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   2012| July-September  | Volume 56 | Issue 3  
    Online since December 3, 2012

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Health promotion for prevention and control of non-communicable diseases: Unfinished agenda
Madhumita Dobe
July-September 2012, 56(3):180-186
DOI:10.4103/0019-557X.104199  PMID:23229208
The magnitude of Non Communicable diseases demands urgent attention. Common, preventable risk factors underlie most NCDs. These include behavioural risk factors and metabolic risk factors. The prevalence of these, varies between income groups and differs with gender. Majority of events occur in individuals with modest elevations of multiple risks rather than with significant elevation of a single risk factor. The need of the hour is to adopt a process which addresses the upstream determinants through enabling people, to increase control over their health and its determinants, thereby promoting and sustaining good health The answer lies in Health Promotion which involves changing behaviour at multiple levels. In order to change, there is need to understand and apply the models which have been widely used to empower people to make healthy choices. These include the Health Belief, Self-Efficacy, Social Learning and Self-empowerment models.Changing behaviour, however, is a process, not an event. Different strategies are most effective at different Stages of Change. The contextual determinants of health and health behaviouralso significantly influence the risks of NCDs.Till date, there has been limited focus on these issues. We urgently, need aclose look at policies and their impact on health. With increasing burden of NCDs, the Health Sector will face strain on services delivery and budgets. Special policies and programs are necessary for the disadvantaged poor to address their differential vulnerabilities and risks. The unfinished agenda of NCD prevention and control needs to be addressed urgently with an integrated comprehensive framework of Health Promotion
  9,551 1,104 6
Public health approach to address maternal mortality
Sanjay K Rai, K Anand, Puneet Misra, Shashi Kant, Ravi Prakash Upadhyay
July-September 2012, 56(3):196-203
DOI:10.4103/0019-557X.104231  PMID:23229211
Reducing maternal mortality is one of the major challenges to health systems worldwide, more so in developing countries that account for nearly 99% of these maternal deaths. Lack of a standard method for reporting of maternal death poses a major hurdle in making global comparisons. Currently much of the focus is on documenting the "number" of maternal deaths and delineating the "medical causes" behind these deaths. There is a need to acknowledge the social correlates of maternal deaths as well. Investigating and in-depth understanding of each maternal death can provide indications on practical ways of addressing the problem. Death of a mother has serious implications for the child as well as other family members and to prevent the same, a comprehensive approach is required. This could include providing essential maternal care, early management of complications and good quality intrapartum care through the involvement of skilled birth attendants. Ensuring the availability, affordability, and accessibility of quality maternal health services, including emergency obstetric care (EmOC) would prove pivotal in reducing the maternal deaths. To increase perceived seriousness of the community regarding maternal health, a well-structured awareness campaign is needed with importance be given to avoid adolescent pregnancy as well. Initiatives like Janani Surakhsha Yojna (JSY) that have the potential to improve maternal health needs to be strengthened. Quality assessments should form an essential part of all services that are directed toward improving maternal health. Further, emphasis needs to be given on research by involving multiple allied partners, with the aim to develop a prioritized, coordinated, and innovative research agenda for women's health.
  7,082 934 1
Effect of drinking arsenic-contaminated water in children
Kunal K Majumdar, DN Guha Mazumder
July-September 2012, 56(3):223-226
DOI:10.4103/0019-557X.104250  PMID:23229215
Chronic arsenic toxicity due to drinking of arsenic-contaminated water has been a major environmental health hazard throughout the world including India. Although a lot of information is available on health effects due to chronic arsenic toxicity in adults, knowledge of such effect on children is scanty. A review of the available literature has been made to highlight the problem in children. Scientific publications on health effects of chronic arsenic toxicity in children with special reference to psychological issues are reviewed. The prevalence of skin abnormalities such as pigmentation change and keratosis, the diagnostic signs of chronic arsenic toxicity, vary in various arsenic-exposed children population in different regions of the world. The occurrence of chronic lung disease including pulmonary interstitial fibrosis has been described in arsenic-exposed children in Chile. Affection of intellectual function has also been reported to occur in arsenic-exposed children studied in Thailand, Bangladesh, and India. Methylation patterns of arsenic in children aggregate in families and are correlated in siblings, providing evidence of a genetic basis for the variation in arsenic methylation. Chronic arsenic toxicity due to drinking of arsenic-contaminated water causes significant morbidity in children resulting in skin lesions, lung disease, and defect in intellectual function.
  5,528 641 3
A cyto-epidemiological study on married women in reproductive age group (15-49 years) regarding reproductive tract infection in a rural community of West Bengal
Shamima Yasmin, Anindya Mukherjee
July-September 2012, 56(3):204-209
DOI:10.4103/0019-557X.104233  PMID:23229212
Background: Reproductive tract infection (RTI) represents a major public health problem in India. Women are either not aware of the symptoms of RTI or refuse to seek health care due to economic and time constrains unless suffering from alarming symptoms. Objectives: To find out the prevalence of women with suggestive symptoms of RTI; to identify clinical and cytological abnormalities among the symptomatic women and to find out association between socio-demographic profile and risk factors with RTI symptomatic and cytology positive patients. Materials and Methods: A total of 385 married women in reproductive age group residing in Baligori sub-center area in Tarakeswar block of Hooghly district, West Bengal, India, were screened for symptom suggestive of RTI; symptomatic women went through gynecological examination and cancer cervix screening by Pap smear. Analysis of results was done by Odds ratio and multivariate logistic regression. Results: Overall, 23.6% of the study population had symptoms suggestive of RTI. Most of them (68.1%) had abnormal vaginal discharge. Among the symptomatic women, cytology proved that 24.4% were suffering from acute cervicitis, 4.7% from A Squamous Cell of Undetermined Significance (ASCUS) and 2.3% from Low Grade Intra epithelial Lesion (LSIL) Squamous. Statistically significant association was observed for age, number of children, contact history of husband, pond bathing, menstrual hygiene, intra uterine device insertion, non-usage of barrier method, and history of abortion among women symptomatic for RTI and asymptomatic women. Conclusions: Prevalence of suggestive symptoms of RTI in women was found to be high (23.6%), and among them 7% had cervical dysplasia. Therefore, enhancing awareness and organizing screening camps are absolute necessity and must be held at frequent intervals to curb the menace due to cervical cancer.
  3,756 604 3
Challenges in neurological practice in developing countries
Sanjay Pandey
July-September 2012, 56(3):227-230
DOI:10.4103/0019-557X.104253  PMID:23229216
The burden of neurological illness is much higher in developing countries. Neurological disorders in these countries are mainly due to poverty and malnutrition. Spectrums of diseases are also different in comparison with developed countries. Lack of resources, ignorance, and overpopulation make it very difficult and challenging to tackle this problem. Majority of the patients are seen by general practitioners who have little knowledge about neurological illnesses. Most of the countries have very few or no neurologist. There is a greater need of taking neurological care at primary care level where majority of the patients struggle with epilepsy, stroke and neuroinfections.
  3,732 454 4
Aging: The triumph of humanity-are we prepared to face the challenge?
Zile Singh
July-September 2012, 56(3):189-195
DOI:10.4103/0019-557X.104217  PMID:23229210
Advances in medicine have increased the life expectancy resulting in an increase in the geriatric population all over the world, and their proportion will only continue to rise in the coming years. It is known that the elderly bear a significant burden of morbidity, which is why health systems globally spearheaded by the WHO are waking up to the need for better geriatric health services. This includes India, whose health system continues to grapple with the health challenges of communicable and noncommunicable diseases. This article enumerates the various government policies and programs, constitutional and legal provisions available for the care of the elderly, and concludes that they are grossly inadequate to deal with the various physical, psychological, and emotional needs of the aging population. Mainstreaming of geriatric health to address the health needs of the elderly at all levels of health care, both in the public and the private sectors, giving due importance to multidimensional rehabilitative services and terminal care, involving NGOs and voluntary organizations, and stepping up social security in old age are the recommended measures for improving geriatric health in India.
  3,386 471 2
Prevalence of domestic accidents in the rural field practice area of a medical college in Bangalore, Karnataka
NR Ramesh Masthi, SG Kishore, Gangaboriah
July-September 2012, 56(3):235-237
DOI:10.4103/0019-557X.104262  PMID:23229218
Domestic accidents are worldwide health problems. A cross-sectional study was conducted in the rural field practice area of Kempegowda Institute of Medical Sciences, Bangalore. A total of 5419 individuals were selected from 30 clusters (villages) using cluster sampling technique. Of the 5419 study population, 50.9% (2748) were males and the rest were females. The prevalence of domestic accidents in the rural community was found to be 9.6% (522 individuals who had sustained domestic accidents), was found to be more in females compared with males, which was statistically significant with P-value =0.0077 (Z value =9.09). Falls 43% (225) was the most common type of domestic accidents. The most common place of occurrence of domestic accidents was 46% (243) kitchen, most frequent site of injures in domestic accidents was upper limbs.
  3,225 453 1
Sexual practices of people living with HIV/AIDS attending school of tropical medicine, Kolkata
Pranita Taraphdar, Aparajita Dasgupta, Bibhuti Saha
July-September 2012, 56(3):231-234
DOI:10.4103/0019-557X.104259  PMID:23229217
A hospital-based, cross-sectional, observational study of People Living with HIV/AIDS (PLWHAs) attending the School of Tropical Medicine (STM), Kolkata was carried out for a period of 6 months from May 2006 to October 2006, to assess the sexual practices of PLWHAs. Past sexual practice of PLWHAs revealed that 93.4% males were polygamous, compared to 16.4% females. Of them, 45.7% males and 92.8% females reported sex with a nonregular sex partner (NRSP) in 1 year. Consistent condom use was low in both sexes. Current sexual practice showed that more than four-fifth (87.9%) of the new patients and two-thirds (68.9%) of the indoor patients were currently sexually active in 1 month recall period (P=3.79, Z=0.0000). However, consistent condom use was found only in 35.5% indoor patients and 15.5% of new patients and the difference was statistically significant.
  3,023 257 1
Economic evaluation of iodine deficiency disorder control program in Sikkim: A cost-benefit analysis
Chandrakant S Pandav
July-September 2012, 56(3):214-222
DOI:10.4103/0019-557X.104242  PMID:23229214
Background: Iodine deficiency disorders (IDDs) are the most common cause of preventable brain damage globally. The strategy of prevention and control of iodine deficiency is based on iodine supplementation. Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. The objective of the study was to conduct a cost-benefit analysis of the two programs of iodine supplementation, i.e., iodized salt program (ISP) and iodized oil program (IOP) against no preventive program (NPP) option. Materials and Methods: The study was conducted in 1990 in the state of Sikkim in India. The costs were calculated on the assumption of universal coverage of ISP and coverage of IOP among all children aged 0-14 years and women in the age group of 15-44 years. Direct and indirect cost of ISP and direct cost of IOP was computed based on the costs of year 1991. The discount rate taken was 10% and all the costs were converted to the year 2010 using wholesale price index (WPI) data. Consequences in terms of health effects, Social/emotional effects, and resource use were included. Results: The discounted cost of ISP and IOP was Rs. 59,225,964 and Rs. 46,145,491, respectively. In ISP, 64.1% of the total cost was required for salt iodization, 17.6% for monitoring, and 18.3% for communication. In IOP, 50.9% of the costs were required for iodized oil; rest was for syringes and needles, manpower expenses, travel, and communication. Total resource saving was Rs. 95,566,220 for ISP and Rs. 92,177,548 for IOP. Incremental benefit for ISP was Rs. 36,340,256 and Rs. 46,032,057 for IOP. The cost-benefit ratio for ISP was 1.61 and 2.00 for IOP. Conclusion: IOP has a higher cost-benefit ratio for prevention of IDDs than ISP in the state of Sikkim, India.
  2,791 485 2
Epidemiology of pandemic H1N1 strains in a tertiary hospital of Maharashtra
Sunanda Shrikhande, SK Bhoyar, SH Tenpe, NG Deogade
July-September 2012, 56(3):242-244
DOI:10.4103/0019-557X.104267  PMID:23229220
Swine-flu is a viral fever caused by a new mutated strain Influenza A virus subtype H1N1, which infects humans. Pandemic H1N1 (pH1N1/2009) virus was detected in the first quarter of 2009 in the west coastal region of North America and spread very rapidly to the other countries during April-June, 2009. This study was conducted to assess the epidemiology of pandemic H1N1 strains using a cross-sectional study design in a tertiary hospital. The symptomatic patients attending the flu outpatient department (OPD)/emergency from August 2009 to April 2011 at Indira Gandhi Government Medical College, Nagpur were included using a standard case definition. A total of 67 (27.01%) samples from 247 patients were pandemic influenza A/H1N1 positive. None of the patients had a history of foreign travel, whereas 23.88% of the patients gave history of travel to an endemic area. Overall, 22.38% of the patients came in contact with proven cases of pandemic H1N1. pH1N1 transmission activity has increased since May 2010.
  2,860 309 2
From guidelines to ground reality: Maximizing the benefits of IDRV in the fourth year of its implementation
Thomas Mathew
July-September 2012, 56(3):187-188
DOI:10.4103/0019-557X.104207  PMID:23229209
The updated Thai Red Cross Intradermal (TRC-ID) regimen is the most effective strategy for India as it uses only 40% volume of vaccines in comparison with intramuscular (IM) when 0.5 ml vial is used and 20% when 1-ml vial is used; hence, the cost-effectiveness of intradermal (ID) regimen further increases when 1 ml vial is used. To improve the compliance of ID, postexposure prophylaxis (PEP) given free of cost is the ideal solution. For availability and avoiding administrative delays, universal ID delivery of PEP is the answer. ID is safe, effective, and well tolerated. Technique of ID can be learned easily. Universal ID with 1 ml is the ethical solution, which is easy to administer and monitor, economical, effective, and imparts early immunity (Five E's).
  2,696 267 1
Hib vaccine: Should it be introduced in the national immunization program?
Davendra K Taneja
July-September 2012, 56(3):177-179
DOI:10.4103/0019-557X.104194  PMID:23229207
  2,292 397 1
Public health in India: The challenge of politics
Anindya Das
July-September 2012, 56(3):245-245
DOI:10.4103/0019-557X.104269  PMID:23229221
  1,854 384 -
Male health clinic strategy in control of STI/HIV: A program review
Karun Dev Sharma, Yuvaraj B Chavan, Deepak S Khismatrao, Radha Y Aras
July-September 2012, 56(3):238-241
DOI:10.4103/0019-557X.104265  PMID:23229219
A community-based, longitudinal interventional study was conducted in a slum in north-east (NE) Mumbai, using a pretested, semi-structured proforma and a pre- and follow-up interview schedule to assess the male health clinic (MHC) strategy as an approach for the control of sexually transmitted infections (STIs) in males. The focus groups that emerged for behavior change communication (BCC) activities were clients in second and third decades of life, unmarried and married but not staying with wife, clients with no permanent place of occupation, clients with habit of alcohol, and illiterate clients. Postintervention, there was an overall increase in STI knowledge score, alcohol habit score, and high-risk sexual activity score. Less than 50% of the clients received advice on substance abuse and information on consequences of STI/human immunodeficiency virus (HIV). The study concluded that MHC strategy is an effective approach for control of STIs in males and recommended strengthening of the weaker components of the strategy with focus on the important client groups.
  1,848 207 1
Emerging need for health policy teaching in India
Anuja Pandey, Kavya Sharma, Habib Hasan, Sanjay P Zodpey
July-September 2012, 56(3):210-213
DOI:10.4103/0019-557X.104237  PMID:23229213
The core functions of public health agencies at all levels of government are identified as assessment, policy development, and assurance. However, the public health agencies in India are struggling with issues of access, inefficiency, and inequity. There has been failure in terms of health service delivery by public sector. Health Policy is being increasingly recognized as a discipline that has much to offer developing countries in addressing the problems related to policy, governance, and regulatory failure. However, the information about skill-oriented courses on health policy especially from the context of translating public health science into policy action is incomplete and limited. This paper attempts to address this knowledge gap and stimulate discussion in this direction.
  1,705 310 -
Unregulated private health care in India: The case of a Kolkata hospital fire
N Nakkeeran
July-September 2012, 56(3):246-247
DOI:10.4103/0019-557X.104273  PMID:23229222
  1,337 166 -
Obituary: Prof. S. P. Mukhopadhyay

July-September 2012, 56(3):248-248
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Author's reply
LS Chauhan
July-September 2012, 56(3):246-246
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