Anita Shankar Acharya

HPV Vaccination in India: Critical Appraisal

Cervical cancer is the third most common cancer in women worldwide. The role of human papilloma virus (HPV) in the genesis of cervical carcinoma is well documented. The HPV 16 and 18 are found to be most commonly associated with invasive cervical carcinoma. The advent of cervical carcinoma vaccine has advanced the hopes that eradication of cervical carcinoma might be possible in future. The scenario of prevention of cervical carcinoma is completely different in developed and developing countries. The implementation of the vaccination as a routine in India is still controversial. Here we have tried to critically analyse these issues in Indian context. However it is clear that cervical cancer vaccine is not an immediate panacea and cannot replace the cervical cancer screening which is mandatory in Indian context.

Making pregnancy safer-birth preparedness and complication readiness study among antenatal women attendees of a primary health center, delhi.

Background: Every pregnancy is a joyful moment for all mothers who dream of a safe pregnancy and a healthy baby. However, every pregnant woman faces the risk of sudden, unpredictable complications that could end in death or injury to herself or to her infant. Birth preparedness and complication readiness (BPACR) is a strategy that encourages pregnant women, their families, and communities to effectively plan for births and deal with emergencies, if they occur. It is a key component of globally accepted safe motherhood programs. Objectives: The objective of our study was to assess the status of BPACR among pregnant women and to study the socio-demographic factors affecting BPACR. Materials and Methods: We conducted a facility-based cross-sectional study among 417 antenatal attendees at a primary health center, Palam, New Delhi from January to April 2012. Knowledge about danger signs, planning for transport, place, and delivery by skilled birth attendant, financial management, and outcome were assessed. BPACR index was calculated. Results: Our study revealed that the BPACR index was very low (41%) although the preparedness level was high. Majority (81.1%) had identified a skilled attendant at birth for delivery. Nearly half of the women (48.9%) had saved money for delivery and 44.1% women had also identified a mode of transportation for the delivery. However, only 179 (42.9%) women were aware about early registration of pregnancy. Only one-third (33.1%) of women knew about four or more antenatal visits during pregnancy. Overall, only 27.8% women knew about any one danger sign of pregnancy. Conclusion: The level of awareness regarding BPACR was very low (41%). Efforts should be targeted to increase the awareness regarding components of BPACR among pregnant women and their families at the Primary Health Center (PHC) as well as at the community level. This will indeed go a long way in reducing morbidity as well as mortality in pregnant women, thus enabling us to reach the millennium development goal.

Prevalence and Risk Factors for Low Back Pain in 1,355 Young Adults: A Cross-Sectional Study

Study Design Cross-sectional study. Purpose To evaluate the prevalence and various risk factors for low back pain (LBP) in young adults in India. Overview of Literature LBP is an emerging problem in adolescents, with an incidence that is the highest in the third decade of life worldwide. Various risk factors such as obesity, smoking, family history, stress, and exercise have been described in the literature. This study was conducted because of paucity of data in the Indian literature. Methods A total of 1,355 (741 males and 641 females) young Indian Administrative Service aspirants and medical postgraduate aspirants aged 18–35 years were enrolled in the study. The subjects completed a detailed, semi-structured questionnaire that gathered data regarding their sociodemographic profile and factors considered to be risk factors for LBP. Anthropometric measurements, including height and weight, were measured and body mass index was calculated. Results Most subjects (90.6%) were aged 20–29 years (mean, 24.49; range, 18–35 years). Results indicated that the following factors were associated with LBP in young adults: marital status, previous history of spine problems, strenuous exercise, job satisfaction, monotony, stress, daily number of studying hours, and family history of spine problems (p<0.05). However, age, sex, smoking, alcoholism, coffee intake, mode and duration of travel, diet, frequency of weightlifting, wearing heels, studying posture, and frequency and type of sports activities were not associated with LBP. Conclusions The study identified various modifiable and non-modifiable risk factors that precipitated LBP in young adult Indians. Identifying these risk factors at an early stage will prevent LBP progression to a chronic disease state, thereby improving an individuals quality of life and increasing productivity.

The influence of television on urban adolescents of Delhi

Indian Journal of Community Medicine/Vol 39/Issue 1/Jan 2014 Sir, The history of television (TV) can be dated back to early 1960’s when TV first came to India by the name of “Doordarshan” commonly named as “DD,” the so-called national TV network of India. It became an important means of mass media communication channel because of its unique feature of combining both audio as well as video technology. After around 50 years it has entered each and every home thus, serving as an important medium for disseminating information to its viewers. As it serves multiple functions of providing entertainment, information and education, it has a great influence on children’s overall development right from a very early age.(1) On one side it makes children aware of healthy habits, on the other hand, excessive TV watching leads to physical inactivity and consequently increased incidence of obesity.(2) Time spent in watching TV may be utilized in reading, outdoor games, etc. Since, adolescents form the most vulnerable and habitforming stage of life, the present community based cross-sectional study was done on urban adolescents of Delhi.

Incidence, Pattern, and Severity of Acute Respiratory Infections among Infants and Toddlers of a Peri-Urban Area of Delhi: A 12-Month Prospective Study

Acute respiratory infections (ARIs) in spite of being the single most important under-five morbidity have not been studied adequately in peri-urban settings in India. We conducted this study prospectively on a cohort of 106 children in a peri-urban area of Delhi. The overall 2-week prevalence of all types of ARI was 34.3%. Annual combined incidence of all types of ARI was 7.9 episodes/100 child-weeks; while that for no pneumonia, cough, and cold, pneumonia, and otitis media was 7.1, 0.85, and 0.09 epi/100 ch-wks, respectively. Incidence of ARI was higher in infancy (9.4 epi/100 ch-wks) as compared to toddlers (7.0 epi/100 ch-wks). Pneumonia incidence was higher among boys (0.9 epi/100 ch-wks as compared to 0.6 for girls) and the highest in infants under 2 months of age (1.09 epi/100 ch-wks; P < 0.01). Incidence of severe pneumonia was roughly one-tenth that of pneumonia. Incidence of both ARI and pneumonia peaked in spring and autumn. Mothers of infants, zespecially those under 2 months of age, need to be made aware of ARI/pneumonia and IEC campaigns may be aired more intensively keeping their peak season in mind.

Entomo-epidemiological investigations of chikungunya outbreak in Delhi, India

Context: An outbreak of fever with severe joint pain started in the Palam area of Delhi in August 2010. An entomological and epidemiological investigation of this outbreak was conducted to ascertain the nature and cause of the outbreak. Aim: Aim of the study was to investigate the nature and cause of the outbreak and to contain its further spread. Settings and Design: It was a cross-sectional study conducted in the Palam area of south-west Delhi, situated at a distance of about 20 km from Medical College. It is one of the field practice areas for training of undergraduate and postgraduate students of Department of Community Medicine of Medical College of Delhi. Materials and Methods: All patients attending OPD of Primary Health Center (PHC) Palam, complaining of ever with incapacitating joint pain, were screened for chikungunya fever. Of the 750 suspected chikungunya patients, 130 blood samples were randomly drawn amongst these patients. Out of the 130 tested, 97 (70.8%) were positive for the IgM antibodies against chikungunya virus. House-to-house survey was conducted in the affected area for more cases and to find out the vector-breeding sites. Statistical Analysis: Frequency distributions were calculated for age and sex. Results: The main breeding sites of the mosquitoes were the desert coolers of houses, water stored in metal and plastic containers, and water collections at construction sites. Aedes mosquito was present in almost all the houses surveyed in the area. Conclusions: It was concluded that the routine campaigns need to be organized regularly within the community highlighting the potential breeding grounds of mosquitoes and the possible control methods. Source reduction strategies like cleaning of desert coolers on weekly basis, emptying of water containers, and close monitoring of construction sites for potential breeding of the vector needs to be done on a regular basis to avoid future outbreaks.