Surya Bali

Isoniazid Preventive Therapy among Children Living with Tuberculosis Patients: Is It Working? A Mixed-Method Study from Bhopal, India

Abstract Objective We assessed uptake of isoniazid preventive therapy (IPT) among child contacts of smear-positive tuberculosis (TB) patients and its implementation challenges from healthcare providers’ and parents’ perspectives in Bhopal, India. Methods A mixed-method study design: quantitative phase (review of programme records and house-to-house survey of smear-positive TB patients) followed by qualitative phase (interviews of healthcare providers and parents). Results Of 59 child contacts (<6 years) of 129 index patients, 51 were contacted. Among them, 19 of 51 (37%) were screened for TB and one had TB. Only 11 of 50 (22%) children were started and 10 of 50 (20%) completed IPT. Content analysis of interviews revealed lack of awareness, risk perception among parents, cumbersome screening process, isoniazid stock-outs, inadequate knowledge among healthcare providers and poor programmatic monitoring as main barriers to IPT implementation. Conclusion National TB programme should counsel parents, train healthcare providers, simplify screening procedures, ensure regular drug supply and introduce an indicator to strengthen monitoring and uptake of IPT.

Socio-cultural and knowledge-based barriers to tuberculosis diagnosis for women in Bhopal, India

Background: In India, only one woman is diagnosed with tuberculosis (TB) for every 2.4 men. Previous studies have indicated gender disparities in care-seeking behavior and TB diagnosis; however, little is known about the specific barriers women face. Objectives: This study aimed to characterize socio-cultural and knowledge-based barriers that affected TB diagnosis for women in Bhopal, India. Materials and Methods: In-depth interviews were conducted with 13 affected women and 6 health-care workers. The Bhopal Diagnostic Microscopy Laboratory Register (n = 121) and the Bhopal district report (n = 261) were examined for diagnostic and care-seeking trends. Results: Women, especially younger women, faced socio-cultural barriers and stigma, causing many to hide their symptoms. Older women had little awareness about TB. Women often sought treatment from private practitioners, resulting in delayed diagnosis. Conclusions: Understanding these diagnostic and help-seeking behaviors barriers for women is critical for development of a gender-sensitive TB control program.

Evaluation of telemedicine centres in Madhya Pradesh, Central India:

In a developing country such as India, there is substantial inequality in health care distribution. Telemedicine facilities were established in Madhya Pradesh in 2007–2008. The purpose of this study was to evaluate the infrastructure, equipment, manpower, and functional status of Indian Space and Research Organisation (ISRO) telemedicine nodes in Madhya Pradesh. All district hospitals and medical colleges with nodes were visited by a team of three members. The study was conducted from December 2013–January 2014. The team recorded the structural facility situation and physical conditions on a predesigned pro forma. The team also conducted interviews with the nodal officers, data entry operator and other relevant people at these centres. Of the six specialist nodes, four were functional and two were non-functional. Of 10 patient nodes, two nodes were functional, four were semi-functional and four were non-functional. Most of the centres were not working due to a problem with their satellite modem. The overall condition of ISRO run telemedicine centres in Madhya Pradesh was found to be poor. Most of these centres failed to provide telemedicine consultations. We recommend replacing this system with another cost effective system available in the state wide area network (SWAN). We suggest the concept of the virtual out-patient department.

Iodine Deficiency and Toxicity Among School Children in Damoh District, Madhya Pradesh, India

ObjectiveTo estimate the prevalence of Iodine Deficiency Disorders, and household consumption of adequately iodized salt in Damoh district, Madhya Pradesh in 2016.MethodsCross-sectional study with cluster sampling method was used among schoolgoing children. 30 clusters, each with 90 children were selected to access Total Goiter rate (TGR). 540 salt samples were collected to estimate salt iodine content from their household and 270 on the spot urine samples were collected to estimate Urine Iodine Excretion level.ResultsTGR was 2.08%. The prevalence of iodine deficiency, adequate iodine nutrition, and either more than adequate or toxic level of Iodine was 26%, 28% and 46 %, respectively. 72.4% people were consuming adequately iodized salt.ConclusionsDamoh district is no more an endemic area for iodine deficiency. We recommend continuous monitoring to assess IDDs as well Iodine-induced toxicity in future.

Evaluation of competency and skills of skilled birth attendants in Madhya Pradesh, central India

The National Health Mission tracks the proportion of women delivered by skilled birth attendants (SBAs). We assessed SBAs competence in Madhya Pradesh, India, using structured evaluation tools. It is a cross-sectional study conducted from 2014 to 2015. We evaluated 335 trained SBAs using multistage stratified random sampling. Of total, 335 skilled births attendant selected 41.8% were auxiliary nurse midwife, 47.8% were staff nurse, and 10.4% were lady health visitors. Grouping all provider and knowledge test versions, SBAs were correct on 75.4% of the questions. By topic, results ranged from 77.9% correct for the management of normal pregnancy and childbirth to 70.2% correct for intranatal care. The skill evaluation score was 88.1% of infection prevention practices to 74.3% for postnatal care. The present study found significant variations in knowledge and skill competency scores of the SBAs. There is a critical need to improve the training quality of skill birth attendants.

Challenges Faced in Providing Primordial Care, Central India

The All India Institute of Medical Sciences, Bhopal is one of the pioneer institutes of health care in India. As we aim at achieving Health for all, we have to shift from medical care to health care. For achieving, it was crucial to have good rapport with the community. Therefore, we organized different awareness, generating activities among the local community. We faced various challenges and learned from them for the future activities in the community. We learned the importance of being a care manager rather than physician only to achieve health in all aspects. Our real time experiences in community and family health can help the new emerging health professional to provide more efficient health care.

Outbreak of gastroenteritis among medical students, Madhya Pradesh, Central India

Introduction: Although diarrheal diseases with known etiologies are under regular surveillance by the integrated disease surveillance project in India, only limited food-borne outbreaks were subjected to systematic epidemiological investigation. We examined one incidence of a food-borne outbreak among medical students in Bhopal, India, to identifying the source and mode of transmission, and to implement appropriate preventive measures. Materials and Methods: We constituted two teams. We did the line listing, filled the structured questionnaire and collected the biological samples. We did in-depth interviews of the case patients. We interviewed food handlers in mess. We randomly collected food and water samples. Results: The study results identified 30 hosteller case patients for a total of 239 students (overall attack rate [AR]: 12.6%). In female students, the AR was 18.1% and in the male students it was 6.7%. The AR was highest in female hostel no. One compared to other female and male hostel (19.8% vs. 14.3%, 6.7%). We identified four different risk factors for the illness. Discussion: As AR s are high compared to the general population. As the AR was high among the girls, the probable source of infection resides in the female hostel.

Portfolio of Outpatients Attending Centre for Urban Health, Madhya Pradesh, Central India

Background: Knowledge on distribution and burden of diseases in a community is essential for planning of public health services. In the absence of information on morbidity profile through community-based surveys, facility-based data provide a good alternative. The aim of this study was to describe the morbidity profile of patients attending the Centre for Urban Health All India Institute of Medical Sciences (AIIMS) Bhopal (CUHA). Methodology: A record-based descriptive study was carried out in the CUHA Bhopal, Madhya Pradesh, Central India. Information on age, gender, residence, new case, and principal diagnosis were extracted from the outpatient registers for the period between January 2014 and December 2014. Only newly registered patients for the study year (2014) were included. Descriptive analysis was done. Results: A total of 6685 new episodes of illnesses were treated. Adults (>15 years) constituted about 85.0%. Overall, the respiratory disorders were the most common (27.2%) followed by the digestive disorders (10.9%), circulatory disorders (9.9%), musculoskeletal disorders (8.8%), and infectious and parasitic disorders (7.4%). Conclusion: This study gives a brief description of the morbidity profile of patients attending a primary health care center over a period of 1 year. This knowledge would help in planning health services to meet the patients’ needs and help in training health staff.

Assessment of cold-chain maintenance in vaccine carriers during Pulse Polio National Immunization Day in a rural block of India

India was certified polio free on 27 March 2014. Supplementary immunization activities, in the form of national immunization days, is one of the core strategies for eradication, where oral polio vaccine is administered to children aged under 5 years throughout the country. Oral polio vaccine is heat sensitive and requires maintenance of a stringent cold chain. Therefore, vaccine carriers with ice packs are used in the Pulse Polio Immunization (PPI) programme. This study assessed whether the cold chain is maintained during National Immunization Day in Beed district. A cross-sectional study was conducted at six randomly selected booths, one each from six primary health centres in Georai block of Beed district in Maharashtra. Electronic data loggers, configured to measure half-hourly temperatures, were kept in vaccine carriers throughout the day of PPI. The vaccine carrier temperature was below 8 °C at all six booths; minimum temperature recorded was -9.5 °C, while the maximum was 4.5 °C. The vaccine vial monitor did not reach discard point in any booth. A vaccine carrier with four ice packs very effectively maintains the cold chain required for oral polio vaccine.