Sara Bhattacharji

Measles vaccination before nine months.

Summary objective  To measure the protective effect of measles vaccine administered before 9 months of age and compare overall mortality of children vaccinated at 6–8 months and at 9–11 months.nsp;Non‐concurrent cohort study involving all 13 134 children born between 16 January 1986 and 31st December 1991 in Kaniyambadi block near Vellore who had not left the area by six months of age. Main outcome measures were risk of disease and death among the under‐five‐year‐olds according to age at measles immunization.ensp;Unimmunized children had a higher risk of developing measles compared to the immunized(P < 0.05). There was no significant difference in risk of measles among those vaccinated prior to and after nine months of age. Unvaccinated children were at significantly higher risk of death than vaccinated children (P < 0.001). There was no difference in risk of death between infants vaccinated between 6 and 8 months and those vaccinated between 9 and 11 months. There was no difference in the risk of death between boys and girls vaccinated between 6 and 8 months with standard‐titre Edmonston‐Zagreb vaccine.p; Administration of standard‐titre Edmonston‐Zagreb measles vaccine at 6–8 months is an effective and safe preventive measure for measles, especially where the age‐specific attack rate for childrenis high.

Persistent rhinorrhoea in rural Indian children: prevalence and consequences.

To determine whether persistent rhinorrhoea constitutes a significant problem requiring intervention, 17 rural day care centres (Balwadis) in Tamilnadu, India, were visited. Among 414 children in the Balwadis 92 (22 per cent) children with persistent rhinorrhoea (15 days duration or longer) were identified. Demographic and clinical data and nasopharyngeal swabs for bacterial culture were obtained from 56 such children and 91 age-matched controls from the same Balwadi. Type of housing or nutritional status did not appear to be significant risk factors. There was a significantly higher number of children aged 5-15 years in the household of cases as compared to controls (1.23 +/- 1.08 vs. 0.83 +/- 0.95, p = 0.02). Other illnesses were noted in 25 (44.6 per cent) cases and seven (7.7 per cent) controls (OR 11.5; CI, 4.13-33.4; p < 0.00001). Notably, chronic ear discharge was noted in 6 (11.7 per cent) cases but in none of the controls (p = 0.007). Streptococcus pneumoniae was isolated from nasopharyngeal swabs in 42/49 (85.7 per cent) cases and 44/80 (55 per cent) controls (p < 0.001) and H. influenzae from seven cases and five controls; S. pneumoniae was isolated in all children with chronic ear discharge and H. influenzae from one child. Serotypes of pneumococci commonly associated with otitis media, i.e., types 6, 14, 19, and 23 were isolated from 25 (51 per cent) cases and 16 (20 per cent) controls (OR 4.17; 95% CI, 1.78-9.85; p < 0.001). Persistent rhinorrhoea, presumably due to pneumococcus, is a common condition among rural Indian children and appears to be associated with chronic otitis media.

The teaching of behavioural sciences

Summary. Medical science over the last few decades has undergone vast changes. Technologically it has advanced at a rapid pace. There has been a realization as well that the behaviour of individuals and communities also influences the occurrence of disease. Medical schools around the globe have realized the need for incorporating behavioural sciences as an integral part of the basic sciences taught to medical students.

The life imprisonment of Dr Binayak Sen

This misconceived application of state power requires international action

Profile of elderly attending a general practice clinic in a poor urban area: A cross-sectional study from South India

Introduction: In India, the number of elderly is steadily increasing and is likely to reach 301 million by 2051. The increasing number and proportion of elderly will have a direct impact on the demand for health and pension services. As per the Demography of Indian Aging (Rajan et al.), information on morbidity profile of this population is essential to plan health-care facilities. Methods: A descriptive cross-sectional study was designed to study the morbidity profile of 100 elderly persons reporting to the outpatient clinic of a family practice unit of a tertiary care center in South India between June 2008 and May 2010. This was done with a view to plan better services for the elderly in that area. Results: In this study, 88% of the participants were on a follow-up while new ailment(s) were diagnosed in 11 participants. A majority of participants were illiterate (62%), unemployed (83%), and financially dependent (54%). Forty-four participants screened had depression that required intervention such as counseling and follow-up; in ten participants, the screening score was sufficient to warrant therapy. In nearly half of the participants, the musculoskeletal system was involved, and a significant number had the involvement of cardiorespiratory system and urinary incontinence. Conclusion: A large number of elderly are affected by a constellation of conditions including mental as well social issues. A family practice unit may be a good setup to provide the first-contact care for the diagnosis and management of common problems in the elderly and help to improve their quality of life.

Reported healthcare utilisation for childhood respiratory illnesses in Vellore, South India.

A 30-cluster survey using a modified WHO method was performed to assess the healthcare utilisation patterns for respiratory illnesses in Indian children < 5 years of age. Families of 600 children were interviewed to assess respiratory illness and healthcare utilisation during the previous month as well as hypothetical healthcare-seeking behaviour in the future. Based on parental report, 381 children (63.5%) had experienced a respiratory illness 1 month prior to the interview; 10 children were reported to have had severe pneumonia, 49 non-severe pneumonia and 322 upper respiratory illnesses (URI), extrapolating to 0.20 (95% CI 0.1-0.4), 0.98 (0.7-1.3) and 6.44 (6.0-6.9) cases per child-year, respectively. Five severe pneumonia cases (50%) were reported to have directly accessed care at a secondary or tertiary care centre, whilst 18 children (36.7%) with non-severe pneumonia and 56 children (17.4%) with URI were reported to have been seen at secondary or tertiary centres. The remaining respiratory illnesses were reported to have been seen by primary care physicians, pharmacists, traditional healers and friends or were not seen by a healthcare professional. This community-based Indian study suggests that, in this community, tertiary care surveillance alone may not accurately sample community disease, even for severe illnesses.

The challenge of patients with severe psychiatric illness who do not access care – a way forward

Psychiatric illnesses are a significant cause of morbidity all over the world. In India many people with mental disorders are unable to access psychiatric care for a variety of reasons. This article describes the successful management of a person with schizophrenia in the community through a primary care team in liaison with psychiatrist services.

Arrest of paediatrician and human rights activist Binayak Sen.

We are writing to make known to the international medical community the shocking imprisonment of Binayak Sen on May 14, 2007, in the central Indian state of Chhattisgarh. A well known paediatrician and public-health specialist, Sen’s is a rare example of the cost of involvement in civil rights activism by physicians. He is being charged by the local police with illicit communication with Maoists in custody. After a distinguished academic career at Christian Medical College, Vellore, during his undergraduate and postgraduate training, Sen joined the faculty of the Centre for Social Medicine and Public Health at the Jawaharlal Nehru University, New Delhi (1976–78). For the past 30 years, Sen has been developing models of primary health in Madhya Pradesh and subsequently in the new state of Chhattisgarh. He is well known for setting up a self-funded cooperative hospital for mine workers, the Shaheed hospital, and he had a signifi cant role in evolving the statewide “Mitanin” programme of training community health workers. In 2004, the Christian Medical College conferred on him the Paul Harrison Award—the highest recognition accorded to an alumnus for distinguished work in rural areas. Apart from these socially relevant health-care activities, what sets Sen apart has been his deep commitment to the defence of civil liberties, including fact-fi nding missions into human rights violations such as custodial deaths, extra-judicial killings by state police, and hunger deaths in remote and politically turbulent communities. In recent times, he has worked ceaselessly to focus national and international attention on largescale oppression and malgovernance within the Salwa Judoom (which has become a kind of non-state militia) in the Dantewara district of Chhattisgarh. He has given leadership to the nationwide People’s Union for Civil Liberties as General Secretary in Chhattisgarh and as Vice President at the national level. Sen is a man of impeccable integrity, self-denial, and peace who has worked steadfastly for the rights and wellbeing of ordinary people, particularly the tribals. We feel that the allegations of unlawful activities on his part are aimed at silencing an inconvenient voice in defence of the oppressed. The Chhattisgarh Special Public Security Act, 2005, under which he is imprisoned, permits arbitrary detention with no remedy of appeal or review for a maximum period of imprisonment of 7 years for any expression or act which the state may deem as disturbing public order. The repressive features of this law make us concerned about his safety and wellbeing. We urge the international medical community to raise their voice to demand the release of this distinguished doctor and civil rights activist.

Pre-school nutrition—a reappraisal of some options

A reappraisal of the problem of undernutrition reveals the difficulty of evaluating nutrition programs and suggests preventive measures to combat the problem. The Community Health Department of Christian Medical College in Vellore South India has conducted an ongoing integrated health and development service to a block in Tamil Nadu state. In 1975 baseline studies of the weights of children in 12 villages were conducted and in 1984 the same information was recorded. 1110 children (1975) and 1330 children (1984) aged 0-60 months were included in the final analysis. The children were classified by nutritional status--normal mild malnutrition moderate malnutrition and severe malnutrition. There was a definite improvement in nutritional status of the children over the study period and in both populations children under age 6 months were normally nourished. However the proportion of undernourished children showed an increase after age 6 months with 50% of children 12-18 months of age undernourished. The lack of nutritionally sound supplemental feeding at 6 months of age and the increased exposure to infections at this age could contribute to poor nutrition. Health promotion and prevention efforts including growth monitoring visits at special village centers (balwadies or creches) health education for mothers and training and support for health workers are recommended to address the problems of undernutrition. The 0-18 month age group should be the primary focus of growth monitoring programs. Health education greater involvement and support for mothers and training and support/feedback services for health workers would yield better results than the treatment of malnourished children alone.