Dilip Kumar Das

Awareness and perception of mothers about functioning and different services of ICDS in two districts of West Bengal

Integrated Child Development Services, a national programme of the Government of India has health, nutrition, and pre-school education components of services. To ascertain awareness, perception of mothers about functioning and different services of ICDS a cross-sectional community based study was conducted between June to September 2007 in Howrah and Purulia districts of West Bengal. A total of 1235 mothers were included as study subjects. As per opinion of the mothers 73% AWCs opened regularly, behaviour of the AWWs was friendly (71.6%) and 63% mothers opined that ICDS is beneficial to their children. 84.2% mothers were aware of any ICDS services. Quantity and quality of supplementary food was acceptable to 88% and 72.7% mothers respectively. 79.2% and 87.5% mothers did not receive any advice on child feeding and growth chart. Making beneficiaries aware about services by targeted interventions will ensure better utilization of ICDS.

Goitre prevalence, urinary iodine and salt iodisation level in a district of West Bengal, India.

Objectives: We carried out a study to assess the prevalence of goitre, measure urinary iodine excretion (UIE) levels and to estimate salt iodine content at the household level in Howrah district of West Bengal, India. Methods: Study Design: This is a Cross-sectional descriptive study conducted in September–December 2006. Setting: Primary schools located in 30 clusters (villages and wards) randomly selected through <5001>30 cluster<5002> sampling methodology. Participants: 2400 school children, aged 8–10 years. Indicators: The indicators used in this study to assess for IDD were recommended by the WHO/UNICEF/ICCIDD. Goitre was assessed clinically by the standard palpation technique. The urinary iodine excretion level was analyzed by the wet digestion method. Salt samples consumed at the household level were collected and tested by the spot iodine testing kit to measure iodine content. Results: The Total Goitre Rate (TGR) was 13.7% (95% CI = 12.3–15.1%). Grade 1 was 11.4% and Grade 2 (visible goitre) was 2.3%. The TGR was influenced by the age and sex factors but not by religion and residence. The median urinary iodine excretion level was 13 μg/dL (normal range: 10–20 μg/dL) and none had a value less than 5 μg/dL. There was significant negative correlation between UIE levels and the age and place of residence factors. Almost 80% of salt samples tested had adequate iodine content (≥ 15 ppm). Consumption of iodized salts was lower among Hindus and in rural area. Conclusion: In conclusion, the Howrah district is in a transition phase from iodine deficiency to iodine sufficiency.

Trend and pattern of various types of cancer with special reference to gall bladder cancer in North Bengal medical college, West Bengal, India: A 3 years record based study

Background: Global burden of cancer is on rise and trends and pattern of cancers are rapidly changing different geographic and population groups. Gall bladder cancers are emerging with increasing proportion among select areas and groups and understanding these variations are important for appropriate strategies and interventions. However, absence of a well-developed universal cancer registry system in India, institution based secondary data analysis can generate useful information. The present study was conducted to determine the trend and pattern of cancer cases (with special reference to gall bladder cancer) treated in a tertiary care hospital in northern part of West Bengal. Methods: Record based cross-sectional study was conducted in Department of Radiotherapy, North Bengal Medical College and Hospital. All newly registered cases between (2010 and 2012) were reviewed. Results: A total of 2058 cancer cases were recorded during the 3-year period. Of these, major types of cancers were oro-pharynx (16.1%), breast (15.4%), cervix (13.2%), lung (12.7%), gall bladder (6.5%) stomach cancer (6.4%), etc., Increasing proportions was observed for breast and gall bladder cancers. The proportion of gallbladder cancer cases in 2010, 2011, and 2012 were 3.8%, 7.3% and 7.8%, respectively. Among 134 gall bladder cancer cases, 93.3% were females, 85.1% alcoholics, 57.4% had a history of fatty liver, 94% had adeno/adenosquamous carcinomas, and 65.7% were metastatic in nature. Conclusions: Increasing trend is observed in gall bladder cancer cases emphasizing the need for further large scale studies.

Access to and utilization of voucher scheme for referral transport: a qualitative study in a district of West Bengal, India

Background: Lack of motorized transport in remote areas and cash in resource-constrained settings are major obstacles to women accessing skilled care when giving birth. To address these issues, a cashless voucher transport scheme to enable women to give birth in a health-care institution, covering poor and marginalized women, was initiated by the National Rural Health Mission in selected districts of India in 2009. Methods: The access to and utilization of the voucher scheme were assessed between December 2010 and February 2011 through a qualitative study in the district of Purulia, West Bengal, India. Data were collected from in-depth interviews and focus group discussions with women, front-line health-care workers, programme managers and service providers. Results: The main factors influencing coverage and utilization of the scheme were: reliance on ill-prepared gram panchayats (village councils) for identification of eligible women; poor birth preparedness initiatives by health-care workers; over-reliance on telephone communication; restricted availability of vehicles, especially at night and in remote areas; no routine monitoring; drivers’ demand for extra money in certain situations; and low reimbursement for drivers for long-distance travel. Conclusion: Departure from guidelines, ritualistic implementation and little stress on preparedness of both the community and the health system were major obstacles. Increased enthusiasm among stakeholders and involvement of the community would provide opportunities for strengthening the scheme.

Repeated Abuse during Childhood and Adolescence Leading to Suicidal Behavior in an Adolescent: A Case Report

Children in all societies are often neglected, maltreated, abused, intentionally or otherwise by their parents, siblings and in school. One of the most important and preventable long term consequences of childhood abuse is the development of suicidal tendencies in adolescence or adulthood. We report such a case of childhood abuse leading to repeated suicidal attempts in an adolescent. Individual and family therapy, coupled with other specific interventions, has helped the teenager and his family lead a normal life. Thus, proper treatment and counseling will be helpful to cope with difficult family and social situations.

Burden of Hospitalized Pediatric Morbidity and Utilization of Beds in a Tertiary Care Hospital of Kolkata, India

Background: Childhood morbidity consumes a substantial portion of health care resources in terms of hospital bed utilization, and overload in hospital ward remains a major concern in many countries, including India. A possible way to minimize the problem of scarcities of bed is to analyze the pattern of bed utilization by causes and plan services accordingly. Objectives: To determine the burden of pediatric morbidity and utilization pattern of pediatric beds in a tertiary care hospital. Materials and Methods: A retrospective analysis of pediatric inpatients records was conducted over a period of 1 year from 1 January 2007 to 31 December 2007. Results: Of 3983 total admitted cases, about one-third were infants, of which neonatal and post-neonatal age group constituted 45% and 55% of the cases, respectively. In terms of bed-day utilization, infants, 1-4 years and 5-11 years age group accounted for 35.10%, 32.58% and 32.32% of total days of admission, respectively. Utilization of pediatric beds by major causes of morbidity was respiratory tract infection (22.23%), convulsive disorder (12.68%), accident and poisoning (6.07%), diarrheal disease (4.97%) and chronic hemolytic anemia (4.42%). Conclusion: A minor change in admission policy through provision of day care unit for management of certain cases would allow efficient use of hospital beds.