Sa Rizwan

High neonatal mortality rates in rural India: what options to explore?

The neonatal mortality rate in India is amongst the highest in the world and skewed towards rural areas. Nonavailability of trained manpower along with poor healthcare infrastructure is one of the major hurdles in ensuring quality neonatal care. We reviewed case studies and relevant literature from low and middle income countries and documented alternative strategies that have proved to be favourable in improving neonatal health. The authors reiterate the fact that recruiting and retaining trained manpower in rural areas by all means is essential to improve the quality of neonatal care services. Besides this, other strategies such as training of local rural healthcare providers and traditional midwives, promoting home-based newborn care, and creating community awareness and mobilization also hold enough potential to influence the neonatal health positively and efforts should be made to implement them on a larger scale. More research is demanded for innovations such as “m-health” and public-private partnerships as they have been shown to offer potential in terms of improving the standards of care. The above proposed strategy is likely to reduce morbidity among neonatal survivors as well.

Prevalence of hypertension in Indian tribes: a systematic review and meta-analysis of observational studies.

Introduction In India there is an increasing trend in hypertension prevalence among the general population. Studies have shown that tribal populations in India are also experiencing this burden. Objective The aim was to estimate the pooled prevalence of primary hypertension among adult tribal populations of India. Methods A systematic search was conducted in MEDLINE, IndMed, Web of Science, Google Scholar and major journals for studies published between 1981 and 2011. Two authors independently reviewed the studies, did quality assessment and extracted data in pre-coded spread-sheets. Pooled estimates of prevalence of hypertension were calculated using DerSimonian-Laird random effects model. Subgroup and sensitivity analyses and meta-regression were performed. Results Twenty studies or 53 subpopulations with 64 674 subjects were included in final review. The pooled estimate of hypertension prevalence was 16.1% (95% CI: 13.5, 19.2). There was significant heterogeneity among the studies (I2 = 99% and Q = 4624.0, df  = 53, p<0.001). Subgroup analyses showed that year of study, acculturation status, special features, and BP measurement techniques significantly influenced prevalence, but after meta-regression analyses, ‘decade of study’ remained the only covariate that significantly and independently influenced prevalence (R2 = 0.57, Q = 119.2, df  = 49, p value <0.001). Conclusion An increasing trend was found in the prevalence of hypertension in adult tribal populations across three decades. Although acculturation was probably the underlying agent that caused this increase, other unmeasured factors that need further research were also important. Concerned policy makers should focus on the changing health needs of tribal communities.

Determinants of underutilisation of free delivery services in an area with high institutional delivery rate: A qualitative study

Background: There has been an increase in institutional delivery rates in India in the recent years. However, in areas with high institutional delivery rates, most deliveries (>50%) occur in private institutions rather than in government facilities where zero expense delivery services are being provided. Aim: This study aimed to understand, from the community health volunteers’ viewpoint, the reasons for underutilization of zero expense delivery services provided in government health facilities. Materials and Methods: Five Focused Group Discussions (FGD) were conducted among Accredited Social Health Activist (ASHAs) of a Primary Health Centre (PHC) in Dayalpur village, Haryana in December 2012. Participants were asked to articulate the possible reasons that they thought were responsible for expectant mothers not choosing to deliver in government health facilities. Verbal informed consent was obtained from all participants. Result: The commonly stated reasons for underutilization of government health facilities for delivery services were lack of quality care, abominable behaviour of hospital staff, poor transportation facilities, and frequent referrals to higher centres. Conclusion: This study reflected the necessity for new policies to make government health facilities friendlier and more easily accessible to clients and to make all government hospitals follow a minimum set of standards for providing quality care.

Influence of alcohol on condom use pattern during non-spousal sexual encounter in male migrant workers in north India.

CONTEXT Migrant workers constitute an important risk group for Human Immunodeficiency Virus/Acquired Immuno-Deficiency Syndrome transmission in India. Alcohol consumption before sexual intercourse has been postulated to influence condom use practices. This study aimed to assess this association with regard to non-spousal sexual encounters among male migrant workers in northern India. MATERIALS AND METHODS A cross-sectional facility-based survey was conducted in 2011. Male migrant workers aged ≥18 years, who were born outside Haryana, who had moved to the current location after 15 years of age,had worked in the current factory for at least 1 year, who were willing to participate and were able to give written, informed consent were included in the study. A consecutive sampling was performed. Descriptive, bivariate and multiple logistic regression analyses were carried out. RESULTS A total of 162 participants reported having experienced non-spousal sexual encounters in the last 1 year. The proportion of men who reported not having used a condom at their last non-spousal sexual encounter was 59.3%, and 78.4% of the men reported having consumed alcohol in the last 1 year. About 48.1% of men reported having consumed alcohol before their last non-spousal sexual encounter. Men who consumed alcohol were three times more likely to not use a condom at their last non-spousal sexual encounter (OR = 3.1, 95% CI: 1.5-6.4). This association persisted even after adjusting for relevant confounders. CONCLUSION Alcohol consumption had a negative influence on condom use during non-spousal sexual encounter among male migrant workers. An integrated approach to promote condom use and reduce alcohol consumption among migrant men needs to be undertaken through targeted intervention strategies.

KAP Study on Sexually Transmitted Infections/Reproductive Tract Infections (STIs/RTIs) among married women in rural Haryana

Context: About 490 million cases of curable Reproductive Tract Infections (RTI) occur throughout the world, of which 79 million cases occur in India annually. Sexually Transmitted Infections/Reproductive Tract Infections (STI/RTI) confers a huge economic burden on the individual and the health system. Complications of RTI/STI are many, ranging from chronic pain syndrome to infertility. Most of these complications can be prevented by early diagnosis and treatment. Aims: To assess knowledge, attitude and practices on STI/RTIs among married women aged 15-45 years in rural Haryana. Setting and Design: Cross-sectional study, conducted in selected villages under the primary health centre Mandi, Sonepat, Haryana. Subjects and Methods: Systematic sampling was used to cover 10 villages. In each village, every tenth house was sampled, taking first house from the center of the village. Face-to-face interview was conducted using pretested questionnaire. Statistical Analysis Used: Descriptive statistics and results were described in percentages. Results: A total of 344 women were interviewed. About 44% women had never heard of STI/RTI. The prevalence of self-reported symptoms of STI/RTI was very high (60%). Only 40% of them opted for treatment and most common cause for not opting for treatment was that they considered it as a minor problem. Advice for use of condom during the treatment was received by only 20% of patients and only 26.5% of their husbands also received treatment. Conclusions: Overall knowledge, attitude and practices relating to STI/RTI among married women in rural Haryana was poor. The prevalence of self-reported STI/RTI was found to be high and treatment seeking behavior was poor.

Correlates of Intention to Use Condom among Male Migrant Factory Workers in Northern India.

OBJECTIVE Consistent condom use among high-risk groups, which in turn are dependant on favourable condom use intention is important for the success of HIV/AIDS prevention programmes. We aimed to determine intention to use condom and delineate their correlates in a sample of male migrant workers in northern India. MATERIALS AND METHODS This was a cross-sectional facility based survey conducted in 2011. Inclusion criteria were: male migrant workers aged ≥18 years, who were born outside Haryana, who had moved to current location after 15 years of age, who had worked in the current factory for at least one year and who were able to give valid consent. Face-to-face interviews were conducted with semi-structured questionnaire. Since this analysis was a secondary objective of a larger migrant study, sample size was not calculated separately. Intention to use condom was measured on a five point Likert scale and expressed as a linear score (higher the score more unfavourable the intention). A linear regression analysis was performed to identify factors independently associated with unfavourable intention. RESULTS Mean (SD) score for intention to use condom was 10.4 (3.4). Unfavourable intention was associated with men who had migrated to greater number of places, who had lesser HIV/AIDS knowledge, who had never used condom and who had not used condom at last non-spousal sex. The model had an adjusted R-square value of 0.63 and was statistically significant (F = 41.9, p < 0.001). CONCLUSION Male migrant workers had unfavourable intention to use condom. This intention could be favourably modified by behaviour change communication through already existing targeted intervention platforms, focussing attention on groups with higher mobility, lower education, lower HIV/AIDS knowledge and inconsistent condom use.

Evaluation of state-run STI/RTI clinics in the state of Haryana, India through a supportive supervision approach

Introduction: Sexually transmitted infections (STIs) are an important public health problem because of their adverse effects on reproductive health of men and women. About 5% of adult population in India suffers from STIs. To tackle this issue the government has set up reproductive tract infection (RTI) clinics across the country. Aims: To assess the effect of supportive supervision on the quality of services provided in STI/RTI clinics in the state of Haryana, India. Settings and Design: Selected state-run STI/RTI clinics, facility-based pre- and post evaluation study. Material and Methods: Sixteen STI/RTI clinics were selected for the study, including six from government facilities and 10 from targeted intervention sites across five districts of Haryana. From each of the selected sites one physician in-charge was interviewed twice with an interval of 2-3 months using pretested formats. Scores were given in selected domains of STI/RTI management for each visit and the improvement was assessed. Statistical Analysis: Wilcoxon signed rank test. Results: A total of 16 physicians one from each site were interviewed. Improvement in mean score of the physicians for knowledge about STI/RTI was 3.6 points. Similarly for skills score, which measured the physicians’ skill in various domains of running STI/RTI clinics, the mean improvement was 3.1 points. Both the improvements were statistically significant (P < 0.001). Conclusions: Supportive supervision proved to be a useful tool for monitoring and improving the quality of services provided by the STI/RTI clinics.

Pre-treatment practices among patients attending an Animal Bite Management clinic at a primary health centre in Haryana, North India

A cross-sectional study was carried out at the Animal Bite Management (ABM) clinic in a primary health centre in the Faridabad district of Haryana. Information about socio-demographic characteristics, animal bite exposure and pre-treatment practices was obtained. Clinical examination determined the severity of the bite. All 619 patients who reported to the ABM clinic during January 2011 to December 2012 were included. Out of the total, 38% had applied chilli-oil paste, and 4% antiseptics to the wound as pre-treatment; only 30.6% had washed the wound with water. There was a direct association between traditional pre-treatment practices and delay in seeking treatment for animal bites which was statistically significant (P = 0.01). Health education of the general population with culturally appropriate Information, Education and Communication material is therefore a necessary strategy to reduce delay in seeking appropriate treatment.

Profile of Patients Attendingan Animal Bite Management Clinic in Rural Pondicherry, India

Aims: In India, annual incidence of animal biteis estimated as 1.7 per 100 population and that of human rabies as1.7 per1,00,000 population. Since rabies is universally fatal it requires prevention throughtimely management by wound care, Anti-Rabies Vaccine (ARV) and rabies immunoglobulin. Study Design:Retrospective record review. Place and Duration of Study:Animal Bite Management (ABM) clinic of a Primary Health Centre in rural Pondicherry, south India, between January and December, 2011. Methodology: This study is a secondary analysis of data collected at an Animal Bite Management (ABM) clinic in a primary health centre in rural Pondicherry. The study population was mainly rural and agrarian. All victims of animal bite, who sought treatment from the ABM clinic between January and December, 2011 were included. Wound washing and administration of ARV through intramuscular route was provided for all