Zulfia Khan

Poor perinatal care practices in urban slums: possible role of social mobilization networks.

Background: Making perinatal care accessible to women in marginalized periurban areas poses a public health problem. Many women do not utilize institutional care in spite of physical accessibility. Home-based care by traditional birth attendants (TBA) is hazardous. Inappropriate early neonatal feeding practices are common. Many barriers to perinatal care can be overcome by social mobilization and capacity building at the community level. Objectives: To determine the existing perinatal practices in an urban slum and to identify barriers to utilization of health services by mothers. Study Design: This is a cross-sectional descriptive study. Setting and Participants: The high-risk periurban areas of Nabi Nagar, Aligarh has a population of 40,000 living in 5,480 households. Mothers delivering babies in September 2007 were identified from records of social mobilization workers (Community Mobilization Coordinators or CMCs) already working in an NGO in the area. A total of 92 mothers were interviewed at home. Current perinatal practices and reasons for utilizing or not utilizing health services were the topics of inquiry. Statistical Analysis: Data was tabulated and analyzed using SPSS 12. Results: Analyses revealed that 80.4% of mothers had received antenatal care. However, this did not translate into safe delivery practices as more than 60% of the women had home deliveries conducted by traditional untrained or trained birth attendants. Reasons for preferring home deliveries were mostly tradition (41.9%) or related to economics (30.7%). A total of 56% of the deliveries were conducted in the squatting position and in 25% of the cases, the umbilical cord was cut using the edge of a broken cup. Although breast-feeding was universal, inappropriate early neonatal feeding practices were common. Prelacteal feeds were given to nearly 50% of the babies and feeding was delayed beyond 24 hours in 8% of the cases. Several mothers had breastfeeding problems. Conclusion: Barriers to utilization of available services leads to hazardous perinatal practices in urban slums.

Prevalence of Common Ocular Morbidities in Adult Population of Aligarh

Aims and Objectives: To determine the prevalence of common ocular morbidities (cataract, refractive errors, glaucoma, and corneal opacities) and their demographic and sociocultural correlates. Settings and Design: The present cross-sectional study was conducted in the field practice areas of the Department of Community Medicine, JNMC, AMU, Aligarh, for a period of one year, from September 2005 to August 2006. Materials and Methods: Systematic random sampling was done to select the required sample size. All adults aged 20 years and above in the selected households were interviewed and screened using a 6/9 illiterate ‘E’ chart. Those who could not read the ‘E’ chart were referred to the respective health training center for a complete eye examination by an ophthalmologist. Statistical Analysis: Chi- square test. Results: The prevalence of visual impairment, low vision, and blindness, based on presenting visual acuity was 13.0, 7.8, and 5.3%, respectively. The prevalence of cataract was 21.7%. Bilateral cataract was present in 16.9% of the population. Cataract was significantly associated with age, education, and fuel use. The prevalence of myopia, hypermetropia, and astigmatism was 11.5, 9.8, and 3.7%, respectively. Glaucoma was diagnosed in six patients, giving a prevalence rate of 0.9%. All the six patients of glaucoma were aged above 40 years. The prevalence of corneal opacity was 4.2%. Conclusion: There is a high prevalence of treatable or preventable morbidities such as cataract, refractive errors, and corneal opacity.

Reducing resistance against polio drops

Aims: The present study was carried out to impart correct health education regarding polio eradication programme and to assess the impact of social mobilization of a Muslim community carried out by medical interns. Methods: One round of a polio immunization campaign was selected randomly. Five highly resistant areas were included in the study. During house to house A-Team activity, teams of health workers visited the houses and resistant families were identified. These families refused to give polio drops to their children. On the second day of A-Team activity, medical interns visited those identified resistant families. They imparted correct health education and tried to convince them to give polio drops. However, after prolonged persuasion, some of the families were not ready to give polio drops. These more resistant families were again visited by more motivated and enthusiastic teams during B-Team activity, started two to three days after the completion of A-Team activity. Data were collected, tabulated and analysed. Results: Total number of resistant families identified during house to house A-Team activity was 1025 in five high risk areas of Aligarh, India. Out of 1025 resistant houses, 510 (49.76%) houses were converted to P houses where polio drops were given to the children. Five hundred and fifteen (50.24%) houses remained resistant even after social mobilization by A-Team members. These most resistant houses were again visited by B-team members. Out of these 515 houses, polio drops were administered in 303 (58.83%). The overall number of converted houses was 813 (79.32%) after A and B-team activities. 20.68% of families remained resistant and their children could not be given polio drops. Conclusions: In all high risk areas, maximum numbers of resistant houses were converted to P houses. These families were persuaded and convinced by the teams of interns, social workers and influential persons that polio drops did not have any side effects. They were more receptive to the advice given by medical interns compared to other staff members of the Government District Hospital because of quality of health services provided to the community. There is a need to impart correct health education regarding importance of polio drops and routine immunization more vigorously through information, education and communication (IEC) activities.

Influence of Behavioral Determinants on the Prevalence of Overweight and Obesity among School Going Adolescents of Aligarh

Obesity has reached epidemic proportions globally and the prevention of adult obesity will require prevention and management of childhood obesity. A study was conducted to determine the prevalence and behavioral determinants of overweight and obesity in school going adolescents. A total of 660 adolescents from affluent and nonaffluent schools were taken. Overweight and obesity was defined as per World Health Organization 2007 growth reference. Prevalence of overweight and obesity was 9.8% and 4.8%, respectively. Prevalence of both overweight and obesity was higher among males. Statistically significant difference was found in prevalence of overweight and obesity among affluent schools (14.8% and 8.2%) and nonaffluent schools (4.8% and 1.5%). Important determinants of overweight and obesity were increased consumption of fast food, low physical activity level and watching television for more than 2 h/day. The prevalence of obesity is high even in small cities. Dietary behavior and physical activity significantly affect weight of adolescent children.

Lifestyle and gallstone disease: scope for primary prevention.

Objective: To study the antecedent risk factors in the causation of gallstone disease in a hospital-based case control study. Materials and Methods: Cases (n = 150) from all age groups and both sexes with sonographically proven gallstones were recruited over a duration of 3 months from the surgical wards of a tertiary care teaching hospital. Modes of presentation were also noted among cases. Age- and sex-matched controls (n = 150) were chosen from among ward inmates admitted for other reasons. Univariate and multivariate logistic regression analyses were performed for selected sociodemographic, dietary, and lifestyle-related variables. Results: Females had a higher prevalence of gallstone disease than males (P < 0.01). Among males, the geriatric age group (<60 years) was relatively more susceptible (28%). Prepubertal age group was least afflicted (3.3%). Univariate analysis revealed multiparity, high fat, refined sugar, and low fiber intakes to be significantly associated with gallstones. Sedentary habits, recent stress, and hypertension were also among the significant lifestyle-related factors. High body mass index and waist hip ratios, again representing unhealthy lifestyles, were the significant anthropometric covariates. However, only three of these, viz., physical inactivity, high saturated fats, and high waist hip ratio emerged as significant predictors on stepwise logistic regression analysis (P < 0.05). Conclusion: Gallstone disease is frequent among females and elderly males. Significant predictor variables are abdominal adiposity, inadequate physical activity, and high intake of saturated fats; thus representing high risk lifestyles and yet amenable to primary prevention.

All slums are not equal: Maternal health conditions among two urban slum dwellers.

Background: Pregnant women inhabiting urban slums are a “high risk” group with limited access to health facilities. Hazardous maternal health practices are rampant in slum areas. Barriers to utilization of health services are well documented. Slums in the same city may differ from one another in their health indicators and service utilization rates. The study examines whether hazardous maternal care practices exist in and whether there are differences in the utilization rates of health services in two different slums. Materials and Methods: A cross-sectional study was carried out in two urban slums of Aligarh city (Uttar Pradesh, India). House-to-house survey was conducted and 200 mothers having live births in the study period were interviewed. The outcome measures were utilization of antenatal care, natal care, postnatal care, and early infant feeding practices. Rates of hazardous health practices and reasons for these practices were elicited. Results: Hazardous maternal health practices were common. At least one antenatal visit was accepted by a little more than half the mothers, but delivery was predominantly home based carried out under unsafe conditions. Important barriers to utilization included family tradition, financial constraints, and rude behavior of health personnel in hospitals. Significant differences existed between the two slums. Conclusion: The fact that barriers to utilization at a local level may differ significantly between slums must be recognized, identified, and addressed in the district level planning for health. Empowerment of slum communities as one of the stakeholders can lend them a stronger voice and help improve access to services.

Childhood leprosy: lest we forget:

Leprosy remains an important public health and social issue in South Asia, particularly in India. Its presence in childhood is an immense social burden because of the associated disabilities and widely prevalent misconceptions regarding communicability and treatment potential. The prevalence of leprosy among children suggests a possible gap in the national programmes aimed at leprosy elimination. This article reports a 10-year retrospective study of childhood leprosy in a tertiary care hospital setting (2000–2009) along with an analysis of selected socio-epidemiologic correlates. We stress the importance of early detection and the application of appropriate prophylactic measures in susceptible children.

Knowledge of diarrhea management among rural practitioners

Objective : To determine diarrhea management in rural practitioners.Methods : This study was conducted among the RMP’s of 4 blocks of Aligarh. Pre-coded questionnaire was completed and educational programme followed. 91 % were prescribing ORS in various combinations, but only 9.8% were advising ORS and feeding as standard management of diarrhea. Only 12.8% could name a WHO ORS brand and 50% were giving wrong instructions for preparation. 95% were advising inadequate amounts of ORS. Only 43.5% were advising feeding during diarrhea but 86.6% were advising to continue breastfeeding. On an average every 3rd to 4th patient was administered IVF’s. 52% felt that drugs should be prescribed.Results : 90% and 55.3% of RMPs could identify diarrhea and key signs of dehydration.Conclusion : There is a need for hands on training for the practitioners and education of the masses regarding proper management of diarrhea.

Leprosy: down but not out.

Leprosy is a chronic disabling disease and there are areas of high endemicity in India. Case findings and management strategies suffer a setback when disease manifestations are not picked up in time by health-care providers. This article attempts to estimate the annual incidents of leprosy and to study the confounding factors which may potentially cause delays in diagnosis in an office-based, tertiary health-care setting.

Potentially modifiable micro-environmental and co-morbid factors associated with severe wasting and stunting in children below 3 years of age in Aligarh District.

Undernutrition among children is a major public health problem in developing countries like India. The most commonly cited causative factors are food availability and dietary intake, breastfeeding, prevalence of infectious and parasitic diseases, access to health care, immunization against major childhood diseases, vitamin A supplementation, maternal care during pregnancy, water supply and sanitation, socio-economic status, and health-seeking behavior.(1) Children, especially the infants and toddlers, constitute the most disadvantaged group. The present study attempts to investigate the potentially modifiable distal and proximal factors that cause severe malnutrition in children under three years of age and suggests ways to mould them to their advantage.