Unintentional childhood injuries and their association with activity and location at the time of injury - A case-Crossover study in Delhi

Background

Childhood injury has been identified as a grave public health problem globally as well as in India. Most studies have reported injuries to have occurred while the child was at home, though injuries while on road, school, or playground also commonly occurred.

Objective

The objective of the study is to find the association between unintentional childhood injury and the activity and location of the child at the time of injury.

Methods

The present study is part of a larger study for preventing childhood injuries, conducted from August 2017 to January 2019 in Delhi, and reports the activity and location of the children at the time of injury. A total of 173 injuries that occurred during the total study duration were included in the analysis. Data regarding activity and location of the subjects were collected and analyzed by case-crossover study design, during "case/hazard period" and two "control/reference periods."

Results

Majority of the injuries occurred while the subjects were at home and engaged in activities other than normal activity. When various locations and activities were combined, unmatched odds ratios (ORs) were raised for activity other than normal activity (statistically significant) and for location other than at home. Similar results were obtained for matched Mantel-Haenszel OR, with activity other than normal being significantly more risk for injury (P = 0.000).

Conclusion

Majority of unintentional injuries occurred in children and adolescents, while the subjects were away from home and engaged in any activity other than normal daily activities. This indicates the importance of teaching safety behavior to children so that they can prevent being injured wherever they go and whatever activity they perform.

Effectiveness of Child-To-Child Approach in Preventing Unintentional Childhood Injuries and Their Consequences: A Non-Randomized Cluster-Controlled Trial

BACKGROUND

Child-to-child approach is an innovative strategy for preventing and reducing the morbidity and mortality burden of unintentional childhood injuries.

OBJECTIVES

To test effectiveness of Child-to-child Approach in preventing unintentional childhood injuries and their consequences.

STUDY DESIGN

Community-based non-randomized cluster-controlled trial of parallel design.

PARTICIPANTS

397 children and adolescents.

INTERVENTION

Eldest literate adolescent of selected families of intervention area were trained on prevention of injuries. They were to implement the knowledge gained to prevent injuries in themselves and their younger siblings and also disseminate this knowledge to other members of their families.

OUTCOME

Data was collected from both intervention and control areas during pre- and post-intervention phases on the magnitude of injuries, time for recovery from injuries, place for seeking treatment, cost of treatment, knowledge and practice of participants and their families regarding injuries.

RESULTS

During post-intervention phase, the intervention group experienced a significant reduction in incidence of injuries, increased preference for institutional treatment of injuries and increased knowledge and practice regarding injuries, in com-parison to its pre-intervention data and data of the control group in post-intervention phase. Total time for recovery and cost of treatment for injuries also decreased in intervention group in post-intervention phase, though differences were not statistically significant.

CONCLUSIONS

Child-to-child approach is effective in reducing childhood injuries, improving choice of place for seeking treatment, increasing knowledge of participants, improving family practices regarding prevention of injuries and reducing expenditure on treatment of childhood injuries.

Preventive Health Practices among Doctors in Delhi

INTRODUCTION

With times, increasing attention is being given to doctor's own health as it is known to influence their patient care. Little is known about preventive health practices among them.

OBJECTIVE

To assess preventive health practices among doctors in Delhi.

MATERIAL AND METHODS

It was a cross-sectional study undertaken amongst the doctors working in selected hospitals, dispensaries and private clinics in Delhi. A self-administered questionnaire containing items for assessment of preventive health and self-care practices was used to collect the data.

RESULTS

Out of the total 160 participants, there were 118 males (73.8%) and 42 (26.2%) females. The mean age of the participants was 29.9±7.4 years. There were 55 doctors (34.4%) who were suffering from chronic diseases like vision problems, dental problems, hypertension and diabetes. Nearly half of the doctors (n=74; 46.2%) did not have any for health insurance. Majority of the doctors (n=65; 40.6%) were obese. The knowledge regarding preventive health guidelines regarding all of the tests asked for, was low among the study participants. As far as preventive health practices were concerned, only 8.8% (14) had checked their blood pressure according to recommended guidelines while none of them had their lipid profile done. While there were 9 female doctors (21.4%) who had done their self breast examination in last six months, there was only 1 participant who had undergone pap test. With respect to self-care practices when the physicians last fell ill, majority had self-managed themselves (n=108; 67.5%).

CONCLUSION

Preventive health care practices among the doctors are low. There an urgent need for them to follow good health care practices which they in turn can advocate to their patients.

Decadal impact of Directly Observed Treatment Short course program on age and gender among New Infectious Tuberculosis cases in Delhi

BACKGROUND

Burden of tuberculosis in India remains enormous. The Revised National Tuberculosis Control Programme (RNTCP), based on the Directly Observed Treatment Short course (DOTS) strategy, was launched in 1997 in India. The question of what DOTS has or has not accomplished over the past 15 years is a central technical question.

OBJECTIVES

To assess the decadal impact of DOTS strategy on some epidemiological factors such as age and gender of new sputum positive (NSP) TB patients in Delhi.

MATERIAL AND METHODS

Secondary Data for Delhi was obtained from the state wise performance of RNTCP (Annual Summary) for the year 2001 and year 2012. Data was analyzed in Microsoft Excel 2007.

RESULTS

The population of Delhi covered under DOTS has considerably increased over the decade. The case detection rate has also shown a considerable increase from 196/100,000 population in 2001 to 306/100,000 population at the end of Quarter 3 of 2011. The number of NSP male and female patients have increased in all age groups from 2001 to 2011 except in 25-34 years age group. NSP male patients on DOTS aged 15-44 years showed a left ward shift in increase, a significant right ward shift was noted in increase in female NSP patients of similar age group.

CONCLUSIONS

The decadal assessment of DOTS in Delhi on TB epidemiology has pointed towards beginning of epidemiological transition in TB control in India.

Effect of mHealth on modifying behavioural risk-factors of non-communicable diseases in an adult, rural population in Delhi, India

BACKGROUND

The rising trend of non-communicable diseases (NCDs) has led to a "dual burden" in low and middle-income (LAMI) countries like India which are still battling with high prevalence of communicable diseases. The incorporation of a target specially dedicated to NCDs within the goal 3 of the newly adopted Sustainable Development Goals indicates the importance the world now accords to prevention and control of these diseases. Mobile phone technology is increasingly viewed as a promising communication channel that can be utilized for primary prevention of NCDs by promoting behaviour change and risk factor modification.

METHODS

A "Before and After" Intervention study was conducted on 400 subjects, over a period of one year, in Barwala village, Delhi, India. An mHealth intervention package consisting of weekly text messages and monthly telephone calls addressing lifestyle modification for risk factors of NCDs was given to the intervention group, compared to no intervention package in control group.

RESULTS

After Intervention Phase, significant reduction was seen in behavioural risk factors (unhealthy diet and insufficient physical activity) in the intervention group compared to control group. Body mass index (BMI), systolic blood pressure and fasting blood sugar level also showed significant difference in the intervention group as compared to controls.

CONCLUSIONS

Our study has demonstrated the usefulness of mHealth for health promotion and lifestyle modification at community level in a LAMI country. With the growing burden of NCDs in the community, such cost effective and innovative measures will be needed that can easily reach the masses.

Practices and Knowledge regarding Prevention of Tetanus among Doctors in Delhi

A cross-sectional study was conducted in Delhi to study immunisation practices regarding prevention of tetanus among doctors and their knowledge regarding its prevention. Delhi was divided into five zones, and from each zone two hospitals and five dispensaries were selected, giving due representation agency-wise. All the doctors posted for casualty duty in the selected hospitals, all doctors posted in the selected dispensaries and two private practitioners selected randomly from the nearby area of the selected dispensaries were included in the study. Only 7% of doctors had received their last dose of tetanus toxoid to complete the immunisation schedule and majority had received it following injury. As much as 38.3% of doctors favoured TT after every injury. Out of the remaining who opposed it only 59.5% could provide the correct reason for this. Less than half of the doctors knew the indications of anti-tetanus serum. There is a need for the doctors to take TT immunisation more seriously and adopt recommended immunisation practices, because if they themselves are not following the guidelines, it is likely to be reflected in their advice and motivation to patients.

Prevalence of Dog Bites in Rural and Urban Slums of Delhi: A Community-based Study

Background:

Rabies is a fatal disease of the central nervous system caused by the bites of warm-blooded animals. One of the important methods of controlling rabies is by interventions to limit the number of dog bites, the most common source of transmission of rabies to humans in the community. Community-based data on dog bites are rare from India.

Aim:

The aim of this study is to determine the prevalence of dog bites and knowledge and practices relating to its management and prevention in an urban and a rural slum of North West Delhi, India.

Subjects and Methods:

A cross-sectional house to house survey of 500 households covering a population of 2887 individuals was conducted. The families were selected by systematic random sampling. A pretested and a prevalidated questionnaire was used. Chi-square test was applied for comparing proportions related to the categorical variables and t-test was used for comparing means.

Results:

The dog bite incidence rate for the study population for the last year was 25.2/1000 population with higher rates in urban (30.1/1000) than rural (19.6/1000) slum. Two-fifths of the dog bite patients did not wash the wound with soap and water. The practice of washing the wound with soap and water was significantly higher in urban than rural slum. One-fifth of the patients did not receive anti-rabies vaccine. There was lower coverage in rural than urban slum. A majority (79.0%) of the patients did not receive anti-rabies serum.

Conclusion:

A high prevalence of dog bites coupled with poor knowledge and dog bite management practices is a worrisome trend which policy makers should take into account to make India rabies free.

Attitude of medical students towards occupational safety and health: a multi-national study

BACKGROUND

Work-related diseases contribute immensely to the global burden of diseases. Better understanding of attitudes of health care workers towards occupational safety and health (OSH) is important for planning.

OBJECTIVE

To assess the attitude of medical students towards OSH around the globe.

METHODS

A questionnaire assessing the attitude towards OSH was administered to medical and paramedical students of 21 Medical Universities across the globe. In the current study 1895 students, aged 18-36 years, from 17 countries were included. After having performed a principal components analysis, the associations of interest between the identified components and other socio demographic characteristics were assessed by multivariate linear regression.

RESULTS

Principal component analysis revealed 3 components. Students from lower and lower-middle-income countries had a more positive attitude towards OSH, but the importance of OSH was still rated higher by students from upper-income countries. Although students from Asian and African continents showed high interest for OSH, European and South-Central American students comparatively rated importance of OSH to be higher. Paramedical students had more positive attitude towards OSH than medical students.

CONCLUSION

The attitude of students from lower-income and lower-middle-income towards importance of OSH is negative. This attitude could be changed by recommending modifications to OSH courses that reflect the importance of OSH. Since paramedical students showed more interest in OSH than medical students, modifications in existing health care system with major role of paramedics in OSH service delivery is recommended.

Accuracy of body weight perceptions among students in a medical school in Central Delhi, India

BACKGROUND

Body image is an important aspect of the complex creation of one's self-identity. The relationship between nutritional disorders, like obesity, and one's perception of her or his body is well documented. Obesity among medical students and health personnel is on the rise. Identifying and measuring the magnitude of distortion in body image self-perception among medical students is particularly relevant, as they are future healthcare providers. This paper assesses self-perceptions of body mass index (BMI) and physical activity among medical undergraduate students in an Indian medical school.

METHODS

A cross-sectional study was conducted among 161 sixth semester medical undergraduate students in a school in Delhi, India. A pretested questionnaire was used. Anthropometric measurements were taken. The participation rate was 93.6%.

RESULTS

Out of the total 161 students, there were 60.9% males and 39.1% females. Most participants were classified as normal (55.9%) according to BMI. The proportions of actual obese, overweight and underweight students were 4.4%, 30.4% and 9.3%, respectively. However, the proportion of students perceiving themselves as obese or overweight was only 37.3%. A significantly higher proportion of females (57.2%) than males (20.4%) perceived themselves as overweight (P < 0.001). The agreement between actual BMI and perceived weight was poor (kappa statistic: 0.33). Among actual overweight and obese students, only one-third were physically active.

CONCLUSIONS

Students who were overweight or obese often failed to perceive themselves as such and, perhaps consequently, were not engaging in weight control practices. There is a need to develop health promotion interventions that help build healthy body habitus perceptions among this group of Indian medical students.

Hypertension and its correlates among school adolescents in delhi

BACKGROUND

Hypertension is fast emerging as a major health problem amongst all school adolescents, particularly in urban areas. Regular screening of the students for this is required for preventing the emergence of complications later in life. Therefore, the present study was undertaken with the objective to determine the prevalence of hypertension amongst urban school adolescents and its correlation with anthropometric measurements.

METHODS

A cross-sectional study was conducted in a school in Central Delhi involving all 315 students of 9(th) and 11(th) standard. A preforma was filled by the students and anthropometric measurements along with blood pressure (BP) measurements were taken for each student. Data was analyzed using Epi-info 2005 and SPSS 16.0.

RESULTS

Out of the total 315 students, 208 (66%) were boys and 107 (34%) were girls and the mean age was 14.31 ± 0.96 years. Overall prevalence of malnutrition was 24% and boys were found to be more obese as compared to girls. There were 5 students (1.6%) who were found to have systolic hypertension while 17 (5.4%) were found to have diastolic hypertension while 4.1% (n = 13) of the participants were systolic pre-hypertensive and 26% (n = 82) were in stage of diastolic pre-hypertension. Body mass index and gender were found to be independent predictor for systolic hypertension.

CONCLUSIONS

Prevalence of hypertension and pre-hypertension was high amongst the school children. BP check-up for children and adolescents is thus recommended to take remedial action on time.

Perception of stigma towards TB among patients on DOTS & patients attending general OPD in Delhi

BACKGROUND

In India, Tuberculosis (TB) continues to be a public health problem. One of the key reasons for it is the stigma associated with the disease which affects the treatment seeking behaviour and hence the outcome.

OBJECTIVES

To assess the perceived and enacted stigma among TB patients and perceptions of other patients related to TB in Central Delhi.

METHODS

A cross-sectional study conducted in urban field practice area of a medical college of Delhi, using a pre-designed questionnaire containing items for assessment of stigma being faced by a TB patient in family, social life and workplace. It also contained questions pertaining to reaction of patients from general OPD to a family member who develops TB.

RESULTS

A total of 100 patients on DOTS and 200 patients from general OPD were interviewed. There were 21 patients who reported to have delayed treatment seeking due to stigma. Nearly one third patients (n=34; 34%) noted negative changes in the behaviour of their family members towards them while 40% were isolated on being diagnosed with the disease. Out of the 36 employed TB patients, 65.5% (n=23) experienced negative change in the behaviour of their colleagues. In general OPD patients, significantly higher proportion of female patients said that they would not disclose the disease status of a family member suffering from TB to their neighbours (p<0.001).

CONCLUSIONS

Perception of stigmatizing effect of Tuberculosis was high both amongst TB and other patients. Behaviour Change Communication (BCC) strategies are needed to address the effects of stigma like delayed treatment seeking.

ABC-VED Analysis of a Drug Store in the Department of Community Medicine of a Medical College in Delhi

A matrix based on coupling of cost (always, better and control) analysis and criticality (vital, essential and desirable) analysis was employed for drug inventory containing 129 items of drug store in the Department of Community Medicine of a Medical College in Delhi. The annual drug expenditure incurred on 129 drug items for the year 2010-2011 was found to be Rs. 4,35,847.85. On always, better and control analysis, 18.6, 24.0 and 57.4% drugs were found to be always, better and control category items, respectively, amounting for 69.1, 20.8 and 10.1% of annual drug expenditure. About 13.2 (17), 38.8 (50) and 48.0% (62) items were found to be vital, essential and desirable category items, respectively, amounting for 18.7, 49.5 and 31.8% of annual drug expenditure. Based on always, better and control-vital, essential and desirable matrix analysis there were 37 (28.68%) items in category I, 53 (41.09%) items in category II and 39 (30.23%) items in category III, amounting for 73.0, 22.2 and 4.8% of annual drug expenditure, respectively. To conclude, scientific inventory management tools are needed to be applied in routine for efficient management of the pharmacy stores as it contributes to not only in improvement in patient care but also judicious use of resources as well.

Effect of Life Skills Training on Dietary Behavior of School Adolescents in Delhi

Skill-based education has been shown to reduce high-risk behavior among adolescents, but in India, life skills have often been looked at only from the reproductive health perspective. Therefore, the current study was undertaken to assess the effect of life skills training on dietary behavior of adolescents studying in grades 9 and 11 of 2 schools in Delhi. This was a nonrandomized interventional study with a control group. A self-administered questionnaire was used for assessment of dietary behavior at baseline, 15 days, and 3 months after the life skills training. Two life skills training sessions were imparted to the intervention group, focusing on the use of life skills in making healthy choices. Participants in the intervention group (n = 180) showed significant improvement in knowledge ( P < .001), attitude ( P = .007), and practices ( P < .001) following the life skills training. To conclude, a skills-based approach does help improve the dietary behavior in adolescents.

Expenditure audit of women with breast cancer in a tertiary care hospital of Delhi

BACKGROUND

Breast cancer is associated with substantial medical and economic burden. This study assisted the expenditure incurred by the subjects on diagnosis and treatment till the period of follow-up.

MATERIALS AND METHODS

This is a prospective study; a case series of patients studied at the time of diagnosis and followed after 6 months. The study was conducted at one of Hospitals in India, from January 2006 to December 2007. One hundred and seventy-two women with new primary breast cancer were included in the study. During the study period 69 subjects were lost to follow-up. The comparative analysis was done for 103 subjects. Cost implications of breast cancer include direct medical costs and indirect costs. Questionnaire for the data collection was used. Descriptive statistics and correlation analysis were used.

RESULTS

The median total direct and indirect expenditure was Rs. 12,100 (US$ 1 = Rs 50) with the range of Rs. 0-54000. The largest component of total direct medical costs was in stage I (median Rs. 6530), total indirect costs (median Rs. 7500), and median total cost was Rs. 17,600. The total expenditures (median Rs. 13,100) were the highest in younger age group (<40). The median direct expenditure was higher in the subjects who visited private setup before coming to Hospital (Rs. 8250) than those who came directly (Rs. 4500).

CONCLUSIONS

Cost of treatment for breast cancer depends on many factors, including the stages of the cancer, the woman's age, perhaps the costs of treatment, private hospital and insurance.

Antepartum morbidities and health seeking behaviour among women in an urban slum of Delhi

A cross-sectional study was conducted to assess the pattern of antepartum morbidities and its relationship with socio-economic, demographic characteristics and the health seeking behaviour among 214 women in an urban slum community of Delhi. Interviews were conducted in the households using a pretested semi-structured schedule. The age at marriage, age at co-habitation, and age at child-birth were below 18 years in 36.4%, 32.7%, and 5.1% respectively. The average number of antepartum morbidities per woman was 1.7. Commonest morbidities were: Urinary problems (11.2%), swelling over hands and feet (9.3%), fever > 3 days duration (7.5%), antepartum bleeding (7.0%), etc. The antepartum morbidities were found to be significantly higher among wives of illiterate (p = 0.01) husbands and of unskilled workers (p = 0.01). Out of 144 morbidities, consultation was sought for 101 morbidities (70.1%), mostly in a government hospital (78.2%). Main reasons for non-consultation among 43 women were: Non-availability of persons to accompany (32.6%), or to look after the children (23.3%) and feeling unnecessary to consult (23.3%). Study findings revealed the need for family support, sensitising men about women's health problems during pregnancy and education regarding identification of danger signs during pregnancy for reducing maternal morbidity and related mortality.

Assessment of quality of life among HIV positive people attending tertiary hospital of Delhi, India

As per global HIV/AIDS estimates, a total of 33 million [30.3 - 36.1 million] People were living with HIV in 2007. The world's second-most populous country, India, is experiencing a highly varied HIV epidemic, which appears to be stable or diminishing in some parts while growing at a modest rate in others. Quality of life (QOL) of HIV/AIDS patients is becoming an important component of overall assessment of health care and management in health care settings. It is one of the indicators effectiveness of management of PLHAS. The objective of this study was to determine the QOL of patients with HIV/AIDS in New Delhi. Purposive sampling was used to identify subjects from the antiretroviral therapy clinic (ART) in Lok Nayak hospital. 180 patients were interviewed with the WHOQOL-HIV instrument. This questionnaire included demographic data, multi-item scales and six domains namely physical, psychological, level of independence, social relationships, environment and spirituality religion. Study subjects were aged between 20-56 years. Mean age of all study subjects was 33.85 +/- 7.01 years, comprising of 34.4 females. More than 50% of the total subjects had received less than secondary school education. All domains have higher scores for women than men except the psychological domain. Correlation of scores of six domains with overall QOL score and among individual domains was statistically significant. Younger people showed poorer QOL and level of education correlated positively with all domains of QOL Overall results indicate that quality of life of AIDS attending Lok Nayak hospital is satisfactory.

Awareness status about HIV/AIDS among Indian railway's employees and their family members

A house to house survey was conducted in December 2005 in the Railway Colony of Shamli, located in the state of Uttar Pradesh, India using a semistructured questionnaire to study the awareness level regarding HIV/AIDS among Indian Railway's employees and their family members. Information regarding demographic characteristics and knowledge about various aspects of HIV/AIDS was recorded by a trained staff nurse of the local Railway Medical Unit from at least one person, aged 15 years to 59 years, from each household. Among 293 individuals interviewed, majority were males (61.8%), aged > 30 years (56.6%) and literate (85.3%). Majority were aware about existence of HIV infection in India (92.5%), AIDS is a fatal disease (92.8%) and laboratory tests are available for detecting HIV infection (89.4%). Although most of them knew the correct routes of HIV transmission viz. sexual (91.50%), parentral (90.8%), perinatal route (86.3%) and blood transfusion (86.0%), misconceptions such as transmission through shaking hands (89.1%), hugging (88.4%), sharing utensils (82.6%), mosquito bite (74.1%) and using public toilets (73.4%) were also observed. Most of them were also aware about preventive measures. Knowledge about various aspects was observed to be significantly higher among females, among individuals aged <45 years and literate individuals. The findings highlight the need of intensified health education focusing on removal of misconceptions and further improvement in awareness level of the study population.

Impact of health education intervention on knowledge and community action for malaria control in Delhi

Malaria affects millions of people in India despite decades of efforts to control it. It has acquired greater importance in last two decades due to emergence of vector resistance, poor quality of care and low utilization of services. The study was conducted to improve the management of malaria by IEC and training activities in slum areas of Delhi. The baseline and post intervention data on knowledge, attitude, behavior and practices (KABP) regarding malaria was collected from 601 and 593 subjects respectively from two zones of Municipal Corporation of Delhi (MCD). At the same time, knowledge and skills regarding management of malaria were assessed among 15 health workers working in these two zones of MCD. An intervention package in the form of health education material for the community and training modules for the workers were designed and implemented. Post intervention data were collected. The knowledge about cause of malaria, season of malaria and breeding places of mosquito increased among community members after the intervention, which was found to be statistically significant. Similarly, more people were aware about the methods of prevention of mosquito breeding after the intervention. Methods like mosquito coil (post-64.92% vs pre-55.41%) and bet nets (post-24.96% vs pre-14.47%) were used by more people in post intervention phase. The Interval between onset of symptoms and seeking treatment decreased after the intervention from 1.66 days to 1.37 days. Among the workers, knowledge and skills regarding malaria management improved after the intervention. More blood slides were made, side effects of the treatment were explained to the patients and better compliance to treatment was observed in post intervention phase. IEC activities using attractive pamphlets to the community and on-job training of workers improves management of malaria and should be used more frequently more so in the slum areas for the success of the National Anti-Malaria Program.

General practitioners' knowledge of childhood asthma in Delhi, India

OBJECTIVE

To assess knowledge of childhood asthma among general practitioners (GPs) in Delhi, India.

DESIGN

In this cross-sectional study, a total of 157 GPs were interviewed using a validated questionnaire, including six questions of local and social relevance. A response rate of 78.5% was obtained.

RESULTS

Although the GPs who participated in the study had adequate knowledge of the importance of appropriate treatment, the safety of inhalers/oral steroids and the role of medicines in the prevention of frequent asthma attacks, the majority lacked knowledge of symptomatology, exercise-induced asthma and inhaled corticosteroids. GPs with >5 years of practice were more likely to have significantly less knowledge about preventive drugs, certain aspects of treatment of acute asthma and misconceptions, such as 'drinking milk increases mucus production' or 'children with asthma should not consume dairy products, chilled drinks, sour or chilled food'. On the other hand, GPs with < or =5 of practice had misconceptions such as 'children with asthma have abnormally sensitive airways' and 'asthmatic children develop dependence on inhalers'.

CONCLUSIONS

The gaps in knowledge about asthma and its management highlight the need to design well-structured educational strategies for health professionals.

Awareness and perception about tuberculosis in the general population of Delhi

The present study was conducted to assess awareness and perception regarding tuberculosis among the general population of Delhi. A total of 1008 adults, selected by multistage stratified systematic sampling, were interviewed using a pre-tested proforma. The majority had heard about tuberculosis (99.1%) and most (89.2%) perceived it to be an infectious disease. The correct mode of transmission i.e. airborne (coughing/sneezing) was known to 71.8% study subjects. The majority (90.1%) knew cough as a symptom. Nearly all (98.2%) perceived Tuberculosis to be a preventable disease, citing the treatment of patients as the mainstay of preventing spread of the disease. However, responses like separation of utensils or hospitalisation of the patient to prevent the spread of the disease indicate persistence of stigma and discrimination in a small proportion of the population. There is a need to widen the scope and intensify the information and education being provided to the population based on gaps identified.

Perception of risk and potential occupational exposure to HIV/AIDS among medical interns in Delhi

A cross sectional study was conducted among 129 medical interns of Maulana Azad Medical College, New Delhi for assessing the perceived levels of risk of acquiring HIV infection in the health care settings among medical interns, reasons for the same and their exposure to situations having potential of HIV transmission. Majority of the interns (68.3%) perceived themselves to be at a very high/high risk of acquiring HIV infection during their medical career. The common reasons for perceived risk of acquiring HIV infection were getting injuries due to needle pricks/cuts during surgical procedures (32.4%), frequent exposure to the blood/ secretions of patients (28.5%) and insufficient availability of gloves (17.6%). Some (23.2%) were of the opinion that students in future might lose interest in the medical profession due to increasing risk of HIV infection and few (3.1%) were even considering to leave the medical profession for the same reason. Majority of the interns (72.9%) had experienced needle pricks and more than half (53.7%) of them even had had blood splashes in their eyes/ nose/ mouth during surgical procedures. The findings of the study call for efforts for bringing a reduction in the risk perception of the interns through awareness campaigns and reorientation trainings, ensuring availability of gloves and other items necessary for observing universal work precautions and proper disposal of potentially contaminated articles.

Changing profile of disease contributing to mortality in a resettlement colony of Delhi

BACKGROUND

The past decade has seen a decline in the disability-adjusted life years (DALYs) contributed by communicable diseases while lifestyle changes and rapid urbanization have led to an increase in DALYs contributed by non-communicable diseases. We studied the causes of death in a low socioeconomic area over 11 years to help identify changes in the pattern of disease.

METHODS

We did this study in Gokulpuri, a resettlement colony in East Delhi. All deaths occurring from 1994 to 2004 were analysed using a verbal autopsy questionnaire completed by trained health workers during their home visits in the area.

RESULTS

A total of 515 deaths occurred during the period; 340 in men (66%) and 175 in women (34%). The six commonest causes of death were tuberculosis (24.8%), chronic obstructive pulmonary disease (11.6%), pneumonia (8.7%), accidents and poisoning (8.6 %), coronary heart disease (8.2%) and cancer (4.6%). The age-specific mortality rate was highest among people > 45 years of age. The cause-specific mortality rate due to communicable diseases showed a decline while that due to non-communicable diseases showed a rising trend in all age groups.

CONCLUSION

Our study shows the coexistence of communicable and non-communicable diseases in a low socioeconomic area with a rising trend in non-communicable diseases. Surveillance for risk factors of non-communicable diseases should be done even in predominantly low socioeconomic areas. The coexistence of communicable and non-communicable diseases and the increase in non-communicable diseases among the economically deprived sections of our society suggest the need to re-prioritize components of healthcare among these sections.

Drug use among juveniles in conflict with the law

OBJECTIVE

To study the pattern of drug use, reasons for initiation and the perception about the effects of using drugs, among juveniles in conflict with law.

METHODS

A qualitative study was conducted at Prayas Observation Home for boys, New Delhi. Eight key informant interviews were conducted to find the prevalence of prior drug use among boys. Five focus group discussions were conducted with 34 children using a topic outline guide.

RESULTS

The study showed that drug use was related to other criminal activities. Peer group and media were the most important influences for initiation of drug use. All kinds of drugs could easily be procured by children and there was a gradual progression from non-use to tobacco and alcohol use, to marijuana and ultimately to other drugs. Knowledge about medical and social mal-effects of consuming drugs did not seem to effect either the consumption of drugs or the desire to leave this habit.

CONCLUSION

Results of the study demonstrate an urgent need for taking stringent measures in order to curb drug use among adolescents.

Practice and knowledge regarding prevention of tetanus among nursing personnel in Delhi

A cross-sectional study was conducted in Delhi to assess the practices and knowledge regarding tetanus immunization among nursing personnel. Majority of the study subjects had received their last dose of tetanus toxoid injection only after injury and just 4.4% received it to complete the immunization schedule. More than 12% subjects did not know whether they had received any tetanus toxoid injection or not, another 5.5% had their last dose of tetanus toxoid more than ten years back. As many as 20 (22.2%) subjects stated that TT should be given after every injury. Of the remaining 70 subjects only 22.9% correctly knew why TT was not required. Only one third of the subjects knew the indications of anti tetanus serum.

Medical students′ perception on eye donation in Delhi

Corneal transplantation remains a major treatment option for restoring sight among those suffering from corneal blindness. The number of corneal transplants done is far less than the actual requirement in India. This is largely due to the inadequate numbers of corneas collected. Medical students can be involved in the motivation of patients and relatives to pledge their eyes and to do grief counseling for donating eyes. The aim of the study was to assess the perception and willingness of 180 first-year medical students towards eye donation in Delhi. They were administered a pretested semi-structured questionnaire on eye donation. Data were analyzed using Epi-Info software package 6.04 version. The majority (99.4%) of students knew that eyes can be donated after death but only 41.1% knew that the ideal time of donation was within six hours of death. Most participants (87.2%) were willing to donate eyes. Nobility in the act of eye donation was the main motivational force for eye donation according to 85.5% of students. Perceived reasons for not pledging eyes by the people were: lack of awareness (32.7%), objection by family members (27.7%), unsuitability to donate because of health problem (17.7%) and the unacceptable idea to separate the eye from the body (15.5%). Mass media such as television, newspapers, magazines and posters were important sources of information on eye donation. Perceived reasons for not donating eyes need to be considered while creating awareness about eye donation in the community.

Perception of risk and potential occupational exposure to HIV/AIDS among medical interns in Delhi

A cross sectional study was conducted among 129 medical interns of Maulana Azad Medical College, New Delhi for assessing the perceived levels of risk of acquiring HIV infection in the health care settings among medical interns, reasons for the same and their exposure to situations having potential of HIV transmission. Majority of the interns (68.3%) perceived themselves to be at a very high/high risk of acquiring HIV infection during their medical career. The common reasons for perceived risk of acquiring HIV infection were getting injuries due to needle pricks/cuts during surgical procedures (32.4%), frequent exposure to the blood/secretions of patients (28.5%) and insufficient availability of gloves (17.6%). Some (23.2%) were of the opinion that students in future might lose interest in the medical profession due to increasing risk of HIV infection and few (3.1%) were even considering to leave the medical profession for the same reason. Majority of the interns (72.9%) had experienced needle pricks and more than half (53.7%) of them even had had blood splashes in their eyes/nose/mouth during surgical procedures. The findings of the study call for efforts for bringing a reduction in the risk perception of the interns through awareness campaigns and reorientation trainings, ensuring availability of gloves and other items necessary for observing universal work precautions and proper disposal of potentially contaminated articles.

Knowledge of general public and health professionals about tetanus immunization

OBJECTIVE

To study the awareness among general public and health care providers about tetanus immunization in relation to injuries, and their knowledge about tetanus immunization schedules in children, pregnant females and adults.

METHODS

It was a cross-sectional study done at a perfect health mela and all the government allopathic health agencies in Delhi.

RESULTS

The knowledge of tetanus immunization was poor among general public as well as health care providers. A substantial proportion of them indicated tetanus injection after every injury, which was unwarranted. The knowledge of tetanus immunization schedule for adults was poor among all categories of respondents, though it was comparatively better for pregnant females, but only 75% of doctors and 51.1% of nursing personnel correctly knew the immunization schedule against tetanus in children.

CONCLUSION

There is a need to upgrade the level of knowledge among health care providers so as to ensure that schedules of tetanus are followed properly and unnecessary repeated immunizations are avoided and the same knowledge is passed on to the general public also.

Economic burden of tuberculosis in patients attending DOT centres in Delhi

Tuberculosis inflicts a negative impact on global socioeconomic prosperity. Though India carries one third of the global burden of the disease, few studies have focussed in the country on this aspect. The present study was therefore, framed to estimate economic loss amongst TB patients. A total of 156 patients attending two DOT centres were interviewed in depth, regarding economic loss due to tuberculosis, using a semi structured pretested interview schedule during a period of 5 months. More than 75% of the subjects belonged to the age group of 15-44 years of which 71.6% were males. 34.6% of patients were housewives and 10.9% were students. Mean expenditure before registration in DOT centre was Rs. 3385.5 irrespective of all socioeconomic classes. The upper lower socio-economic class of patients incurred maximum mean expenditure of Rs. 9782.0. Mean duration of wage loss was found to be 47.1 days. Study participants incurred economic loss both in terms of direct and indirect costs, more so in lower socio-economic group, besides delay in attending DOT centres for treatment. Awareness campaign focussing on treatment availability and DOT centre could help in reducing such economic loss.

Increasing access to cataract surgery in a rural area--a support strategy

The objectives of the study were to elicit the reasons for not undergoing cataract surgery from those having cataract, aged 50 years and above, in a village community and, develop, implement and assess a support strategy for getting cataract surgery done. The leading reasons identified were monetary constraints (18.8%), transport difficulty (17.4%), lack of awareness about cataract in the eyes (17.4%) and lack of escort (14.5%). Based on the identified reasons, patients were transported in groups to a government eye hospital for free surgery after completion of required pre operative formalities at the village health center itself. Out of 65 eligible individuals, 66.2% underwent surgery. The success of the approach was evident by perceived improvement in vision in 88.4% operated patients, occurrence of only few minor complications and a satisfactory hospital experience being reported by all.

Knowledge about tetanus immunization among doctors in Delhi

BACKGROUND

In spite of the clear-cut guidelines regarding tetanus immunization, we have observed that tetanus toxoid injection is often given after injury without considering previous immunization status. One of the reasons for this could be that the doctors themselves are not aware of the correct immunization schedules against tetanus.

AIMS

1. To assess the knowledge about tetanus immunization in relation to injuries among doctors. 2. To assess their knowledge about tetanus immunization schedules in children, pregnant women and adults.

SETTING AND DESIGN

It was a cross-sectional study conducted in Delhi.

MATERIALS AND METHODS

After complete enlisting of all the government allopathic hospitals and dispensaries, a representative sample (including private practitioners from the nearby area of selected dispensaries) of doctors was selected. All the doctors were personally contacted and information was collected through a pre-structured self-administered proforma.

STATISTICAL ANALYSIS

Data was analyzed using a computer and wherever applicable Chi-square test/Z test or Fishers' Exact test was applied.

RESULTS AND CONCLUSION

As many as 38.3% of doctors favored tetanus toxoid injection after every injury. The correct knowledge of immunization against tetanus in children, pregnant women and adults was 75%, 90.8% and 35.8% respectively. The knowledge regarding when to give boosters was even poorer. The present study showed that doctors had poor knowledge about tetanus immunization that needs to be improved.

Mental health status of runaway adolescents

There are 47.22 million homeless and runaway adolescents roaming on the streets of our country (Voluntary Health Association of India - VHAI) of which one lakh are in Delhi.1 Very little is known about them, their needs or their experiences.

OBJECTIVE

(1). To assess the psychological problems amongst the runaway adolescent boys. (2). To determine possible risk factors.

METHODS

This study was cross-sectional in design and done at a child observation home for boys in Delhi. All runaway boys aged 10 to 16 years of age were included in the study. The study was conducted from 15th June to 15th July 2001. A comprehensive schedule consisting of five parts, viz identification data, hopelessness scale for children by Kazdin, Beck depression inventory, Psychological survey questionnaire and RUTTER-B2 scale were used to assess various mental health problems.

RESULTS

20.7% of children were found to have high hopelessness and 8% of children had depression. 2% of children revealed that they had attempted suicide at any point of time in life. Among children with high hopelessness, 3.2% had ever attempted suicide. 8.3% of the depressed children gave history of suicidal attempts. 38% of children gave history of physical abuse, 14.6% of sexual abuse and a large number reported substance abuse. 69.33% were found to have behavioral problems (i.e. scored above the recommended cut off score of 9). 81% of children had antisocial behavior, 7.8% were neurotic and 10.5% remained undifferentiated.

CONCLUSION

Runaway adolescents suffer from a wide array of mental health problems and there is a need for a broad based psychosocial intervention programme.

Knowledge regarding tetanus toxoid immunization among persons attending health mela in Delhi

Although vaccine against tetanus has been in use for more than two decades, often people are not aware of tetanus immunization schedules and its significance in preventing tetanus. The current cross-sectional study was carried out to (1) assess knowledge about tetanus immunization (in relation to injury) among persons attending a health mela and (2) To assess their knowledge about tetanus immunization schedules in children, pregnant women and adults. Every tenth person above 15 years of age, who came to health post in the mela was interviewed. A total of 231 persons attending a health mela in Delhi in October 2003 were interviewed. About two third of them were males. Majority (55%) were graduates or above. Only half of them indicated that they would give tetanus immunization after an injury, two fifth indicated it after animal bite and only one fourth indicated it after burns. Knowledge was higher among females and with higher education. However, knowledge regarding correct immunization schedules, prevention of tetanus by DPT and when to give booster in case of injury after primary immunization was poor. There is need to create greater awareness among people about immunization against tetanus, duration of immunity and disease prevented by it. This is to ensure immunization when it is needed and avoid unnecessary repeated immunization.

Knowledge, attitude, the perceived risks of infection and sources of information about HIV/AIDS among pregnant women in an urban population of Delhi

Knowledge, attitude, perceived risks of infection and sources of information about HIV/AIDS were assessed among pregnant women. Large proportion of study subjects was illiterate (44.5%) and least was graduate or more (3.5%). Subjects mainly belonged to middle (46.1%) and lower socioe-conomic status (53.8%). Only 39.3% of subjects heard of AIDS. There was rising trend on heard of AIDS with various educational levels. Only 45% subjects responded correctly that AIDS was not transmitted by mosquito bite. Lower level of correct knowledge was also observed among all educational groups and it was lowest 21.1% among illiterate. Senior secondary or graduate or more educated responded 100% correct to question that one could get AIDS by having sex with prostitutes while illiterate responded 78.9% correctly. More educated had higher correct knowledge on modes of transmission compared to illiterate and less educated. Among various groups of educational status, the relationship of correct knowledge on modes of transmission was statistically significant. Of those heard of AIDS 79.3% perceived threat of AIDS to the health of local community. Mass media was source of information on HIV/AIDS among 86.3% out of which television was most popular source (74.6%). Large proportion of subjects (48.6%) had preference to get information on AIDS from doctors.

AIDS-related apprehensions among nursing students of Delhi

Students from a nursing school of Delhi were surveyed anonymously using a self-administered questionnaire to explore various AIDS-related apprehensions and their possible reasons. The observations revealed that, majority of the students and their families/friends feared that these students were at risk of contracting HIV infection while providing routine patient care. A large number of students also opined that they would feel uncomfortable while talking, hugging, shaking hands, and sharing a room with an HIV positive person. The main reasons for their apprehensions were unsatisfactory anti-AIDS campaigning by the government, non-availability of sufficient protective measures in the health care settings, inadequate professional education related to prevention of HIV infection, and increase in HIV transmission following false sense of security due to excessive condom promotion. Findings of the study imply imparting factual knowledge addressing the concerns and removing misconceptions which influence attitudes and willingness of the nursing students to provide care to the HIV positives/AIDS patients, facts regarding efficacy of various preventive measures, and provision of counselling services in the event of exposure.

Some AIDS-related policy issues and nursing students' willingness to provide AIDS care

Two thirty three diploma students from a Nursing School, in Delhi were surveyed anonymously to seek their opinion on some AIDS-related policy issues and willingness to provide AIDS care. More than one fourth of students opinionated that health personnel should be given a choice to refuse care to the AIDS patients and an equal proportion felt that authorities should be empowered to terminate the services of such personnel. Majority were in favour of making HIV testing compulsory for various high risk groups, indoor patients and health workers. Perceiving the risk of HIV infection, 41.2% students felt that girls might not opt for nursing career, whereas few (10.7%) were considering even to leave the profession. However, majority (58-72%) were willing to nurse the high risk individuals, if adequate training and preventive measures were provided in the health care settings. The study implies framing of an AIDS policy taking in to consideration the views of health professionals and imparting comprehensive training to the nursing students in order to promote a humane approach towards AIDS care.

Knowledge and attitudes of university students regarding HIV/AIDS: an urban--rural difference

A total of 322 students from two colleges of Delhi University, one located in urban and the other in the rural area were surveyed to assess and compare their knowledge, attitudes and beliefs regarding HIV/AIDS. A pretested and self-administered questionnaire containing mostly close ended questions was used. Observations revealed that majority of the students were aware of various aspects of HIV/AIDS. However, they also had some misconceptions particularly regarding transmission of the disease. The science and urban students had significantly more knowledge as compared to their counter parts, there by leading to more positive attitudes among them. Findings suggest intensification of AIDS education campaign focussed on removal of misconceptions and changing negative attitudes, more so amongst rural students. Science students can prove as a potential source of peer communication to the non-science students both in urban as well as rural areas.