Jai Veer Singh

A study on determinants of immunization coverage among 12 -- 23 months old children in urban slums of Lucknow district India.

CONTEXT To find out the suitable factors for raising the coverage of immunization. AIMS To determine the coverage and to identify the various factors of primary immunization. SETTINGS AND DESIGN Urban slums of Lucknow district. METHODS AND MATERIAL WHO 30-cluster sampling technique was used for the selection of the subjects. Mother, father or relative of a total of 510 children with 17 children per cluster were interviewed in the study. STATISTICAL ANALYSIS Chi-square test, binary logistic regression and multinomial logistic regression analysis were done to test the statistical significance of the association. RESULTS About 44% of the children studied were fully immunized. Multinomial logistic regression analysis revealed that an illiterate mother (OR=4.0), Muslim religion (OR=2.5), scheduled caste or tribes (OR=2.3) and higher birth order (OR approximately 2) were significant independent predictors of the partial immunized status of the child; while those associated with the unimmunized status of the child were low socioeconomic status (OR=10.8), Muslim religion (OR=4.3), higher birth order (OR=4.3), home delivery (OR=3.6) and belonging to a joint family (OR=2.1). CONCLUSIONS The status of complete immunization is about half of what was proposed to be achieved under the Universal Immunization Program. This emphasizes the imperative need for urgent intervention to address the issues of both dropout and lack of access, which are mainly responsible for partial immunization and nonimmunization respectively.

Effectiveness of 3-Day Amoxycillin vs. 5-Day Co-trimoxazole in the Treatment of Non-severe Pneumonia in Children Aged 2-59 Months of Age: A Multi-centric Open Labeled Trial

This cluster randomized, open labeled trial was conducted to compare the effectiveness of 3 days of oral amoxycillin and 5 days of co-trimoxazole treatment in terms of clinical failure in children with World Health Organization (WHO) defined non-severe pneumonia in primary health centers in rural India. Participants were children aged 2-59 months with WHO defined non-severe pneumonia, with or without wheeze, who were accessible to follow up. From seven primary health centers in each arm, 2009 cases were randomized, 993 and 1016 in treatment with amoxycillin and co-trimoxazole, respectively. Fever was present in 1247 (62.1%) and wheeze in 443 (22.1%). There was good adherence and low loss to follow-up. Clinical failure on amoxycillin and co-trimoxazole on intention to treat analysis was 137 and 97, respectively (absolute difference = 0.04, 95% confidence interval: - 0.035-0.12). We conclude that there was no difference in effectiveness of oral co-trimoxazole or amoxycillin in treating non-severe pneumonia.

Factors influencing utilization of ASHA services under NRHM in relation to maternal health in rural Lucknow

Background: Under National Rural Health Mission (NRHM), ASHA (accredited social health activist) has been identified as an effective link to address the poor utilization of maternal and child health (MCH) services by rural pregnant women. Objective: To study the factors influencing utilization of ASHA services in relation to maternal health. Study Design: Cross-sectional. Setting Primary Health Centre (PHC), Sarojininagar, Lucknow and its rural field area. Study Period: September 2007 to August 2008. Study Unit: RDW (recently delivered women) were considered as those who delivered a live newborn at PHC Sarojininagar, within a week of interview and belonged to villages within the confines of the PHC being served by ASHA. Materials and Methods: 350 RDW were interviewed at their bedside, by a preformed and pretested schedule and then were followed-up after six weeks. Results: Utilization of ASHA services for early registration was significantly associated with age and religion of RDW. Young, educated and socio-economic class III RDW utilized ASHA services the maximum for early registration. Utilization of ASHA services for adequate ANC or antenatal care (100 iron and folic acid tablets, 2 tetanus toxoid injection and ≥3 antenatal visits) was also inversely associated with age of RDW. Young, Hindu, scheduled caste, middle school pass, Class III RDW and those with birth order one had high odds for utilization of ASHA services for adequate ANC. With regard to postnatal check-up, again young RDW with birth order one, Hindu RDW in reference to Muslim and RDW in socio-economic class III had higher likelihood for utilization of ASHA services. Caste-wise scheduled caste (SC) and other backward caste (OBC) RDW had higher odds for utilization of ASHA services. Educated RDW and those with educated husband had higher odds for utilization of ASHA services for postnatal check-up. Conclusion: Young, educated RDW with low parity, educated husband and belonging to higher socio-economic class had higher odds of utilization of ASHA services.

Social Correlates in Reproductive Tract Infections among Married Women in Rural Area of Meerut

NFHS-2 (1998-1999) results show that more than one-third of ever married women in India report at least one reproductive health problem related to vaginal discharge or urination; and two-fifths of currently married women report at least one reproductive health problem related to vaginal discharge, urination or intercourse that could be a symptom of more serious reproductive tract infection.(1) Majority of women bear the problems silently without seeking advice and treatment.(2,3) The present study was undertaken to assess the magnitude of the problem of RTIs and its social correlates among married females aged 15-44 years in rural Meerut.

Neonatal health program management in a resource-constrained setting in rural Uttar Pradesh India.

This analysis identifies salient features of team management that were critical to the efficiency of program implementation and the effectiveness of behavior change management to promote essential newborn care practices in Uttar Pradesh, India. In May 2003, the Johns Hopkins Bloomberg School of Public Health and King George Medical University initiated a cluster-randomized, controlled neonatal health research program. In less than 2 years, the trial demonstrated rapid adoption of several evidence-based newborn care practices and a substantial reduction in neonatal mortality in intervention clusters. Existing literature involving research program management in resource-constrained areas of developing countries is limited and fails to provide models for team organization and empowerment. The neonatal research project examined in this paper developed a unique management strategy that provides an effective blueprint for future projects. Transferable learning points from the project include emphasizing a common vision, utilizing a live-in field site office, prioritizing character and potential in the hiring process, implementing a learning-by-doing training program, creating tiers of staff recognition, encouraging staff autonomy, ensuring a broad staff knowledge base to seamlessly handle absences, and maintaining the flexibility to change partnerships or strategies.

Perception of sex workers of Lucknow City, Uttar Pradesh, India towards sexually transmitted infections.

The prevention, control, and management of sexually transmitted infections/reproductive tract infection (STI/RTI) are well-recognized cost-effective strategies for controlling the spread of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). A cross-sectional descriptive study was done over a period of 1 year to assess the prevalence of STI, knowledge level about STI, and the STI-HIV link among the female sex workers (FSWs) of Lucknow city, Uttar Pradesh, India along with their biosocial characteristics. Most of the FSWs were illiterate, married, Hindus, and belonged to general category. The prevalence rates of STI among street-based and home-based FSWs were 50.6% and 29.8%, respectively. Knowledge about the role of condom in prevention of STI and the STI-HIV link was significantly less among home-based FSWs than those who are street-based. There is a great lack in the awareness among FSWs regarding STI and their prevention. Behavior change communication (BCC) and advocacy strategy were developed, especially for the home-based group, to strengthen their knowledge regarding the STI-HIV link.

Determinants of maternal deaths amongst mothers who suffered from post-partum haemorrhage: a community-based case control study

Postpartum haemorrhage (PPH) is the leading cause of maternal deaths, accounting for about 35% of all maternal deaths. 1 There is a continuing trend of reduction in maternal deaths globally however, developing countries still experience higher numbers of maternal deaths in comparison to developed countries. 2 Most deaths (about 99%) from PPH occur in lower and middle income countries compared with only 1% in industrialized nations. 3,4

Care seeking for childhood pneumonia by rural and poor urban communities in Lucknow: A community-based cross-sectional study

Context: Globally, around 16% of under-five children die due to pneumonia. Childhood pneumonia, if identified early is a readily treatable through low-cost antibiotics. Access to timely and appropriate care is a key action to control pneumonia. Aims: The aim of the study was to understand the caregivers care-seeking behavior for the management of childhood pneumonia among rural and urban poor communities in Lucknow. Settings and Design: Rural areas and urban slums of Lucknow district, from September 2014 to August 2015. Subjects and Methods: A community-based cross-sectional study. Total of 1065 under-five children were selected by multistage random sampling method. Caregivers of children (<5 years of age) were interviewed through pretested, semi-structured interview schedule. Information was gathered on episode of cough, difficult breathing, and or chest indrawing in child within 2 weeks preceding the survey, and caregivers treatment seeking practices. Results: Out of total 1065 children, 52 (%) had pneumonia within 2 weeks preceding the survey. At the onset of illness, difficult/fast breathing was identified by 86.5% caregivers, but majority of them did not perceive it as a serious condition and resort to home remedies. Only 9.6% sought appropriate care at onset of illness. Appearance of chest indrawing in the child was identified by caregivers as a serious condition and sought treatment from outside. The mean time taken from onset of illness to the seeking care from health facility was around 2½ days (2.39 ± 0.75). Qualified private practitioners (70.5%) were the preferred choice and majority (87.0%) of the children received antibiotic for pneumonia. However, even after perception of seriousness of the illness, 26.8% and 11.1% caregivers in urban slums and rural areas, respectively sought inappropriate care at the first consultation. Conclusions: Caregivers were unable to perceive the severity of fast breathing leading to the delayed initiation of the appropriate treatment. There is a need of community mobilization through behavior change communication interventions to promote early symptom recognition and appropriate care seeking for pneumonia.

Predictors of sexually transmitted infections among female sex workers (FSWs) in a city of northern India.

Introduction: Sexually transmitted infections (STIs) and Reproductive tract infections RTIs are important public health problems in India. The prevalence of these infections is considerably higher among high risk groups (HRGs) ranging from 20-30%. It is high time that a study should be conducted to explore different factors and conditions responsible for the practice of unsafe sex among female sex workers (FSWs) in Uttar Pradesh (UP) and the impact of this on social life and health of FSWs. As Lucknow provides a comprehensive opportunity in terms of tourism, occupation, and economy, it becomes a potential hub for sex work. Studying FSW in Lucknow can thus be considered as a yardstick for the entire FSW population of UP population. The present study was thus planned with the objective of knowing the STI prevalence and its determinants among FSWs. Materials and Methods: A cross-sectional descriptive study was conducted on FSWs registered with Targeted Intervention-Non-government Organization (TI-NGO), registered with Uttar Pradesh State Acquired Immuno Deficiency Syndrome (AIDS) Control Society (UPSACS) of Lucknow city. Total 288 subjects were studied. Results: The average age of FSWs was 31 years. FSWs were mostly Hindus and illiterate. The overall prevalence of STI as per Syndromic diagnosis was found to be 35.8%. However, the percentage of FSWs with STI was higher in street-based (50.6%) than home-based (29.8%). Majority (42.7%) of sex workers with STI had non-regular partners only while majority (52.4%) of sex workers without any STI had only regular partners. Condom usage with regular partners was poor. However, with the non-regular partners the condom usage was better. On multivariate analysis being single, having sex work as a sole means of earning, duration of sex work > 2 years, having pallor, and giving in to clients demand for unsafe sex were found to be significant in causing STI. Conclusions: Prevalence of STI among the female sex workers as per Syndromic diagnosis was found to be 35.8%. Unemployment, anemia, and having sex without condom for extra money, failure to persuade the client and not doing anything were found to be important predictors for presence of STI.

Illness response of rural elderly

Background: A dramatic increase in the population of elderly individuals has intensified the need to make geriatric care services easily available. Little research has been conducted to find out the response of rural elderly residents to illness. Aims: To identify the response of elderly rural Indian residents to illness and examine the reasons for these actions . Materials and Methods: A cross-sectional community-based study was designed and conducted at block level Primary Health Centre, Khatauli, (District Muzaffarnagar), the Rural Health Training Centre of the Department of Community Medicine, Muzaffarnagar Medical College, Muzaffarnagar (UP) covering the area by a network of 40 sub-centers, comprising of 384 elderly aged 60 years and above for a period of 6 months. Results: Less than half (49.4%) subjects preferred to use home remedies as first response to illness. During severe illness, 68.4% of elderly visited a private practitioner. Out of them, 73.1% visited private practitioners because they were near the residences of elderly, while 97.2% visited private practitioners during medical emergencies. Conclusion: Inaccessibility and inability to pay were found to be the main reasons for inadequate utilization of health services. This gap can be filled by integration of geriatric care with the primary healthcare facilities, by increasing the patients capacity to pay by broadening the base of old-age pension or by introducing a uniform health insurance program for the aged.