Indian Journal of Forensic and Community Medicine

76-81

Authors: Balaji Arumugam, Iyappan. M, Hariharan. N, Reddy R G, Selvaraju K S, Franklin Roy. J

Background: Despite the increasing prevalence of chronic diseases and co-morbidities, the essential attributes of the patient and family approach of care, are still to be defined in terms of disease-specific approaches. Effective improvements in family-based approach will require alternative ways of thinking about chronic care design and practice. Objectives: The study was designed with the objectives of assessing the approach of the family members towards chronic disease persons in their family. Methodology: The study was conducted as a community based cross sectional study during November and December 2013, in a nearby village among the families affected from any of the chronic disease. The study participants were selected randomly from the community and they were interviewed using a preformed pretested questionnaire after getting the informed consent. The questionnaire includes general information about the family and the person affected from the chronic disease, money spent, duration of disease, approach of the family members towards the diseased person. The data were analyzed using EPI-INFO software version 3.5.1. Results: A total of 105 persons were interviewed, among whom 44 (41.9%) were suffered from Diabetes Mellitus, 14 (13.3%) were having Hypertension, tuberculosis 9 (8.6%), Osteoarthritis 8 (7.6%) and the remaining had co-morbid chronic diseases. Among the family members 82 (78.1%) had satisfactory attitude towards the diseased persons. Around 52 (49.5%) ignore the diseased persons for celebrations, 35 (33.3%) ignore them for decision making, 23 (21.9%) gave a separate room and 18 (17.1%) felt that treatment expenditure as waste of money. As far as the knowledge, attitude and practice were concerned, attitude and practice were associated (p < 0.05) with lesser age group and nuclear family using chi-square test. Conclusion: Our study had concluded that the overall approach and knowledge, attitude and practice of the family members towards the chronic illness patients in their family was not satisfactory.

87-90

Authors: Balaji Digamber Almale, Seema S Bansode-Gokhe, Sudam Rambhau Suryawanshi, Ashok Jaykumar Vankudre,

Introduction: The police as one of the visible important component governance and control have always been under intense scrutiny and hence vulnerable to wide spread criticism. Growing unemployment, increasing violence and rising expectations of the people have caused serious challenges before police. They work routinely for 12 hours or more often goes a couple of days nonstop at police station with a catnap in between. The truth is that many policemen live lives of fatigue and despair so the objective of present study was to find health status of Mumbai police. Aim and Objective: To study health profile of Mumbai Police Material Methods: The present study was conducted in Mumbai district selected police stations. A multistage and systematic random sampling technique was used to represent a total of 276 policemen out of 40,000 police population. Results: We found 40-50 age groups predominant among policemen. Maximum policemen were married (91%). Educational qualification in policemen were secondary (36.2%), higher secondary (48.6%), graduation and above (15.2%). In our study 55% were addicted to nicotine alcohol abuse in 26% policemen. Most of the policemen were complaining of musculoskeletal problems (62.7%), gastrointestinal problem (51.8%), and dental problems (41%). Prevalence of hypertension was 42.4%. Forty eight percentage policemen were pre obese while 20% obese in this study. Conclusion: policemen require periodic medical examination to remain healthy. Government machinery require to look into the health problems of Mumbai policemen to form a comphrsnvice health insurance policy. Periodic counselling is required on health issue as well as job stressor from team consisting of specialist in medicine, psycharity, dieticians and psychologist.

95-99

Authors: Kamlesh Jain, Bala DV, Kartik Trivedi, Haresh Chandwani

Background: Medical Certification Cause of Death (MCCD) Scheme is an important tool to obtain reliable and scientific information in terms of causes of mortality. In India still MCCD are registered only in 14% case of all death. The present study was conducted to assess the accuracy and completeness of the Medical Certificate of Cause of Death (MCCD) forms, study the leading causes of death derived from the MCCD forms and to find out the life expectancy at birth in male and female. Methodology: A total of 7392 MCCD forms were available during one year from the Ahmedabad Municipal Corporation’s Registrar Birth and death office and all of them were scrutinized for the completeness of the certificate and tried to find out the cause of death in which underlying cause of death was written. Data collected was analyzed using Epi-Info software (version 6.04d). Appropriate statistical tests were applied. Results: Out of total 7392 MCCD forms, 7336 (99.2%) mentioned age and 7299 (98.7) mentioned sex of the deceased person. Only 151(2.04%) forms were completely filled. The completeness for immediate cause, antecedent cause, and underlying cause was 95.56%, 66.67% and 40% respectively. Main leading cause of death in the present study was disease of circulatory system 868(29.35%), followed by Neoplasm (16.54%) and Certain infectious and parasitic disease (16.44%). Conclusion: The present study showed incompletely and inaccurately filled MCCD forms. Therefore adequate training and proper sensitization of the private and government doctors regarding the usefulness of MCCD data is required.

106-109

Authors: Suresha, Manjunatha S N

Background: Biomedical waste management is an important area in hospital safety and sanitation. Despite the presence of legislation there are many concerns and deficiencies in the optimum practice of the guidelines prescribed. Hospital waste produced is hazardous and carries variety of health risks, if not handled and disposed properly. The target group affected is vast, starting from doctors, patients, general public and waste handers. Teaching hospitals should act as leaders in following the right practices and should also involve themselves in training other health professionals in the appropriate hospital waste management. So it becomes imperative for the teaching hospitals to adopt the best practices in this area. Method: The study was undertaken to study the current practices of hospital waste management at K.R. Hospital & Cheluvamba Hospital, attached to Mysore Medical College, Mysore. It was a cross sectional study done using a checklist. Thirteen major departments in the two hospitals were selected for the study. The questionnaire was administered to the staff nurses in these locations to know their knowledge and attitude regarding safe hospital waste management. Results: 48.7% of Staff nurses were trained but showing poor level of knowledge regarding color coding used for different categories and their method of disposal. Majority were not using protective devices provided to them showing lack of attitude. From the observation made we could see that basic facilities like colour buckets, bags, needle burners were missing in many locations and in most of the locations waste produced was not being properly processed in the next stage, showing that none of them could ensure for safe waste management without break in the series. Conclusions: Periodic training, supervision and monitoring by staff and strengthening of the infrastructure are required.

118-121

Authors: Makandar U.K, Abdul Ravoof, Rajendra R., Patil B.G.

1189. Non-Pathological adult crania are studied, out of them 510 Male crania and 251 Female crania are from North India while 285 Male and 143 Female crania are from South India. Prevalence of Metopism in the North Indian Male crania is 12 crania (2.35%) and female crania is 5 Crania (1.99%) while. In South Indian Crania the prevalence of Metopism was in Male 11 Crania (3.85%) in female it was 5 Crania (3.49%). It is observed that, Prevalence was more in South Indian Crania of both sexes as compared to North India. It is also observed that, Prevalence of Metopism is more in Male Crania of North India & South Indian Crania compared to female crania of both North and South India. Previous workers have studied only regional or racial skull but the sexual dimorphism and regional comparison this study appears to be new method. Study is important for anthropologist, anatomist and medico-legal expert above all to radiologist & Neurosurgeon who confuse in the fracture of crania1.

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.

1-6

Authors: Itisha Singh.

The hair perforation is a prominent feature in several infected hairs. Different types of perforators are found in human hairs. Various types of hair perforations were seen in different individuals in this study. Other structure and type of hairs, their chemical structures are also reviewed in order to consolidate important aspects of hair diagnosis.

12-18

Authors: Mahesh C. Sharma, Dayanand Singh, Kusum Lata Gaur, Dilip Raj.

Background: Integrated Child Development Service (ICDS) is India’s response to the challenge of meeting the holistic needs of children below six years of age, adolescent girls expectant and nursing mothers through the network of Anganwadis. Objectives: To assess the knowledge of Anganwadi Workers of Jaipur Zone (Rajasthan) India. Materials and methods: 8 AWCs were selected from each of the 5 Zones of Jaipur. So, total 40 AWCs were included in the present survey. Performance of each of the AWW from identified AWCs was assessed as per the ‘Form no. (1)’ of ICDS. Performance of various districts and various activities were analyzed and inferred in proportion and percentages. Results: 100% of AWWs of Jaipur zone was well aware about the care of pregnant women and lactating women except Kangaroo Method Care (KMC) which is known to only 10%. All the surveyed AWWs had knowledge about Infant feeding and family planning except the advantage of breast feeding which were know to 72.5%. Referral services about children, pregnant women and lactating mothers were known to 80% of surveyed AWWs. Conclusion: Knowledge of AWWs was excellent except Kangaroo Cara Method, advantage of breast feeding and Referral services.

23-26

Authors: Shilpa K, Amit R Ugargol, Harshal Kawanpure.

Background: Medical profession is a much chosen profession today. It is a noble profession, which requires a great deal of commitment. Ignorance of medical students or doctors can endanger the lives they handle. The present study attempts to find out the medical knowledge of students joining MBBS and the association between medical knowledge and family members being doctors, type of admission (government, management, NRI) and reason for joining the course. Methods: The present study was carried out among 100 first year MBBS students of Azeezia medical college, Meeyannoor, Kollam on the first day of the joining of MBBS course. The study was done in the month of September 2014.Data was collected using a predesigned questionnaire. It consisted of 50 questions related to medical knowledge. Questions were all of multiple-choice type. Data was collected and was analyzed using SPSS software (20 th version). Chi square test was used to find out the association p value <0.05 was considered statistically significant. Results: Out of 92 students, the performance of 44 (47.8%) was good (score 40-50), 38 (41.3%) were average (score 30-39) and 10 (10.9%) were poor (below 30). 31(33.7%) were male and 61(66.3%) were female. Among the 92 students, 44(47.8%) were admitted under government seat, 32(34.8%) under management quota and 16(17.4%) under NRI seat. The relationship between type of admission and performance was highly significant (p = 0.000). The reason in 88(95.7%) students for joining MBBS was by their own interest, 1(1.1%) under peer pressure and 3(3.3%) on family interest. We found that the relationship between reason for joining MBBS and performance was significant (p=0.03). Conclusions: Our study showed that the medical knowledge among students joining MBBS was average. There was no relationship between parents being doctors or family members being in the medical profession and medical knowledge of students. Those who joined on their own interest rather than under peer or family pressure had better knowledge than others It was sad to notice that some of the students were not aware of the duration of the course and many of them were ignorant of even the basic things.

35-40

Authors: Sumit Saxena, S. B.Gupta, Peeyush Kariwal, V. P. Shrotriya.

Background: Most of the population strongly believed that chickenpox can be cured with home remedies only and their child has to be treated at home. They believed the superstitions that chickenpox was due to their past evils against the spirit of devi and as the deity is the guardian of the locality, this disease can be cured by Goddess only. Objective: To study beliefs and practices regarding Chickenpox and effect of sociodemogrphic variables. Materials and Methods: A cross sectional study was carried out in the field practise area of community medicine among women in reproductive age group(15-45years), whose children already suffered from Chickenpox were chosen for study. Total 400 women were interviewed by using pretested semi structured questionnaire which was designed by obtaining the information by women of the villages, ASHA & AWW. Data were analysed using SPSS version 20. Results: Most of the women, 314(78.5%) believed that chickenpox is supernatural disease. Out of 400 women, 346(86.5%) believed that chickenpox is a supernatural disease and performing the rituals would solace the deity and the child will not suffer again. Conclusion: As per study findings we concluded that in era of advanced medical research and vaccination, still people are using different practices to avoid angriness of deity. They still live in the dilemma that disease can be cured by Goddess only.

44-48

Authors: Donald S. Christian.

International travel is a growing industry and millions of international travellers arrive and depart all through-out the world in this jet age. International travellers are prone to have certain health risks. It includes physical problems, psychological problems, Infectious Diseases, Injuries etc. The health risk to the travellers also depend on the various factors like destination, duration of travel, season of travel, purpose of travel, standards of accommodation etc. Thus it is a big challenge to public health in that way. Travellers with pre-existing diseases pose additional threat to their health. There are certain infectious diseases for which mandatory vaccination is required (e.g. Yellow Fever). SARS, Ebola virus disease and Swine flu are the recent examples which greatly influenced the international travel. Visiting Friends and Relatives (VFR) and the Hajj Pilgrimage are the two important categories of international travellers worldwide. The International Health Regulations (IHR) aims to prevent, protect against, control and provide public responses to the international spread of diseases. International responses and collaborations are required to combat the public health issues emerging out with rapid international travel. The roles and responsibilities of the travel industry professionals as well as the travellers are also discussed.