Poliomyelitis trends in Pondicherry, south India, 1989-91.

STUDY OBJECTIVES: To assess the poliomyelitis trend, including study of the epidemiological features, and to correlate this with the immunisation coverage of infants. DESIGN: Three annual lameness surveys in children aged 0-60 months employing cluster sampling methods and a series of five cross sectional surveys of immunisation coverage in children aged 12-23 months of age were undertaken. SETTING: Pondicherry, India, 1988-92. SUBJECTS: More than 10,000 children in the age group of 0-60 months took part in the three annual lameness surveys and samples of 210 children aged 12-23 months were covered each year in immunisation coverage surveys. MEASUREMENTS AND MAIN RESULTS: Altogether 50 of 11,461, 24 of 10,093, and 17 of 11,218 children surveyed during 1989, 1990, and 1991 respectively had become lame as a result of poliomyelitis, giving prevalences of 4.4, 2.4, and 1.5 per 1000 children for the three surveys. The corrected prevalences of poliomyelitis were 5.9, 3.2, and 2.0 per 1000 children during 1989, 1990, and 1991 respectively. The proportion of cases aged up to 36 months fell from 48% in 1989 to 12.5% in 1990 and 6% in 1991. The age at onset was less than 1 year in most. The median age at onset was 10.7 months. About 54% of the affected children had received three doses of oral poliomyelitis vaccine (OPV) before the onset of paralysis. In 1988 immunisation coverage for the third dose of OPV was 91% and in 1992 it was 97.6%. The drop out rate for the first versus the third dose of OPV fell from 6.3 in 1988 to 1.9% in 1992. CONCLUSION: Three successive annual lameness surveys showed that poliomyelitis was declining between 1989 and 1991. Five immunisation coverage surveys conducted from 1988 to 1992 showed high initial coverage followed by an improvement in the form of almost universal coverage for OPV.

Impact of maternal and child health strategy on child survival in a rural community of Pondicherry.

OBJECTIVE: To determine the impact of Maternal and Child Health (MCH) services on child survival in a socio-economically backward rural community. SETTING: Twelve villages in Pondicherry with a population of 16,803. DESIGN: Prospective study. SUBJECTS: A birth cohort of 356 live births (LB) born between January 1st and December 31st 1988. METHODS: The live births were followed-up from birth to five years age (1988-1993). The health care received by this cohort and the antenatal services received by the cohort mothers was reviewed. Outcome measures related to child survival were determined and their changing trend since 1967 was examined. RESULTS: Fifty-four per cent of the cohort children were from families below the poverty line. Antenatal registration and tetanus immunization coverage of the mothers of the cohort was 100%. Immunization coverage of the cohort children was more than 98% for BCG, DPT (three doses) and OPV (three doses) and 82% for measles. The infant mortality rate had reduced from 201/1000 LB in 1967 to 64/1000 LB (95% CI 58.9-68.1) in 1989. The child death rate decreased from 29.4/1000 children 1-4 years of age (1970) to 18/1000 (95% CI 13.9-22.1) in 1992. There were no deaths due to neonatal tetanus or measles. Neonatal mortality (35/1000 LB; 95% CI 29.9-40.1) was higher than the post-neonatal mortality (29/1000 LB; 95% CI 24.1-33.9). Fifty eight per cent of the neonatal deaths were due to non-infective causes like prematurity, birth asphyxia, birth injuries and congenital anomalies. Eighty per cent of post neonatal deaths were due to infections. Overall, the child survival index was high (91.27%; 95% CI 88.14-94.26). This was inspite of the low socio-economic background of the children's families. CONCLUSIONS: Good MCH services can substantially improve child survival inspite of prevailing low socio-economic situations. Inputs for neonatal care need to be strengthened to further enhance child survival.

PIP: A cohort of 356 live births (LBs) in 12 villages in Pondicherry during 1988 was followed from birth to age 5 years to determine the impact of maternal and child health (MCH) services upon child survival in a low income, rural community. 54% of the children were from families living in poverty. All mothers of the cohort were registered antenatally and immunized against tetanus, and more than 98% of the children had been immunized with BCG, DPT (3 doses), and OPV (3 doses). 82% of the children were immunized against measles. The infant mortality rate declined from 201/1000 LBs in 1967 to 64/1000 in 1989, while the child death rate decreased from 29.4/1000 children aged 1-4 years in 1970 to 18/1000 in 1992. No death occurred due to neonatal tetanus or measles. Levels of neonatal and post-neonatal mortality were 35/1000 LBs and 29/1000, respectively. 58% of the neonatal deaths were due to non-infective causes such as prematurity, birth asphyxia, birth injuries, and congenital anomalies, while 80% of post-neonatal deaths were due to infections. The child survival index was 91.27%. These findings demonstrate how the provision of good MCH services can improve child survival in low income populations.

Effect of indoor air pollution on the respiratory system of women using different fuels for cooking in an urban slum of Pondicherry.

BACKGROUND: Some of the highest exposures to air pollutants in developing countries occur inside homes where biofuels are used for daily cooking. Inhalation of these pollutants may cause deleterious effects on health. We studied the effects of exposure to indoor air pollution from the use of cooking fuels on lung functions and respiratory symptoms in women aged 15-60 years. METHODS: The study was conducted in Kuruchikuppam, an urban slum in Pondicherry. The study participants were 105 women using biofuels, 105 using kerosene and 105 using liquid petroleum gas (LPG), selected from among 1117 women aged 15-60 years, by a stratified random sampling technique. These women were interviewed at home to collect information about exposure to fuel smoke and presence of respiratory symptoms. Lung functions were assessed by measuring forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and peak expiratory flow rate (PEFR). Occurrence of respiratory symptoms over six months was noted by making monthly follow up visits. RESULTS: Women using biofuels experienced more respiratory symptoms (23%) than those using kerosene (13%;p > 0.05) or LPG (8%; p < 0.05). Lung functions-FVC, FEV1, FEV1% and PEFR-were significantly lower in biofuel users compared with both kerosene (p < 0.01) and LPG users (p < 0.001). Lung functions in kerosene users also were significantly poorer when compared with LPG users (p < 0.01). Predicted pulmonary functions using multiple regression equations, derived from the data set of the present study, indicated that women using biofuels were more liable to have reduced pulmonary functions than women using kerosene or LPG. CONCLUSION: Women exposed to biofuel smoke suffer more from respiratory illnesses and have decreased pulmonary functions compared with women exposed to kerosene or LPG smoke. To reduce pollutant exposures we recommend the use of smokeless chullas or cleaner fuels such as charcoal, biogas and kerosene.

Natural history, trend of prevalence and spectrum of manifestations of Bancroftian filarial disease in Pondicherry (South India).

The study examines the changes in the disease parameters of lymphatic filariasis over a period of time based on three surveys during 1957, 1986 and 1992 in Pondicherry, South India. The overall prevalence of filarial disease in the three surveys was 4.7, 6.7 and 9.9% respectively. It was significantly higher in males (1957:5.3%; 1986:13.7%; 1992:18.8%) when compared to females (1957:3.8%; 1986:2.3%; 1992:2.7%) in all the three surveys (P <0.05). The overall prevalence of acute adenolymphangitis declined from 1.0 in 1957 to 0.2 in 1986 and 0.04% in 1992. While the prevalence of hydrocele showed an increasing trend from 2.7 in 1957 to 11.9 in 1986 and 17.3% in 1992, the prevalence of lymphoedema (1.9 in 1957; 1.9 in 1986 and 1.8% in 1992) was stable over the same period. The prevalence of disease was relatively higher in all age groups of both male and female population in 1992 when compared either to 1957 or 1986. Similarly a monotonic increase in the prevalence of hydrocele was observed in all age groups in 1992 when compared to previous surveys. The implications of the changes in prevalence of the chronic manifestations when compared to the changes in the acute manifestations over a period of 35 years are discussed.

Research as a tool for the teaching of epidemiology.

At a medical school in India, undergraduates have been given the opportunity to volunteer to conduct research as a means of improving their knowledge and understanding of epidemiology. First-year clinical students have conducted case-control studies with emphasis on methodological detail. Second-year students have been involved in community-based epidemiological studies. At the intern level, projects related to social factors in health and disease and to health administration have been encouraged. This initiative has been largely welcomed by the students and has yielded highly encouraging results.

PIP: Starting in 1985, at the Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, modifications concerning teaching community medicine and epidemiology were introduced. Students were encouraged to conduct epidemiological investigations for better understanding of the subject. First-year students were free to participate in a hospital-based case control study involving 3-7 students over a period of 6-8 months. 5 projects were completed between 1990 and 1992 pertaining to risk factor analysis in oral cancers, protein-energy malnutrition, myocardial infarction, birth asphyxia, and cervical carcinoma. Methodology included objectives, review of the literature, definitions, questionnaires, and statistical methods. Faculty members monitored progress. Each student made a presentation to a gathering of 1st- and 2nd-year students and answered their questions. 2nd-year students undertook projects in community medicine lasting 2 months during vacation. Each student had a separate project of value for planning urban and rural field practice areas. Between 1987 and 1992, field studies were carried out on immunization coverage and mothers' knowledge about child immunization; the prevalence of caries among preschool children; cultural and economic factors affecting pregnancy; the epidemiology of cataract; blood pressure and hypertension; the nutritional status of preschool and school-age children; and drug compliance by leprosy patients. Case school studies were also undertaken on risk-factor analysis of low birth weight; factors affecting the acceptance of tubectomy; and treatment-seeking behavior among patients with cervical carcinoma. Similar public presentations were made. Interns were invited to assist in difficult subjects. A hospital study was completed by 2 students on injections given unnecessarily to children aged under 5 years. 111 out of 149 1st- year students questioned stated that they had gained knowledge and skills. Benefits reported included improved thinking, communication, statistical knowledge, understanding of human behavior, and a social view on health and disease.

Paralytic poliomyelitis in children under 6 years in Pondicherry: a community survey.

STUDY OBJECTIVES: To assess the amount of poliomyelitis and its epidemiological features including risk factors. DESIGN: This was a retrospective study of cases of paralytic poliomyelitis among children 0-6 years of age. SETTING: Pondicherry, India, 1983-89. SUBJECTS: A total of 47,960 children aged less than 6 years. MEASUREMENTS AND MAIN RESULTS: In 1989, 469 field workers undertook a door to door survey of children 0-6 years old to identify those with limb paralysis. This was followed by clinical examination to establish the cause, supplemented by case notes held by the Child Development Services. Altogether 203 cases of limb paralysis were identified, 188 of which were judged a result of paralytic poliomyelitis. The prevalence of poliomyelitis in 1989 was 3.9/1000 among children below 6 years of age. There was a male preponderance with a male:female ratio of 1.4:1. The prevalence was least in infants (1/1000) and highest in children aged 2 to 3 years (6.4/1000). The age at onset was less than 12 months in 42% of cases and less than 3 years in 98%. The median age at onset was 13.4 months. Time series analysis showed a high occurrence of cases from May to September between 1983 and 1989. The legs were affected in 97%. About 41% of children had received three doses of oral polio vaccine. There was a history of intramuscular injection, possibly provoking a paralytic attack, in 54% of cases. CONCLUSION: This retrospective community study involving the staff of the Integrated Child Development Services provided valid data about poliomyelitis with little additional cost and minimum training. Because the study covered a whole population of children under 6 years, rather than a sample, the data will help in monitoring and surveillance of poliomyelitis and also in planning strategies for effective control.

Community experience for medical students.

This article outlines the features of community postings for medical students in their second clinical year at the Jawaharlal Institute of Postgraduate Medical Education and Research, in Pondicherry, India. Their exposure to the realities of preventive and social medicine in the field clearly helps them to cope with what would otherwise be only theoretical knowledge.

Prevalence of psychiatry morbidity in an urban community of pondicherry.

A cross-sectional study on psychiatric morbidity was conducted in an urban area of Pondicherry between October 1988 and July 1989. A sample of 225 families covering 1115 people of all ages was selected by simple random technique. The prevalence rate was 99.4 per 1000, the prevalence among children being 58.6 per 1000. It was found that age, education, occupation and marital status had significant correlation with mental morbidity. Out of 90 cases detected among adults, psychosis formed 20%, neuroses 47% and alcohol dependence syndrome constituted 30%. Among children two conditions commonly identified were mental retardation and nocturnal enuresis.

Infant mortality in Pondicherry--an analysis of a cohort of 8185 births.

Infant mortality rate is one of the 12 global indicators for monitoring Health for All. Reliable data on infant mortality are not available for the majority of developing countries including India. To plan strategies for bringing down the rate and, later, to evaluate them, 'Cause Specific Rates' would be necessary. Pondicherry has achieved low rates of infant mortality. A study was conducted in the Anganwadis of Pondicherry to determine the causes of infant deaths. The 8185 children born between 1-4-1987 and 31-3-1988 in Pondicherry formed the study group. The Anganwadi workers collected information on the cause of death for the 222 children dying within the first year. The infant mortality rate was 27.1 per 1000 live births. Acute respiratory infections and diarrheal diseases accounted for 45% of the deaths.

Serological response to tetanus toxoid: a field study in Pondicherry, India.

To study the serological response to various doses of tetanus toxoid given to pregnant women, 320 samples of blood obtained from 173 pregnant women were analysed using the indirect haemagglutination technique. Two doses of toxoid were necessary to achieve protective titres in women who were previously unimmunized. The antibody levels appeared to persist for up to 4 years. During a subsequent pregnancy, a single booster dose of toxoid was sufficient to raise the titres adequately for protection. These findings are in accordance with the immunization programme followed for prophylaxis against tetanus among pregnant women.