Suneela Garg

Domestic Violence Against Women: A Qualitative Study in a Rural Community:

Domestic violence is a major contributor to physical and mental ill health of women and is evident, to some degree, in every society in the world. The World Health Organization reports that globally 29% to 62% of women have experienced physical or sexual violence by an intimate partner. Ending gender discrimination and all forms of violence against women requires an understanding of the prevailing culture of bias and violence. The present study was conducted in a rural area in India. Focus group discussions (FGDs) were conducted among married women in the age group of 18 to 35 years. Physical violence was a major cause of concern among these women. Some women had to suffer even during pregnancy. An alcoholic husband emerged as the main cause for domestic violence. Husbands’ relatives instigating wife beating was also common. Majority of the women preferred to remain silent despite being victimized. The women feared to resort to law because of implications such as social isolation. To address this, all sectors including education, health, legal, and judicial must work in liaison. Gender inequality must be eliminated and equal participation of women in the decision-making and development processes must be ensured.

Risk factors with breast cancer among women in Delhi.

BACKGROUND The incidence of breast cancer is on the rise in India, breast cancer is the second most common malignancy in Indian women. AIM The aim of this study was to find out the association of various risk factors with breast cancer among women in Delhi. SETTINGS AND DESIGN This was a case-control study in Lok Nayak Hospital, Delhi. METHODS AND MATERIAL 332 women were studied. Subjects were women with breast cancer (N = 115) and age matched Control subjects (N-217) without breast cancer, attending Lok Nayak Hospital during 2006. Subjects were interviewed using a pretested questionnaire. The risk factors studied were: age, parity, socioeconomic status, marital status, breast feeding, menarche, menopause, family history. STATISTICAL ANALYSIS Data was expressed in proportion. RESULTS AND CONCLUSIONS Age of the patient ranged from 25 to 80 years. In this study, 69 (60%) cases and 127 (58.5%) controls were illiterate, the mean duration sum of total breast feeding for all children was 6.58 years in cases and 7.4 years in controls (OR = 1.91; 95% CI, 1.17 - 3.13) (P P P< 0.05). There was a significant difference between breast cancer cases and controls in relation to place of residence, occupation, marital status, body mass index and breast feeding.

Maternal health-care utilization among women in an urban slum in Delhi

Maternal mortality and morbidity continue to be high despite the existence of national programs for improving maternal and child health in India. This could be related to several factors an important one being non-utilization or under-utilization of maternal health-care services especially amongst the rural poor and urban slum population due to either lack of awareness or access to health-care services. Understanding of the knowledge and practices of the community regarding maternity care during pregnancy delivery and postnatal period is required for program implementation. Therefore the present study was carried out to evaluate the sociodemographic correlates and barriers of maternal healthcare utilization amongst married women aged 15-45 years living in a slum in Delhi. (excerpt)

Polymerase Chain Reaction for Detection of Endocervical Chlamydia trachomatis Infection in Women Attending a Gynecology Outpatient Department in India

OBJECTIVES To detect Chlamydia trachomatis infection by polymerase chain reaction (PCR) in symptomatic women attending a gynecology clinic in a city hospital and in randomly selected slum dwellers. STUDY DESIGN Endocervical specimens were collected from 350 women with genitourinary complaints (group I) and 53 slum dwellers (group II). Samples were analyzed by PCR, direct fluorescence assay (DFA) and Giemsa stain cytology for detection of C trachomatis and compared for their sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS The prevalence of endocervical C trachomatis infection was 43.1% and 24.5% in groups I and II, respectively. The sensitivity, specificity, PPV and NPV of PCR were 80.0%, 75.0%, 66.6% and 85.7%, respectively, when DFA was considered true positive. The percent increment in detection of C trachomatis by PCR was 15.3%. CONCLUSION Giemsa stain cytology has low sensitivity and specificity; hence, it cannot be recommended for use as a diagnostic technique. It appears that PCR can be used routinely in Chlamydia diagnosis and in screening selected populations. The high positivity of C trachomatis infection in urban slum dwellers is cause for concern.

Addressing Domestic Violence Against Women: An Unfinished Agenda

“Domestic violence is a burden on numerous sectors of the social system and quietly, yet dramatically, affects the development of a nation… batterers cost nations fortunes in terms of law enforcement, health care, lost labor and general progress in development. These costs do not only affect the present generation; what begins as an assault by one person on another, reverberates through the family and the community into the future”. (Zimmerman)(1) Domestic violence is a global issue reaching across national boundaries as well as socio-economic, cultural, racial and class distinctions. This problem is not only widely dispersed geographically, but its incidence is also extensive, making it a typical and accepted behavior. Domestic violence is wide spread, deeply ingrained and has serious impacts on womens health and well-being. Its continued existence is morally indefensible. Its cost to individuals, to health systems and to society is enormous. Yet no other major problem of public health has been so widely ignored and so little understood.(2)

Reproductive morbidity in an Indian urban slum: need for health action

In developing countries the mortality and morbidity due to reproductive tract infections/sexually transmitted infections (RTIs/STIs) are very high relative to those associated with other health problems. The consequences of RTIs which are numerous and potentially devastating include postabortal and puerperal sepsis, ectopic pregnancy, fetal and perinatal death, cervical cancer, infertility, chronic physical pain, emotional distress, and social rejection in women. The impact of RTIs on the transmission of HIV infection and the morbidity and mortality of HIV adds substantially to the total health impact of RTIs. This study has been conducted in an urban slum in the vicinity of Maulana Azad Medical College, of New Delhi, India, during August 1996 to November 2000. The slum settings are characterised by a migratory population living under overcrowded and stressful conditions, where loosened traditional and social constraints, a range of sociocultural factors, and economic compulsions limit access to health care and social support services, thereby providing an environment conducive to acquiring and transmitting RTIs/STIs. The slum area comprised 826 hutments with a total population of 3676. The area had adverse sex ratio, 635 females per 1000 males and there were 500 (13.6%) single men. The majority of residents were migrants from the neighbouring states of Uttar Pradesh and Bihar. The present study was conducted with the objective of assessing the prevalence of various RTIs among married women in the urban slum setting using peripheral (field level) and confirmatory laboratory tests. The study population consisted of all 446 ever married women aged 15–45 years residing in the area. It was decided to include all women in the study to fulfil the obligation of not denying diagnosis and treatment to any. To enrol the eligible subjects, a demographic survey was conducted which included a house to house survey. A quantitative reproductive health schedule (RHS) developed …

Adolescent friendly health services in India: A need of the hour.

Adolescents account for almost one third of Indias population. They are prone to suffer from reproductive and sexual health, nutritional, mental and behavioral problems. Health services which cater exclusively to the needs of adolescents are scanty and concentrated in urban areas. Adolescent Friendly Health Services (AFHS) which provide a broad range of preventive, promotive and curative services under one roof can help to ensure improved availability, accessibility and utilization of health services. AFHS is being initiated by governmental, private and non-governmental organizations. Lessons to improve the quality of AFHS could be further learnt from evaluation of pilot projects and success stories of similar initiatives in other countries.

Prevalence of Bacterial Vaginosis in a Community Setting and Role of the Pap Smear in Its Detection

OBJECTIVE To study the revalence of bacterial vaginosis (BV) in symptomatic and asymptomatic women in a community setting, to assess the validiy of the Pap smear in the detection of BV and to determine the sensitivity and specificity of clinical criteria for the diagnosis of BV. STUDY DESIGN Gram staining was performed on vaginal secretions collected from 301 women to determine the prevalence of BV. Each smear was assigned a score on the basis of the bacterial morphotypes identified. The bacterial pattern was also studied on 270 adequate, Pap-stained cervical smears and compared with the gold standard, the morphotypes on gram stain, to derive the validity of the Pap smear in diagnosing BV. Also each clinical criterion defined for diagnosis of BV was independently evaluated to determine their sensitivity and specificity. RESULTS The overall prevalence of BV was 41.5% in the study subjects using Amsels and Nugents criteria. The Pap smear was 78.3% sensitive and 86.9% specific in detection of BV. Among the clinical criteria, the presence of clue cells on wet mounts was both highly sensitive (76.7%) and specific (92.4%) for diagnosing BV, while a positive whiff test had a specificity of 86.9% with sensitivity of 33.9%. Vaginal pH > 4.5 was sensitive (88.3%) but less specific (58.6%). The presence of a thin, homogeneous discharge clinging to vaginal mucosa had low sensitivity (56.3%) and specificity (48.9%). In this study, BV was prevalent in both symptomatic and asymptomatic women. The routine Pap smear was able to detect BV in the majority of women. Its utility can be greater in asymptomatic women, in whom this infection may go undetected otherwise, resulting in future complications related to reproductive health. Among Amsels clinical criteria, the most sensitive and specific was the presence of clue cells in wet mounts. They can be detected easily by laboratory staff with little training in primary health care seting

Dengue serotype-specific seroprevalence among 5- to 10-year-old children in India: a community-based cross-sectional study

BACKGROUND Dengue surveillance data in India are limited and probably substantially underestimate the burden of disease. A community-based study was undertaken to assess the prevalence of dengue-specific immunoglobulin G (IgG) antibodies in children across India and to examine historical dengue exposure rates. Potential associations between socio-economic factors and dengue seroprevalence were also assessed (registered at ctri.nic.in: CTRI/2011/12/002243). METHODS A convenience sample of 2609 healthy children aged 5-10 years was enrolled; these children were registered at or were living in the vicinity of eight centres located at six geographically distinct sites across India. Blood samples were drawn to test for the presence of dengue IgG antibodies using ELISA. Serotype-specific neutralizing antibody titres were measured in dengue IgG-positive children using dengue plaque reduction neutralization tests. Socio-demographic and household information was collected using a questionnaire. RESULTS Overall, 2558/2609 children had viable samples with laboratory results for dengue IgG. Dengue IgG seroprevalence across all sites was 59.6% (95% confidence interval 57.7-61.5%): the lowest (23.2%) was in Kalyani, West Bengal, and the highest (80.1%) was in Mumbai. Seroprevalence increased with age. Multivariate analysis suggested associations with household water storage/supply and type of housing. Half of the subjects with positive IgG results presented a multitypic profile, indicating previous exposure to more than one serotype. CONCLUSIONS The overall dengue seroprevalence suggests that dengue endemicity in India is comparable to that in highly endemic countries of Southeast Asia. Additional prospective studies are required to fully quantify the disease burden, in order to support evidence-based policies for dengue prevention and control in India.

Prevalence and awareness about sexually transmitted infections among males in urban slums of Delhi.

BACKGROUND India is at present facing an emergence of sexually transmitted infections (STIs) and human immunodeficiency virus. Community-based studies on the prevalence of STIs among males are scanty. AIM (i) To study the prevalence of STIs and (ii) to assess the level of awareness about STIs among males belonging to the reproductive age group residing in an urban slum. SETTING AND DESIGN This is a cross-sectional study conducted in selected areas of Delhi, using a camp approach. MATERIALS AND METHODS One hundred ninety-six males in the reproductive age group were interviewed regarding their awareness about STIs, past history and present complaints of any symptoms suggestive of an STI. This was followed by a clinical examination. Required samples were also collected for microbiological tests. STATISTICAL TESTS Simple proportions and Chi-square test. RESULTS AND CONCLUSIONS As many as 70% of the study participants were unable to mention even one symptom of an STI. About 73.4% of the study participants stated that staying in a monogamous relationship could help prevent STI, while only 39.2% were aware that condoms could afford protection against an STI. As many as 8.7% complained of urethral discharge, while 5.6% complained of itching, 2.5% reported presence of genital ulcer and 1.0% complained of groin swelling. We found a seroprevalence rate of 1.5% for trichomoniasis and 3.6% for syphilis. Thus the overall awareness level about STIs and their prevention was rather low. Poor treatment-seeking behavior was also observed. The actual prevalence rate in the general population might be higher due to the likelihood of presence of an asymptomatic infection. The present study calls for a multipronged approach which also includes targeted interventions and strategies to be adopted in the reproductive health programs for males who have been neglected by the program managers so far.