Vinoth Gnana Chellaiyan

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.

Effect of literacy on family planning practices among married women in rural south India

Background and Aim: Few studies in India have tried to examine the role of female literacy on contraception usage. This study aimed to determine family planning related knowledge and practices and their association with female literacy. Materials and methods: Facility based cross-sectional study was done among married women aged 15-45 years attending outpatient department of three primary health centres in rural Tamilnadu. Data were collected using pretested semi-structured questionnaire by a convenience sampling technique. To assess family planning related knowledge, a composite score was calculated and final score was categorised into satisfactory and unsatisfactory. Results: A total of 100 women participated. Fifty nine percent had satisfactory Family Planning related Knowledge and practices (FPK). Contraception prevalence rate for modern methods was 60%. Eighty percent had ever undergone abortions and among them, one fifth had undergone uncertified abortions.With increase in the literacy status, proportion having satisfactory family planning related knowledge increased (p Conclusion: This study offers evidence that promotion of female literacy could be considered a strategy for promoting contraceptive usage and addressing population growth in India.

Integrated counseling and HIV testing centers of Delhi: An evaluation.

Background: HIV counseling and testing services are a key entry point in prevention of HIV infection, treatment, and care of people with HIV. Evaluation of counseling, testing, and referral services help to increase the effectiveness, efficiency, and quality of services delivered by providers by improving any deficiencies in availability, accessibility, and acceptability of testing and counseling services. The objective of this study was to evaluate the integrated counseling and testing centers (ICTC) in New Delhi. Materials and Methods: The evaluation study was conducted among ICTCs during 2014–2015. Twenty ICTCs of New Delhi were selected on the basis of population proportion to the size of clients catered. The study tool was pretested structured tool for evaluating HIV voluntary counseling and testing (VCT). The evaluation tool consists of an assessment of components including the availability of infrastructure, laboratory services, referral services, and staff availability. Counseling sessions were also observed for assessing content and quality. Means and proportions were calculated. Results: Twelve (60%) ICTCs had dedicated counseling rooms ensuring privacy for the clients. Waiting space was reported to be adequate in 16 (80%) ICTCs. Space within counseling room was observed to be adequate in 8 (40%) ICTCs. Counselors of both sexes were present in 12 (60%) ICTCs. Both external and internal quality assurance was observed in all ICTCs. Standard operating procedures were followed in 15 (75%) ICTCs. On observation of the counseling sessions, it was found that 67.4% of male counselors and 67.2% of female counselors addressed all the issues of content of counseling. Conclusion: ICTCs lack waiting area and adequate space in counseling room and required staff personnel. Records maintenance and laboratory quality control maintained by ICTCs were found to be adequate. The counseling rooms lack privacy that may compromise the confidentiality of clients. Few components of counseling need improvement.

A study on compliance of antenatal care among the mothers attending immunisation clinic of Murshidabad Medical College and Hospital, West Bengal

Introduction: Maternal death is more common in developing countries than developing countries. Though the death rate is declining, there are new targets set to accelerate the decline. One of the main way to reduce the maternal death is through proper Antenatal care. Objective: To determine number of antenatal visits and to assess the knowledge and practice regarding antenatal care among mothers. Methodology: A cross sectional study was conducted in Murshidabad Medical College and Hospital, of West Bengal state with the sample of 154 using pretested questionnaire. Results: Out of 154 participants, awareness about antenatal care is present for 35.7% and 90.26% had more than 3 antenatal visit. Around 40.9% had awareness about IFA tablets and TT immunisation. Around 41.6% had gender preference and 27.3% had preference for male child. Conclusion: Community awareness should be created to improve early registration and antenatal care.

Availing entitlements under Janani Shishu Suraksha Karyakram in Tamil Nadu: a reality

Globally, on any given day, a staggering 830 women die from pregnancy and childbearing related causes. World Health Organization (WHO) estimates that of the overall maternal mortality burden, a staggering 99% is contributed by developing nations. India, over the past 20 years has seen a gradual decline in maternal mortality ratio (MMR) and the figure stood at 174 maternal deaths per 100,000 live births in 2015. IMR in the year 2015 was 32 deaths per 1000 live births worldwide and in India it was 38 per 1000 live births. This decline is expected to take India to the target MMR of 100 deaths per 100,000 live births and IMR of 28 per 1000 live births as envisaged by the National Health Policy of India 2017.

Profile and client satisfaction among clients of Integrated Counselling and Testing Centre for human immunodeficiency virus in Delhi

Background: Integrated Counseling and Testing Centre (ICTC) is a place where a person is counseled and tested for human immunodeficiency virus (HIV) and also a key entry point to the prevention of HIV infection and treatment of HIV infected people. The ICTC services are cost-effective and noncoercive intervention in the prevention of HIV/AIDS. The satisfaction of the clients availing these services indicates the quality of the services provided. Objective: The objective was to study the profile and satisfaction of clients attending counseling services of integrated counseling and testing centers in Delhi. Materials and Methods: The study was a descriptive, cross-sectional, health facility based study. The study was done in 20 ICTCs of Delhi. The ICTCs were chosen on the basis of population proportion to size. Consecutive sampling method was followed for recruiting the clients. After obtaining written consent, exit interview of 300 clients was undertaken. Results: Among 300 clients, 204 (68%) were males, and 96 (32%) were females. Majority, 267 (89%) of the clients were staying with family and 33 (11%) were staying with friends/roommates. The total number of referred clients was 270 (90%) and self-referred or direct walk-in client was 30 (10%). Among the direct walk-in/self-referred clients, 12 (40%) clients were recommended by their friends to come, 4 (13.3%) clients seek to avail ICTC services because of high risk behavior and 14 (46.7%) clients wanted to get tested for HIV as their spouse was HIV positive. About 96.3% of the clients who attended the counseling services were found to be satisfied. Conclusion: The proportion of self-referred/direct walk-in clients was very low, and low level of awareness about the HIV test and counseling services was found among the clients. This reflects the need to enhance the efforts directed at increasing the awareness of HIV test and counseling services. The satisfaction of clients could be further improved by better counseling sessions.