Indian Journal of Forensic and Community Medicine

1-6

Authors: Geetu Singh, Bhakt Prakash Mathur, Shobha Chaturvedi, Preeti Rai, Disha Agarwal

Introduction: As Sub-centres are the first contact point with the community, the success of any nationwide programme would depend largely on the well-functioning Sub-centres providing services of acceptable standard to the people. Objective: Literature reviewed shows few studies on monitoring and supervision aspect of subcentres reflecting need to further assess this domain. In the above context, this study was carried out to highlight the monitoring, supervision and quality control at subcentres in district Jhansi. Material and Methods: This was a crosssectional study in district Jhansi from 2012-2013.20 subcentres were selected and ANMs from selected centres were interviewd. Results:All ANMs prepared the Sub- Centre plan for the year, they had due list of beneficiaries for all villages under subcentres. Supervision and record checking at periodic intervals by the male and female health supervisors from PHC (at least once a week) and by MO (at least once in a month) was done only at 50 -60% of subcentres. Citizen's charter in local language was displayed at none of subcentres. Availability of various guidelines issued by GOI or State Govt was absent in all subcentres. Conclusion:The study concludes that monitoring of subcentres need to be strengthen to ensure efficient working of human resources and appropriate utilization of various services by community.

13-22

Authors: Suchitra Lisam

Background: The introduction of a three years Diploma in Medicine and Rural Health Care (DMRHC) course in 2005 under the purview of Assam Public Health Act has lead to augmentation of human resources through deployment of Rural Health Practitioners (RHPs) in Assam, India. Objectives: The study aimed to understand the performance of Sub-Centers (SCs) in terms of ranges, uptake and quality of primary health care services in SCs with and without RHPs over consecutive three years since deployment of RHPs at Health Sub-Centers (HSCs) in April, 2008. Methods: We used mixed research method i.e. qualitative technique complemented by quantitative analysis of data. Purposive sampling method was adopted for selection of HSCs in High Focus Districts (HFDs) where RHPs were deployed. Key Informant (KI) interviews were conducted comprising of RHPs, Auxiliary Nurse Midwives (ANMs), beneficiaries and government officials to gain perspectives about RHP model, service delivery and challenges etc. Semi structured, open-ended questionnaires were used for KI interviews and checklists for community group discussions. Results: Performance of HSCs with RHPs has improved substantially in terms of management of Out Patient Department (OPD) cases and institutional deliveries as compared to HSC without RHPs over the years from 2010-11, 2011-12 and 2012-13. RHPs cited DMRHC was apt for serving the rural population. Key challenges include lack of referral transport, housing and promotion avenues. ANMs, beneficiaries and community perceptions of RHPs are positive in terms of managing increased number and types of common ailments, drugs availability, improved care, proper referral and initiation of institutional deliveries. RHPs had gained community‘s confidence in service delivery at HSC. Conclusions: Replication of RHP model is critical for improved rural health care systems, provided supervisory and support mechanisms are streamlined. Recognition of DMRHC, upgrade to a Bachelor’s degree course and creation of regular cadre is necessary for sustainability of rural health systems.

29-34

Authors: Shankar M Bakkannavar, Pradeep Kumar G, Vinod C Nayak, Ganesh Rajendiran, Swati Chhikara,

The violent deaths are increasing day by day in the developing world. Deaths due to asphyxia are one of the most important causes in the violent deaths. One hundred and thirty five asphyxial deaths were studied by the authors and described various epidemiological and demographical parameters of these deaths in the present study. The changing demographics and the increased incidence and variations observed are described here. Males outnumbered females in asphyxial deaths. Most common age group involved was 21 – 30 years. Hanging was the most common method of death constituting 56.3% of cases. Majority of the hanging cases took place in homes with suicide being the preferred manner. The victims drowned in river in most number of cases followed by well. The strangulation deaths constituted for 8.8% of total asphyxial fatalities. But not a single case of suffocation was reported.

43-49

Authors: Neeta PN, Prashanth N, Shivaswamy MS, Shilpa K, Mallapur MD

Background: Risks of milk-borne zoonoses posed by the informal market are amplified by poor handling procedures in the market, the lack of quality standards and the fact that most consumers prefer raw milk over pasteurized milk. Objective: To evaluate microbial quality and health risks associated with consumption of raw milk. Methods: A community based cross sectional study was done among 250 households to assess knowledge regarding health risks associated with consumption of raw milk. Microbial quality assessment was undertaken by evaluating 10% of households (25) by collecting 50mL of raw milk, in rural area of Karnataka. Milk quality was assessed using a combination of tests in order to quantify the occurrence of Brucellosis (milk ring test, BMRT), Coliform bacteria (coliform test, CT). Methylene blue reduction test (MBRT) and Specific gravity was used as an indicator of adulteration. Results: None of the participants had knowledge that milk can transmit the diseases. But one third of them could name some reasons for milk contamination as addition of water, unclean handling, utensil or animals. Among randomly selected 25 samples, 13 milk samples were from own house animals and 12 were from vendors. Mean specific gravity was 1.0250 ± 0.007. Nine samples (36%) showed positive results for CT and MBRT; whereas 2 samples (8%) were positive for BMRT. Conclusion: It can be concluded that raw market milk in the study area is of poor bacteriological quality and hazardous for human consumption. This highlights the need to implement good hygiene practices and effective monitoring from production through the delivery chain to the consumer. Further studies are needed for detection of standard plate count for E.coli, toxins that are produced by E. coli, other pathogenic spore forming bacteria (Bacillus spp& Clostridium spp) and other harmful microorganisms.

56-63

Authors: Gourikumari Padhy, Rabi Narayan Padhy, Sangeeta Das, Abhisek Mishra

On the evening of October 12, 2013 a very severe tropical cyclone, Phailin, brought damaging winds of more than 220 kilometres per hour (km/h), storm surges of up to 3.5 metres and torrential downpours to the eastern Indian states of Odisha. The impacts of Phailin and ensuing floods affected more than 13.2 million people, and caused enormous damage .The estimated total damage to houses, crops and public properties was 14373.47 crore. There was massive destruction of power supply system, communication and transportation system. However, early warning alerts, disseminated four days before landfall of Phailin, allowed for the evacuation and relocation of approximately 1.2 million people, resulting in the largest evacuation operation in India in 23 years. A total of 21 lives were lost as a result of the cyclone and an additional 23 lives due to severe flash flooding in the aftermath of the cyclone. A comparable cyclone, Cyclone 05B, hit Odisha in 1999 with winds of up to 260 km/h, but had a much more than 10,000 lives were lost. Early warning using multiple channels of communication and timely action saved lives during Phailin. Government cooperation, preparedness at the community level, and lessons learned from Cyclone 05B contributed to the successful evacuation operation, effective preparation activities and impact mitigation. This event exhibits the importance, benefits and effectiveness of the use of early warning for a massive disaster. The lesson learnt from this event can act as a guide for development of plan for management of other similar disasters in future.

67-70

Authors: Vinod C Nayak, Shankar M Bakkannavar, Somshekhar Sharma, Manu Sharma, Ranjit Immanuel James, Baishwa

Paraquat is one of the most dangerous poisons in the medical field as Ingestion of small quantities (>10mL) may damage lung irreversibly and also lead to renal failure causing to death. The paraquat is sold in more than 130 countries around the world to be used in small as well as large farms. The easy availability of this poison makes it a commonly employed agent for suicide. More than 93% of deaths due to paraquat poisoning are suicidal in nature and most of them are occurring in developing countries. The clinical features vary from case to case based on the amount and type of compound consumed. As it is a fatal condition, early diagnosis and proper management is warranted which can reduce the morbidity and mortalities. But sometimes early diagnosis may not save the victim as in our case. We present a case wherein the victim succumbed to acute respiratory distress following consumption of paraquat.