a postnatal checkup within 7 days of delivery (odds ratio 3.02, p < 0.05), and delayed bathing of newborn (odds ratio 1.93, p < 0.05). Thus, communicating messages using m-Health was found to be an effective intervention for behavior change. The study demonstrated that mobile phones can be used effectively to reach men with MCH information and encourage them to promote healthy behavior in their family.

Conditional and Unconditional Cash Transfers to Improve Use of Contraception in Low and Middle Income Countries: A Systematic Review.

This systematic review synthesizes evidence on the impact of conditional and unconditional cash transfers (CCT and UCT) on contraception in low- and middle-income countries. Scientific and gray literature databases were searched from 1994 to 2016 and 11 papers from ten studies were included. Most of the studies had low risk of bias. Cash transfers were used for increasing school attendance or improving health and nutrition, but not directly for contraception. Three studies showed positive impact on contraceptive use and four showed a decrease in fertility outcomes. An increase in childbearing was observed in two studies, and three studies demonstrated no impact on fertility indicators. All studies treated contraceptive use or fertility only as unintended and indirect outcomes. The available evidence on impact of CCT and UCT on contraception is inconclusive due to the limited number of studies, varying outcome measures, and lack of intervention specifically for contraception.

Gender-Based Violence in Rural Uttar Pradesh, India: Prevalence and Association With Reproductive Health Behaviors.

This study explores the prevalence of different forms of domestic violence and their impact on women's reproductive health behavior in rural Uttar Pradesh (UP), India. Data were collected as a part of a large household survey carried out in 2009-2010. A multistage stratified systematic sampling design was used. A total of 4,223 married women aged 15 to 49 years and 2,274 husbands of these women were interviewed. Data were analyzed using bivariate and multivariate analyses. More than one third of married women in rural UP had experienced one or more forms of violence, such as verbal abuse, physical manhandling, and sexual abuse by their spouse. Nearly 47% of the women had experienced some form of violence during their last pregnancy. Significant associations were found between violence and incorrect reproductive health behaviors, pregnancy complications, poor birth preparedness, poor likelihood of institutional delivery, limited postnatal care, and limited spousal communication for family planning. After controlling for socio-economic variables in multivariate analysis, only pregnancy complications (odds ratio [OR] = 1.62, 95% confidence interval [CI] = [1.40, 1.85]) and lack of delivery preparedness (OR = 0.79, 95% CI = [0.68, 0.93]) were found to be significantly associated with violence. Husband's attitude and reporting of violence by their wives in different situations were not significantly associated. This study provides evidence of the association of violence on the reproductive health behavior of married women in rural India. The results argue for frontline health workers to identify and counsel pregnant women experiencing violence during antenatal check-up to reduce maternal morbidity and mortality.

Challenges in Introducing New Contraceptive Methods: A Case Study of India.

Increasing choice and introducing new contraceptive methods in the National Family Welfare Program in India could play a significant role in increasing adoption of contraception and meeting the unmet need of a large proportion of couples. However, inclusion of any new contraceptive method in India has to face many challenges at different steps: from clinical trials, administrative processes, acceptance in the national program, and reaching the intended beneficiaries. Having a good product is necessary but not sufficient for widespread accessibility, acceptance, and use. This article reviews the challenges based on the available policy documents, literature review, and discussions with senior program managers of the Ministry of Health and Family Welfare and development organizations. It concludes that comprehensive strategic planning is needed to address all possible barriers to ensure new contraceptive access at an affordable price by the beneficiaries it is intended for.

Mainstreaming of emergency contraception pill in India: challenges and opportunities.

BACKGROUND: Emergency Contraception Pill (ECP) is an essential intervention to prevent unwanted pregnancies. However, its use has remained low due to various barriers including reservations among medical fraternity. MATERIALS AND METHODS: This paper presents findings on barriers to ECP's easy access for potential users from (i) a cross-sectional survey of providers' attitudes, beliefs, and practices and interviews with key opinion leaders, (ii) three consultations organized by Population Council with policymakers and public health experts, and (iii) evidence from scientific literature. RESULTS: The major barriers to easy access of ECP include misconceptions and reservations of providers (disapproval of ECP provision by CHWs, opposition to its being an OTC product, and myths, misconceptions, and moral judgments about its users) including influential gynecologists. CONCLUSION: For mainstreaming ECP, the paper recommends educational campaign focusing on gynecologists and CHWs, relaxing restrictive policy on advertisement of ECP, involving press media and strengthening supply chain to ensure its regular supply to ASHA (CHW).

Medical barriers to emergency contraception: a cross-sectional survey of doctors in North India.

BACKGROUND: Some medical doctors in India have publicly expressed opposition to making emergency contraceptive pills (ECPs) easily accessible, even though ECPs are included in the method mix of the Ministry of Health and Family Welfare program and as an over-the-counter (OTC) product. Such opposition affects access to ECPs by influencing policy, procurement, and distribution, besides stigmatizing the ECP user. This study was conducted to assess ECP knowledge, attitudes, and practices of doctors in North India. METHODS: A cross-sectional survey of 83 doctors who provide ECPs, randomly selected from 3 cities in the state of Uttar Pradesh, was conducted in 2011. The quantitative data were complemented by 19 in-depth interviews with purposively selected senior gynecologists and other opinion leaders. RESULTS: All surveyed physicians cited the correct dose and regimen for ECPs. However, the large majority of those surveyed believed that ECPs work by preventing implantation. (The best evidence currently indicates that ECPs do not work by preventing implantation.) Most doctors also believed incorrectly that ECPs have several contraindications and side effects. They also had strong reservations against OTC provision of ECPs by pharmacists and community health workers (CHWs) and negative attitudes toward ECP users, which serve as serious medical barriers to mainstreaming use of ECPs. CONCLUSION: Physicians and their professional associations exert a strong influence on the operationalization of national contraceptive policies. Evidence-based advocacy and educational campaigns targeting doctors are needed to address and resolve their reservations about ECPs, particularly about its provision as an OTC product and its distribution by CHWs. Partnerships with medical associations can help reduce doctors' negative attitudes and create a conducive environment for influencing clinical practices. Such changes are needed to increase the availability and use of ECPs as part of a package of a full range of contraceptive method options to prevent unwanted pregnancy among the most vulnerable populations.

Promoting healthy spacing between pregnancies in India: need for differential education campaigns.

OBJECTIVE: Birth spacing intervals are relatively short in India. Healthy spacing of 3-5 years between births is an effective way to prevent maternal and child mortality and morbidities. Socio-cultural and structural barriers, including limited awareness, socio-cultural norms, and misconceptions need to be addressed for behavior change. Hence the objective was to understand these barriers and accordingly develop separate messages for young women, her husband and her mother-in-law. METHODS: Data were collected from young women, husbands and mothers-in-law using qualitative methods. Altogether 16 Focus Group Discussions and 30 in-depth interviews were conducted. Beliefs related to need of spacing, disadvantages of closely spaced pregnancies and messages considered suitable for different stakeholders were investigated. Messages were identified for women, husband and mother-in-law; communication aids prepared and community workers trained to appropriately communicate the messages to stakeholders. Quantitative data were collected to measure the effect of the intervention. RESULTS: Educational campaign resulted in higher use of contraceptives for spacing among registered pregnant women from experimental area compared to control area. CONCLUSION: Differential audience specific educational campaign is feasible and effective. PRACTICE IMPLICATIONS: For an effective communication in the community, workers should know how exactly to convey the different health messages to different target population.

Exploring opportunities to project a "responsible man" image: gatekeepers views of young men's sexual and reproductive health needs in Uttaranchal, India.

Increase in extramarital sex among youths, gender-based violence, lack of contraceptive knowledge among newly married couples and lack of knowledge of protection against diseases like STIs/HIV are the information and service needs of young people that need to be addressed urgently in order to make them future knowledgeable, responsible, and non-violent partners. In addressing these needs the gatekeepers, including parents, formal and informal community leaders and teachers, play a critical role, by facilitating/hindering access to appropriate and correct information about sexual and reproductive health to young people. The study was conducted in a district of Uttaranchal, India. The specific objective was to understand the social context and gatekeepers' views on family planning and sexual and reproductive health needs of young men. Thirty-two in-depth interviews and four focus group discussions were conducted with parents, formal and informal community leaders, teachers, and selected development officials. The findings indicate that gatekeepers are worried about rapid changes in the aspiration, expectation, and behavior of young men. Most of them were seriously concerned about the increasing drinking habit, use of drugs, and changing values of sexuality leading to various risk behaviors among young men. They felt that many of these changes are consequences of wider societal changes, rising aspirations, explosion of electronic media, and globalization of a new youth culture where extramarital sex, alcohol consumption, and violence are expressions of different facets of masculinity and symbols of the affluent class. Overall, there was a feeling that TV/films and their peers now influence more the socialization of young people and parents are losing control in guidance and mentoring of their children.

Achieving the Cairo Conference (ICPD) goal for youth in Bangladesh.

Sexual and reproductive health education is not yet formally introduced in Bangladesh without which the International Conference on Population and Development (ICPD) in Cairo's goal to ensure young people's right to access to such information and services will remain unfulfilled. The Population Council provided technical assistance to a governmental department to pilot youth reproductive health education. Study findings from the pre- and posttests of 379 matched respondents revealed significant changes in knowledge, attitudes, and life-skills. Knowledge about long-term contraceptives and skills on negotiating safe sex improved significantly by 63% and 26%, respectively. Youths who do not consider menstruation as a disease nearly doubled, and misunderstandings about the mother's role in sex determination of a child were significantly dispelled. Decisions not to accompany friends in visiting sex workers and to use condoms, ignoring friends' disapproval, were increased over 18%. Over 98% of students reported that teachers discussed condoms, while only 12% alleged unfriendly behavior. Findings motivated the department to scale up the reproductive health curriculum.

Safer maternal health in rural Uttar Pradesh: do primary health services contribute?

India accounts for about one-quarter of maternal deaths world wide, with the most recent statistics showing an average maternal mortality ratio of 407 per 100 000 live births at the national level. The government had hoped to reduce maternal mortality to 200 by 2000, but it is clear that this was not achieved. This paper explores the reasons why the most populous state of Uttar Pradesh continues to have one of the highest reported maternal mortality ratios in India. Data from two districts of Uttar Pradesh on mother and child health-care utilization and the readiness of the public sector to provide antenatal and emergency obstetric services are used to illustrate the reasons why maternal mortality has not declined. While blueprints for safe motherhood programmes exist, the equipment and technical competence to provide services is weak at the present moment. Reductions in maternal mortality would require interventions to improve service delivery as well as community mobilization to improve utilization of services, especially in life-threatening situations.

A model of costs of RTI case management services in Uttar Pradesh.

PIP: This paper develops a model of standardized reproductive tract infection (RTI) management in the public sector using guidelines prepared by the National AIDS Control Organization. It also discusses the costs of upscaling the service to similar sites in Sitapur and Agra districts of Uttar Pradesh, India. The model shown in the paper conceives providing RTI case management services at the block Primary Health Centers (PHC) and Community Health Centers (CHC) levels. It estimates the cost of providing RTI case management at PHC and at CHC and by extension to the district. Furthermore, the model presents differing options according to the level of health system services that are available. The paper concludes that the costs of RTI case management varies widely by the levels of utilization, the levels of infection and the capability of health centers to provide the services. The model of RTI case management indicates that laboratory testing and treatment costs are higher than expected. The estimated cost for RTI management is beyond the existing budgets, and policymakers and program managers need to examine both the initial and continuing costs of the RTI case management in the context of the entire Reproductive and Child Health package.^ieng

The state of family planning in uttar pradesh, India: a literature synthesis.

A 1993 review of the state of the family welfare program in the State of Uttar Pradesh (UP) India. With 139 million people, UP is larger than all but six countries in the world. This synthesis of previous studies and recent Census and other existing data provides: 1) a socio-economic and demographic profile with emphasis on fertility and mortality; 2) a review of family size and family planning preferences; 3) an evaluation of the performance of the family welfare services in place; and 4) a review of the extent of involvement of NGO's and the organized sector in the family welfare program.

Generating Demand for contraceptives in India: A Case Study of IEC Activities in Uttar Pradesh.

The article presents a review of current Governmental family welfare program information, education and communications (IEC) activities in Uttar Pradesh, the most populous state in India (139 million in 1991). The review is based on available literature. The extent of general outreach of mass media as well as constraints and problems related to provision of appropriate IEC are discussed. Suggestions for improvement are made, particularly in terms of interpersonal communication.