Smita Sinha

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.

Burden of diabetes mellitus and prediabetes in tribal population of India: a systematic review.

OBJECTIVE To estimate the burden of diabetes mellitus and pre-diabetes in tribal populations of India. METHODS The authors reviewed studies from 2000 to 2011 that documented the prevalence of diabetes mellitus in various tribal populations of India. The search was performed using electronic and manual methods. Meta-analysis of data on point prevalence was performed. RESULTS A total of seven studies were retrieved. The prevalence of diabetes mellitus ranged from 0.7% to 10.1%. The final estimate of diabetes prevalence obtained after pooling of data from individual studies, was 5.9% (95% CI; 3.1-9.5%). The prevalence for impaired fasting glucose (IFG) varied from 5.1% to 13.5% and impaired glucose tolerance (IGT), from 6.6% to 12.9%. CONCLUSION Chronic disease research in tribal populations is limited. The reported prevalence of IFG/IGT was higher than the prevalence of diabetes and this observation could be suggestive of a potential increase in diabetes in the coming years. Given that lifestyle changes have occurred in the tribal populations, there is a need to synthesize evidence(s) relating to diabetes and other chronic diseases in these marginalized populations and inform policy makers.

Diagnostic agreement between a primary care physician and a teledermatologist for common dermatological conditions in North India.

Background: Primary care physicians (PCPs) encounter a large number of patients with dermatological diseases. However, delivering appropriate management is a challenge considering the inadequate dermatology training offered during the undergraduate medical curriculum. Teledermatology is the clinical evaluation of skin lesions by dermatologists and allows patients to be diagnosed and treated from a distant site. It is seen as a potential solution to the shortage of specialists and providing equitable service in remote areas. Aim: The study was aimed at estimating the diagnostic agreement of common dermatological conditions between a PCP and a teledermatologist. Materials and Methods: Consecutive patients with dermatological ailments who attended a primary health care clinic were recruited into the study, examined by the PCP and offered a diagnosis. The clinical images and patients′ history were collected and transferred to a dermatologist at a tertiary center who also made a diagnosis. Agreement between diagnosis made by the PCPs and the teledermatologist was measured using kappa (κ) statistics. Results: Overall agreement between the diagnoses made by a PCP and the dermatologist was found to be 56%. Poor κ agreement (<0.4) was seen in the diagnosis of psoriasis and eczema. Conclusion: Teledermatology can supplement specialist dermatology service in remote areas. There was poor agreement in the diagnosis of psoriasis, classifying various types of eczematous conditions and fungal infections. Scarce manpower in dermatology at the primary health care level compounded by the burden of skin ailments necessitates training of PCPs in common dermatological conditions.

Prevalence of metabolic syndrome and its selected determinants among urban adult women in South Delhi, India

Aims Metabolic syndrome is a clustering of cardiovascular risk factors. Asian Indians, particularly women, have been reported to be at higher risk of developing metabolic syndrome. We aimed to estimate the prevalence of metabolic syndrome and its selected known determinants among adult Asian Indian women of lower socioeconomic status. Methods We conducted a cross-sectional study over a period of 1 year from January 2008 to December 2008 in South Delhi, which included 300 women (>20 years) recruited through multistage systematic random sampling. Blood pressure and anthropometric measurements were taken. Biochemical tests were performed on blood samples collected after overnight fasting. Metabolic syndrome was defined using updated National Cholesterol Education Program/Adult Treatment Panel-III (NCEP/ATP-III) guidelines with modified waist circumference for Indians and International Diabetes Federation (IDF) criteria. Results The overall prevalence of metabolic syndrome was 29.6% (95% CI 23.8 to 36.0) and 20.4% (95% CI 15.3 to 26.1) using NCEP/ATP-III and IDF criteria, respectively. The risk of metabolic syndrome increased with age and calorie intake. Most (203 (90%)) of the study participants were involved in physical activity with a low metabolic equivalent (MET) score but one-fifth (19.5%) had a calorie intake recommended for women involved in vigorous activity. Conclusions The high prevalence of metabolic syndrome among women of lower socioeconomic status is a cause of concern, and calls for an effective public health response.

A Community-Based Study of Metabolic Syndrome and Its Components Among Women of Rural Community in Ballabgarh, Haryana

BACKGROUND The metabolic syndrome is an important cluster of coronary heart disease risk factors with common insulin resistance. Although the prevalence of metabolic syndrome is high among Asians, including Indians, no sizeable literature is available about the magnitude of metabolic syndrome in rural areas, especially in women. METHODS Blood pressure and anthropometric measurements were noted in 307 women, aged ≥20 years, selected through a multistage sampling technique. Blood samples were collected after overnight fasting and subjected to biochemical quantification such as fasting blood glucose, triglycerides, and high-density lipoprotein cholesterol (HDL-C). Data were analyzed using updated National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) definition by modifying the waist circumference cutoffs as per Asia-Pacific guidelines. RESULTS Overall metabolic syndrome was observed in 12.0% [95% confidence interval (CI); 8.5-16.8] of the rural women population. Women in the age group ≥60 years had the highest prevalence (27.8%), whereas those in the age group 20-39 years had the lowest prevalence (4.2%). At least one component of metabolic syndrome was present in nearly 95% of the study respondents; 41.6% had at least two, 12.0% had at least three, and 2.6% had at least four components of metabolic syndrome. None of the participants had all the five components. CONCLUSION The current prevalence of metabolic syndrome in women in rural communities of the selected area, although less than that in their urban counterparts, could be a serious problem in the future. It is incumbent on government agencies and the medical community to address this issue to prevent the consequences of its increased burden.

Does Utilization of Antenatal Care Result in an Institutional Delivery? Findings of a Record-Based Study in Urban Chandigarh

BACKGROUND Antenatal care is an important pillar of safe motherhood initiative and is essential to reduce maternal as well as neonatal morbidity and mortality. The study aimed to explore whether women availing antenatal care are more likely to go for an institutional delivery. METHODS The study area was an urban resettlement colony located in Chandigarh. The antenatal records, at Urban Health Clinic, from January 2010 to December 2010 were analyzed. The information on the place of delivery was collected by the health workers during routine post-natal care visits. RESULTS The records of 332 pregnant females were analyzed. Majority had an institutional delivery (75.9%). Women with higher education (i.e. more than secondary school) and those with first pregnancy preferred institutional delivery compared to those who were illiterate and multigravid respectively. CONCLUSION There is a need to understand the societal and familial dynamics that influence the choice of the place of delivery.

Suicide an emerging public health problem: evidence from rural Haryana, India.

Analysis of annual mortality data for year 2002-2009 of twenty eight villages in Ballabgarh block of rural Haryana was carried out to calculate suicide rates per 100,000 population. In addition, informal discussions were carried out amongst health providers to understand their perceptions regarding suicides. In a period of 8 years, out of total 4552 deaths, 163 (3.5%) deaths were attributed to suicides giving a suicide rate of 24.4/100,000 population (95% CI 24.1- 24.7). Mean years of productive life lost for males and females were estimated to be 44.4 (SD 1.1) years and 39.9 (SD 1.4) years respectively. Poisoning (41.1%) was the most common mode of suicide followed by hanging (36.8%) and burns (14.7%). Health workers also perceived suicide as major problem in the community and marital conflict was identified as major cause for suicides. There is need to address the complex issue of suicide by public- health approach at the community level.

India's poliomyelitis eradication: a milestone in public health.

India has recently completed 2 years without single case of poliomyelitis on 13 January 2013. This has brought South East Asian Region closer to eradication. Recently, India is being regarded as a role model for polio eradication efforts in other low-income endemic countries-Pakistan, Nigeria and Afghanistan. However, the near elimination of wild polio virus in India has set forth newer challenges. Stricter surveillance measures are now needed to check for importations spread of virus in migratory populations and rapid containment of newly found virus. Indias battle against polio will soon be cited as biggest public health achievement or most expensive public health failure.

Poliomyelitis eradication: Rhetoric or reality

Since the launch of Global Polio Eradication Initiative in 1988, disease burden has been reduced by more than 99% globally. Lately, India has witnessed a year without a case of poliomyelitis. It no longer stands endemic and is being regarded as a model for polio eradication efforts in other low income endemic countries: Pakistan, Nigeria and Afghanistan. The near elimination of wild polio virus in India has set forth new challenges of vaccine derived polio virus and need for newer strategies in oral poliomyelitis vaccine cessation preparatory phase. Stricter surveillance measures are needed to check for importations, any spread of virus in migratory populations and rapid containment of newly found virus. No stone should be left unturned in this last ditch effort for extermination of polio virus form environmental circulation. Indias battle against polio will be cited as the biggest public health achievement or the most expensive public health failure.

Directly observed iron supplementation for control of iron deficiency anemia

Anemia is major public health problem affecting 1.6 billion people worldwide. The poor compliance of iron supplementation remains main contributor for high prevalence of anemia. The current paper reviewed the effectiveness of direct observation of oral iron supplementation on anemia. A systematic search was performed through electronic databases and local libraries. Search strategies used subject headings and key words “directly observed” and “iron supplementation.” Searches were sought through April 2014. A total of 14 articles were included in the study. Findings were presented in three categories. First, all of those reported an improvement in compliance of iron supplementation. Second, reduction in the prevalence of anemia was reported by all and third, all except one reported increased blood hemoglobin level. Directly observed an iron supplementation is an effective approach for prevention and management of anemia in vulnerable groups. However, larger trials are needed before concluding that scaling up directly observed iron supplementation through community health volunteers would be beneficial.