The Journal of Community Health Management

154-159

Authors: Donald S. Christian, Mansi Patel

Medical or Clinical Audit is a tool that evaluates quality of care and patient satisfaction in clinical practice. It deals with many things like data, documents, resources, performance, standards etc. It is a cyclical process. The paper describes medical audit in relation to its contribution to health care services and the improvement of care. The research from various sources across the globe was evaluated. The barriers and facilitators of clinical audit were identified. Despite of the fact that it has some pros and cons, medical audit should become an integral part of the medical management. The process and the types of medical audit were also analyzed in the article. The differences between audit and feedback were also determined.

168-178

Authors: Abhishek Dixit, Diksha Prakash, Samir Kumar, Mousumi Mutsuddi, OPS Maurya, S P Singh, Abhishek Chand

Aim: To investigate the role of the methylenetetrahydrofolate reductase (MTHFR) 677C>T polymorphism in a large cohort of patients with POAG. Methods: genetic analysis of 80 patients of POAG and 80 controls was done for MTHFR 677C>T polymorphism using PCR. Results: The C677T genotype is found to be very significantly associated with POAG) as compared to the controls. There is a significant difference in the frequency of distribution of genotype. The homozygous mutant genotype (TT) is also 1.25% more in cases as compared to controls. Conclusion: There is significant association of MTHFR 677C>T polymorphism with POAG.

187-194

Authors: Samir Kumar, Diksha Prakash, Reshmee Boodoo, OPS Maurya, Sanjay Singh, Abhishek Chandra

Aim: To estimate Intracameral concentration of Moxifloxacin applied topically in different schedule. Methods: Measurement of moxifloxacin was done in Aqueous aspirated before cataract extraction of different patients instilling topical drug in different schedule. Results: Significant difference was found between drug concentration of two groups, one instilling single drop of drug 30 min before surgery( 1.20 ± 0.43 µg/ml) and other, instilling 4 drops a day before and one drop on day of surgery (1.80 ± 0.34 µg/ml). Conclusion: Instilling moxifloxacin drops 1 day before cataract surgery results in higher concentration and is effective in endophthalmitis prevention.

199-204

Authors: Amitabha Dan, Kunal Kanti De, Pasi A R, M Jalaluddeen

Background: As per National Rural Health Mission (NRHM), India launched ASHA programme in the year 2006, to bridge the gap between health services and the underserved population of community. We conducted a study in Murshidabad district of West Bengal to describe socio-demographic profile, recruitment process and perceived reason for joining the health services. Methods: We conducted a cross sectional study among 237 ASHAs and the result was analysed in Epi info. Results – Of the total 237 ASHAs interviewed, one third (n=79) ASHAs were Muslims in that district where two third of the population belonged to the same religious community and one third were not local residents of their areas. More than 90% of the ASHAs were recruited by village pradhan and or village panchayat. Majority (44%) joined for financial benefits. Majority (67%) of the ASHA had to serve more than 1000 populations and only 10% of the ASHA were trained in module 6 & 7. Conclusion: Recruitment process of ASHA was not in line with the prescribed guideline and reasons for joining the services as perceived by ASHAs was not matching with the programme objective.

209-224

Authors: Subrata Chanda

Background: World Health Organization has estimated that tobacco use (smoking and smokeless) is currently responsible for the death of about six million people across the world each year with many of these deaths occurring prematurely. This total includes about 600,000 people are also estimated to die from the effects of second-hand smoke.1 The provision of educational interventions in combination with systematic outreach practice-based support could be an effective strategy to engage smokers in smoking cessation activities2. As the evidence for harmful effects of tobacco use has mounted, epidemiological research has progressed from simply identifying health risks associated with smoking to more detailed studies of the long-term effects of different smoking behaviours on mortality and morbidity.3. Search methods: Electronic database searches were conducted using the following keywords; smoking cessation education intervention randomized controlled trials. Studies were included if they were used- (1) randomized or controlled designs, (2) controlled before and after trials designs, and (3) designs that presented objective and (4) interpretable measures of smokers behaviour and smokers quit rates, (5) articles written in the English language. An effect size (ES) was calculated for every outcome measure reported, risk ratio, calculated as: (number of quitters in intervention group/ number randomized to intervention group) / (number of quitters in control group/ number randomized to control group).4 Meta-analysis is performed using a Mantel-Haenszel fixed-effect method to estimate a pooled risk ratio with 95% confidence intervals.5 Results: A total of 26 trials met the inclusion criteria for comparisons in this review. The study failed to detect evidence that education based strategies was more effective than a similar intensity of non educational format. There was limited evidence that the addition of Education Based interventions (EBIs) to other forms of treatment, such as nicotine replacement, produced extra benefit. Conclusions: There is not enough evidence to evaluate whether Education Based interventions (EBIs) are more effective than other non educational intervention. Identifying the most effective and cost-effective education based intervention for different populations of smokers is still an area for research. However Education Based interventions (EBIs) are likely to be effective when used independent of pharmacotherapy.

95-96

Authors: Ruhi Varghese, Minakshi Rai

The Journal of Community Health Management is a peer reviewed journal and an official publication of Innovative Publications. The journal publishes papers, original research articles, editorials on Preventive Medicine, Community Health, Health Management, Health Statistics, Biostatics, Nutrition, Epidemiology and Health Services Research. All correspondence to the Journal be made to the Chief Editor, The Journal of Community Health Management (JCHM).

104-110

Authors: J K Mishra, Usha Singh, Ragini Tilak, S K Meena, G Singh

Background: Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus mycelia that colonize in the bronchi. The susceptibility of asthmatic patients to develop ABPA is not fully understood. Aim: To evaluate the clinical, immunological, microbiological and radiological features of Aspergillus infection in patients with asthma. Methodology: 50 Patients with Bronchial Asthma as cases and 20 age and sex matched non asthmatic individuals as controls were selected for study from OPD of Department of TB and Respiratory Diseases, University Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi during the period of January 2013 to July 2014. Various clinical, immunological, microbiological and radiological features of aspergillus infection in patients were recorded. The observed data was analyzed and intergroup comparisons were done. Result: In patients of bronchial asthma with positive aspergillus the percentage of presence of breathlessness, cough, family history, allergic rhinitis, history of ATT intake, AEC, IgE, IgG, BAL and CECT Thorax lied between 62.5% to 100% and most of these showed statistically significant difference. Conclusion The development of ABPA is probably the combination of many genetic susceptibility factors. Understanding of the genetic risks and immuno-pathogenesis of ABPA will lead to early diagnosis and improved treatment of ABPA.

120-126

Authors: Kshitij Raj, Hari Shankar

Introduction: There has been growing concern about nutritional status of Indian young population especially girls. This study was planned to find out nutritional status of nursing students using BMI and their knowledge about obesity. Method: A cross sectional study was conducted at college of nursing, IMS, BHU among 112 nursing students by using a pre-tested, semi-structured questionnaire. The weight and height was taken at that time. Data analysis was done by using excel. Result: Out of 128 girls 42.2 % were undernourished with BMI <18.5 and 17.2% out of 29 boys were undernourished. Family size, type of ration card, year of study, source of drinking water and per capita monthly income seems to have no role on BMI. About 18.5% of students think that substance abuse does not contribute to obesity. 29.3% of nursing students do not consider obesity as a disease. Conclusion: Though Indian govt. is running programs nutrition supplementation and upliftment, even in educated individuals the percentage of under nutrition is high. Malnutrition leads to vicious cycle of disease occurrence and malnutrition.

140-143

Authors: Gopalakrishnan. S, Anand Shankar, Rudhra Thampi. M.S.

Ageing is a universal process and inevitable. With the increase in life expectancy the percentage of old people in the population has increased dramatically. Industrialization, urbanization, education and exposure to western culture have brought about changes in our values and lifestyles. There are more than 76 million elderly people in the country who constitute 77% of India’s population. By the year 2020, the estimated population of the elderly with be 142 million or about 11% of the country’s population.1 There are certain general points that emerge out of the demographic trend: (1) The rate at which the size of the elderly population is increasing is higher than that of the general population. (2) The increase in the number of elderly women is much more than in case of men. (3) The percentage of elderly persons working is declining, particularly in the case of women. (4) Nearly two-thirds of elderly women will be widows, while only 22% of elderly men will be widowers. (5) A large population of the elderly population will continue to live in poverty, or at the subsistence level, and will also remain illiterate.

56-57

Authors: KS Patel, Ruhi Varghes, Swami PGN, Ravindra HN

The Journal of Community Health Management is a peer reviewed journal and an official publication of Innovative Publications. The journal publishes papers, original research articles, editorials on Preventive Medicine, Community Health, Health Management, Health Statistics, Biostatics, Nutrition, Epidemiology and Health Services Research. All correspondence to the Journal be made to the Chief Editor, The Journal of Community Health Management (JCHM).

64-67

Authors: Kumara N

A study was conducted in Tumkur District Hospital of Karnataka state to evaluate the Management and Regulatory Capacity to how Resources like men, money, materials are used effectively to achieve goals / objectives. A sample of 100 respondents was selected randomly from Specialists, Ministerial Staff, Staff Nurse, technical / supporting staff and group D staff of 20 each. If the recourses not utilized properly resulted in failure of organizational objectives and programme failed. Coordination effort is essential to utilize recourses effectively by motivation. It was revealed that 87 % of staff expressed the good availability of funds (money) and 13 % not knowing the fund availability. There is a vacancy of 118 posts (35.65 %) against the 331 sanctioned post and 66 equipments (13 %) out of 508 were not working as a result patients treated reduced to 3302 in 2013-14 with a total of 104679 patients against the total patients treated in 2012-13 were 107981. From the study it is clear that 33.56 % vacant posts and 13 % of the equipments not in working condition resulted in treatment of patient reduced by 3302 compare to last year 2012-13 of 107981.

72-74

Authors: S C Mohapatra, Avinash Sunthlia, Sabiya

Background: Antenatal care is the systemic medical supervision of women during pregnancy. Its aim is to preserve the physiological aspect of pregnancy and labour and to prevent or detect, as early as possible, all that is pathological. Early diagnosis during pregnancy can prevent maternal ill health, injury, maternal mortality, infant mortality and morbidity. Methodology: It was thus decided to carry out a community based longitudinal study in an urban area at Community health centre, Shahganj, Jaunpur district to observe the effects of the time of antenatal registration, number of antenatal visits, iron folic acid supplementation on the birth weight of the new born. A total of 150 cases were studied who attended the hospital and the information was collected using a pre-tested questionnaire. Results: Out of total 150 pregnant females studied, low birth weight was found in 18.2%. The birth weight of the infant was seen to improve significantly after increasing the number of antenatal visits. Women who had no iron and folic acid supplementation had a higher percentage of low birth weight babies. Lower haemoglobin levels were found to be significantly associated with low birth weight.

82-84

Authors: Mir Insha Ali, Neyaz Ahmed

This article describes terminal illness and in the way that can be understood and related from a psychosocial viewpoint. The diagnosis of terminal illness disturbs the person’s biological, psychological, social and spiritual aspects of life. A person who is suddenly struck with news of his inevitable mortality approaching sooner than thought goes through several turbulences and disturbances. It has a great impact and affects both his internal as well as his external world. This pain is experienced differently by each person but has a universality of undergoing various kinds of psychological and social disturbances are the same. In dealing with this condition a person goes through several stages of awareness. The social circle of the affected person is also greatly impacted, and the near and dear ones play a big role in social and moral support of the patient. The frustrations and agonies of dealing with such a shock require courage and a sense of acceptance.

89-94

Authors: Awdhesh Kumar, S. C. Mohapatra

Introduction: Gerontology or geriatrics medicine which s a branch of medicine deals with disease of the old age. Aging process is inevitable, irreversible, progressive once it starts, always associated with physical and biological decline. Aging process is inevitable, irreversible, progressive once it starts, always associated with physical and biological decline. In present study we consider geriatric age (elderly) ≥60 years. Aim of the study: To determines the epidemiological features and highlight outcome of geriatric unnatural deaths in Varanasi area. Material & method: The present retrospective study has been conducted for the period of 5 consecutive years i.e. 2009 to 2013 based on autopsy record of the unnatural death cases among elderly individuals deaths. During study period total numbers of unnatural death cases were 10195 and deaths among elderly were 1310.These cases were brought to the Department of Forensic Medicine, IMS, BHU, Varanasi and have been analyzed retrospectively. Result: geriatrics autopsy 12.85% of total unnatural deaths. In present study we consider geriatric age (elderly) ≥60 years. Male to female ratio were 3.68:1. Most of the deaths were accidentals i.e. 626 cases (17.79%). Road traffic accidents 567 cases 43.28% were more common. Rural habitat out numbers 73.89% urban habitat only 4.81%. Hindu out numbers 76.03%, Muslim 2.52%. Summer season 480(36.64%), rainy season 422(32.21%) and in winter season 408(31.15%).Conclusion: Analysis of data for retrospective study suggests that prevalence, age, gender, manner of death, cause of death, habitat, religion and seasonal variations significantly affect community.

1-4

Authors: SC Mohapatra

The Journal of Community Health Management is a peer reviewed journal and an official publication of Innovative Publications. The journal publishes papers, original research articles, editorials on Preventive Medicine, Community Health, Health Management, Health Statistics, Biostatics, Nutrition, Epidemiology and Health Services Research. All correspondence to the Journal be made to the Chief Editor, The Journal of Community Health Management (JCHM).

13-16

Authors: Shravan K. Mishra, Avinash Sunthlia,SC Mohapatra

The concept of well baby clinic has been fading away in the lives of under 5 care, IMNCI or neonatology programs; of late. However, the stand of well baby clinic encompasses more proactive health than all other under 5 clinic programs. It was thus decided to carry out a comparative study of well baby clinics in the Army and Civil Hospitals of Allahabad; giving importance to the quality of care of well baby clinics was categorized by the score developed by the researchers. A total of 389 children were observed in the Army hospital as compared to 290 in the civil hospital. Over the past 2 decades, researchers have explored the quality of various child care settings and its effects on children. Key indicators of quality include the relationship between the child and the caregiver and structural characteristics of the child care setting, such as the child-to-adult ratio, the size of each group of children, and the formal education and training of caregivers. These two aspects of quality are often inter-related (White Book M et al., 1993). Results: The immunization coverage of BCG was to the tune of 89.97% in Army hospital as compared to 97.99% in city hospital coverage of measles was 92.94% in Army and 91.11% in Civil hospital. However the polio and DPT vaccine coverage in the Civil Hospital who double that of Army hospital.

22-28

Authors: Naveen Kumar Mishra

As far as river basin cities are concerned they have complete dependency over the river. In Varanasi, issues that require immediate attention to protect and conserve the Ganga River are (i) Garbage Dumping, (ii) Proper Sanitation, and (iii) Proper Sewage Treatment. River pollution means the presence of any foreign substance (organic, inorganic, radiological and biological) in the water of the river, which tends to degrade the quality of water. Though eight Indian states discharge their wastes into the river. In Varanasi also Nagar Nigam sewage constitutes 60 per cent by volume of the total waste that is dumped into the Ganges, and industries contribute about 15 percent of river pollution. The industrial wastes are smaller in volume but they have far more dangerous impacts than the sewage pollution in the river. Both, however, enters in the river largely untreated. Road sweeping waste (75%) and commercial waste comprises the maximum percentage of solid waste generated. Commercial waste is about 80 Million Tons per day Industrial waste is 15 Million Tons per day. As far as the relationship between the garbage and river is concerned there is direct relationship between the garbage and the river Ganga because Ganga is not only polluted by sewage disposal but poor solid waste disposal management is also responsible for the contamination of the river.

33-42

Authors: Rohitkundap, Diksha Prakash, Amit Rai, Shashikant Patne, Samir Kumar, OPS Maurya, Abhishek Chandra

Aim: Identification of human limbal stem cell by p63, a specific stem cell marker in cadaveric limbal tissue and in in-vitro limbal stem culture. Methods: Identification of limbal stem cell was done on cadaveric limbal biopsy sample using immuno-histo-chemistry analysis with p63 staining and a secondary anti mouse (GOAT) Fab fragment antibody staining. In- vitro cultured limbal stem cells over amniotic membrane were also stained by p63 marker. Results: Basal layer of limbus shows intense staining for p63. Stained cells showed brown color (due to DAB chromogen). There was no uniform staining of basal layer. Some cells showed intense staining while other cells did not show stain. This indicates that limbal stem cells are not uniformly distributed in basal limbal layer but are present in small groups. The time taken by human limbal epithelial cells to form a monolayer on denuded amniotic membrane was 2-3 week and 4-6 layers sheet was obtained after 4 weeks. Conclusion: p63 was maximally expressed in limbal basal layer which is highly mitotic layer and is responsible for epithelial cell proliferation. Similarly p63 also stained cultured stem cells over denuded amniotic membrane which proves that cultured limbal cells have high mitotic activity and therefore are true stem cells rather than differentiated epithelial cells.

47-50

Authors: J K Mishra, Rashid Parvez, Usha, Girish Singh

Asthma is a disorder defined by its clinical, physiological, and pathological characteristics. The predominant feature of the clinical history is episodic shortness of breath, particularly at night, often accompanied by cough. The main physiological feature of asthma is episodic airway obstruction characterized by expiratory airflow limitation. The dominant pathological feature is airway inflammation, sometimes associated with airway structural changes. This immunological study on bronchial asthma was conducted at Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi in the year 2010. Based on clinical history one group of 70 cases with history of asthma and other group of 36 controls with no history of asthma were made. The mean serum level of IL-4, IgE, and AEC was observed significantly higher in cases as compared to controls whereas; mean IFN- γ as well as FEV1 were observed significantly lower in cases as compared to controls. The cut-off values at appropriate sensitivity and specificity using ROC curve for IL-4, IFN- γ, IgE, AEC and FEV1 were found as 7.25, 0.35, 225, 345 and 79.50 respectively. The imbalance in the serum levels of IL-4 and IFN- γ is predicted to drive the asthma pathogenesis while reducing IgE levels may now be considered as a treatment strategy.