Bir Singh

Typhoid fever in children aged less than 5 years

BACKGROUND Calculation of the incidence of typhoid fever during preschool years is important to define the optimum age of immunisation and the choice of vaccines for public-health programmes in developing countries. Hospital-based studies have suggested that children younger than 5 years do not need vaccination against typhoid fever, but this view needs to be re-examined in community-based longitudinal studies. We undertook a prospective follow-up study of residents of a low-income urban area of Delhi, India, with active surveillance for case detection. METHODS A baseline census was undertaken in 1995. Between Nov 1, 1995, and Oct 31, 1996, we visited 8172 residents of 1820 households in Kalkaji, Delhi, twice weekly to detect febrile cases. Blood samples were obtained from febrile patients, and those who tested positive for Salmonella typhi were treated with ciprofloxacin. FINDINGS 63 culture-positive typhoid fever cases were detected. Of these, 28 (44%) were in children aged under 5 years. The incidence rate of typhoid per 1000 person-years was 27.3 at age under 5 years, 11.7 at 5-19 years, and 1.1 between 19 and 40 years. The difference in the incidence of typhoid fever between those under 5 years and those aged 5-19 years (15.6 per 1000 person-years [95% CI 4.7-26.5]), and those aged 19-40 years (26.2 [16.0-36.3]) was significant (p<0.001 for both). The difference between the incidence of typhoid at 5-19 years and the incidence at 19-40 years was also significant (10.6 [6.3-14.8], p<0.001). Morbidity in those under 5 and in older people was similar in terms of duration of fever, signs and symptoms, and need for hospital admission. INTERPRETATION Our findings challenge the common view that typhoid fever is a disorder of school-age children and of adults. Typhoid is a common and significant cause of morbidity between 1 and 5 years of age. The optimum age of typhoid immunisation and the choice of vaccines needs to be reassessed.

ROAD TRAFFIC FATALITIES IN DELHI: CAUSES, INJURY PATTERNS, AND INCIDENCE OF PREVENTABLE DEATHS

India reported nearly 50,000 traffic accident deaths in 1989. Yet, literature addressing the causes, timing, and preventability of these deaths is sparse. We undertook an autopsy study of road traffic fatalities in South Delhi to determine the injury patterns and incidence of deaths that could be prevented by optimal utilization of available medical resources. Among the 177 autopsies reviewed, neurological injury caused death in 60% of patients and hemorrhagic shock in 25%. Twenty-three percent of the deaths were felt to be preventable, 41% possibly preventable, and the rest not preventable. The majority of preventable deaths resulted from a failure to diagnose or treat a treatable injury. Adherence to establish principles in the hospital management of intracavitory hemorrhage could have salvaged 70% of preventable deaths.

Unmet family planning need: differences and levels of agreement between husband-wife, Haryana, India.

Research question: Is there agreement between husbands and wives regarding unmet need of family planning? Hypothesis: The unmet need of family planning is perceived more by women then their husbands. Objective: 1) To ascertain the unmet needs of family planning for husbands and wives. 2) To ascertain the level of agreement between husbands and wives regarding unmet needs of family planning. Design: A cross-sectional survey Setting: Dayalpur village in Intensive field practice area of Comprehensive Rural Health Services project (CRHSP), Ballabgarh, Haryana. Study Period: July 2003- June 2005. Participants included 200 married couples selected by simple random sampling. Statistical Analysis: Level of agreement between husbands and wives was analyzed using Kappa statistics. Results: Unmet need for family planning was 11% (22 out of 200) for husbands and 17.5% (35 out of 200) for wives. The difference was seen both in unmet need for spacing (M-3.5% vs. F-6%) as well as limiting family size (M-7.5% vs. F-11.5%). Overall, 93.5% concordance was observed amongst husbands and wives. In all the cases where disagreement was seen (6.5%), wives reported having unmet need for contraception whereas their husbands perceived none. The unadjusted Kappa statistic was 0.73 and prevalence adjusted Kappa was 0.88. Conclusion: Unmet need for family planning was significantly higher for wives compared to husbands. Despite high degrees of agreement amongst the couples, the nature of disconcordance reinforces the need for policy makers to take into account the perspective of men.

Tobacco and alcohol use in rural elderly Indian population.

Background: Tobacco and alcohol use are serious health problems. Studies focusing on problems associated with tobacco and alcohol use in the elderly are limited. Aim: To find out the prevalence of tobacco and alcohol use among rural elderly population. Methods: This cross-sectional study was conducted in the intensive field practice area of the Comprehensive Rural Health Services Project in Ballabgarh in Faridabad, Haryana, a rural field practice area of the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi. The sample was selected using stratified random cluster sampling. The participants were ≥60 years of age at the time of interview. Data on tobacco and alcohol use pattern of 1117 elderly were collected during the interview. Results: The prevalence of smoking was 71.8% in men (n=490) and 41.4% in women (n=497). Among men smokers, 41.5% were light smokers (≤5 beedis/day), 42.9% were moderate smokers (6–20 beedis/day) and 15.6% were heavy smokers (>20 beedis/day). Among women smokers, 71.8% were light smokers, 23.8% were moderate smokers and 4.4% were heavy smokers. Regular alcohol intake was seen in 16.3% of the men compared with 0.8% of the women. Conclusion: The finding of a high prevalence of smoking and alcohol consumption among men in this rural population of India is of serious concern and therefore needs remedial measures.

Agreement and concordance regarding reproductive intentions and contraception between husbands and wives in rural Ballabgarh, India

Background: Traditionally, women have been the chief respondents in most demographic and health surveys focusing on family planning; the role of men has been limited. However, in recent years there has been realization of the importance of mens role in family planning. Aims and Objectives: To assess the levels of agreement and concordance between husbands and wives regarding reproductive intentions and contraception. Materials and Methods: A cross-sectional survey was carried out in 200 randomly selected married couples (in the age range of 15-44 years) in village Dayalpur, Haryana. Data pertaining to reproductive intentions and contraception was collected and the level of agreement (kappa statistics) between husbands and wives was calculated. Results: The observed concordance was 67.5% for ideal family size, 84.5% for contraceptive attitude, 88.5% for fertility desire, 93.5% for unmet need, and 97% for report of number of currently living children. The adjusted kappa statistic varied from a low of 0.43 (P ≤ 0.001) (ideal family size) to a high of 0.96 (P ≤ 0.001) (number of living children) with contraceptive attitude (0.7) (P ≤ 0.001), unmet need (0.88) (P ≤ 0.001), and current use of contraception (0.93) (P ≤ 0.001) having kappa values in between. Overall, a greater degree of agreement was observed for reproductive health events as compared to family planning attitudes and intentions. An in-depth analysis of the responses in the current study provides further evidence of male domination in decision making. Conclusion: In surveys pertaining to reproductive health events, the wifes response can be taken as proxy for the couples response, but for assessing family planning attitudes and intentions, there is a need to collect information from husbands and wives separately.

Prevalence of knee osteoarthritis amongst perimenopausal women in an urban resettlement colony in South Delhi

A community-based cross-sectional study was carried out in an urban resettlement colony in South Delhi to study the prevalence of knee osteoarthritis in women aged ≥40 years and treatment seeking behavior of women suffering from osteoarthritis. Osteoarthritis was diagnosed by using clinical criteria given by American College of Rheumatology for diagnosis of Idiopathic Osteoarthritis of knee joints. A total 260 women were interviewed out of which 123 (47.3%) women were found to be suffering from knee osteoarthritis. Prevalence of osteoarthritis found to be increased with age. Less than half of those with osteoarthritis underwent treatment. With this high prevalence of osteoarthritis, there is need to spread awareness about the disease, its prevention, and rehabilitation in the community.

Role of Cultural Beliefs in Influencing Selected Newborn Care Practices in Rural Haryana

BACKGROUND The role of prevalent culturally driven beliefs and practices in influencing home-based newborn care has not been adequately studied, especially in North India. METHODS The study was conducted in 28 villages under Comprehensive Rural Health Services Project (CRHSP), All India Institute of Medical Sciences (AIIMS). A total of 415 mothers who had a baby in the second month of life, at the time of the visit for data collection were interviewed using pre-tested questionnaire. RESULTS Nearly 77% of mothers reported some beliefs/practices with regard to care of the cord. Similarly, 81.0% mothers had beliefs regarding taking the baby out of the house for the first time after birth. Out of all the mothers that were interviewed, around 11% did not prefer their baby to be weighed at frequent intervals because according to them, doing so could lead to slowing of the growth of the baby. CONCLUSION Traditional knowledge and practices must be considered before developing neonatal health care intervention strategies.

Pulse polio immunization in Delhi--1995-96: a survey.

A coverage evaluation survey of the campaign for mass Pulse Polio Immunization (PPI) on 9th December, 1995 and 20th January, 1996 in Delhi was carried out using the modified cluster sampling technique and a pre-structured proforma. Six-hundred-and-nine children of under-3 age group were covered in the survey. Overall coverage for both the doses was found to be 77% While coverage for 9th December dose was found to be 80%, it rose to 90.2% on 20th January, 1996. Coverage levels for male and female children were similar. Parental literacy was seen as a definite factor, positively affecting the coverage levels. Proportion of not covered under PPI was significantly higher in the 0–6 months age group. Television and health workers were found to be the main sources of awareness about PPI.

Prevalence of anaemia in the postpartum period: a study of a North Indian village

Anaemia is a common public health problem but there is a paucity of studies regarding anaemia in the postpartum period. The objective of this study was to investigate the prevalence of anaemia in the postpartum period and factors associated with it. This prospective community-based study was carried out in a village of Haryana, India. Blood samples were collected for haemoglobin estimation at the end of six weeks postpartum. A total of 211 women were recruited and 168 women were included in the final analysis. It was found that 70% of the study participants were anaemic (Hb < 11 g/dL). Only 37% of the population had consumed ≥90 iron folic acid (IFA) tablets. The mean haemoglobin level of women who had consumed ≥90 IFA tablets in the antepartum period was higher (10.43 g/dL) than those who consumed <90 IFA (9.9 g/dL). Multicentric studies are recommended to get the true picture for the whole country.

Maternal morbidity during postpartum period in a village of north India: a prospective study

This prospective community-based study was conducted in the village of Chhainsa, Haryana, India, in order to discover the incidence and types of postpartum morbidity and the factors associated with the morbidities. The subjects were followed up to 42 days of postpartum with a minimum of three visits; the first visit was within 14 days of delivery and subsequent visits were every 14 days. A first visit was made to 211 women and 174 (82.46%) completed the study. Seventy-four percent reported at least one morbidity and there were 1.75 reported morbidities per woman per postpartum period. Common problems reported were: weakness, lower abdominal pain, perineal pain, abnormal vaginal discharge, high fever, breast problems, excessive vaginal bleeding, etc. There was greater morbidity among women of lower socioeconomic status, parity >4, birth interval >36 months, having a breech or caesarean delivery or a delivery assisted by relatives/neighbours. A significant positive association was found between age and non-maintenance of the ‘five cleans’ during delivery. Seventy-five percent of those who had reported morbidity had taken some action, but only 20% sought help from a qualified doctor and 14% from other health workers.