Sandeep Sachdeva

Lifestyle and gallstone disease: scope for primary prevention.

Objective: To study the antecedent risk factors in the causation of gallstone disease in a hospital-based case control study. Materials and Methods: Cases (n = 150) from all age groups and both sexes with sonographically proven gallstones were recruited over a duration of 3 months from the surgical wards of a tertiary care teaching hospital. Modes of presentation were also noted among cases. Age- and sex-matched controls (n = 150) were chosen from among ward inmates admitted for other reasons. Univariate and multivariate logistic regression analyses were performed for selected sociodemographic, dietary, and lifestyle-related variables. Results: Females had a higher prevalence of gallstone disease than males (P < 0.01). Among males, the geriatric age group (<60 years) was relatively more susceptible (28%). Prepubertal age group was least afflicted (3.3%). Univariate analysis revealed multiparity, high fat, refined sugar, and low fiber intakes to be significantly associated with gallstones. Sedentary habits, recent stress, and hypertension were also among the significant lifestyle-related factors. High body mass index and waist hip ratios, again representing unhealthy lifestyles, were the significant anthropometric covariates. However, only three of these, viz., physical inactivity, high saturated fats, and high waist hip ratio emerged as significant predictors on stepwise logistic regression analysis (P < 0.05). Conclusion: Gallstone disease is frequent among females and elderly males. Significant predictor variables are abdominal adiposity, inadequate physical activity, and high intake of saturated fats; thus representing high risk lifestyles and yet amenable to primary prevention.

All slums are not equal: Maternal health conditions among two urban slum dwellers.

Background: Pregnant women inhabiting urban slums are a “high risk” group with limited access to health facilities. Hazardous maternal health practices are rampant in slum areas. Barriers to utilization of health services are well documented. Slums in the same city may differ from one another in their health indicators and service utilization rates. The study examines whether hazardous maternal care practices exist in and whether there are differences in the utilization rates of health services in two different slums. Materials and Methods: A cross-sectional study was carried out in two urban slums of Aligarh city (Uttar Pradesh, India). House-to-house survey was conducted and 200 mothers having live births in the study period were interviewed. The outcome measures were utilization of antenatal care, natal care, postnatal care, and early infant feeding practices. Rates of hazardous health practices and reasons for these practices were elicited. Results: Hazardous maternal health practices were common. At least one antenatal visit was accepted by a little more than half the mothers, but delivery was predominantly home based carried out under unsafe conditions. Important barriers to utilization included family tradition, financial constraints, and rude behavior of health personnel in hospitals. Significant differences existed between the two slums. Conclusion: The fact that barriers to utilization at a local level may differ significantly between slums must be recognized, identified, and addressed in the district level planning for health. Empowerment of slum communities as one of the stakeholders can lend them a stronger voice and help improve access to services.

Childhood leprosy: lest we forget:

Leprosy remains an important public health and social issue in South Asia, particularly in India. Its presence in childhood is an immense social burden because of the associated disabilities and widely prevalent misconceptions regarding communicability and treatment potential. The prevalence of leprosy among children suggests a possible gap in the national programmes aimed at leprosy elimination. This article reports a 10-year retrospective study of childhood leprosy in a tertiary care hospital setting (2000–2009) along with an analysis of selected socio-epidemiologic correlates. We stress the importance of early detection and the application of appropriate prophylactic measures in susceptible children.

Potentially modifiable micro-environmental and co-morbid factors associated with severe wasting and stunting in children below 3 years of age in Aligarh District.

Undernutrition among children is a major public health problem in developing countries like India. The most commonly cited causative factors are food availability and dietary intake, breastfeeding, prevalence of infectious and parasitic diseases, access to health care, immunization against major childhood diseases, vitamin A supplementation, maternal care during pregnancy, water supply and sanitation, socio-economic status, and health-seeking behavior.(1) Children, especially the infants and toddlers, constitute the most disadvantaged group. The present study attempts to investigate the potentially modifiable distal and proximal factors that cause severe malnutrition in children under three years of age and suggests ways to mould them to their advantage.

Cultural determinants: Addressing barriers to holistic diabetes care

Background: Cultural beliefs and traditional practices nearly affect all aspects of diabetes care. Therefore, understanding its broader cultural context can serve as important background information for effective care for diabetes. Materials and Methods: We conducted this study to explore the cultural determinants in diabetes care and to propose a broad theoretical framework for cultural assessment in persons with diabetes. Explanatory Model Interview Catalog interviews of 25 diabetes persons were conducted. Results: We found that perception about diabetes is influenced by tradition, customs and ethos. Diabetes does not show early signs and therefore symptoms are usually ignored until they interfere with their day-to-day living. Following dietary advice was the most difficult part of diabetes care due to varied cultural barriers. Due to cultural reasons, diabetes is still not assigned due priority by the family. Health illiteracy and cost of care were important barriers for seeking care. Diabetics taking conventional treatment often used complementary treatment, which may be hazardous. Language was also considered a barrier for effective diabetes care. Females struggle more for receiving appropriate care for their diabetes due to social and cultural factors. Conclusion: Cultural assessment needs to be done at various stages - initial assessment, identification of cultural issues in care, planning for culturally relevant intervention and evaluation. This calls for focused elements relevant to the presenting problem, necessary intervention, and participatory evaluation. Cultural values, beliefs, customs, and family patterns may be used as clues for planning diabetes care. Such interventions are likely to bear significant impact on diabetes care in times to come.

Clinico-social profile of sexually transmitted infections and HIV at a tertiary care teaching hospital in India

Background: The prevalence of sexually transmitted infections (STI) varies widely from region to region in India. Objective: To study the pattern of STIs and the profile of STI patients with HIV co-infection. Materials and Methods: A retrospective record-based case study of patients attending STI clinic, JNMC, Aligarh, from May 2008 to May 2013 was carried out. Results: A total of 4876 patients attended the STI clinic, out of whom 2764 (56.7%) had proven STI. STIs were more common in men, with a male (2201): female (563) ratio of 3.90:1. Their age ranged from 16 years to 55 years (mean age = 26.38 years) with the maximum number of patients in the age group of 16-25 years. Genital scabies 1466 (53.0%) constituted the most common STI followed by genital warts with 588 (21.2%) of patients. Human Immunodeficiency Virus (HIV) infection was noted in 36 (1.3%) of all STI cases.

Utilization of Health Services under Janani Suraksha Yojna in Rural Haryana

Objective: To study the utilization of health services by mothers during antenatal, natal and post-natal period under Janani Suraksha Yojna (JSY). Materials and Methods: This cross-sectional study was conducted in rural areas of two districts of Haryana as per the rate of institutional deliveries. A total of 48 sub-centers were selected by multistage random sampling. 1386 JSY beneficiary mothers were interviewed by house-to-house visits, after obtaining informed consent. Results: Majority 1216 (87.5%) of the study subjects were registered between 12-26 weeks of pregnancy whereas only 170 (12.3%) of them were registered within first 12 weeks. Around one-fourth of the mothers did not receive the recommended minimum three antenatal check-ups. The coverage of TT immunization was 92.1%. Majority 1253 (90.4%) of the deliveries were institutional. More than three-fourth of the home deliveries were conducted by trained dais and 15% of the home deliveries were conducted by untrained persons. Out of the 1253 institutional deliveries, 84.6% were conducted in Government institutions while 15.4% deliveries were conducted in Private hospitals. About two-third mothers received at least three post-natal care visits by the health functionaries. Discussion: Janani Suraksha Yojna is an ambitious scheme serving as a safe motherhood intervention under NRHM. It has been fairly successful in promoting institutional deliveries but the key components of Essential Obstetric Care i.e., early antenatal registration, minimum three antenatal care visits, three post-natal care visits still need strengthening.