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   2011| April-June  | Volume 55 | Issue 2  
    Online since September 22, 2011

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Public health in India: Issues and Challenges
LS Chauhan
April-June 2011, 55(2):88-91
DOI:10.4103/0019-557X.85237  PMID:21941042
Health is determined not only by medical care but also by determinants outside the medical sector. Public health approach is to deal with all these determinants of health which requires multi sectoral collaboration and inter-disciplinary coordination. Although there have been major improvements in public health since 1950s, India is passing through demographic and environmental transition which is adding to burden of diseases. There is triple burden of diseases, viz. communicable, non-communicable and emerging infectious diseases. This high burden of disease, disability and death can only be addressed through an effective public health system. However, the growth of public health in India has been very slow due to low public expenditure on health, very few public health institutes in India and inadequate national standards for public health education. Recent years have seen efforts towards strengthening public health in India in the form of launch of NRHM, upgradation of health care infrastructure as per IPHS, initiation of more public health courses in some medical colleges and public health institutions and strengthening of public health functional capacity of states and districts under IDSP.
  46,233 3,783 5
Eradicating and eliminating infectious diseases: Past, Present and Future
Jai P Narain
April-June 2011, 55(2):81-87
DOI:10.4103/0019-557X.85236  PMID:21941041
During the past 60 years, a number of infectious diseases have been targeted for eradication or elimination, with mixed results. While smallpox is the only one successfully eradicated so far, campaigns on yaws and malaria brought about a dramatic reduction in the incidence in the beginning of the campaign but ultimately could not achieve the desired goal. There is again a renewed interest in disease eradication. The World Health assembly in May 2010 passed a resolution calling for eradication of measles by 2015; the target of polio eradication still remains elusive. In view of these developments, it is appropriate time to revisit the concept of disease eradication and elimination, the achievements and failures of past eradication programmes and reasons thereof, and possibly apply these lessons while planning for the future activities. This paper based on the Dr. A.L.Saha Memorial Oration describes various infectious diseases that have been targeted for eradication or elimination since 1950s, the potential direct and indirect benefits from disease eradication, and the issues and opportunities for the future.
  16,364 919 3
Public health engineering education in India: Current scenario, opportunities and challenges
Mohammad Akhtar Hussain, Kavya Sharma, Sanjay Zodpey
April-June 2011, 55(2):100-106
DOI:10.4103/0019-557X.85240  PMID:21941044
Public health engineering can play an important and significant role in solving environmental health issues. In order to confront public health challenges emerging out of environmental problems we need adequately trained public health engineers / environmental engineers. Considering the current burden of disease attributable to environmental factors and expansion in scope of applications of public health / environmental engineering science, it is essential to understand the present scenario of teaching, training and capacity building programs in these areas. Against this background the present research was carried out to know the current teaching and training programs in public health engineering and related disciplines in India and to understand the potential opportunities and challenges availables. A systematic, predefined approach was used to collect and assemble the data related to various teaching and training programs in public health engineering / environmental engineering in India. Public health engineering / environmental engineering education and training in the country is mainly offered through engineering institutions, as pre-service and in-service training. Pre-service programs include diploma, degree (graduate) and post-graduate courses affiliated to various state technical boards, institutes and universities, whereas in-service training is mainly provided by Government of India recognized engineering and public health training institutes. Though trainees of these programs acquire skills related to engineering sciences, they significantly lack in public health skills. The teaching and training of public health engineering / environmental engineering is limited as a part of public health programs (MD Community Medicine, MPH, DPH) in India. There is need for developing teaching and training of public health engineering or environmental engineering as an interdisciplinary subject. Public health institutes can play an important and significant role in this regard by engaging themselves in initiating specialized programs in this domain.
  9,985 530 -
An assessment of rural health care delivery system in some areas of West Bengal-An overview
Sandip Kumar Ray, Subhra S Basu, Amal Kumar Basu
April-June 2011, 55(2):70-80
DOI:10.4103/0019-557X.85235  PMID:21941040
A cross sectional observational study was carried out in three districts of West Bengal by following observational, quantitative and qualitative methods during July to December 2006 to find out the extent of utilization, strengths, weaknesses and gap as well as suggest recommendations in connection with health care delivery system for the state of West Bengal, India. A total of 672 episodes of illnesses were reported (2 weeks recall) by the study population of the three selected districts in three geographically separated divisions of West Bengal. None did seek care from any health facilities for treatment in case of 221 (32.89%) episodes; especially from tribal areas where in case of 76.19% none sought any health care from any facilities depended on their home remedies. In rest of episodes the (451), majority preferred government health facilities (38.58%), followed by Unqualified quacks (29.27%) due to low cost as well as living in close proximity, 27.27% preferred qualified Private practitioners and only 4.88% preferred AYUSH, as a first choice. Referral was mostly by self or by close relatives/families (61%) and not by a doctor. Awareness is required to avoid unnecessary referral. Cleanliness of the premises, face-lift, and clean toilet with privacy and availability of safe drinking water facilities could have an improved client satisfaction in rural health care delivery systems. This could be achieved through community participation with the involvement of PRI. However, as observed in the study RCH services including Family Planning as well as immunization services (preventive services) were utilized much better while there was a strong need of improvement of Post Natal Care, otherwise, Neonatal and Maternal mortality and morbidity will continue to be high.
  7,527 999 3
A study on sex ratio at birth in suburban slums of Mumbai
Ancilla Tragler
April-June 2011, 55(2):128-131
DOI:10.4103/0019-557X.85250  PMID:21941049
A cross sectional study was conducted in four selected suburban slums of Mumbai to determine the sex ratio at birth and to assess the various factors related to it. Information were collected on the sex of new born babies and other socio demographic characteristics of selected couples, including number of births, history of spontaneous and induced abortions and the preferred sex of siblings. Data were collected from a total of 302 families using a pre-tested interview schedule. There were 698 births of which 351(50.3%) were males and 347 females. The sex ratio at birth was 988 females for 1000 males. There were 84 abortions of which 60(71.4%) were induced and 24 (28.6%) were spontaneous. The reason stated for induced abortions was related to sex of the child in 31(51.7%) of the cases and in 26(83.9%) of these, the abortions were induced to prevent the birth of a female child. There was a preference for male children in the study families. Gender bias and its implications are discussed.
  7,186 317 3
Emergence of Schoengastiella ligula as the vector of scrub typhus outbreak in Darjeeling: Has Leptotrombidium deliense been replaced?
Rina Tilak, Rajesh Kunwar, Urmila B Wankhade, VW Tilak
April-June 2011, 55(2):92-99
DOI:10.4103/0019-557X.85239  PMID:21941043
Background: Following a suspected outbreak of scrub typhus in Kurseong, Darjeeling, the Armed Forces Medical College, Pune was requested by the National Institute of Epidemiology and the State authorities to undertake investigation of the ongoing scrub typhus outbreak and suggest containment measures. Materials and Methods:The epidemic team undertook clinical, entomological and serological studies to understand the local disease pattern and delineate high risk areas, host diversity by rodent trapping using Sherman traps, mite fauna diversity, abundance and vector species identification by phase contrast microscopy for preparation of electronic database and rodent and human serological studies by Weil Felix and PCR. Results:The results indicate no association of scrub typhus with age and sex (P=0.37 and 0.74 respectively). The maximum cases occurred amongst the tea garden workers (73%) in the age group of 25-44 years. The predominant clinical presentation was fever (100%) with headache (75%), lymphadenopathy (45%) and presence of eschar (76.7%). The dominant host species (50% of trapped rodents) was shrew Suncus murinus, the index animal for scrub typhus, which contributed maximally to the vector abundance (52.96%) with a chigger index of 61.56. The trombiculid mite Schoengastiella ligula was the vector species much against the expected mite vector Leptotrombidium deliense, in the area. The study found the presence and abundance of vector species which corroborated well with the occurrence of cases in the various localities within the subdivisions. Conclusion:The study thus establishes Schoengastiella ligula as the vector of scrub typhus outbreak in Kurseong, Darjeeling. Preventive and containment measures with emphasis on reduction of man - vector contact were suggested to the state authorities to contain the outbreak.
  5,556 442 9
Additional cash Incentive within a conditional cash transfer scheme: A 'controlled before and during' design evaluation study from India
Chandrakant Lahariya, Ashok Mishra, Deoki Nandan, Praveen Gautam, Sanjay Gupta
April-June 2011, 55(2):115-120
DOI:10.4103/0019-557X.85245  PMID:21941046
Background : Conditional Cash Transfer (CCT) schemes have shown largely favorable changes in the health seeking behavior. This evaluation study assesses the process and performance of an Additional Cash Incentive (ACI) scheme within an ongoing CCT scheme in India, and document lessons. Material and Methods: A controlled before and during design study was conducted in Madhya Pradesh state of India, from August 2007 to March 2008, with increased in institutional deliveries as a primary outcome. In depth interviews, focus group discussions and household surveys were done for data collection. Results: Lack of awareness about ACI scheme amongst general population and beneficiaries, cumbersome cash disbursement procedure, intricate eligibility criteria, extensive paper work, and insufficient focus on community involvement were the major implementation challenges. There were anecdotal reports of political interference and possible scope for corruption. At the end of implementation period, overall rate of institutional deliveries had increased in both target and control populations; however, the differences were not statistically significant. No cause and effect association could be proven by this study. Conclusions: Poor planning and coordination, and lack of public awareness about the scheme resulted in low utilization. Thus, proper IEC and training, detailed implementation plan, orientation training for implementer, sufficient budgetary allocation, and community participation should be an integral part for successful implementation of any such scheme. The lesson learned this evaluation study may be useful in any developing country setting and may be utilized for planning and implementation of any ACI scheme in future.
  4,531 493 4
Blood pressure distribution and its relation to anthropometric measurements among school children in Aligarh
Anisa M Durrani, Fatima Waseem
April-June 2011, 55(2):121-124
DOI:10.4103/0019-557X.85246  PMID:21941047
A cross-sectional study among 701 school children (12-16 years) was conducted in Aligarh to find out the prevalence of hypertension and to correlate school going adolescent's blood pressure with age, sex, height and weight. The weight was taken by a standardized weighing machine while height was measured using a standard stediometer. Blood pressure measurements were taken by a mercury sphygmomanometer. The distribution of blood pressure by anthropometric characteristics were studied. Mean, standard deviation and correlation coefficient were used for statistical analysis. The overall prevalence of hypertension was found to be 9.4%. Blood pressure of both gender appear to have positive correlation with anthropometric characteristics. Study recommends that children must be screened regularly for blood pressure so that remedial measure can be initiated as early as possible.
  4,375 644 5
The allure of the private practitioner: Is this the only alternative for the urban poor in India?
Nupur Barua, Chandrakant S Pandav
April-June 2011, 55(2):107-114
DOI:10.4103/0019-557X.85242  PMID:21941045
The main objective of the study has been to identify trajectories of health seeking behaviour of the urban poor, particularly their use of the private health sector, with the aim to identify strategies to improve quality of health care for this burgeoning population. This article presents findings from a slum settlement in Delhi where ethnographic sub-studies were carried out over two years among private health providers and selected households alongside a survey of household expenditure patterns. The primary research tools were in-depth interviews with practitioners and key informants as well as observations of clinical interactions. Illness narratives and case studies were documented over two years. The software package q.s.r. Nvivo was used for coding and content analysis. It was found that almost 90% of the respondents exclusively depend on local unlicensed and unregistered practitioners for basic primary health care. Long distances, time-consuming procedures, rude behaviour and, in many cases, bribes that had to be paid to staff in the hospitals were cited as major deterrents to utilising government facilities. Despite the public health consequences of inappropriate treatment protocols and misuse of drugs by these untrained private providers, in the absence of a structured urban primary health care system in the country, they seem to be the only alternative for the burgeoning urban poor in vast metros such as Delhi.
  3,928 380 9
Prevalence of hearing impairement in the district of Lucknow, India
Anupam Mishra, Veerendra Verma, Girish Kumar Shukla, Subhash Chandra Mishra, Raghav Dwivedi
April-June 2011, 55(2):132-134
DOI:10.4103/0019-557X.85251  PMID:21941050
A multi-cluster study (survey) was carried out by department of ENT KG Medical University, Lucknow from July 2003 to August 2004 in rural and urban population of Lucknow district to estimate prevalence and causes of hearing impairment in the community. Data included audiological profile and basic ear examination that was analysed through EARFORM software program of WHO. Overall hearing impairment was seen in 15.14% of rural as opposed to 5.9% of urban population. A higher prevalence of disabling hearing impairment (DHI) in elderly and deafness in 0-10 years age group was seen. The prevalence of sensorineural deafness necessitating hearing aids was 20% in rural and 50% in urban areas respectively. The presence of DHI was seen in 1/2 urban subjects and 1/3rd of rural counterparts. The incidence of cerumen / debris was very common in both types of population and the need of surgery was much more amongst rural subjects indicating more advanced / dangerous ear disease.
  3,502 411 5
Unintentional injuries among children admitted in a tertiary care hospital in North Kerala
Akbar Sheriff, Asma Rahim, MP Lailabi, Jibin Gopi
April-June 2011, 55(2):125-127
DOI:10.4103/0019-557X.85248  PMID:21941048
World Health Organization global disease update (2004) points out injuries as the sixth leading cause of morbidity and mortality in childhood. A descriptive hospital based study was conducted to find out the common types of unintentional injuries among children admitted for management of unintentional injuries in Pediatric Surgery department and Intensive Care Unit of a tertiary care hospital of North Kerala and to find out the contributing risk factors. A total of 400 children admitted during the study period of 6 months of 2009 constituted the study population. Mechanical injuries comprising of Road traffic accidents and accidental fall were the major cause of unintentional injuries (36%), followed by Poisoning (22.3%). A higher proportion of unintentional injuries were noted to occur among children of younger mothers, overactive child, children belonging to extended or joint families, child left alone or with friends, pre-school children, male child and from urban dwellings. The study highlights the need to identify the different types of unintentional injuries and the risk factors of childhood injuries which require hospitalisation. Identification of risk factors will help to formulate strategies aimed at risk reduction and prevention of childhood injuries.
  2,877 380 3
Effect of oral sucrose on pain during DPT immunization in older infants
Dipankar Chattopadhyay, Purnima Kundu, Sova Gunri, Sukamal Bisoi
April-June 2011, 55(2):136-138
DOI:10.4103/0019-557X.85254  PMID:21941052
  2,951 294 1
Make dementia a public health priority in India
Rabindra Nath Sinha
April-June 2011, 55(2):67-69
DOI:10.4103/0019-557X.85234  PMID:21941039
  2,486 326 4
Delayed presentation of anorectal malformations: Need of community awareness
Kirtikumar J Rathod, Santosh Mahalik, Monika Bawa, Ram Samujh, K.L N Rao
April-June 2011, 55(2):135-136
DOI:10.4103/0019-557X.85253  PMID:21941051
  1,861 198 4