Jyoti Khandekar

How the findings of national family health survey-3 can act as a trigger for improving the status of anemic mothers and undernourished children in India: a review.

The national family health survey-3 (NFHS-3) reports of declining fertility rate while increasing prevalence of anemia in women and children, since NFHS-2 in 1998-99. The proportion of anemic, stunted and wasted children has also increased since the previous two rounds. NFHS trends show that the status of mothers and childs health indicators is continuing to deteriorate in spite of the many government-run targeted programs, e.g. integrated child development scheme (ICDS), Midday meal program. The only good sign in the findings is the favorable trend in fertility indicators and infant mortality rate. A review of the findings of NFHS surveys, the current government policies and programs targeted upon the improving of health status of women and children in India and of the published scientific literature was conducted. The aim of the review was to understand the health situation of women and children in India and to suggest measures to bring about positive changes in the health status of this population. The analysis suggests that the findings of these successive surveys are not being utilized for the necessary corrective measures. The authors argue that although the NFHS is a useful exercise, in the wake of decentralized planning, the country needs more detailed data focusing on the districts. Synchronization of the ICDS and national rural health mission (NRHM), along with entrusting the responsibility of conducting NFHS to the planning commission, is the other possible solution to tackle the problems of rising anemia and malnutrition in the country.

Effect of impairment and disability on health-related quality of life of elderly: a community-based study from urban India.

Introduction: Increasing population of elderly and the emergence of epidemic of chronic or (non-communicable) diseases, which is likely to adversely affects their health-related quality of life (HRQOL), has implications on health systems in developing countries such as India. A study was conducted to know the common impairments and disabilities and their effect on HRQOL in elderly population. Materials and Methods: A community-based cross-sectional study on elderly, selected by cluster sampling from central Delhi, India, was conducted from April 2005 to February 2006. A pre-tested, semi-structured questionnaire, along with Short Form -36 (SF-36) survey was used for data collection. The data was analyzed using Chi square and students t test on SPSS v12 statistical software. P value of less than 0.05 was considered statistically significant. Results: A total of 200 elderly were included in the study. 71.5% subjects had at least one disability/impairment. Around 40% subjects reported their health being poor and another 50% of worsening of their health in the last 1 year. HRQOL score for people with and without chronic morbidity/disability was 51.8 and 73.5, respectively (P<0.05), with overall mean score 56.7 (±17.2). The most commonly affected HRQOL domains were Role Physical, Physical Functioning, and General Health. The HRQOL and domain scores decreased with increasing age, and females had lower mean scores than males (P<0.05). Conclusion: The HRQOL of elderly in urban India is severely affected by impairments and disabilities. There is an immediate need for specific preventive and rehabilitative measures targeted on elderly to maintain their health related quality of life. This information may be utilized for designing any policy and/or program targeted for elderly in India and in other similar settings.

Childhood Morbidity and Mortality in India — Analysis of National Family Health Survey 4 (NFHS-4) Findings

National Family Health Survey (NFHS)-4 report was recently released for health-related data. This review compares the child health indicators across NFHS-3 and NFHS-4 with a background of existing health programs catering to child health. Reports of NFHS-4 and NFHS-3, along with ministry reports and existing literature were reviewed to understand the current status of child health. Child health indicators were compared between the two rounds of NFHS and among Empowered Action Group states of India. National Health Policy 2017 and National Health Programs related to child health were also analyzed. There has been an improvement in almost all child health indicators from NFHS-3 to NFHS-4. The infant mortality rate has reduced to 41 per 1000 live births. The immunization rate is 62%, and has almost doubled in the states of Uttar Pradesh, Rajasthan and Madhya Pradesh. Despite existence of many health programs, there is still a substantial lack of achievement in most of the indicators.

Burden and correlates of disability and functional impairment in an urban community

Introduction: The risk of developing chronic diseases and general disability increases with aging, resulting in loss of functioning ability and decrease in performing optimally. Early diagnosis of impairment and disability may improve the quality of life of elderly and enable them to lead a full and productive life. The study is a part of a larger study done in an urban area of Delhi. Materials and Methods: Systematic random sampling was used to select a cross-sectional sample of the study subjects >20 years and above. Locomotor, Visual Hearing and Speech were assessed using the guidelines given in gazette of India, extraordinary, part II section. Visual disability was measured by the presenting visual acuity in the field area using Snellens chart using WHO guidelines. Result and Conclusion: A total of 120 study subjects out of 1300 screened were in geriatric age group. The overall magnitude of the physical disability was 43.3% among elderly. aVisual disability was most common form of disability (60%). Many study subjects were suffering from >1 disability, but treatment was sought only in 50% of disabilities. Treatment seeking for disabilities is an important and neglected issue leading to severe degree of disabilities that would be prevented if taken care of, in due time. A multidimensional approach for prevention is the need of the hour.

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.