Applicability of near-miss tools to address maternal mortality

In India, there is a mandate to increase institutional delivery, which has led to an overwhelming response in health-care delivery. The maternal mortality rate has been an essential yardstick, used by health-care planners to assess the quality of obstetric services. As of late, there has been a shift in focus to maternal near-misses (MNMs) as a more valuable indicator of maternal health than the maternal mortality rate. The aim of this research article was to compare various standardized tools to address MNM, namely, the World Health Organization MNM tool, The Government of India's facility-based MNM review tool, etc.

Evaluation of severe acute maternal morbidity and mortality at a tertiary referral center of Uttarakhand, India

Background: Maternal mortality is an area of concern for the Governments across the globe. India is signatory to millennium declaration and is committed to achieving the target of millennium development goals by reducing MMR to 100. Known obstacles to reducing the MMR in developing countries, include lack of material and human resources, as well as difficulties in accessing services due to financial, geographical, and cultural limitations.Methods: It was a descriptive cross-sectional study conducted at a tertiary care centre in Uttarakhand for a period of one year. WHO’s near-miss approach was implemented for evaluation of severe maternal outcomes and to assess the quality of maternal health care.Results: During the period of this study there were 2243 total antenatal admissions, 1675 deliveries, 1591 live births and 59 near miss cases. Prevalence of SAMM in the present study is 3.52%. Out of every 9-10 women who survived a life-threatening condition 1 died. Mortality Index is 10.17%. Maternal mortality ratio is 377.12 per 1 lakh live births. A total of 43 patients with potentially life-threatening conditions were admitted in ICU out of which 26 were near miss cases. The leading cause of near miss in this tertiary health facility is obstetric haemorrhage (45.8%).Conclusions: Prompt identification of complications and timed intervention remains the key determinant in making mothers survive a life-threatening complication.

Screening for Hypertension and Morbidity Profile of Patients - A Primary Care "High Risk Approach".

Background: The world is ageing fast. Increased longevity is not only a triumph for society but a huge challenge for health systems which need to be prepared to address the needs of older people at the community level. Most preventative health care and early disease screening takes place in primary health centres within health systems. These centres play a critical role in the health of older people worldwide at the local level by increasing quality of life. Menace of rising burden of non-communicable diseases can be controlled by developing a model of screening at primary health care level. A study has been planned, to identify one of the major iceberg disease i.e. hypertension which acts as precursor of many other morbidities Methodology: Study was conducted at Rural Health Training Centre, Rajeev Nagar. Sample size included all the patients above 40 years of age attending (for any ailment ) OPD during one year period i.e. 1 January – 31 December 2011. Screening for hypertension was done and morbidity profile along with demographic indicators were also recorded during data entry. Results: Study subjects included females (58.2 %) and males (41.8). About one fourth (22.7 %) of the patient screened were in Pre-Hypertensive category while 12.3 % and 3.6 % were in hypertensive Stage I and II respectively. 38.6 % persons were diagnosed with high blood pressure. Most of the patients with high blood pressure were in age group of 60-69 years, followed by 50-59 years. Higher blood pressure was slightly more among males (39.6 %) as compared to females (37.9%). Locomotor (17.6%), GIT (16.0 %), respiratory (13.5 %) and skin diseases (10.1%) were the principal morbidities. Conclusion: A community based hypertension screening programme targeting older adults above 40 years of age can help in early detection of new cases of 'iceberg diseases' to initiate primary and secondary level prevention. Utilising basic health facility to screen for hypertension suggested here is promising to identify and cater vulnerable population.

Habits and beliefs pertaining to tobacco among undergraduates of medical college in the state of Uttarakhand.

Background: Tobacco surveillance among medical students offers an opportunity to assess the preparedness for tobacco control among future healthcare professionals in India. The purpose of the present study was to evaluate the use of tobacco in the undergraduate medical students and to assess the factors influencing medical students to indulge in tobacco use. Objective: To assess the prevalence of tobacco use among undergraduate students and to assess the attitude and awareness towards participating in tobacco cessation. Material and methods: A cross-sectional questionnaire-based study to assess the prevalence of tobacco use among undergraduate students of Himalayan Institute of Medical Sciences, Dehradun (Uttarakhand State) was conducted from January 2010 to January 2011. A pre-designed structured questionnaire was used to study various correlates of the tobacco use. Data was collected and analysed. Global Health Professional Students Survey (GHPSS), questionnaire given by the Centers for Disease Control (CDC), Atlanta, USA, which is a standard pre-tested questionnaire for assessing prevalence of tobacco use among health care professionals around the world was used. Results: Overall, 386 of 400 eligible students (97%) participated in the survey. The mean age and standard deviation of the study group was 21.47 ± 3.70 years. The rates of smoking among male medical and female medical students were 38.6% and 6.5%, respectively (p < 0.001). A 6-times higher tobacco use was found among male medical students as compared to females. Out of the 386 participants, current tobacco use (last 30 days) was reported by 11.1% of students. About 21.7% of students had never used tobacco. More than 80% favoured a ban on tobacco sales to adolescents, tobacco advertising, and tobacco use in public places. Over 90% reported interest in further training in tobacco control. There was a familial aggregation of the use of tobacco. The factor initiating the use of tobacco was peer pressure in most of the cases. Conclusion: This study reflects an alarming situation and demands urgent measures to be adopted by health professionals, who happen to be health promoters and health role models for the society.