The Journal of Community Health Management

47-48

Authors: S.C. Mohapatra, Paramita Sengupta, VP Gupta

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).

55-58

Authors: Sarita Tripathi, TB Singh, Kusumakar Gautam, Indira Bishnoi

Background: Mass media plays a significant role in strenghring the rural resources of the individual as well as the whole society and motivating the families for the adoption of new technologies. Mass media like Television, News paper, Radio, Magazines are playing a key role in information dissemination to rural population of the community. It may be more effective if the centers of information sources, their availability and utilization pattern is known to media planners. Taking this drawback, the present study was conducted with the objective to know the utilization pattern of information sources among the families residing the rural areas of Kacchehriya village of Varanasi district. Most of the village populations were engaged in vegetable production. Total agriculture land was approximately100 acre of the village with population of nearly three thousand.

64-66

Authors: Shavi Garg, Sushil Kumar Srivastava, Vishal Singla, Ashish Singla

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).

72-74

Authors: V P Gupta, Patel Puja Bharat, Anuj Kamboj, Bharat Paul, S C Mohapatra

Iodine is one of the essential micronutrients required for the normal mental and physical well being of human beings. Iodine Deficiency Disorder (IDD) has been considered as major public health problem in India including Mewat. The present goiter survey was done in Mewat district with the objective of estimating the prevalence of goiter in primary school children, of age six to twelve years. 1050 children from six to twelve years were clinically examined for the presence of goitre during survey. Overall goitre prevalence rate was 15.2%. Prevalence was significantly higher among females than males (P=0.039). Age-specific prevalence rate (ASPR) was higher in 9 to 12 yrs age group as compared to 6 to 8 yr age group and it was statistically significant.

80-84

Authors: Karan Talreja, Ladusingh Rajput, Pooja Thawani

Context: Government is trying diligently to reduce the sale of tobacco products among the consumers by taking proactive measures like mandatory statutory and pictorial on the tobacco packaging. This study was conducted to check the effectiveness of such warnings amongst consumers. Aim: To assess the effect of statutory and pictorial health warning among individuals consuming smokeless tobacco product. Settings and design: The questionnaire study was conducted among 203 smokeless tobacco consumers of Pune from 01st August to 30th August 2015. Material and Methods: 203 consumers formed the sample size of the study. 12 closed ended questions were asked by interview method. The responses were collected, tabulated and analysed. Statistical Analyses used: Descriptive analysis. Results: Mean age of the study participants was 37.67±8.14 ranging from 23-65. 198(97.5) of the study participants were aware of the pictorial warning. Though 157(77.3) wanted to quit tobacco, 33(18.2) were not able to understand pictorial warning. Conclusion: It was concluded that though there was awareness about pictorial and statutory warnings which are found to be effective tools to help consumers quit tobacco. Poor quality of packaging and absence of warnings on few of smokeless tobacco did not serve the purpose.

92-95

Authors: Sebastian N.M, Sheela P. Haveri, Jesha M.M

Background and Objectives: India is facing the dual burden of non-communicable disease along with communicable diseases. High prevalence of hypertension, diabetes and their risk factors are being reported in India. For reducing the high cost of health care and premature loss of life these risk factors are to be identified early and controlled. This study aims to estimate the burden of diabetes, hypertension, renal failure and risk factors like overweight, smoking, over use of alcohol and physical inactivity among a rural community in Kerala, India. Methods: A survey was conducted among an estimated sample of 802 adults aged 20 years and above in a rural Panchayat in northern Kerala. The presence of diabetes, hypertension and renal diseases among the subjects were obtained from medical records and treatment history. Data on smoking, alcohol consumption and physical activity were obtained by interview, and Body mass index and blood pressure were obtained by measurement. Prevalence rates were obtained by data analysis using computer software. Results and Interpretations: The mean age of subjects was 47.1(CI = 46 to 48.2). The prevalence of hypertension was 25.7% and diabetes 21.3% (already diagnosed cases only) and 10.3% of subjects had both. 5.7% of subjects had chronic kidney disease already diagnosed indicating inadequate control of diabetes and hypertension. Smoking was reported by 37.2% of men, regular alcohol consumption by 2.5% men and low level of physical activity by 17.7% of all. Conclusions: There is high prevalence of hypertension and diabetes. High prevalence of kidney disease points to inadequate control of diabetes and hypertension. There is also high prevalence of smoking among men.

100-101

Authors: T.B Singh, D. Kumar

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).

1-2

Authors: Raja Danasekaran, Kalaivani Annadurai, Geetha Mani

Inadequate and inappropriate handling of health-care waste may have serious public health consequences and a significant impact on the environment. Sound management of health-care waste is thus a crucial component of environmental health protection. Establishment of a national policy and a legal framework, training of personnel, and raising public awareness are essential elements of successful health-care waste management.

5-10

Authors: Akash Ranjan Singh, Ashok Madhukarrao Mehendale, Pradeep Ramrao Deshmukh, Abhishek V Raut, Arun Maha

Background: Despite the large numbers of women who are estimated to have suffered maternal hemorrhage, little is known about their health effects, psychological, social and economic consequences. This study was carried to find out the magnitude and epidemiological determinants of Maternal hemorrhage through a community based cross sectional study. Method: This cross sectional study was conducted in field area of a Primary Health Center of Central India. The study subjects were mothers who delivered a live baby or still birth, within the past one year from the date of interview. Thirty clusters of individuals recruited through cluster sampling method. From every cluster 12 subjects were selected using random walk method giving a total sample size of 360. Data collection was done by using pre-tested and pre-designed questionnaire. ANC card and/or any medical record if available were used to retrieve the relevant data. The data was entered and analysed by using Epi_info (Version 6.04d) software package. Results: The prevalence of maternal hemorrhage was found 15% among study subjects. Out of those who suffered Maternal hemorrhage 30% suffered from Antepartum and 70% from postpartum hemorrhage. Maternal hemorrhage was significantly associated with ANC package utilization however, it was not found to be associated with age, caste, parity and birth order of mothers. Conclusion: Maternal hemorrhage is significantly associated with the ANC services utilization. ANC services, in spite of being easily accessible to the mothers, are poorly utilized and this might be an important determinant of maternal hemorrhage and subsequently ‘continuum of care’.

16-18

Authors: Bindhu.V.R, Ganga. S, Susha Dayanandan

Two medicinal plants Centella asiatica and Boerhavia diffusa were found to be effective in controlling the larval instars and adults of Callosobruchus chinensis. Formulations of granules of the two plants were prepared and they caused significant mortality in adults and larvae of the insect. Thus the plants are proved to be effective in controlling the pest.

23-27

Authors: D. Kumar, A.K. Goel, V. Ghanghoria, P. Ghanghoria

Introduction: Health improvement for the tribal and their delivery system cannot be the same because of cultural pattern, lifestyle and health seeking behavior of tribal population. Maternal and child health care practices observed to be poor among particularly vulnerable tribal groups (PVTGs) in India. Methods: Focus Group Discussions (FDS) were conducted among ever married women aged 15-49 years. Areas explored included disclosure of pregnancy status, access barriers, perceptions about existing maternal and child health (MCH) services and influencing factors for utilization of traditional health care facilities. Content and thematic analysis was used to identify common responses and ideas. Results: Twelve FDGs were undertaken by trained investigators one in each village. Participants were identified through the Accredited Social Health Activists (ASHAs) residing in the same village. It was observed that few women are disclosing their pregnancy status to their family members after first trimester; women have many wrong perceptions about safe delivery and abortions. Due to lack of transport facilities and poverty they felt seeking health care was difficult and costly. Conclusion: This study demonstrates that Baiga is one of the PVTGs residing in dense forest in central India have low awareness and underutilization of MCH services.

33-36

Authors: Jeroen F De Man, Bheemaray V Manganawar, Arupa J Das, Bart Criel, Narayanan Devadasan

One of the strategies of the National Rural Health Mission (NRHM) was the appointment of Block Programme Managers (BPMs) to support the management of the rural health system. This descriptive study provides first insights on who BPMs are, what they do, and what they perceive as barriers to their well-functioning. Data were collected through a semi-structured and self-administered questionnaire from 117 BPMs of Karnataka. Seventy four percent of the contacted BPMs responded. Their average age was 30.4 years, 85% was male, 88.8% had a Master in Business Administration. Self-reported performance and perceived ability is high. BPMs report low salary, lack of cooperation from higher level and field staff, lack of training, lack of logistic support and lack of authority as important barriers to their work. This study suggests that the BPMs require capacity building and supportive supervision with regular feedback to improve their performance. We encourage more research on this important element of NRHM.

41-43

Authors: Sankalp Yadav, Gautam Rawal, Mudit Baxi

The present state of emerging and re-emerging infections around the world has resulted in panic and confusion. The loss of lives due to these infections is huge. Also, the absence of clear guidelines and definitive treatment due to the paucity of literature has instilled fear among the general public. In this paper authors discuss some of these infectious diseases that have led to a state of complete chaos in the recent past.

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.