Prevalence and predictors of risk factors for cardiovascular diseases among women aged 15-49 years across urban and rural India: findings from a nationwide survey.

BACKGROUND: Women's health is usually looked upon in terms of their reproductive health. However, cardio-vascular diseases are one of the leading causes of death and disability among women, globally as well as in India. Risk factors of today can be disease of tomorrow. Gradience in level of epidemiological transition is observed across different states. The study aims to estimate the national and regional prevalence, and sociodemographic determinants of biological and behavioural risk factors for cardiovascular diseases. MATERIALS AND METHODS: The present study was conducted among women in the age group of 15 to 49 years using nationally representative sample from fifth round National Family Health Survey in India. The data analysis in the current study included 7,24,115 women in the age group of 15 to 49 years. SPSS version 20 was used for the purpose of analysis. Weighted prevalence was computed for the studied behavioral and biological (dependent variable) risk factors using women specific weights as provided in the dataset. Binary logistic regression model was employed to calculate the adjusted odds ratio (OR) with the corresponding 95% confidence interval (CI) to study the sociodemographic determinants (independent variables) of these risk factors. RESULTS: Highest prevalent risk factor for cardiovascular diseases was reported to be central obesity (78.2%), followed by overweight/obesity (23.9%), oral contraceptive use (13.4%), raised blood pressure (11.8%), raised blood sugar (8.6%), tobacco use (4.0%), and alcohol use (0.7%). Higher odds of all the studied risk factors were reported with increasing age. All of the studied risk factors, except for alcohol consumption [OR (95%CI): 0.9 (0.8-0.96)], had higher odds in rural areas compared to urban areas. Compared to other castes, the odds of tobacco [OR (95% CI): 2.01 (1.91-2.08)] and alcohol consumption [OR (95% CI): 5.76 (5.12-6.28)], and raised blood pressure [OR (95% CI): 1.07(1.04-1.11)] was significantly higher among the people belonging to schedule tribe. CONCLUSION AND RECOMMENDATION: The present study highlights the state-wise disparities in the burden and predictors of risk factors for cardio-vascular diseases among women of reproductive age. The study provides insights to these disparities, and focuses on the need of tailoring the disease prevention and control measures suiting to the local needs.

Nutritional status among elderly: A community-based cross-sectional study.

BACKGROUND: Malnutrition in the elderly is a significant public health problem and has serious implications on the overall health of the elderly. There are very few community-based studies on malnutrition among the elderly, especially in India. OBJECTIVES: The objective was to find out the prevalence of malnutrition and its associated risk factors among the elderly in urbanized villages of Delhi. METHODS: A cross-sectional study was conducted during November 2015 to April 2017 in two urbanized villages of East Delhi among 353 elderly (>60 years) individuals. A semi-structured interview schedule was used to record the sociodemographic and relevant personal details of the elderly. To determine the prevalence of malnutrition, Mini Nutritional Assessment scale was used. Statistical analysis included simple descriptive analysis and tests of significance such as Chi-square test. Multivariable logistic regression was used to identify the predictors of malnutrition. RESULTS: The prevalence of possible malnutrition was found to be 49.3%. On bivariate analysis, age, gender, education status, marital and residential status, per capita income, financial dependency, and family size were found to be associated with malnutrition (P < 0.05). Age >70 years, being tenant, and financial dependency were observed to be significant predictors of possible malnutrition in multiple logistic regression. CONCLUSION: Malnutrition needs to be identified at an early stage using appropriate tools so that proper interventions can be directed to those who need it to ensure healthy aging. Social and economic parameters are linked with the occurrence of malnutrition among the elderly and must be considered in the development of preventive strategies.

Contraceptive use and unmet need for family planning among HIV-positive women: A hospital-based study.

BACKGROUND: For women living with HIV who do not want to become pregnant or who wish to delay pregnancy, contraception has the added public health benefit of reducing the number of infants who might acquire HIV. The unmet need for contraception must be addressed to prevent unintended pregnancies among HIV-positive women and consequently mother-to-child transmission of HIV. OBJECTIVES: The objectives of this study were to assess the contraceptive usage and its various determinants and to find out the unmet need for family planning among HIV-positive women. METHODS: This was a cross-sectional descriptive hospital-based study conducted among 235 HIV-positive women attending the ART center of a medical college. Data were collected using a questionnaire-containing sociodemographic details, obstetric history, treatment information, contraceptive usage, and their fertility desires. Data analysis was performed using MS Excel and the SPSS version 20.0 using frequencies, Chi-squared test, and multiple logistic regression. RESULTS: The mean (standard deviation) age of the study participants was 28.8 (5.5) years. Majority (96.6%) of them were married and were illiterate (34.4%). The prevalence of unmet need for family planning was found to be 17%, and the prevalence of consistent contraceptive use was 74.5%. The most common family planning method used by women was male condom. Not having HIV-positive children, HIV-negative partner, and discussing contraceptive with partner were observed to be significant predictor of consistent contraceptive use on multiple logistic regression. CONCLUSION: There is a need to boost family planning counseling and address the unmet need and contraceptive use among HIV-infected women.

Air pollution and weather as the determinants of acute attacks of asthma: Spatiotemporal approach.

BACKGROUND: Although air pollution and weather changes have been identified as putative risk factors that precipitate acute attacks of bronchial asthma, so far there have been no studies that could conclusively establisha clear association. OBJECTIVES: This study was carried out to investigate the effect of the concentrations of NO2, SO2, and particulate matter on exacerbation of bronchial asthma. METHODS: A longitudinal study was conducted during February 2014-January 2015. Sixty-one known cases of asthma were recruited from the outpatient department of a chest hospital. Data regarding weather parameter (temperature, rainfall, and relative humidity) and environmental pollution (SO2and NO2) and respirable suspended particulate matter were procured from the Indian Meteorological Department and Delhi Pollution Control Committee, respectively. Association was examined using the generalized estimation equation (GEE). RESULTS: Separate models were developed for weather parameter and pollution parameters. This study could not find a significant association between any of the weather parameters and occurrence of asthmatic attacks. In the GEE model, where average values of SO2, NO2, and PM were used, the PM was found to be significantly associated with asthmatic attacks. CONCLUSION: PM was found to increase the risk of exacerbation of asthma three folds.

Severe maternal morbidity and maternal near miss in a tertiary hospital of Delhi.

Background: In addition to maternal mortality, information on maternal near miss and severe maternal morbidity are important in maternal healthcare. We aimed to determine the incidence, causes and outcome of severe maternal morbidity and near miss, and the sociodemographic and obstetric factors associated with these at a tertiary care teaching hospital in Delhi. Methods: Women admitted with severe maternal morbidity and near miss, as defined by the WHO study group, were included in the study. The incidence ratio of near miss and severe morbidity in the hospital was determined, and a case-control study was conducted to study the factors associated with the occurrence of near miss. Information was obtained from hospital records and interviews, using a semi-structured open-ended questionnaire. Results: The incidence ratio of near miss was 6.85/ 1000, and severe morbidity was 11.38/1000 live births. Hypertensive disorders and haemorrhage were the common causes of cases of near miss and severe morbidity. Coagulation dysfunction (62%) was the most common organ dysfunction, followed by uterine dysfunction (22%). Older age (odds ratio [OR] 2.01, confidence interval [CI] 1.02-3.93), the absence of formal education (OR 2.05, CI 1.11-3.75), <18 years of age at marriage (OR 2.01, CI 1.21-3.32), lower income (OR 3.8, CI 1.88-7.64), gravida of four or more (OR 2.25, CI 1.21-4.17) and residence outside Delhi (OR 9.31, CI 4.36-19.90) were significant predictors of near miss. Sepsis, hypertensive disorders and haemorrhage were the most common underlying conditions in women who died. The foetal outcome was a live birth in 64% of near-miss cases and 62% among severe morbidity. Conclusions: The burden of severe maternal morbidity and near miss is high. These need to be identified and managed at the earliest.

Evaluation of quality of multivariable logistic regression in Indian medical journals using multilevel modeling approach.

BACKGROUND: Availability of user-friendly statistical software has increased the application of multivariable logistic regression (MLR) in the medical journal many fold. The reporting quality in terms of checking assumptions, model building strategies, proper coding, and report format need proper care and attention to communicate correct and reliable model results. OBJECTIVE: The objective of this article is to evaluate the quality of MLR article based on 10-point well establish criteria and to study the factors that may influence the quality. METHODS: Study included PubMed indexed Indian medical journals as on March 2010 and published at least ten original articles that applied MLR during 10 years was included in the study. Multilevel modeling was applied to assess the role of journal and article attributes on MLR quality. RESULTS: Twelve out of 39 Indian PubMed indexed journals fulfilled the inclusion criterion. Of a total 5599 original articles in these journals, 262 (4.68%) applied MLR in their study. Conformity of linear gradient assumption for continuous covariate was the least fulfilled criterion. One-third of the MLR articles involved statistician or epidemiologist as co-author, and almost same number of MLR articles' first author was from outside India. The trend of 10-point criteria remained consistent although the number of MLR articles increased over the period. The average quality score was 3.78 (95% confidence interval: 2.97-4.60) out of a possible 10. Larger sample size, involvement of statistician as co-author, non-Indian as the first author, and use of SAS/STATA software increased the quality of MLR articles. CONCLUSIONS: The quality of MLR articles in Indian medical journals is lagging behind as compared to the quality of MLR articles published from the United States and Europe medical journals. Joint effort of editors, reviewers, and authors are required to improve the quality of MLR in Indian journals so that the reader gets the correct results.

Low Dose Atropine in Preventing the Progression of Childhood Myopia: A Randomised Controlled Trial.

PURPOSE: To study the efficacy of low dose atropine (0.01%) eye drops in preventing myopia progression in children by comparing the mean change in spherical equivalent (diopter) and axial length (mm) over a period of one year to a control group and study its effect on near vision, pupil size, keratometry and pachymetry. METHODS: 200 eyes of 100 myopic children were randomized into two groups based on a computer-generated random number table. The treatment group was administered 0.01% atropine eye drop once at bedtime and control group was administered a placebo. The follow up was done 3-monthly for 12 months by assessing the mean change in spherical equivalent and mean change in axial length. Other parameters like near vision, pupil size, keratometry and pachymetry were assessed at each follow up. RESULT: The study was age and sex matched. The mean change in spherical equivalent refraction and axial length was significantly lower in the treatment group (0.31 ± 0.55 D; 0.11 ± 0.22 mm) than the placebo group (0.80 ± 1.65 D; 0.23 ± 0.44 D) (p-value: 0.003). Less steepening of the corneal curvature was observed in the treatment group (0.16 ± 0.28 D vs 0.29 ± 0.3 D; p < 0.001) and the mean change in pachymetry was comparable between the groups (0.00 ± 0.01) (p-value 0.489). No significant change was seen in near vision (96% of the eyes with atropine had no change in near vision; 2% of the eyes had a change of near vision by one line (p-value 0.500); 2% had a change by 3 lines (p-value: 0.07) or pupil size following treatment. CONCLUSION: The use of 0.01% atropine eye drop reduced the progression of myopia over the study period of one year with no significant changes in near vision, pupil size. No patient reported any systemic and local side effects with administration of 0.01% atropine eye drop.

Role of traditional birth attendants (TBAs) in provision of antenatal and perinatal care at home amongst the urban poor in Delhi, India.

More than 80% of deliveries amongst the urban poor are conducted at home, mostly by traditional birth attendants (TBAs). In all, 29 eligible TBAs in the study area were identified and interviewed to assess their knowledge and practices regarding antenatal and perinatal care. Their knowledge about complications in antenatal and perinatal period was inadequate. The majority provided inadequate advice to the mothers. Over seventy-nine percent (79.3%) gave injections of oxytocin. Sixteen (55.2%) did not wait or waited for less than 10 minutes for the mother to expel the placenta. Fourteen (48.3%) encountered excessive vaginal bleeding, but none knew how to manage it. Overall knowledge and care provided by the TBAs was poor.

Prevalence and Predictors of Risk Factors for Noncommunicable Diseases among women in an Urbanized Village of India.

Background: The burden of noncommunicable diseases (NCDs) and their risk factors among the underprivileged women of the urban areas are expected to increase. The objective of the study was to estimate the prevalence and sociodemographic predictors of these risk factors. Materials and Methods: A cross-sectional study was conducted among 370 women between 25 and 64 years in an urbanized village of India. Risk factors for NCDs were assessed using the WHO STEPS instrument. To determine the sociodemographic predictors of these risk factors binary logistic regression was used. Results: The prevalence of tobacco consumption, physical inactivity, and insufficient fruit and vegetable intake, overweight, and obesity was found to be 18.3%, 61.6%, 96.5%, 27.6%, and 5.9%, respectively. Raised blood pressure, blood glucose, and cholesterol were found to be present in 23%, 22%, and 42%, respectively. Older age was found to be a significant predictor of tobacco consumption, physical inactivity, raised blood pressure, and raised blood glucose. Conclusion: The current study reported a high prevalence of physical inactivity and insufficient fruit and vegetable intake, with age being a significant predictor of the majority of risk factors. Thus, arises the need for programs and policies tailored toward addressing the local needs, targeted toward older women.

Gender-specific factors associated with hypertension among women of childbearing age: Findings from a nationwide survey in India.

Background: The association of conventional (modifiable and non-modifiable) risk factors for hypertension has already been established in the literature. However, there are other putative risk factors specific to women (early menarche, age at first childbirth, women empowerment, number of children born, hysterectomy, etc.) in the development of hypertension. This study is the first study to highlight the potential association of gender-specific factors along with other conventional risk factors and hypertension, using a nationwide sample. Methods: The study is a secondary analysis of the data collected from the National Family Health Survey-4 (NFHS-4), a nationally representative sample of 699,686 women of reproductive age in India. The interview schedule included data on general background characteristics, marriage, reproductive history, hysterectomy, knowledge, and utilization of family planning services, maternal and child care, women empowerment, non-communicable diseases, and domestic violence. The blood pressure was measured by direct observation by the study investigators using a digital blood pressure monitor. To account for disproportionate sampling and non-response, a weighted statistical analysis was performed. Logistic regression analysis was done to study the strength of the association between the risk factors and hypertension (computation of unadjusted and adjusted odds ratio). Results: The prevalence of hypertension was 11.8% among women. Among the conventional factors, older age, higher body mass index (BMI), tobacco use, and alcohol use had higher odds for hypertension, while higher education, higher socio-economic position, and living in urban areas had lower odds. Among the gender-specific factors, younger age at first childbirth, early menarche, oral contraceptive pill use [adjusted OR: 1.23; (1.18-1.28)], and hysterectomy [adjusted OR: 1.10; (1.05-1.69)] were found to be risk factors for hypertension. Domestic violence was significantly associated with hypertension [unadjusted OR: 1.11; (1.02-1.20)]. Empowered women had lower odds of hypertension [adjusted OR: 0.93; (0.95-1.03)]. Conclusion: Significant association of these gender-specific factors among women necessitates the need for taking into account these factors while screening for hypertension among women and thus, designing a tailored model better suited to them for risk assessment.

Complementary Feeding Practices and Nutritional Status of Children (6-23 months) in an Urban Resettlement Colony of East Delhi.

BACKGROUND: Even with optimum breastfeeding, children are at risk of being stunted if they do not receive timely adequate and appropriate complementary feeding. OBJECTIVES: The objective is to determine the prevailing complementary feeding practices, and nutritional status of children aged 6-23 months. MATERIALS AND METHODS: Mothers of 350 children of age 6--23 months of an urban resettlement colony of East Delhi were interviewed using a pre-tested questionnaire based on the WHO indicators to record their complementary feeding practices. Weight and height was taken to assess the nutritional status. RESULTS: The minimum meal frequency was adequate in 60.6%, minimum dietary diversity in 15.1%, and minimum acceptable diet in 9% children. The prevalence of wasting was 43.7%, underweight 43.4%, and stunting 29.1%, as per Z-score. Statistically significant association of wasting with low birth weight, bottle feeding, and consumption of market food was observed (P < 0.05). CONCLUSIONS: Complementary feeding indicators were unsatisfactory in most children. A high prevalence of wasting and under-nutrition was observed.

Functional disability among elderly: A community-based cross-sectional study.

BACKGROUND: Old age is often associated with functional decline and physical dependence, thus compromising the ability to carry out basic tasks required for daily living. There are very few community-based studies on functional disability among elderly, especially in India. This study was done to find out the prevalence of functional disability and associated risk factors among the elderly in urbanized villages of Delhi. METHODS: A cross-sectional study was conducted in two urbanized villages of East Delhi. A semi-structured interview schedule was used to record the socio-demographic and relevant personal details of the elderly (>60 years). Functional disability was defined as a disability in activities of daily living (ADL) or blindness or bilateral hearing impairment or a combination of these. Statistical analysis included simple descriptive analysis and tests of significance like Chi-square test. The multiple logistic regression was used to identify predictors of functional disability. RESULTS: Data were collected from 360 study participants. Around one-fourth (25.6%) of the study participants were having a functional disability. Older age, presence of chronic disease, and having possible malnutrition were found to be significant predictors of functional disability among the elderly by applying the multiple logistic regression. CONCLUSIONS: Functional disability needs to be identified at an early stage using appropriate tools so that proper interventions can be directed to those who need it to ensure healthy aging.

Knowledge and Parity: Perspectives of Usage of Emergency Contraceptive Pills among Women of a Rural Area of Delhi.

CONTEXT: Correct use of emergency contraceptive pills (ECPs) may prevent up to 95% of unwanted pregnancies which may significantly decrease unsafe abortions and maternal mortality. AIMS: Assessment of knowledge and use of ECPs among women and to explore factors associated with them. MATERIALS AND METHODS: This was a facility-based cross-sectional study. Data were collected using a prestructured, pretested questionnaire from 381 reproductive age women (15-49 years) selected by systematic random sampling. Statistical Package for the Social Sciences version 16 and Epi info (version 7.0.) were used for all statistical analyses. Descriptive analysis was performed, and results were expressed in terms of frequencies and percentages. The Chi-square and Fisher's exact test were used as tests of significance in univariate analysis. Determinants of use of ECPs were identified using logistic regression. RESULTS: Of 381 women interviewed, awareness level of ECPs (ever heard about ECPs) was found to be 34% (n = 128). Ever use of emergency contraception was reported by 38 (9.7%). Age (odds ratio [OR] = 3.02, 95% confidence interval [CI] [1.88-4.87]), education (OR = 0.086, 95% CI [0.047-0.158]), husband's education (OR = 0.11, 95% CI [0.067-0.187]), socioeconomic status (OR = 6.14, 95% CI [3.28-11.51]), and family status (OR = 2.6, 95% CI [1.59-4.24]) were found to be significantly associated with the use of emergency contraceptives. CONCLUSIONS: The study identified that most respondents lack adequate knowledge about ECPs, and ever use of ECPs was very low. Factors that were associated with the use of ECPs were age, literacy, socioeconomic status, and knowledge about the method. Creating a sustainable awareness on ECPs and their use may serve them with power to control their parity.

Presenile cataract and its risk factors: A case control study.

PURPOSE: Early onset opacification of the lens (cataract) has been observed to be on the rise globally. This study was conducted to determine the various types of presenile cataract and to determine the probable risk factors associated with the occurrence of presenile cataract. MATERIALS AND METHODS: Patients in the age group of 18-40 years attending the Out-Patient Clinic of the Ophthalmology Department who were found to have presenile cataract were recruited as cases. An equal number of consecutive patients of the same age group were included in the control group. Those who gave consent to participate in the study were interviewed through a preformed questionnaire and underwent a complete ocular examination and set of blood investigations. The type of cataract was noted, data obtained were compiled, and examination and investigations done were documented and analyzed using frequency distribution and Chi-squared test. RESULTS: In total, 90 cases and 90 controls that fulfilled the inclusion criteria were recruited. Most common type of cataract was found to be posterior subcapsular cataract. Presenile cataract was observed to be significantly associated with tobacco intake (P = 0.035), hypercholesterolemia (P = 0.002), fuel exposure (P = 0.004), and lower socioeconomic status (P = <0.001). CONCLUSIONS: Tobacco chewing, hypercholesterolemia, and excessive fuel exposure are risk factors for early development of cataract.

Pattern of severe maternal morbidity in a tertiary hospital of Delhi, India: a pilot study.

Severe maternal morbidity also known as 'near miss' may be a good indicator of the quality and effectiveness of obstetric care, as it may identify priorities in maternal care more rapidly than mortality alone. The objective of the study was to observe the pattern of severe maternal morbidity and its associated factors in a tertiary care hospital in Delhi. All patients admitted to the obstetrics and gynaecology department who fulfilled the definition of severe maternal morbidity conditions were included. A proforma was used to record sociodemographic, obstetric, antenatal care treatment and outcome details. A total of 63 women were included for analysis. The incidence of severe maternal morbidity was 3.3/100 deliveries. The mean age of the patients was 26.3 +/- 5 years. More than half (55.5%) were uneducated: almost one-third (32%) were from outside Delhi - the median distance travelled was 10 km. The majority were antenatal admissions (68.3%). The proportion of postdelivery or abortion cases were greater among women who came from outside Delhi. Only 38.1% were registered during the antenatal period. The diagnoses were: eclampsia/pre-eclampsia (35%); haemorrhage (35%); sepsis (13%); obstructed labour (9.5%) and other medical conditions (11%). Severe anaemia was observed in 22% of cases. Only 43.5% were normal vaginal deliveries and 54.5% were delivered by caesarean section or with the use of instruments; 61.3% were live births. Hysterectomy was performed in 14.8%: the proportion of hysterectomy was higher in obstructed labour. Severe maternal morbidity cases constitute a significant burden on health resources.

Distribution and determinants of body mass index of non-smoking adults in Delhi, India.

Data on height and weight of 3,428 non-smoking healthy adult subjects, obtained during an earlier community-based study in Delhi, India, on chronic respiratory morbidity due to ambient air pollution was analyzed to study the distribution of body mass index (BMI) and its determinants among adults in Delhi. The sample was drawn by systematic sampling from rural and urban areas of Delhi. In urban areas, the sampling frame was restricted to areas around air quality-monitoring stations. However, the areas were spread across the city and reflected wide economic spectrum. Subjects were classified as underweight, normal, overweight, and obese as per the criteria of the World Health Organization for BMI. The mean BMI of the entire sample was 22.14 +/- 4.61. It was higher among females, urban residents, and the higher-income group. Overall, 49.7% of the 3,428 subjects had a normal nutritional status, 24.8% were underweight, 19.4% overweight, and 6.1% obese. The prevalence of underweight was higher in rural areas (38.5%) and among the lower-income group (39.9%), while overweight and obesity were more common in urban residents (22.7% and 7.5% respectively), among females (21.7% and 7.7%), and the higher-income group (31.8% and 11%) (p < 0.05). The adjusted odds for underweight were 2.02 for rural subjects and 4.00 for the lower-income group. For overweight or obesity, odds were 5.6 for the higher-income group, 3.62 for urban residents, and 2.5 for females. It was concluded that problems of both underweight and overweight and obesity exist among the adults of Delhi. While females, residents of urban areas, and economically-better-off were more likely to be overweight or obese, residents of rural areas and those from lower-income groups were more likely to be underweight.

Awareness of cervical cancer and willingness to participate in screening program: Public health policy implications.

BACKGROUND: Cervical cancer is one of the most common malignancies among women in India. There is a high mortality as patients usually present at an advanced stage because of lack of awareness and nonexistent screening programs. AIM: This study was planned to find out awareness about cervical cancer among women and their willingness to utilize screening services in an urban resettlement colony of Delhi, India. SETTINGS AND DESIGN: A community-based, cross-sectional study was carried out in a resettlement colony of North-West Delhi. MATERIALS AND METHODS: Semi-structured interview schedule was used to collect information regarding different aspects of cervical cancer. Analysis was done using SPSS package (SPSS version 16 (UCMS and GTBH, Delhi, India)). RESULTS: A total of 373 women were included in the study. Mean age of study participants was 39.14 years. Two-third of the study population were illiterate. Half of the study population was aware of cervical cancer, and only one-fourth of population were willing to participate in a screening test. Willingness was higher among educated, ever user of family planning method and having knowledge about at least one risk factor, signs or symptoms, or possibility of early diagnosis of cancer cervix. CONCLUSIONS: The country's national program advocates for opportunistic and targeted screening of women. An understanding of the factors that influences womens' willingness to participate in screening program is essential for the success of such programs. Hence, this study emphasizes the need for dissemination of knowledge about various aspects of cancer cervix which is critical for uptake of any screening program in a developing country.

Do our medical students have enough knowledge of Hepatitis B ? A Delhi based study.

Hepatitis B virus is the world's most common blood borne viral infection. Occupational risk of Hepatitis B infection is well known in medical and dental workers especially during the professional training period. The present study was conducted among medical students of a Medical College in Delhi to assess their knowledge regarding Hepatitis B. A questionnaire was administered to the first, third and final year medical students regarding Hepatitis B vaccine, disease, and mode of spread, sequel and prevention. The knowledge regarding all aspects was maximum amongst the final year students as compared to first and third years. Knowledge regarding the booster dose of vaccine, transmission through formites, universal precautions for prevention was not good. There is need for strengthening in these areas and training in these should be started at the earliest.

Knowledge, attitudes, beliefs and practices regarding measles in a rural area of Delhi.

387 mothers in Mehrauli block of Delhi were interviewed regarding their knowledge, attitudes, beliefs and practices regarding measles. 98.4% enumerated one or the other symptoms, fever being the commonest. 77.5% were aware of the infectious nature and 97% had favourable attitude regarding feeding the child during measles. The commonest foodstuff given was cowmilk and khichdi. 95.1% of the respondents intended to apply local herbs on eruptions. There was a variety of local medicines for home treatment and Laung, Tulsi leaves and Kishmish being the practice in descending order of preference. 98.4% respondents favoured giving special nutritional care during the attack of measles to their children.