Indian Journal of Community Medicine

Published by Medknow Publications
Online ISSN: 0970-0218
Publications
Article
An estimated 186 million of the world population are school children of 13-15 years. Among them, approximately 34.8 million are current tobacco users.(1) In India, the most susceptible time for tobacco use is during adolescence and early adulthood (15-24 years). In rural settings, family members and neighbours who often ask young children to get tobacco from nearby shops. Media advertisements and colorfully packaged tobacco products act as pro-tobacco influences.(2) There is an urgent need to curb tobacco use among youth. Hence, this study was conducted to estimate the prevalence of tobacco use among rural school children of 13-15 years and to find the reasons for use of tobacco products. Also, reasons for initiation, access, availability, source of funding, knowledge about the dangers of tobacco consumption, tobacco use among family and teachers, and cessation behavior were assessed.
 
Prevalence of tobacco use among the children in the age group of 13-15 years 
Article
Despite increasing awareness to the harmful effects of tobacco, the use of tobacco in various forms continues to be a significant health risk factor. It has been predicted by the World Health Organization (WHO) that more than 500 million people alive today will be killed by tobacco use by 2030 and tobacco consumption will become the single leading cause of death.(1) In India, it is estimated that on current trends tobacco will kill 80 million males currently aged 0-34 years.(2) Considering the social and economic impact of tobacco consumption, Government of India introduced “Cigarettes and other tobacco products (Prohibition of Advertisement and regulation of Trade and Commerce, Production, Supply and Distribution) Bill 2001,” which was enacted in 2003. The state of Sikkim imposed a ban on the advertisement of tobacco in any form and sale of cigarettes to the minors and smokeless tobacco as a whole in the state since July 2001. The Tobacco Free Initiative of World Health Organization in collaboration with the Office on Smoking and Health, Centers for Disease Control, USA has undertaken Global Youth Tobacco Survey (GYTS) in Sikkim during January-March 2001 as in the rest of India, which revealed that 54.7% of the children between 13 and 15 years of age are using tobacco in one form or the other(3). The present study was carried to assess the effectiveness of the existing legislation to control tobacco use.
 
Article
Clinico-epidemiological profile of the Human immunodeficiency virus (HIV) epidemic in India is varied and depends on multitude of factors including geographic location. We analyzed the characteristics of HIV-infected patients attending our Immunodeficiency Clinic to determine any changes in their profile over five years. A retrospective observational study. The study sample included all patients with HIV infection from January 1, 2003 to December 31, 2007. Diagnosis of HIV was made according to National AIDS Control Organization guidelines. Of 3 067 HIV-infected patients, 1 887 (61.5%) were male and 1 180 (38.5%) were female patients. Mean age of patients was 35.1 ± 9.0 years. Majority (91.8%) of patients were in the age group of 15 to 49 years. Progressively increasing proportion of female patients was noted from year 2004 onward. Median CD4 count at presentation in year 2003 was 197/μl (Interquartile range [IQR] = 82.5-373) while in year 2007 it was 186.5/μl (IQR = 86.3-336.8). Mean CD4 count of male patients was 203.7 ± 169.4/μl, significantly lower as compared with female patients, which was 284.8 ± 223.3/μl (P value ≤0.05). Every year, substantial proportions of patients presenting to clinic had CD4 count<200/μl indicating advanced disease. Predominant route of transmission was heterosexual in 2 507 (81.7%) patients. Tuberculosis and oropharyngeal candidiasis were the most common opportunistic infections (OIs). Cryptococcal meningitis was the most common central nervous infection. Our patients had comparatively lower median CD4 counts at the time of presentation with various OIs. Patients had advanced stage of HIV infection at the time of presentation throughout five years. Females presented earlier during the course of HIV infection. There is need for early screening and increasing awareness in healthcare providers to make a diagnosis of HIV much sooner.
 
Cases of gastroenteritis by date of onset, Tibetan Transit School, Khaniara, Himachal Pradesh, India, 2006
Article
On 28(th) June, 2006, 55 cases of the gastroenteritis were reported among the hostellers of the Tibetan Transit School, Dharamshala. We investigated the outbreak to identify the source, propose control and preventive measures. We defined a case of the gastroenteritis as the occurrence of more than three smelly loose motions between 28(th) June to 2(nd) July, 2006 among some sections of the resident hostellers. We determined age and sex specific attack rate. We hypothesized it as a food borne beef meat outbreak. We conducted the case control study and collected the information about the food items consumed inside and outside the hostel at dinner using the standardized questionnaire. We calculated floor wise incidences of four hostels, odds ratios and attributable fractions. We interviewed food handlers. We lifted the seven rectal stool, four water and three samples from floor, kitchen and meat chopper room for culture and sensitivity. 116 cases patients of 802 hostellers met the case definition. The maximum attack rate (16%) was in the youngest group (15-20yrs) and nil in staff and 31-40 years age group with 5 overall attack rate as 14%. Sex specific attack rate was more (18%) in females. The floor wise incidences of the case patients were the highest in 2nd and 3rd floors, occupied by the youngest group. The median age was 20 yrs (Range 17-40 yrs). The most common symptoms were watery diarrhea (71/116, 61%) and bloody diarrhea-(45/116, 39%); abdominal pains-(87/116, 75%). Of the six food/water items examined, the food specific attack rate was highly statistically significant in the beef meat eaters (82% with PAF 71%), and Odds Ratio 19.19 (95% C.I. as 9.3-140). The food handlers & their cooking conditions in the kitchen were unhygienic. The food was not available for testing. Escherichia coli were detected in the samples from rectal stools, kitchen and meat chopper room. No fatality was reported. CONCLUSION/RECOMMENDATION: The beef meat purchased from outside was implicated for the explosive common source outbreak. The school authorities were counseled for hygienic food handling.
 
Article
Mass drug administration (MDA) means once-in-a-year administration of diethyl carbamazine (DEC) tablet to all people (excluding children under 2 years, pregnant women and severely ill persons) in identified endemic areas. It aims at cessation of transmission of lymphatic filariasis. What has been the coverage and compliance of MDA in Gujarat during the campaign in December 2006? Cross-sectional population based house-to-house visit. Urban and rural areas in Gujarat identified as endemic for filariasis where MDA 2006 was undertaken. Exploratory - Rural and urban districts; Outcome - coverage, compliance, actual coverage, side effects. Percentage and proportions. Twenty-six clusters, each comprising 32 households from six endemic districts, yielded an eligible population of 4164. The coverage rate was 85.2% with variation across different areas. The compliance with drug ingestion was 89% with a gap of 11% to be targeted by intensive IEC. The effective coverage (75.8%) was much below the target (85%). Side effects of DEC were minimum, transient and drug-specific. Overall coverage was marginally better in rural areas. The causes of poor coverage and compliance have been discussed and relevant suggestions have been made.
 
Article
Sir, A total of 168 strains of Vibrio cholerae were isolated and tested over a period of 3 years (2004-2006). The strains were identified by standard methods(1) and were identified using a slide agglutination test with Vibrio cholerae O1 antisera and biotyped using a polymyxin B sensitivity test. The non-agglutinating strains were tested with V. cholerae O-139 antisera. Of 168 strains, 96 were isolated in 2004, 39 were isolated in 2005, and 33 were isolated in 2006. Eighty-three V. cholerae O1 isolates were sent to the National Institute of Cholera and Enteric Diseases (NICED) in Kolkata for serotyping and phagetyping. All the V. cholerae O1 isolates were of El Tor biotype. Among the two non-agglutinating vibrios isolated in 2005, both did not agglutinate with O-139 antisera. V. cholerae El Tor serotype Inaba was found only in 2006. The isolates of 2004 and 2005 were of the Ogawa serotype. In a previous study in the same institute, all isolates detected over a period of 5 years (1996-2000) were of the Ogawa serotype.(2) From 2001 to 2005, all isolates were V. cholerae El Tor Ogawa (unpublished). We had isolated serotype Inaba in 2006 for the first time. A shift in the occurrence of Ogawa and Inaba serotypes in a given area are thought to be a consequence of the genetic reversal that occurs in-vivo and in-vitro and is possibly mediated by the immune pressure in the population.(3) It appears that as an alternate to the Ogawa serotype, Inaba have appeared to aid the persistence of cholera and thus perpetuate the spread of Vibrio cholerae El Tor. All the isolates during 2004 to 2006 were Basu and Mukherjee phage type 2. Turbadkar et al.(4) from Mumbai have reported Ogawa serotypes in 2004 and all belonged to phage type 4. In the new phage typing scheme, out of 26 isolates sent to NICED in 2004, 14 were T26 and 12 were T27. Out of 39 isolates sent in 2005, 33 were T27 and 6 were other phage types (T13, T21, T22, T25, T23, or T15). In 2006, out of 18 isolates sent to NICED, 17 were T27 and only 1 was T26. Therefore, the most common phage type in this part of Mumbai is T27 (74.7%), followed by T26 (18.1%). In the study by Turbadkar et al.,(4) the majority belonged to phage type 27 (97.5%), which is in accordance with the present study. The 168 isolates of V.cholerae showed maximum sensitivity to amikacin (92.3%), followed by cefotaxime (89.9%). Tetracycline sensitivity was 91.1% followed by norfloxacin (86.3%). In the previous study during 1996-2000, tetracycline sensitivity was 39.6% and norfloxacin sensitivity was 46.2%.(2) Therefore, tetracycline and norfloxacin sensitivity have increased over the years. Co-trimoxazole and nalidixic acid susceptibility was only 2.4% and 1.2%, respectively in the present study. A decrease in sensitivity to nalidixic acid was observed in the present study (13.6% in previous study).(2)
 
Distribution of study population by age and sex
Coverage of MDA as per DMO/Survey report for the Bidar district
Distribution of study population according to reasons for not taking DEC and Albendazole tablets (n = 363)
Article
Lymphatic Filariasis is a mosquito transmitted disease, caused by parasitic worm Wuchereria bancrofti. Global Programme for Elimination of Lymphatic Filariasis was established in early 2000. The strategy recommended by the World Health Organization is annual Mass Drug Administration (MDA) of single-dose of Diethylcarbamazine 6 mg/kg (DEC), distributed to inhabitants of Filariasis endemic areas, excluding children below 2 years of age, pregnant women, and seriously ill persons, and Morbidity Management. The health system distributes the drugs by a door-to-door strategy. To assess the coverage and compliance of MDA in Bidar district during the campaign in November 2008. Cross-sectional population-based house-to-house visit. Outcome is assessed as actual coverage and compliance, in Percentage and proportions. Eight clusters, total eligible population of 1 131 individuals were interviewed. The coverage rate was 78% with variation across different areas. The compliance with drug ingestion was 68%. The effective coverage was below the target (85%). Side effects of DEC were minimum, the overall coverage was better in rural areas compared with urban areas.
 
Article
In the midst of physical comforts provided by the unprecedented developments in all spheres of life, the humanity is at cross roads and looking at something beyond these means. Spirituality has now been identified globally as an important aspect for providing answers to many questions related to health and happiness. The World Health Organization is also keen at looking beyond physical, mental and social dimensions of the health, and the member countries are actively exploring the 4(th) Dimension of the health i.e. the spiritual health and its impact on the overall health and happiness of an individual. National Institute of Health and Family Welfare (NIHFW), realized this need and initiated a research study in this direction. In this study, an effort was made to define this 4(th) Dimension of health from a common worldly person's perspective and measure it. 3 Domains, 6 Constructs and 27 Determinants of spiritual health were identified through a scientific process. A statistically reliable and valid Spiritual Health Scale (SHS 2011) containing 114 items has been developed. Construct validity and test- retest reliability has been established for urban educated adult population. The scale is first of its kind in the world to measure the spiritual health of a common worldly person, which is devoid of religious and cultural bias. Its items have universal applicability.
 
Article
It is the obligation of the state to provide free and universal access to quality health-care services to its citizens. India continues to be among the countries of the world that have a high burden of diseases. The various health program and policies in the past have not been able to achieve the desired goals and objectives. 65(th) World Health Assembly in Geneva identified universal health coverage (UHC) as the key imperative for all countries to consolidate the public health advances. Accordingly, Planning Commission of India constituted a high level expert group (HLEG) on UHC in October 2010. HLEG submitted its report in Nov 2011 to Planning Commission on UHC for India by 2022. The recommendations for the provision of UHC pertain to the critical areas such as health financing, health infrastructure, health services norms, skilled human resources, access to medicines and vaccines, management and institutional reforms, and community participation. India faces enormous challenges to achieve UHC by 2022 such as high disease prevalence, issues of gender equality, unregulated and fragmented health-care delivery system, non-availability of adequate skilled human resource, vast social determinants of health, inadequate finances, lack of inter-sectoral co-ordination and various political pull and push of different forces, and interests. These challenges can be met by a paradigm shift in health policies and programs in favor of vulnerable population groups, restructuring of public health cadres, reorientation of undergraduate medical education, more emphasis on public health research, and extensive education campaigns. There are still areas of concern in fulfilling the objectives of achieving UHC by 2022 regarding financing model for health-care delivery, entitlement package, cost of health-care interventions and declining state budgets. However, the Government's commitment to provide adequate finances, recent bold social policy initiatives and enactments such as food security bill, enhanced participation by civil society in all health matters, major initiative by some states such as Tamil Nadu to improve health, water, and sanitation services are good enough reasons for hope that UHC can be achieved by 2022. However, in the absence of sustained financial support, strong political will and leadership, dedicated involvement of all stakeholders and community participation, attainment of UHC by 2022 will remain a Utopia.
 
Article
Background: India's National Family Welfare Programme is dominated by sterilization, particularly tubectomy. Sterilization, being a terminal method of contraception, decides the final number of children for that couple. Many studies have shown the declining trend in the average number of living children at the time of sterilization over a short period of time. So this study was planned to do time series analysis of the average children at the time of terminal contraception, to do forecasting till 2020 for the same and to compare the rates of change in various subgroups of the population. Materials and Methods: Data was preprocessed in MS Access 2007 by creating and running SQL queries. After testing stationarity of every series with augmented Dickey-Fuller test, time series analysis and forecasting was done using best-fit Box-Jenkins ARIMA (p, d, q) nonseasonal model. To compare the rates of change of average children in various subgroups, at sterilization, analysis of covariance (ANCOVA) was applied. Results: Forecasting showed that the replacement level of 2.1 total fertility rate (TFR) will be achieved in 2018 for couples opting for sterilization. The same will be achieved in 2020, 2016, 2018, and 2019 for rural area, urban area, Hindu couples, and Buddhist couples, respectively. It will not be achieved till 2020 in Muslim couples. Conclusion: Every stratum of population showed the declining trend. The decline for male children and in rural area was significantly faster than the decline for female children and in urban area, respectively. The decline was not significantly different in Hindu, Muslim, and Buddhist couples.
 
Socio-demographic and clinical characteristics of the study population
SF-36 scale descriptives, tests of item internal consistency and discriminant validity
Interscale correlations and reliability coefficients for the eight SF-36 scales
Summary of principal component analysis for the eight SF-36 scales
Mean SF-36 scale scores in relation to socio-demographic and clinical characteristics
Article
Health is defined as the state of complete physical, mental and social well-being than just the absence of disease or infirmity. In order to measure health in the community, a reliable and validated instrument is required. To adapt and translate the Medical Outcomes Study Short-Form Health Survey (SF-36) for use in India, to study its validity and reliability and to explore its higher order factor structure. Face-to-face interviews were conducted in 184 adult subjects by two trained interviewers. Statistical analyses for establishing item-level validity, scale-level validity and reliability and tests of known group comparison were performed. The higher order factor structure was investigated using principal component analysis with varimax rotation. The questionnaire was well understood by the respondents. Item-level validity was established using tests of item internal consistency, equality of item-scale correlations and item-discriminant validity. Tests of scale-level validity and reliability performed well as all the scales met the required internal consistency criteria. Tests of known group comparison discriminated well across groups differing in socio-demographic and clinical variables. The higher order factor structure was found to comprise of two factors, with factor loadings being similar to those observed in other Asian countries. The item-and scale-level statistical analyses supported the validity and reliability of SF-36 for use in India.
 
Distribution of patient characteristics/risk factors according to stroke subtype 
Article
There is one comparable study from India performed on all subtypes of stroke in young adults(1) that also found that ischemic stroke was the most common subtype followed by hemorrhagic and embolic. Overall, there is a male preponderance of stroke. Studies performed on ischemic stroke among the 15–45 years age group from India also reported a male preponderance.(3,4) Similar findings have been reported from Denmark in cases of thromboembolic stroke.(12) A higher proportion of males was found among cases of ischemic stroke in studies outside India.(13,14) The proportion of cases is higher in the 31-45 years age group, which is similar to the findings reported by Nayak et al.(3) No pattern could be observed among occupation, although the proportions (56.8%) in sedentary (professional, business) occupation outnumbered the more physically active occupations (40.3%). No comparable findings were reported from Indian studies.Presenting symptoms similar to those in our study have been reported by Chopra and Prabhakar(15) and Nayak et al.(3) Although day time onset is reported to be more common,(3,16,17) we could not find such a difference. The proportion of nonischemic strokes (44%) is slightly less than ischemic strokes (56%). Cases of ischemic stroke had a day time onset (43 out of 61), and no pattern could be observed in nonischemic stroke. This could have accounted for the differences.Smoking, alcoholism and hypertension have been found to be significantly associated with ischemic stroke,(3,4,18) and in all subtype strokes(6) from India, which is similar to our finding. Diabetes mellitus is reported to be a risk factor for ischemic stroke from India(4) and Switzerland,(18) which was not found in our study. Diabetes was not found to be a risk factor for ischemic stroke in Sweden(19) and Taiwan.(20) Lipska et al.(4) have reported that diabetes is not a risk factor for stroke when compared with hospital-based controls. Apart from differences in patient profile (all subtypes, i.e. our study vs. ischemic stroke), there does not seem to be a consistent association between diabetes and stroke in studies conducted in various countries. Hypercholesterolemia and hypertriglyceridemia are known to be associated with stroke in young adults.(18,20) Lipska et al.(4) did not find such an association in south Indian patients. The proportion of patients who did not have an abnormal lipid profile was so low in this study that we could not undertake a meaningful analysis. The role of elevated homocysteine levels requires further investigation in the Indian setting, although its association was reported from the USA.(21) A majority of the investigated cases had normal platelets and coagulation parameters, indicating that it is not an important cause of stroke in young adults. A majority of the cases had good outcome and low mortality, which is comparable with other Indian studies.(3,15)There are some limitations in our study. Apart from inadequate numbers (in spite of including 10 years records), not all the patients underwent all the investigations, thereby making analysis and interpretations difficult. Being a tertiary care center, the referred patients’ profiles may not be representative, creating a bias. Because of paucity of information, this study gives an idea of the sample size required to undertake more detailed studies with bigger sample sizes to explore the associations and risk factors.
 
Article
Disturbances of menstrual bleeding are major social and medical problem for women and account for high percentage of gynecological visit. The objective of the study was to document menstrual abnormalities experienced by female college students, their awareness and health seeking behavior. A cross-sectional survey was undertaken, 400 students were selected using stratified sampling technique and interviewed using semi-structured self-administered questionnaire. Inferential statistical analysis such as Chi-square test and logistic regressions were carried out. The mean age at menarche was 14.18 years. Irregular menstrual cycles were reported in 9.0%. Dysmenorrhea was present in 62.5%, and 12.5% reported school absenteeism. Students' awareness of menstrual abnormalities was poor (29%). A few of them (10.5%) decided to seek help for menstrual abnormalities. The awareness of students on menstrual abnormalities was significantly influenced by their age (OR = 2.33, P = 0.03); however, age at menarche and level of study did not influence their awareness (OR = 0.45, P = 0.24 and OR = 1.42, P = 0.12). History of dysmenorrheal (OR = 10.2, P = 0.001) and academic disturbance (OR = 5.45, P = 0.001) had significant influence on the health seeking behavior of the students. There was a general lack of information about menstrual issues and when to seek help. There is a need to educate female college students about menstrual issues in order to improve their health seeking behavior as regards menstrual abnormalities.
 
Age and sex distribution of the injured cases
Seasonal trend of RTAs
Types of injury combination
Article
In the northern states, there is hardly any scientific study except road traffic accidents (RTAs) statistics obtained by the Ministry of Home whereas the main way of transportation is by road. There is the increasing load of motor vehicles on the already dilapidated roadways which has resulted in the increasing trend of RTAs in Assam. To find out the prevalence, probable epidemiological factors and morbidity and mortality pattern due to RTAs in Dibrugarh district. Descriptive study was carried out in Dibrugarh district from September 1998 to August 1999 under the department of Community Medicine. The information was collected from Assam Medical College and Hospital and cross checked with the police report. A medical investigation including interview, clinical and radiological investigation was carried out; in case of fatality, post-mortem examination was examined in details. An on the spot investigation was carried out in accessible RTAs to collect the probable epidemiological factors. RTAs affected mainly the people of productive age group which were predominantly male. Majority of the RTAs were single vehicle accidents and half of the victims were passengers. Accident rate was maximum in twilight and winter season demanding high morbidity and mortality. Head and neck, U.limb and L.limb were commonly involved. RTAs is a major public health problem in Assam which needs more scientific study.
 
Highlights the positive trend both linear and logarithmic for pedestrians and passenger category
Distance traveled and frequency of different types of injuries
Types of RTA and road familiarity
Trend of RTA outcome in relation to admission to the hospital
Article
Road Traffic Accident (RTA) is one among the top five causes of morbidity and mortality in South-East Asian countries.(1) Its socioeconomic repercussions are a matter of great concern. Efficient addressing of the issue requires quality information on different causative factors. What are different epidemiological determinants of RTA in western Nepal? To examine the factors associated with RTA. Prospective observational. Study was performed in a tertiary healthcare delivery institute in western Nepal. 360 victims of RTA who reported to Manipal Teaching hospital in one year. Demographic, human, vehicular, environmental and time factors. Statistical analysis: Percentages, linear and logarithmic trend and Chi-square. Most of the victims i.e. 147 (40.83%) were young (15 to 30 years); from low i.e. 114 (31.66%) and mid i.e. 198 (55%) income families and were passengers i.e. 153 (42.50%) and pedestrians i.e. 105 (29.16%). Sever accidents leading to fatal outcome were associated with personal problems (P<0.01, chi(2) - 8.03), recent or on-day conflicts (P<0.001, chi(2) - 18.88) and some evidence of alcohol consumptions (P<0.001, chi(2) - 30.25). Increased prevalence of RTA was also noticed at beginning i.e. 198 (55%) and end i.e. 69 (19.16%) of journey; in rainy and cloudy conditions (269 i.e. 74.72%) and in evening hours (3 to 7 p.m. 159 i.e. 44.16%). Out of 246 vehicles involved; 162 (65.85%) were old and ill maintained. The contributions of old vehicle to fatal injuries were 33 (50%). Head injury was found in 156 (43.33 %) cases and its associated case fatality rate was 90.90%. In spite of a good percentage receiving first aid i.e. 213 (59.16%) after RTA; there was a notable delay (174 i.e. 48.33% admitted after 6 h) in shifting the cases to the hospitals. The estimated total days lost due to hospital stay was 4620 with an average of 12.83 days per each case. Most of the factors responsible for RTA and its fatal consequences are preventable. A comprehensive multipronged approach can mitigate most of them.
 
Article
Occupational accidents are a major point of concern in industries. The academic community should take the first step to address the long-neglected concerns of occupational safety. To assess the prevalence and pattern of occupational accidents. A record-based, cross-sectional study was done in three tile factories of Mangalore city, in Karnataka. A total of 416 workers were analyzed for the year 2004, and data regarding age, sex, job duration, type and nature of injury, body parts involved, and time of injury were collected in a prestructured proforma. Proportions, Chi-square test, Univariate and Multivariate analysis. The overall prevalence rate of accidents was found to be 18.5%. It was found that almost around 86% of the accidents had affected the limbs (upper limb 24.7%, lower limb 61%), around half (52%) of the injuries were contributed by superficial injuries, 40% of accidents were due to stepping/striking against objects and while handling. Hand tools and machinery in motion contributed to around 20% of the accidents. Accidents were more common among the younger age group and less-experienced workers. Multiple logistic regression analyses revealed that the age group of 30-39 years had an independent significant association with accidents (OR = 0.21, P = 0.04). Accidents in tile industries are an important occupational health problem in this area of the country. There is a need for proper safety training of the workers.
 
Article
Expansion in road network, motorization, and urbanization in the country has been accompanied by a rise in road accidents leading to road traffic injuries (RTIs). Today RTIs are one of the leading causes of deaths, disabilities, and hospitalizations with severe socioeconomic costs across the world. The following study analyses the: Age and sex distribution of injured in road traffic accidents (RTAs).Circumstances leading to RTA.Pattern and severity of injuries sustained in RTAs cases. Retrospective record-based study. The aim of this study was to audit retrospectively the circumstances, severity, and pattern of injury sustained by vehicle occupants presenting to the Saraswathi Institute of Medical Sciences (SIMS) hospital Hapur, for a period of one year. Data were collected using the case sheets of 347 patients from the medical records section of hospital and analyzed using SPSS computer software version 16.0. Results are interpreted in terms of percentage, mean, chi-square, and z-test. The pattern and severity of injuries sustained by 347 vehicle occupants admitted to the emergency department of SIMS, Hapur were retrospectively documented. Male victims 258 (74.35%) were more commonly involved than females 89 (25.65%) and majority of victims 141 (40.63%) were in age group of 20-30 years. Urban victims 222 (64.00%) outnumbered rural. The most frequently injured body regions were the extremities 499 (53.54%), followed by maxillofacial180(19.31%).. Out of total 802 external injuries, the most common type of injury was lacerations 307 (38.28%), abrasions 306 (38.15%)and followed by bruises 154 (19.20%). Multiple external injuries were more common on upper limb 216 (26.93%), lower limbs 210 (26.18%) and face 170 (21.20%), while crush injuries were more predominently seen in both the limbs. While laceration were common on face 120 (38.83%). Injuries to the chest 19 (2.36%), abdomen13 (1.61%), and spine 11 (1.36%) were seen in roughy equal proprotion of victims. The bones on right side 55 (55.55%) were more commonly fractured which is statistically significant. Skull injuries were mostly found on frontal 77 (47.53%), followed by parietal bone 33 (20.37%), mostly on right side. RTAs constitute a major public health problem in our setting. Urgent preventive measures targeting at reducing the occurrence of RTAs are necessary to reduce the morbidity and mortality resulting from these injuries.
 
Article
Domestic accidents are worldwide public health problems. The consequences of a domestic accident may prove disastrous as it may result in disability and loss of productivity. In this context, the present study was carried out to characterize the occurrence of domestic accidents in a semi-urban community. To study the incidence of domestic accident in a semi-urban community and its association with various epidemiological factors. Community-based cross-sectional study of 796 households consisting of 4086 individuals residing in a semi-urban area. Complete information from 796 households consisting of 4086 individuals was collected through semi-structured, pre-tested questionnaire. Domestic accident was considered when any of these individuals had met with an accident inside the house or in the immediate surroundings of the house during the last 6 months from the date of survey. The collected data were tabulated and analyzed. Simple proportions and Chi-squared test. The incidence of domestic accidents was found to be 1.7%. The most common accident reported was fall. Occurrence of falls was found to be associated with age and overcrowding. Other accidents noted were burns, scalds, electrocution, injuries and accidental poisoning. Accidents were reported in significantly higher proportion in extreme age groups and in females. Higher proportion of accidents occurred during the morning and evening hours. About 10.1% were treated at home, 72.5% as outdoor patients and 17.4% as indoor patients. The mean duration of hospital stay was found to be 2 weeks. Full recovery was observed in 82.6% cases, whereas permanent disability was found in only 2.9% subjects, while 14.5% reported chronic pain after the accident. No death related to domestic accident was reported in the present study. Domestic accidents are more common in extreme age groups and in females. The reasons may be the higher amount of time spent at home and greater participation in daily home activities. Falls being the most frequent type of accidents, proper designing of house and adequate illumination may help in reducing their occurrence, as the majority of accidents occurred during the morning and evening hours in our study.
 
Calcutta Medical College (established in 1835)  
King Edward Medical College, Lahore (established in 1860)  
Surgeon Major Sir Ronald Ross (1857-1932)
Article
The evolution of public health in British India and the history of disease prevention in that part of world in the 19th and early 20th century provides a valuable insight into the period that witnessed the development of new trends in medical systems and a transition from surveys to microscopic studies in medicine. It harbors the earliest laboratory works and groundbreaking achievements in microbiology and immunology. The advent of infectious diseases and tropical medicine was a direct consequence of colonialism. The history of diseases and their prevention in the colonial context traces back the epidemiology of infectious diseases, many of which are still prevalent in third world countries. It reveals the development of surveillance systems and the response to epidemics by the imperial government. It depicts how the establishment of health systems under the colonial power shaped disease control in British India to improve the health of its citizens [Figure 1]. Figure 1 Map of British India
 
Myers index by terminal digit
Age ratios by sex for five year age groups
Article
Age is an important variable in epidemiological studies and an invariable part of community-based study reports. The aim was to assess the accuracy of age data collected during community surveys. A cross-sectional study was designed in rural areas of the Yavatmal district. Age data were collected by a house-to-house survey in six villages. An open-ended questionnaire was used for data collection. Age heaping and digit preference were measured by calculating Whipple's index and Myers' blended index. Age Ratio Scores (ARS) and Age Accuracy Index (AAI) were also calculated. Whipple's index for the 10-year age range, i.e., those reporting age with terminal digit "0" was 386.71. Whipple's index for the 5-year range, i.e., those reporting age with terminal digit '0' or '5' was 382.74. Myer's blended index calculated for the study population was 41.99. AAI for the population studied was 14.71 with large differences between frequencies of males and females at certain ages. The age data collected in the survey were of very poor quality. There was age heaping at ages with terminal digits '0' and '5', indicating a preference in reporting such ages and 42% of the population reported ages with an incorrect final digit. Innovative methods in data collection along with measuring and minimizing errors using statistical techniques should be used to ensure the accuracy of age data which can be checked using various indices.
 
Article
The Millennium Development Goals (MDGs) which include eight goals were framed to address the worlds major development challenges with health and its related areas as the prime focus. In India considerable progress has been made in the field of basic universal education gender equality in education and global economic growth. However there is slow progress in the improvement of health indicators related to mortality morbidity and various environmental factors contributing to poor health conditions. Even though the government has implemented a wide array of programs policies and various schemes to combat these health challenges further intensification of efforts and redesigning of outreach strategies is needed to give momentum to the progress toward achievement of the MDGs. The MDGs adopted by the United Nations in the year 2000 project the efforts of the international community to "spare no effort to free our fellow men women and children from the abject and dehumanizing conditions of extreme poverty." The MDGs are eight goals to be achieved by 2015 that respond to the worlds main development challenges. These goals are further subdivided into 18 numerical targets which are further measured by means of 40 quantifiable indicators. Health constitutes the prime focus of the MDGs. While three out of eight goals are directly related to health the other goals are related to factors which have a significant influence on health. Hence the goals and targets are inter-related in many ways. The eight MDG goals are to (1) eradicate extreme poverty and hunger; (2) achieve universal basic education; (3) promote gender equality and empower women; (4) reduce child mortality; (5) improve maternal health; (6) combat HIV/AIDS malaria and other diseases; (7) ensure environmental sustainability; (8) develop a global partnership for development. Ever since Indias independence in 1947 various national health schemes programs and policies have been launched with the view to improve the health status of people. The most recently launched National Rural Health Mission (NRHM) in 2005 aims to improve and strengthen the existing rural health care with the phased increase of funding amounting to 2-3 % of gross somestic product (GDP) as well as to bring out some innovative interventions. In addition the NRHM has addressed two of the major problems identified under the MDGs i.e. poor governance and policy neglect. The half-way point in the time period of achievement of the MDGs has already been crossed. It is therefore crucial to capture Indias achievements toward attaining the MDGs and to analyze the challenges and policies with reference to the goals and targets.
 
Age and sex distribution of patients presenting to the OPDs with urinary tract infections
Year wise distribution of microbiological flora causing urinary tract infections in OPD patients
Percentage distribution of extended spectrum beta-lactamase producing uropathogens isolated over the study period
Year wise representation of the antibiotic resistance profile of various uropathogens to antimicrobials tested
Article
Urinary tract infections (UTIs) are amongst the most common infections described in outpatients setting. A study was conducted to evaluate the uropathogenic bacterial flora and its antimicrobial susceptibility profile among patients presenting to the out-patient clinics of a tertiary care hospital at Jaipur, Rajasthan. 2012 consecutive urine specimens from symptomatic UTI cases attending to the outpatient clinics were processed in the Microbiology lab. Bacterial isolates obtained were identified using biochemical reactions. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method. Extended spectrum beta lactamase (ESBL) production was determined by the double disk approximation test and the Clinical and Laboratory Standards Institute (formerly NCCLS) confirmatory method. Pathogens were isolated from 346 (17.16%) of the 2012 patients who submitted a urine sample. Escherichia coli was the most frequently isolated community acquired uropathogen accounting for 61.84% of the total isolates. ESBL production was observed in 23.83% of E. coli strains and 8.69% of Klebsiella strains. With the exception of Nitrofurantoin, resistance to agents commonly used as empiric oral treatments for UTI was quite high. The study revealed E. coli as the predominant bacterial pathogen for the community acquired UTIs in Jaipur, Rajasthan. An increasing trend in the production ESBLs among UTI pathogens in the community was noted. Nitrofurantoin should be used as empirical therapy for primary, uncomplicated UTIs.
 
Consumption of specific tobacco products across residence and sex  
Article
Tobacco is the leading cause of mortality globally and in India. The magnitude and the pattern of tobacco consumption are likely to be influenced by the geographical setting and with rapid urbanization in India there is a need to study this differential pattern. The aim was to study the rural, urban, and urban-slum differences in patterns of tobacco use. The study was conducted in Ballabgarh block, Faridabad district, Haryana, and was a community-based cross-sectional study. The study was conducted in years 2003-2004 using the WHO STEPS approach with 7891 participants, approximately equal number of males and females, selected using multistage sampling from urban, urban-slum, and rural strata. The analysis was done using the SPSS 12.0 statistical package (SPSS Inc., Chicago, IL, USA). Direct standardization to the WHO world standard population was done to and chi-square and ANOVA tests were used for comparison across three study settings. Self-reported tobacco use among males was as follows: urban 35.2%; urban-slums 48.3%; and rural 52.6% (P value <0.05). Self-reported tobacco use among females was as follows: Urban 3.5%; urban-slums 11.9%; and rural 17.7% (P value <0.05). More males reported daily bidi (tobacco wrapped in temburini leaf) smoking (urban 17.8%, urban-slums 36.7%, rural 44.6%) than cigarette use (urban 9.6%, urban-slums 6.3%, rural 2.9%). Females using smoked tobacco were almost exclusively using bidis (urban 1.7%, 7.9%, 11% in rural). Daily chewed tobacco use had urban, urban-slum, and rural gradients of 12%, 10.5%, and 6.8% in males respectively. Its use was low in females. The antitobacco policies of India need to focus on bidis in antitobacco campaigns. The program activities must find ways to reach the rural and urban-slum populations.
 
Article
The Pre-Natal Diagnostic Techniques (PNDT) Act(1) was implemented in 1996 in view of the falling gender ratio, because of the misuse of sonography machines for prenatal gender determination by doctors. Not much data are available on the perception of the doctors on the PNDT Act. With this background in mind, the present study was undertaken.
 
Model for a multi-sectoral partnership with political commitment
Article
Major noncommunicable diseases (NCDs) share common behavioral risk factors and deep-rooted social determinants. India needs to address its growing NCD burden through health promoting partnerships, policies, and programs. High-level political commitment, inter-sectoral coordination, and community mobilization are important in developing a successful, national, multi-sectoral program for the prevention and control of NCDs. The World Health Organization's "Action Plan for a Global Strategy for Prevention and Control of NCDs" calls for a comprehensive plan involving a whole-of-Government approach. Inter-sectoral coordination will need to start at the planning stage and continue to the implementation, evaluation of interventions, and enactment of public policies. An efficient multi-sectoral mechanism is also crucial at the stage of monitoring, evaluating enforcement of policies, and analyzing impact of multi-sectoral initiatives on reducing NCD burden in the country. This paper presents a critical appraisal of social determinants influencing NCDs, in the Indian context, and how multi-sectoral action can effectively address such challenges through mainstreaming health promotion into national health and development programs. India, with its wide socio-cultural, economic, and geographical diversities, poses several unique challenges in addressing NCDs. On the other hand, the jurisdiction States have over health, presents multiple opportunities to address health from the local perspective, while working on the national framework around multi-sectoral aspects of NCDs.
 
Article
Early childhood developments constitute the foundation of the human development. Early years of the life are the most crucial period for the physical, mental, social, emotional, language development and lifelong learning. In a malnourished child, development of the milestones is delayed. Developmental delays are mainly observed in the areas like vision and fine motors, language and comprehension and personal social development. The delay was noticed to the extent of 7-11 months in these areas in different age groups.(1) In urban areas, nutritional status of the slum children is poorer than their counterparts in the rural areas.(2) Two-third of the preschool children in the urban slum are underweight. According to NFHS-2 of Delhi, 35% of children under 3 years of age are underweight and 37% are stunted.(3) Anaemia is the most frequent malnutrition among the children from the slum community.(4) ICDS scheme, in such scenario of health, occupies a significant place as an intervention in the socially and economically disadvantaged class of the society. The effective outcome of the nutrition services rendered through the Anganwadi centers (AWCs) depends on the knowledge of the anganwadi workers (AWWs) regarding growth monitoring (GM). A sound knowledge of the AWWs strengthens their skills and raises their capabilities to identify the children earliest moving towards malnutrition with the help of regular GM so as to take appropriate and early corrective action for further departure from good health. It also helps them as a teaching tool for empowering the mothers for preventive actions and better nutrition care of their children. Therefore, attempt has been made to discuss knowledge of AWWs about GM activities and the influence of reorientation training on their correct knowledge.
 
Article
A performance target (PT) for the incidence rate (IR) of acute encephalitis syndrome (AES) was not defined by the World Health Organization (WHO) due to lack of data. There is no specific treatment for ~90% of the AES cases. (1) To determine the IR of AES not having specific treatment (AESn) in two countries, India and Nepal. (2) To suggest the PT. This was a record-based study of the entire population of India and Nepal from 1978 to 2011. The WHO definition was used for inclusion of cases. Cases that had specific treatment were excluded. IR was calculated per 100,000 population per annum. Forecast IR was generated from 2010 to 2013 using time-series analysis. There were 165,461 cases from 1978 to 2011, of which 125,030 cases were from India and 40,431 were from Nepal. The mean IR of India was 0.42 (s 0.24) and that of Nepal was 5.23 (σ 3.03). IRs of 2010 and 2011 of India and that of 2011 of Nepal were closer to the mean IR rather than the forecast IR. IR of 2010 of Nepal was closer to the forecast IR. The forecast IR for India for 2012 was 0.49 (0.19-1.06), for 2013 was 0.42 (0.15-0.97) and for Nepal for both 2012 and 2013 was 5.62 (1.53-15.05). IRs were considerably different for India and Nepal. Using the current mean IR as PT for the next year was simple and practical. Using forecasting was complex and, less frequently, useful.
 
Article
To assess the adherence to antiretroviral therapy (ART) in the human immunodeficiency virus (HIV)-infected population in India. Systematic review and meta-analysis. The Medline and Cochrane library database were searched. Any prospective or retrospective study enrolling a minimum of 10 subjects with a primary objective of assessing ART adherence in the HIV population in India was included. Data were extracted on adherence definition, adherence estimates, study design, study population characteristics, recall period and assessment method. For metaanalysis, the pooled proportion was calculated as a back-transform of the weighted mean of the transformed proportions (calculated according to the Freeman-Tukey variant of the arcsine square root) using the random effects model. There were seven cross-sectional studies and one retrospective study enrolling 1666 participants. Publication bias was significant (P = 0.003). Pooled results showed an ART adherence rate of 70% (95% confidence interval: 59-81%, I(2) = 96.3%). Sensitivity analyses based on study design, adherence assessment method and study region did not influence adherence estimates. Fifty percent (4/8) of the studies reported cost of medication as the most common obstacle for ART adherence. Twenty-five percent (2/8) reported lack of access to medication as the reason for non-adherence and 12% (1/8) cited adverse events as the most prevalent reason for non-adherence. The overall methodological quality of the included studies was poor. Pooled results show that overall ART adherence in India is below the required levels to have an optimal treatment effect. The quality of studies is poor and cannot be used to guide policies to improve ART adherence.
 
Article
Adherence to therapies is a primary determinant of treatment success in HIV/AIDS. Poor adherence attenuates optimum clinical benefits and therefore reduces the overall effectiveness of health systems.(1) It is often said that the most effective regimen for an HIV-infected individual is the one they will take. Both patients and healthcare providers face significant challenges with respect to adherence to antiretroviral therapy (ART). Once initiated, highly active antiretroviral therapy (HAART) is a life-long treatment that consists of multiple medications to be taken two to three times a day with varying dietary instructions. These medications also have side effects, some of which may be temporary, while others may be more permanent requiring a change of treatment. Unlike other chronic diseases, the rapid replication and mutation rate of HIV means that very high levels of adherence are required to achieve a durable suppression of viral load. Inadequate adherence to treatment is associated with detectable viral loads, declining CD4 counts, disease progression, episodes of opportunistic infections, and poorer health outcomes.(2,3) India-specific data on adherence is sparse. In the light of the expansion of free ART in the country, there is a need to learn what works and what does not. The reasons for non-adherence to ART need to be studied in order to identify patients who may need support in maintaining adherence and explore the means to do so.
 
Article
The current study was conducted to determine the effect of adiposity on vascular distensibility in Gujarati Indian adolescents as research indicating the pathogenesis of hypertension among overweight and/or obese Indian adolescents is scant and ethnic differences exist in the pathogenesis of hypertension A cross-sectional study was conducted on 488 Gujarati Indian adolescents of 16-19 years age group. Adiposity was assessed in terms of BMI, Body Fat %, Fat Mass, Fat Mass Index and Waist Circumference. Arterial blood pressure was recorded and pulse pressure (PP) was calculated using the standard equation based on the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP). Pearson's correlation coefficient was determined to find the association between the markers of adiposity and SBP, DBP and PP. A significant positive correlationship was found between adiposity and PP in boys. However, no significant correlationship was found between adiposity and PP in girls. An increase in total as well as visceral adiposity is probably associated with a decrease in vascular distensibility in the Gujarati Indian adolescent boys but not in girls, thus indicating a protective role of female sex hormone estrogen which has been shown earlier to protect the vasculature from atherosclerosis, endothelial dysfunction which occurs with increase in adiposity.
 
Sociodemographic characteristics of the respondents
Distribution of study population based on consumption of tablets
Distribution of study population according to the reason for not consuming tablets
Distribution of study subjects according to compliance (DEC+albendazole)
Article
Lymphatic filariasis (LF) is endemic in 83 countries and territories, with more than a billion people at risk of infection. In view with the global elimination, mass drug administration (MDA) with single dose of diethylcarbamazine and albendazole tablets was carried out for the eligible population in Bagalkot and Gulbarga districts. Assess coverage of MDA against LF in Bagalkot and Gulbarga districts. In this cross-sectional coverage evaluation survey, one urban and three rural clusters were selected randomly in each district. The data were collected in a pretested performa, computed and analyzed using SPSS-10 to calculate frequencies and proportions. A total of eight clusters in two districts resulted in a total study population of 1,228 individuals. The overall compliance rate in Bagalkot district was 78.6% and in Gulbarga district it was only 38.8%. The prime reason for noncompliance was fear of side effects and not received tablets. There is an urgent need for more effective drug delivery strategies to improve the compliance in both the districts.
 
Month-wise distribution of dengue cases during 2002–2008 (n=466)
Article
India is one of the seven identified countries in the South-East Asia region regularly reporting dengue fever (DF)/dengue hemorrhagic fever (DHF) outbreaks and may soon transform into a major niche for dengue infection in the future with more and more new areas being struck by dengue epidemics To study the clinical manifestations, trend and outcome of all confirmed dengue cases admitted in a tertiary care hospital. Record-based study conducted in a coastal district of Karnataka. Required data from all the laboratory confirmed cases from 2002 to 2008 were collected from Medical Records Department (MRD) and analyzed using SPSS 13.5 version. Study included 466 patients. Majority were males, 301(64.6%) and in the and in the age group of 15-44 years, 267 (57.5%). Maximum number of cases were seen in 2007, 219 (47%) and in the month of September, 89 (19.1%). The most common presentation was fever 462 (99.1%), followed by myalgia 301 (64.6%), vomiting 222 (47.6%), headache 222 (47.6%) and abdominal pain 175 (37.6%). The most common hemorrhagic manifestation was petechiae 84 (67.2%). 391 (83.9%) cases presented with dengue fever, 41 (8.8%) dengue hemorrhagic fever, and 34 (7.3%) with dengue shock syndrome. Out of 66 (14.1%) patients who developed clinical complications, 22 (33.3%) had ARDS and 20 (30.3%) had pleural effusion. Deaths reported were 11(2.4%). Community awareness, early diagnosis and management and vector control measures need to be strengthened, during peri-monsoon period, in order to curb the increasing number of dengue cases.
 
Top-cited authors
Sanjeev Kumar Gupta
  • All India Institute of Medical Sciences
Baridalyne Nongkynrih
  • All India Institute of Medical Sciences
Pradeep Kumar
  • Gujarat University
Sanjiv Kumar
  • Indian Academy of Public Health
H M Swami
  • Government Medical College & Hospital