Neeti Rustagi

An Assessment of facilities and services at Anganwadi centers under the Integrated Child Development Service scheme in Northeast District of Delhi, India

OBJECTIVE The current study was aimed to assess the facilities and services being provided at the Anganwadi Centres (AWCs) by the Anganwadi workers with regards to the norms laid down by Integrated Child development Service (ICDS) scheme, with special emphasis on the children of 0-6 years of age. DESIGN Cross-sectional study. SETTING A resettlement colony of North-West District of Delhi, having a population of hundred thousand. PARTICIPANTS A total of 41 AWCs were present in the study area and were included in our study. The Anganwadi workers at these AWCs were interviewed. MAIN OUTCOME MEASURES The outcome measures were the facilities present at the AWCs and knowledge of Anganwadi workers regarding the services to be provided and revised supplementary nutrition norms laid down by ICDS. RESULTS The AWCs in the area were covered under three projects namely Project A, B and C consisting of 18, 9 and 14 AWCs, respectively. The mean room size for all the AWCs was 108.97 ± 62.18 square feet. A weighing machine was present in 29 (70.7%) of the AWCs. Growth charts for growth monitoring of children were present in 28 (68.3%) of AWCs. A drug kit was not present in 14 (34.1%) of the 41 AWCs. The mean number of children of 0-3 years enrolled per AWC was 45.78 ± 14.07. However, the mean number of children present at the time of the visit at the AWCs was 6.24 ± 5.39. Knowledge of Anganwadi workers regarding revised norms for calorie and protein for beneficiaries was found to be poor. CONCLUSION This study showed a lack of facilities at the AWCs and poor knowledge of Anganwadi workers. Thus a regular training and supportive supervision of the Anganwadi workers is recommended along with the availability of adequate facilities and infrastructures.

LBOS 03-06 ANTI HYPERTENSIVE TREATMENT COMPLIANCE AND ADVERSE EFFECT PROFILE AMONG HYPERTENSION CLINIC ATTENDEES IN JODHPUR, INDIA.

Objective: To study the treatment compliance and adverse effects among hypertensive patients receiving treatment at Hypertension clinic, UHTC Pratap Nagar, Jodhpur, India. Design and Method: A longitudinal study was conducted on 1036 hypertensive patients enrolled at Hypertension clinic, Pratap Nagar, Jodhpur, India. Patients attendees to the clinic during inception (Nov 2013) were selected for study purpose and quarterly follow-ups were done. The participants were asked about their socio-demographic status, therapy, side effects, and compliance with physicians’ instructions. In addition, 8 physicians reported: prescribing practices, drug side effects, and patient compliance for data corroboration. Noncompliance was defined as a ≥2-point decrease on the 8-item Morisky Medication Adherence Scale assessed during follow-ups after baseline. Multivariate regression analysis was done with P < 0.05 considered significant for variable effect under study. Results: We observed an attrition rate of 9.2% (n = 96) participants in the study. The participants mean age was 65.0 ± 5.6yrs (37–88 yrs); 67.9% were male; 51.9% illiterate and 39.0% belonged to lower socioeconomic strata (SES). 61.9% had hypertension for more than 10 years, and 48.0% were receiving multiple drug therapy. Over the 2 years of follow-up, 32.2% participants demonstrated noncompliance to antihypertensive medications. After multivariate adjustment noncompliance was significantly associated with: age (>60yrs, p = 0.003), uncontrolled BP (p = 0.025), illiteracy (p = 0.041), lower SES (p < 0.01) and adverse effect (p < 0.001). Drug adverse effects were reported among 19.01% participants; most frequently observed were dizziness (56.8%), cough (44.6%), oedema (28.4%) and rash/itch (17.7). Important predictors for changed therapy (41.21%) status were inadequate BP control (68.9%), adverse effects (11.9%), service dissatisfaction (7.0%) and cost (4.9%) etc. Conclusions: Poor adherence to treatment is common in hypertensives mostly due to dissatisfaction with treatment & services and adverse effects. During follow-ups efforts shall be made to ensure full compliance and safe treatment by active patient engagement.

Neglected health literacy undermining fluorosis control efforts: A pilot study among schoolchildren in an endemic village of rural Rajasthan, India

Background: Ingestion of excess fluoride can cause fluorosis which adversely affects teeth and bones. Fluorosis is a major public health problem in the state of Rajasthan with all its 32 districts having variable fluoride contamination, and many initiatives are currently implemented in this region to mitigate the fluorosis burden. Objective: The objective of this study was to assess fluorosis, its risk factors, and the awareness among school students and teachers in endemic villages of Jodhpur district, Rajasthan. Materials and Methods: A representative sample of 300 students of age 12–15 years were enrolled for cross-sectional study in selected villages. Data were collected regarding awareness, behavioral and preventive practices about fluorosis and clinical assessment and fluoride estimation in water and urine samples was done. Results: Dental fluorosis through Deans index was observed in 24.5% of students. The awareness and practices for fluorosis prevention and its risk factors were poor among both students and teachers. Intake of piped water supply was reported by majority of students (95.8%). High fluoride concentration was found in 35 (81.3%) out of 43 urine samples. Conclusion: Improvement in drinking water supply in the endemic village of Rajasthan has decreased the burden of fluorosis, but low level of awareness and prevailing dietary and behavioral practices still pose them at risk of high fluoride intake. This signifies the need to address nonconventional sources of fluoride intake (diet and toothpaste) and early screening of disease by involving teachers and family physicians in fluoride mitigation efforts.

[PP.15.18] FINDING SUPPLEMENTS TO TRADITIONAL BP MONITORING: A CORRELATION RESEARCH ANALYSIS FROM MODEL NCD LIFESTYLE CLINIC, JODHPUR, INDIA

Objective: To monitor relationship between hypertension and indicators/risk factors in patients at model NCD lifestyle clinic (MNLC) and suggest supplementary indicators based on findings. Design and method: Present study was carried out at MNLC situated Urban Health Center (UHC) Pratap Nagar, Jodhpur. Secondary data i.e digital medical records of the patients (n = 1036) collected between Nov, 2015 to Nov, 2016 were analyzed using appropriate statistical tests (descriptive, pearsons correlation analysis). Data included patients personal and clinical examination details, diagnosis, laboratory values, anthropometric measures etc. Confidentiality of the data was maintained and ethical approval obtained from Institutional ethical committee: AIIMS, Jodhpur. Results: The mean age of patients was 58 ± 4.6 years and majorly females (57.6%). Prevalent morbidities were: Hypertension (72.9%), Diabetes (23.7%) and Obesity (67.2%). The mean systolic (SBP) 152 ± 9.8 mmHg, diastolic blood pressure (DBP) 91 ± 5.7 mmHg, Fasting blood sugar 112 ± 7.4 gm/dl and total cholesterol (TC) 178 ± 12 gm/dl. Mean weight (BW) 76 + 5.4 kg, body mass index (BMI) was 26.4 ± 4.7, mean waist circumference (WC) 97.5 ± 7.2 cm and waist-hip ratio (WHR) 0.97 ± .17 reflecting the high burden of central obesity. Correlation analysis demonstrated positive relationship between BP-Weight (r = 0.88) BP-FBS (r = 0.76), BP-WHR (r = 0.70). However, the BP-BMI (r = 0.16) and BP-TC (r = 0.28) showed a weak positive relationship. Conclusions: Present research suggests BW, FBS and WHR demonstrate incremental risk trend towards rising BP, major pathology in hypertension. It is suggested that further research be conducted to devise research backed proxy indictors/risk factors as supplements to error prone tradition BP monitoring for improved clinical outcomes.

[LB.02.02] AN ASSESSMENT OF HYPERTENSION AND RISK FACTORS AMONG LAW ENFORCEMENT PERSONNEL IN JODHPUR, India

Objective: Non-communicable diseases (NCDs) are rising globally particularly in developing nations like India. These NCDs share common behavioural risk factors, namely, tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity etc. Law enforcers are exposed to various occupational stressors leading to NCDs like hypertension, diabetes etc. Therefore this study is conducted to estimate the burden of hypertension and risk factors in this group for recommending a health promotion strategy. Design and method: A cross-sectional study was conducted among law enforcement personnel of Jodhpur city of Rajasthan for 2 months (Aug-Sep 2016). A total 5 camps were conducted in the project to cover 280 study participants from all 23 stations/posts on pre-defined dates. The standard WHO-STEPwise approach for NCD surveillance was incorporated as data collection strategy. Data collection process included: A structured interview, physical and biochemical measurements coupled with a health promotion session. Multivariate logistic regression analysis was done to test risk association. Requisite permission, consents and institutional ethical clearance (IEC) were obtained. Results: The participants had mean age of 39.09 years, most 266 (95.0%) being men and more than half 162 (57.8%) were college educated. Risk assessment revealed high burden of: Tobacco 83 (29.6%) & Alcohol 94 (33.6%) intake, inadequate fruit-vegetable intake 243 (86.8%) & high salt intake 29 (10.4%), inadequately physically activity 212 (75.8%) & obesity 116 (44.3%) and past history of disease i.e CVDs 21 (7.5%), Hypertension 82 (14.64%), Hypercholesterolemia 16 (21.62%) and Diabetes 29 (10.59%). The mean BP reading of participants were 115.8 ± 11.5 mmHg (Systolic) and 80.4 ± 4.9 mmHg (Diastolic).Screening tests suggested that 82 (29.28%) and 213 (76.1%) had Hypertension and Pre-Hypertension respectively. On multivariate logistic regression analysis, hypertension was significantly associated with tobacco (OR:3.7,p = 0.045) & alcohol (5.2,0.023), obesity/overweight (5.2,0.022), lower education (3.9,0.041)and diabetes (5.9,0.014). Study participants had poor knowledge and health behaviour in respect of Hypertension and risk factors. Conclusions: Present study suggests a heavy burden of Hypertension and risk factors among the law enforcement, coupled with poor awareness, lifestyle and treatment seeking behaviour. Its highly pertinent for stakeholders to develop custom health promotion policy for risk reduction and prevention and control of NCDs.

Traumatic brain injury related research in India: An overview of published literature.

Aim: This paper provides an overview of publications by Indian researchers on traumatic brain injury between 1966 and 2014, to set up a platform for evaluating and synthesizing the results and findings from brain injury research in India. Materials and Methods: All published articles from India related to brain injury since 1966 to 2014 were retrieved from PubMed using the search for (“craniocerebral trauma”[MeSH Terms] OR (“craniocerebral”[All Fields] AND “trauma”[All Fields]) OR “craniocerebral trauma”[All Fields] OR (“head”[All Fields] AND “injury”[All Fields]) OR “head injury”[All Fields]) AND (“India”[MeSH Terms] OR “India”[All Fields]) A data base for variables like study type/category, year of publication, place of study institutes and departments to which the corresponding author belonged or where the study was conducted and the journal of publication was developed in FileMaker Pro 13 Advanced® software. Frequencies and percentages was obtained using R statistics software. Results: A total of 624 original research articles from India were reviewed. There was a substantial increase in the number of publications from 2006 (175) to 2014 (213). Eighty percent of studies were primary clinical observational type. Only 1.6% of studies were on animal experiments. Original research articles were about 55.8%. One fourth of the studies are prospective in nature. Researchers from 46 medical departments have been involved in publishing papers on traumatic brain injury. Among these, the neurosurgery department has published highest number of publications (262), followed by the forensic medicine (32) and the neurology (21). Many institutes from 22 states have contributed in brain injury research. Delhi alone had published nearly one-fourth (23%) of papers. Eleven states had published papers in collaboration with other countries. Papers were published both in national and international journals. Neurology India had published 20.6% of papers. Conclusion: There is rapid increase in publications since last decade with multi departmental integration and international collaborations. However with existing brain injury resources in our country much more research work at both basic and clinical level should be encouraged.

Food safety: Who's who

Healthy lifestyle has fashionably accommodated so-called high-quality eating practice among the great majority of masses. It has been believed by the practitioners of medicine since civilization time immemorial, usually than not, that healthy intake of foods is key elements of disease prevention and health promotion. In the epoch of millions of innovations and protocol supported clinical practice guidelines, transparent steps and ethical approaches have been initiated as the mainstay of health care delivery. As a natural expectation, every patient and their caregivers expect the advice on diet as a hidden agenda from their health care providers. Holistic dietary practice guideline and training module on diet and food safety are needed for all levels of health care providers for the optimum care in health and disease to the last man on the road.