Binod Kumar Patro

Community Perception and Client Satisfaction about the Primary Health Care Services in an Urban Resettlement Colony of New Delhi.

Research Question: This study attempts to assess the community perception and client satisfaction of primary health care services provided by mobile health clinics. Objectives: To assess the awareness of the community about mobile health clinic services and its utilization in an urban area and to assess the client satisfaction of those who have utilized the services. Study Design: A cross-sectional community-based study. Setting: Dr. Ambedkar Nagar, urban resettlement colony of New Delhi. Study Period: July 2006 and September 2006. Participants: For exit interviews, patients who have utilized the mobile health clinic; for community interviews, an adult member present in the family. Materials and Methods: For the community survey, two blocks were randomly chosen and the interview was carried out by house visits. For exit interviews, patients were selected randomly from those attending the mobile health clinic. Statistical Analysis: Descriptive statistical analysis. Results and Conclusions: A total of 377 interviews were conducted (295 community interviews and 82 exit interviews). It was seen that 82% were aware of the mobile health clinic but more than two-thirds preferred private practitioners; reasons given were that they have more trust in private practitioners, convenient timings, and less waiting time. Approximately two-thirds to three-fourths of the clients were satisfied with the mobile health clinic services. Client satisfaction is an important measure of the quality of health care and needs to be addressed in order to improve the utilization of primary health care services in urban areas.

Prevalence of dental caries among adults and elderly in an urban resettlement colony of New Delhi

BACKGROUND Dental caries remains the most important dental health problem in developing countries. In India the prevalence of dental caries is reported to be about 50-60%. Most of the Indian studies have been carried out in school children and very few in adults. This study aimed to estimate the prevalence of dental caries in the adult population (aged 35-44 years) and in the elderly (60 years and above) in an urban resettlement colony in New Delhi. METHODOLOGY A community-based cross-sectional study was carried out in Dakshinpuri, New Delhi, from January to February 2007. A local adaptation of the WHO questionnaire was used. Oral examination was done and dentition status was recorded by trained investigators and according to the standard procedures. RESULTS A total of 452 participants were enrolled in the study. The prevalence of dental caries in the 35-44 years age-group was 82.4% and it was 91.9% in those > or =60 years. The DMF index was 5.7 +/- 4.7 in the 35-44 years age-group and 13.8 +/- 9.6 in the > or =60 years age-group. Of the participants, 27.9% were currently using tobacco. A statistically significant association was found between tobacco consumption and dental caries ( P = 0.026). The awareness about good and bad dental practices was found to be low among the study participants. One-fifth of the individuals with dental problems relied on home remedies. CONCLUSION The prevalence of dental caries among adults is high in this population. There is a need to generate awareness about oral health and the prevention of dental caries and to institute measures for the provision of dental care services at the primary level.

Assessment of noise pollution in and around a sensitive zone in North India and its non-auditory impacts

Noise pollution in hospitals is recognized as a serious health hazard. Considering this, the current study aimed to map the noise pollution levels and to explore the self reported non-auditory effects of noise in a tertiary medical institute. The study was conducted in an 1800-bedded tertiary hospital where 27 sites (outdoor, indoor, road side and residential areas) were monitored for exposure to noise using Sound Level Meter for 24h. A detailed noise survey was also conducted around the sampling sites using a structured questionnaire to understand the opinion of the public regarding the impact of noise on their daily lives. The equivalent sound pressure level (Leq) was found higher than the permissible limits at all the sites both during daytime and night. The maximum equivalent sound pressure level (Lmax) during the day was observed higher (>80dB) at the emergency and around the main entrance of the hospital campus. Almost all the respondents (97%) regarded traffic as the major source of noise. About three-fourths (74%) reported irritation with loud noise whereas 40% of respondents reported headache due to noise. Less than one-third of respondents (29%) reported loss of sleep due to noise and 8% reported hypertension, which could be related to the disturbance caused due to noise. Noise levels in and around the hospital was well above the permissible standards. The recent Global Burden of Disease highlights the increasing risk of non communicable diseases. The non-auditory effects studied in the current work add to the risk factors associated with non communicable diseases. Hence, there is need to address the issue of noise pollution and associated health risks specially for vulnerable population.

Diagnostic agreement between a primary care physician and a teledermatologist for common dermatological conditions in North India.

Background: Primary care physicians (PCPs) encounter a large number of patients with dermatological diseases. However, delivering appropriate management is a challenge considering the inadequate dermatology training offered during the undergraduate medical curriculum. Teledermatology is the clinical evaluation of skin lesions by dermatologists and allows patients to be diagnosed and treated from a distant site. It is seen as a potential solution to the shortage of specialists and providing equitable service in remote areas. Aim: The study was aimed at estimating the diagnostic agreement of common dermatological conditions between a PCP and a teledermatologist. Materials and Methods: Consecutive patients with dermatological ailments who attended a primary health care clinic were recruited into the study, examined by the PCP and offered a diagnosis. The clinical images and patients′ history were collected and transferred to a dermatologist at a tertiary center who also made a diagnosis. Agreement between diagnosis made by the PCPs and the teledermatologist was measured using kappa (κ) statistics. Results: Overall agreement between the diagnoses made by a PCP and the dermatologist was found to be 56%. Poor κ agreement (<0.4) was seen in the diagnosis of psoriasis and eczema. Conclusion: Teledermatology can supplement specialist dermatology service in remote areas. There was poor agreement in the diagnosis of psoriasis, classifying various types of eczematous conditions and fungal infections. Scarce manpower in dermatology at the primary health care level compounded by the burden of skin ailments necessitates training of PCPs in common dermatological conditions.

Occupational health and safety: Role of academic institutions

The occupational disease burden is growing at an unprecedented rate. The profile of occupational diseases has also changed over the period of time as a result of modernization, market liberalization and globalization which now encompasses minor allergy and injuries, systemic infections and diseases as well as the life-threatening leukemia and cancers. Trained human resources in the field of occupational health and safety are far below the requirement. Training in the area of occupational health and industrial medicine is not keeping pace with the changing industrial growth and technologies. There is an urgent need for strengthening skills, developing newer competencies and broadening our knowledge in occupational health and safety and disaster management. Traditional training in occupational health, needs to be supplemented with techniques of environmental epidemiology, environmental impact assessment and environmental risk assessment. The academic community should take the first step in demonstrating its leadership to address the long neglected concerns of occupational health and safety.

Epidemic diseases act 1897, India: Whether sufficient to address the current challenges?

In this age of noncommunicable diseases, communicable diseases still contribute 30% of disease burden in India. Hundreds of epidemics occur each year and we fail to respond and contain most of them. Apart from various biological and behavioral public health interventions, we need to closely look at the structural intervention, that is, the legal framework to review health system preparedness. Although India has a number of legal mechanisms to support public health measures in an epidemic situation, they are not being addressed under a single legislation. The Epidemic Act 1897 is a century old blunt act which needs a substantial overhaul to counter the rising burden of infectious diseases both new and old. Issues like definition of epidemic disease, territorial boundaries, ethics and human rights principles, empowerment of officials, punishment, etc., need more deliberations and warrant a relook.

Tracking progress toward elimination of iodine deficiency disorders in Jharkhand, India

RESEARCH QUESTION What is the current status of Iodine Deficiency Disorders (IDD) in the state of Jharkhand? OBJECTIVES (1) To determine the status of iodine deficiency in the state. (2) To determine the availability and cost of adequately iodized salt at the retail shops. (3) To study the perceptions of the community regarding iodine deficiency, salt and iodized salt. DESIGN A cross-sectional community-based survey. STUDY SETTING Thirty clusters selected through the probability proportion to size (PPS) sampling in the state of Jharkhand. STUDY PARTICIPANTS Children aged 6-12 years, households, retail shopkeepers and opinion leaders. STUDY TOOL: Quantitative and qualitative methodology using a pretested questionnaire and focus group discussion used to carry out the community-based survey. RESULTS Total goiter rate (TGR) was 0.9%. Median urinary iodine level was 173.2 microg/L. The proportion of individuals with urinary iodine levels less than 100 and 50 microg/L were 26.4% and 10%, respectively. Slightly less than two-thirds (64.2%) of the households were found to be consuming adequately iodized salt as measured by titration (greater than 15 ppm). Iodized salt was available across the state and the cost varied between Re. 1 and Rs. 8 per kilogram. A common belief among the community was that iodized salt is equivalent to refined packet salt that is further equivalent to expensive salt. CONCLUSION The results of the present survey show that the iodine nutrition in the state of Jharkhand is optimal. Considering that the consumption of adequately iodized salt should increase from 64.2% to the goal of more than 90%, sustained efforts are required in this place to consolidate the current coverage of adequately iodized salt and increase it to greater than 90%.

Pathway to care of epilepsy patients: Exploratory study from an urban slum in Northern India.

Introduction: Epilepsy is a chronic neurological disorder with major psychosocial correlates. Most epilepsy patients in developing countries are untreated or inadequately treated. It is essential to understand the pathway, to care taken by epilepsy patients in a community, to be able to target appropriate services to them. Materials and Methods: A community based study was conducted on all epilepsy patients in an urban slum in Northern India to study their pathways to care. A list of persons suffering from epilepsy was generated by house to house visits, snowballing, and key informant contacts. In-depth interview and Medical Record Review were used to document their pathway to care. Results: Thirteen of the twenty two patients had contacted a health-care provider for their first episode. The most common first link of care for the patients was secondary level Government hospitals. The next common was private practitioners, followed by Tertiary Care Hospitals, and registered medical practitioners. Eleven out of twenty two patients had to contact a Tertiary Level Center for seeking care. The number of health-care facilities consulted before arriving at their latest point of care ranged from 0 to 5. Traditional or faith healers were consulted at some point of time for cure. Conclusion: There is a need to focus on strengthening and capacity building of the primary care settings for managing epilepsy to enable their better utilization. This shall prevent unnecessary referrals and hence the load on the already burdened higher facilities.

Management of diabetes mellitus: need for empowering primary health care

Chronic diseases are on a constant rise in developing countries. India ranks second globally in terms of diabetes burden. In this case report, an attempt was made to analyse the health care-seeking behaviour of Mrs. SM, receiving treatment at Non-Communicable Diseases Prevention Clinic, All India Institute of Medical Sciences, Bhubaneswar. The patient travels a long distance to seek treatment at AIIMS although she suffers from financial hardships. The pathway of care included referral from Primary Health Centre to tertiary health care facility and back referral. This prompted the authors to study the health care-seeking behaviour with the aid of Health Belief Model. Analysis of the model revealed the enabling factors for treatment adherence and treatment continuity. The present study also analysed the chronic disease care gap from the health system perspective and focused on the need for reformatory measures.

Primary health care teaching to postgraduate public health students, comparison of two models: A natural experiment.

Background: Primary health care as an approach forms an integral part of any public health curricula. The knowledge regarding primary health care can be delivered to public health trainee through conventional or the modular teaching models. Objectives: We aimed to observe whether there was any difference in the summative assessment scores between two different modalities of teaching primary health care to public health trainee at School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Methods: The present study was a natural experiment. Students of Masters of Public Health (MPH) and MD (Community Medicine) formed two natural groups. They were taught by modular and conventional methods of teaching respectively. A total of seven MPH students and nine MD students, participated in the study. Results: Overall summative assessment score among MPH students was 63.9 ± 10.0 in comparison to 61.1 ± 10.9 among MD students. The difference in total scores was not statistically significant. Conclusion: We conclude that approaching a complex topic such as primary health care requires a mix of both modular and non-modular teaching to maximize outputs.