Achhelal Pasi

Preterm birth among pregnancies conceived by assisted reproduction techniques in Mumbai, Maharashtra, India

Background: Preterm births are an enormous global problem on families, medical system and economy. The rates of preterm birth are increasing and one of the contributors is growing use of Assisted Reproduction Techniques (ART) leading to multifetal gestations. Some risk factors for preterm birth are specific to women who conceive by ART. Since there is limited data from India, this pilot study was undertaken to assess the magnitude of preterm birth among pregnancies conceived by ART and to study the contributing factors. Methods: Clinic based descriptive cohort study through eight ART clinics in Mumbai for one year. Data was collected using an in-depth questionnaire on socio-demographic characteristics, medical history, ART details, course and complications during pregnancy, mode of delivery, pregnancy outcome, risk factors related to preterm birth and neonatal outcome. Complete details of 113 participants who completed the study were analyzed. Results: Study showed high incidence of preterm birth (76.23%) among women conceived with ART. Multiple gestations were observed in 45.1%. Pregnancy related complications like heterotrophic pregnancy (3%), pre eclampsia (15%) and gestational diabetes (11%) were high. Incidence of caesarean section was very high (98%). Neonatal outcome was good with 98% live births and only 2 still births. Conclusions: Present study highlights that preterm birth, multiple pregnancies, pregnancy related complications like preeclampsia, gestational diabetes and caesarean sections are very high among women conceived by ART. With growing use of ART there is an urgent need to develop a National ART Surveillance system in India like the one in Centre for Disease Control Atlanta to get complete data on the pregnancy course and outcomes of ART conceptions. Efforts to limit the number of embryos transferred should be strengthened to prevent multiple births.

Profile of Indians died abroad: analysis of secondary data of human remains arrived at point of entry in Mumbai

Travelling abroad for business, employment, study or holidays is increasing globally, including among Indians. According to the Ministry of Tourism and World Bank, 18.33 million Indians travelled overseas in 2014 compared to around 16 million in 2013. More than half of the passenger traffic to and from India is accounted for by the countries in the Africa & Middle East. The international migration report-2017, estimated 258 million people living in a country other than their country of birth an increase of 40% since 2000. Around three quarters (74%) of all international migrants were of working age (between 20 and 64 years) and 48.4% were women. The number of Indian-born persons residing abroad numbered 17 million.

Capacity assessment of district health system in india on services for prevention and management of infertility

Background: Infertility is a neglected service component in the public health-care system in India. Objectives: This study aims to assess the availability and practices on prevention and management services for infertility in the district health system. Methodology: A cross-sectional survey of selected health facilities and the staff from 12 district hospitals (DHs), 24 community health centers (CHCs), 48 primary health centers (PHCs), and 48 subcenters was conducted using qualitative and quantitative methods. Interviewed staff included 26 gynecologists; 91 medical officers; 91 auxiliary nurse midwife; 67 laboratory technicians; and 84 accredited social health activist workers. Results: The findings indicate that adequate staff was in place at more than 70% of health facilities, but none of the staff had received any in-service training on infertility management. Most of the DHs had basic infrastructural and diagnostic facilities. However, the majority of the CHCs and PHCs had inadequate physical and diagnostic facilities related to infertility management. Semen examination service was not available at 94% of PHCs and 79% of CHCs. Advanced laboratory services were available in <42% at DHs and 8% at CHCs. Diagnostic laparoscopy and hysteroscopy were available in 25% and 8% of DHs, respectively. Ovulation induction with clomiphene was practiced at 83% and with gonadotropins at 33% of DHs. Conclusion: The district health infrastructure in India has a potential to provide basic services for infertility. With some policy decisions, resource inputs and capacity strengthening, it is possible to provide advanced services for infertility in the district health system.

Training, Opportunities and Challenges of Accredited Social Health Activists for providing Maternal and Child Health care in Murshidabad district of West Bengal

Introduction: Accredited social health activists (ASHAs) are community health workers. ASHAs play an important role in identifying child morbidity at the earliest and help in improving their health status. While working in the community ASHAs face certain challenges and need specific training to work effectively and efficiently. Present study was conducted to study the training need, challenges and opportunities faced by ASHAs while working in community. Objectives: To study the socio-demographic profile, training status, opportunity and challenges of ASHAs working in Murshidabad district of West Bengal. Material and Methods: A cross sectional study was conducted among ASHAs in Murshidabad district of West Bengal. A total of 237 ASHAs were interviewed by using systematic random sampling. Data was collected by using pretested standard questionnaire. Data analysis was done by using Epi info. Results: Out of 237 ASHAs, Majority (n=208, 88%) received the recommended 23 or more days of training while the rest of them received less than 23 days of training. Non availability of transport for referring pregnant women for delivery (39%, n=93), and absence of services (n=83, 35%) or staff (n=36, 15%) at health facility were the main challenges faced by ASHAs while performing their work.

Risk Factors associated with unsafe neonatal practices in rural area of Nadia district of West Bengal

Introduction: Neonatal mortality is the main barrier to reduction of infant mortality in West Bengal. Home based simple newborn care by mothers in the neonatal period can reduce neonatal mortality. The practices of mothers in this aspect in Nadia are not known. A cross sectional survey of mothers of Nadia with the objectives of describing their neonatal care practices, determine factors associated with it. Methods: Nadia district has a population of 5 million and estimated pregnancies of 74000. We used PPS method cluster sampling technique. We needed 575 mothers in 23 clusters assuming 52% prevalence at 5% precision, 95% Confidence interval and design effect 1.48.Structured questionnaire was used for data collection on different socio-demographic and health system related factors and mothers’ newborn care practices. Data was analysed using Epi info 3.5 software. Results: Among 575 mothers, 518 (90.1%) kept the neonates cord stump clean. Delaying the first bath of the neonate was least practiced 292 (50.8%). Only 39 (6.8%) mothers had all safe practices. Living below poverty line (Adjusted OR 5.2, C.I. 3.4-7.8), not registering in the first trimester (Adjusted OR 2.6, C.I 1.6-4.2), maternal education not more than secondary level (Adjusted OR 2.3, C.I. 1.3-3.9) and having home delivery(Adjusted OR 3.2, C.I. 1.5-6.8) were significant factors for non-adoption of at least five safe practices. The overall neonatal morbidity rate was 57 per 1000 live births (33 /575) and neonatal mortality rate was 10 per 1000 live birth (6/575). Median contacts with the health system in the mothers having unsafe practices was 6 (range 0-11) compared to 10(range 1-11) in the other group. Out of 33 sick neonates 26(78.8%) were from mothers with unsafe practices. Conclusion: Poor and uneducated were unaware of safe newborn care practices especially for hypothermia. They had more neonatal sickness and deaths. They had less contact with the health system. There is a need to reach out to such vulnerable group and improve their coverage in existing facilities. Training of ASHA in Home based newborn care and educating mothers can be cost effective option for this section to save neonates by promoting best neonatal practices. Keywords: Risk factors, Unsafe practices, Neonatal morbidity, ASHA, Rural Nadia, West Bengal

Containing an Outbreak of Human Pathogenic Avian Influenza Outbreak in Nadia district of West Bengal-India

Background: On 12th September 2011, unusual poultry deaths were reported from a poultry farm at Putimari Christianpara under Tehatta Gram Panchayat. On 14th September there were more deaths accordingly, samples were collected and sent to the Regional Disease Diagnostic Laboratory, Kolkata. Preliminary reports confirmed the presence of avian influenza. High Security Disease Detection Laboratory at Bhopal confirmed avian influenza. The state Govt notified the outbreak as avian influenza on 19th September 2010. This outbreak was investigated and epidemiological characteristic & containment measures were described. Material and Methods: Operational definition of avian influenza was established. Fever surveillance in animals and human beings was conducted within 10 kms radius of epicenters. Culling was conducted. All health workers, and cullers were examined and prophylaxis was administered. Results: Out of total 56 Gram Panchayat 25(45%) were affected. Out of 568 villages 131(23%) were affected. Out of 131 affected villages 22 were in the core area and the rest outside. Population affected was estimated to be 400007. Mean population covered per day was 104603 (26%). Conclusion: In all 217 cases were detected with upper respiratory tract but none matched the case definition of avian influenza.

Epidemiology of cataract surgeries in Hooghly district of West Bengal – India

Background: Blindness is a major public health problem. Major causes of blindness are cataract (62.6%), refractive error (19.7%), glaucoma (5.8%) and corneal pathologies (0.9%). National Programme for Control of Blindness (NPCB) is a centrally sponsored programme with goal to reduce the prevalence of blindness from 1.4% to 0.3% by 2020. Objective: Present study was conducted to describe the epidemiology of cataract surgeries done in Hooghly district and to identify the strengths and gaps. Materials and Methods: A secondary analysis was done on NPCB data on cataract surgery. Data was collected from all 5 governmental hospitals, NGOs and private hospitals of Hooghly district. Data from year 2006-07 to 201011 was collected and compared. Results: During the study period there were 2860 registered blinds in Hooghly district, so the blindness prevalence rate was 0.06 percent. The target of cataract surgery was 23000 and achievement was 23951(104.1%). Out of total 23951 cataract surgeries done, more than 50% were from NGO sector followed by Private and Government sector. More than 99% surgeries were done with IOL. Conclusions and Recommendations: As per the strategy of NPCB, role of NGOs and private sectors are increasing gradually. Intense IEC activities are necessary to increase public awareness.