A Banerjee

Correlates of Job Satisfaction in Medical Officers

BACKGROUND A study was carried out to assess the job satisfaction of medical officers of the Armed Forces. METHODS Medical officers having a minimum of five years service, stationed in a large cantonment having a tertiary care service hospital were administered anonymously the scale developed by Brayfield and Rothe to assess job satisfaction. A total of 64 medical officers (22 administrative cadre, 26 specialists and 16 superspecialists), participated in the study. RESULTS Overall there was a low level of job satisfaction among the medical officers. There was no significant difference in the level of job satisfaction in the three groups. Only 3 each of administrative cadre and specialist officers were in the higher satisfied group. The most common factor stated (91.5% of the respondents), as contributing towards job satisfaction was an opportunity for self-development. Others in decreasing frequency were job security (51.6%), prestige of organization (38.5%), nature of work (28.8%) and opportunity for promotion (21.6%). Factors for dissatisfaction were poor utilization of skills (80.8%), poor promotional prospects (78.4%), inadequate redressal of grievances (72.7%), organizational policy (68.7%) and inadequate pay and allowances (48.7%). CONCLUSION It was concluded that job satisfaction is a multi-dimensional phenomenon where it is not easy to assign one factor as the sole determinant of satisfaction/dissatisfaction with the job.

Determinants of Smoking Habit among Medical Students.

A cross sectional study of smoking habits among medical students was carried out to find out the prevalence of smoking and its association with certain factors such as parental smoking, peer pressure, use of alcohol and other drugs. Prevalence of smoking was 46%. There was significant association of smoking with parental smoking habit, peer pressure, use of alcohol and other drugs. Strategies to counter these social determinants have been discussed.

Medical Certification of Cause of Death

Medical Certificate of Cause of Death, commonly called Death Certificate, is the most frequently issued certificate, at least by a government employed medical officer, if not by a private practitioner. It is common knowledge that many medical officers, even some of those with incomparable medical knowledge and expertise, do not fill up this document of immense medical and legal importance correctly. The reasons may be many, ranging from ignorance to indifference. Medical officers of Armed Forces Medical Services attending refresher courses (MOJC) have always requested the authors for a class on this topic. Considering these aspects, the authors have tried to clarify different issues concerning the question.

Outbreak of Rubella Among Cadets in an Academy

BACKGROUND Rubella is traditionally considered a childhood disease, but has the potential to cause outbreaks in closed community of young adults. The present paper describes one such outbreak in a military training establishment. METHOD The cases of rubella outbreak were identified by clinical features (fever, rash and lymphadenopathy) and confirmed by detection of high titre of anti-rubella IgM antibodies by enzyme-linked immunosorbent assay. Initial serum samples were also tested for antibodies against measles, scrub typhus and dengue. Salient epidemiological features of the outbreak were studied. RESULT 163 cadets were admitted in the local military hospital within two months. The cases presented with fever, coryza, lymphadenopathy and maculopapular rash. 117 (71.78%) of the samples showed presence of anti-rubella IgM antibodies. CONCLUSION Rubella outbreaks in military communities have the potential to adversely affect military training/operations. The need for administration of vaccination against rubella in such population may be reviewed.

Outbreak of Viral Hepatitis E in a Regimental Training Centre

BACKGROUND An outbreak of viral hepatitis occurred in a regimental centre with 265 cases occurring during a 3 months period. METHODS 190 serum samples were tested for IgM antibodies against viral hepatitis E by Enzyme Immuno Assay (EIA) and for antibodies against Hepatitis A and Hepatitis B viruses. Epidemiological investigation comprised review of surveillance data, filling up epidemiological case sheet, sanitary survey, inspection of water supplies and bacteriological examination of water for coliforms. RESULT 97.4% of the serum samples were positive for IgM antibodies against Hepatitis E virus. Two leaks were detected in water pipelines, which were passing through contaminated areas around improperly functioning septic tanks and soak pits. The attack rate among recruits being supplied water through leaking pipelines was 11.1% whereas it was 2.89% in those not directly exposed. This difference was statistically significant (p<0.001). Bacteriological examination of water showed a high coliform count. CONCLUSION The outbreak of viral hepatitis E occurred due to sewage contamination of water pipelines.

EPIDEMIOLOGICAL AND ENTOMOLOGICAL CORRELATION OF MALARIA TRANSMISSION IN AN AIR FORCE STATION.

An epidemio-entomological study was carried out at an Air Force Station located in a semi-hilly, forested, highly malarious, tribal belt in Central India. Malaria incidence for the period 1995-1998 showed highest incidence among DSC personnel. Entomological studies identified exophilic vectors (A culicifacies), whose bionomics coincided with outdoor nature of occupation of the DSC personnel. Active surveillance among neighbouring villages showed high endemicity particularly in the tribal villages. Heavy rainfall in 1997 had a slight inhibiting effect on transmission. Because of exophilism of the vectors and occupational hazard of malaria faced by the DSC personnel, personal protective measures hold the key to malaria control in this group.

HEIGHT AND WEIGHT PATTERNS AS INDICATORS OF GROWTH AMONG SCHOOL CHILDREN IN AN AIR FORCE STATION : A CROSS-SECTIONAL STUDY.

A cross sectional study of school children between 6-17 years of age was carried out in an Air Force Station to determine their growth patterns as indicated by weight and height with a view to detect gender bias, if any, and compare the findings with those of affluent Indian children and National Centre for Health Statistics (NCHS), USA, standards. A total of 763 boys and 605 girls were examined. There was no gender bias in growth. Though the children compared almost favourably, with affluent Indian children, particularly in respect to stature, they were lagging far behind the NCHS standard. Goal for achieving the NCHS standards in the long run has been discussed.

Malaria Control: Current Concepts

Malaria continues to be a major public health problem in many countries and its role as a military medical problem goes back into antiquity [1], Malaria has the potential to incapacitate such a large number of troops that military operations may be jeopardized [2]. In India, the Vedic medical literature recognized it as the “King of Diseases” [3]. Shifting from the ancient to the present – about 100 countries in the world are considered malarious with more than 2400 million of the worlds population at risk [4]. The incidence of malaria worldwide is estimated to be 300-500 million cases each year, killing between 1.1 to 2.7 million people. Urban and periurban malaria is on the increase in South Asia. Military conflicts and civil unrest, along with unfavourable ecological changes, have greatly contributed to malaria epidemics, as large number of unprotected, non-immune and physically weakened refugees move into malarious areas. Such population movements contribute to new malaria outbreaks and make epidemic prone situation more explosive [4]. Today, major advances have taken place in our understanding of the molecular biology of the malaria parasite and of the immunologic responses to it; in the development of diagnostic techniques, vector control methods, antimalarial drugs and vaccines; and in the trials of a variety of strategies for malaria control [5]. Contemporary malaria control efforts aim to reduce malaria related morbidity and mortality through a combination of multiple interventions that disrupt the parasite-vector-human cycle at several points. This stratified approach is based on the observation that the effectiveness of different malaria control options can depend heavily on local conditions [6]. Some understanding of these conditions is therefore essential in order to develop a malaria control project. First of all, basic surveillance data are necessary to determine the level of endemicity, assess the seasonality of transmission, and identify the level of risk in different population groups. In some areas, drug efficacy testing will be needed to understand the relative prevalence of antimalaria drug-resistant parasites and to develop effective treatment and chemoprophylaxis policies. An understanding of local attitudes and beliefs is also important, since these can affect the acceptability of some interventions, particularly those that depend on changing human behaviour. Finally entomological studies to identify the principal vectors are necessary for selecting appropriate vector control options [7., 8.]. Approaches focusing upon vector control have progressed beyond that of engineering and larval control to use of residual insecticides, aerosol distribution of insecticides, the use of mosquito netting and screens, repellants of various types and most recently the development of insecticide treated bed nets. In the last ten years increasing experience with insecticide treated bed nets have shown reduction of transmission, clinical disease, and childhood mortality in at least three large controlled trials [9., 10., 11., 12.]. However, not all studies have demonstrated such positive benefits, and there is much controversy about the role of insecticide treated bed nets in control programs. An evaluation of a national program of insecticide treated bed nets under routine use failed to provide evidence for any reduction in child mortality [13]. Similarly, use of deltamethrin treated mosquito nets did not have significant impact in reducing malaria incidence in an air force setting where the vectors were exophilic [14]. In spite of such conflicting reports, insecticide treated bed nets are one more potentially valuable weapon to be included in working through an integrated approach to malaria control based upon epidemiological, ecological, and socioeconomic circumstances. For example, between 1992 and 1997, Vietnam reduced its malaria death toll by 97%, when number of people using insecticide treated nets provided free of charge soared form 300,000 to 10 million. Vietnams success was achieved through countrywide provision of insecticide treated nets, indoor spraying with insecticides, the use of high-quality antimalarial drugs, preventing malaria in pregnant women, and disease monitoring and reporting [15]. In India, the Enhanced Malaria Control Project (EMCP) was launched in April 1997 with the assistance of World Bank. This is directly benefiting six crore tribal population of the eight peninsular states covering 100 districts and 19 urban areas. One of the components of EMCP is the insecticide treated bed net programme. During 1999-2000, 1,50,000 insecticide treated bed nets were distributed in the North-Eastern States. During 2000-2001 the supplies were increased in more areas besides the North-East and 3,20,000 nets were distributed [16]. The Roll Back Malaria (RBM) initiative was launched in October 1998. It has four founding partners; WHO, UNICEF, UNDP and the World Bank. This initiative is unique in that, unlike previous global campaigns against malaria, RBM is horizontal in its approach, focusing on building sustainable community capacity. RBM is also unique in its ability to raise the level of political commitment and advocacy at the country level. Remote Sensing Technologies through satellites is likely to become a rapid epidemiological tool for surveillance of vector borne diseases and malaria in particular [16]. Scientists in USA had used this technique way back in 1971 to identify the habitats of a nuisance mosquito Aedes sollicitans. In India, The National Remote Sensing Agency is located in Hyderabad. A feasibility study using satellite data in collaboration with the Indian Space Research Organization in and around Delhi was carried out and correlation of changes in water bodies and vegetation with mosquito density was found significant in some sites. Malaria, along with tuberculosis and HIV/AIDS is considered one of the diseases of poverty and global efforts are on to scale up the remedial activities.

Behavioural Surveillance Survey Among Troops in a Large Military Station

A cross sectional survey was carried out among the troops located in a large cantonment using the UNAIDS standard survey questionnaire (UN Best Practice Collection) for Behavioural Surveillance Survey (BSS). A total of 556 randomly selected recruits and soldiers were administered the questionnaire. The median age at first sexual encounter was 25 years for service personnel and 18 years for recruits. 5.5% of the recruits and 1.7% of regular soldiers reported having regular sexual partners other than spouse. Among those who had casual sex 46.3% reported using condoms. 52.3% were aware about the two main preventive indicators. Some incorrect beliefs regarding transmission of HIV/AIDS were also present among some of the respondents. The findings have been discussed in relation to previous studies.

TRIBAL MALARIA AND ITS EFFECTS ON AIR FORCE STATION AMLA AND SURROUNDING AREAS : AN EPIDEMIOLOGICAL STUDY

An epidemiological study on the transmission of malaria was carried out in an Air Force (AF) station located in a densely forested, highly malarious tribal belt in Central India. Among the AF station population, Defence Service Corps (DSC) personnel, whose occupation involved night patrolling in densely forested locales on the perimeter of the AF station, with the tribal villages within flight range of the vector mosquitoes, were the group most affected in terms of both overall malaria incidence and high falciparum rates. Among the neighbouring villages, the tribal villages had significantly higher rates of malaria as compared to the non-tribal villages. Vector identification revealed the presence of malaria vectors Anopheles culicifacies and A fluviatilis. Heavy breeding was noted in the surrounding villages, both in natural water channels and man made projects, such as installation of village hand pumps without proper drainage. A rising trend of malaria was obvious in these villages. Incidence among the service population could be controlled to some extent by specifically targeted measures inside the camp area. Strategy for controlling malaria in such endemic pockets has been discussed.