ABSTRACT
Background: Moderate Acute Malnutrition (MAM) is defined as Weight for Height between -2SD to -3SD, and/or Mid Upper Arm Circumference (MUAC) 11.5 cm to 12.5 cm. Effect of not treating MAM has a significant impact on Severe Acute Malnutrition (SAM) burden. Management of MAM is possible through supplementary feeding or Community centre counselling.Methods: Present study was a prospective case control study done in 2013-14 in 200 children in adjacent communities. Community in which intervention (dietary counselling) was planned, it was labelled as case group. For dietary counselling 'structured group counselling' method was selected in which at a time parents of six MAM children were involved. Counselling was done by a trained counsellor using all techniques proposed by IYCF. Counselling sessions were scheduled at 0, 1, 3 and 6 months.Results: 60% children of case group moved to improved or well- nourished nutritional status (p-value 0.00001). Amongst improved group, weight for height improvement is statistically significant (p-value 0.001), average weight attained is 2-3 kg in 6 months with average weight gain of 1.5-3 grams/kg/day. MUAC improvement was also found to be statistically significant (p-value 0.003), there was 47% improvement in case group with average MUAC gain is 0.6 cm to 1 cm in 6 months (0.13 cm/month). Also, there is early rise in weight for height then MUAC. Average duration to achieve target weight for height is 4.3 months in case group as compare to 5.3 months in control group.Conclusions: Structured and integrated group counselling using all counselling skills by a trained counsellor should be an integral part of managing MAM in community. Weight for height should be primary indicator in early phase of response as compare to MUAC in measuring impact of counselling.
ABSTRACT
Objectives: Present study was conducted to find out currenttrend of drug prescribing of antihypertensive drugs prescribedeither as monotherapy or in combinations. As well as variationswere seen in prescribing drugs with regards to the age, sex.Materials & Methods: An observational, prospective, crosssectional study involving 120 prescriptions for patients ofessential hypertension was conducted in the outpatientdepartment of Medicine SGT Medical Hospital, Faculty ofMedicine and Health Sciences, Gurugram. The blood pressure(BP) measurement was done at the time of enrolment andother patient information like demographics and the drugdetails were recorded in Performa sheet. Data obtained wereanalyzed and expressed in percentage.Results: 71 males and 49 female of essential hypertensionpatients were included in study. Most of patients were in theage group of 40 -49 years constituting 72.5 % of total 120patients. 52 patients were on mono therapy 64 (53%) ofpatents were put on Dual therapy and few patients 4 (3.33%)were on Triple therapy. Out of 52 patients those were on monotherapy maximum patients were put on angiotensin receptorblocker (38.46%) and 11.54% of patients were takingAngiotensin converting enzyme inhibitor. 64 patients wereprescribed with Dual therapy. Out of these 46.9% of patientswere prescribed with ARB + Diuretics and nearly 2% patientswere on ARB + β blocker combination therapy. Only fourpatients were taking Triple therapy, 50% of patients were onCCB + ARB + Diuretics and 50% were on CCB + ACEI +Diuretics.Conclusions: Hypertension is more prevalent in male patientsthan female patients. ARBs (38.46%) were the most commonsingle drugs used for most of the uncomplicated essentialhypertension followed by CCBs (36.54%) ARB prescription asmonotherapy may be increases because of few or minimal sideeffects caused by them. Most common mode of treatment ofhypertension was Dual therapy or triple therapy combinationtherapy fixed dose combinations (56%). In the FDCs ARB +Diuretics (48%) were most preferred combination for treatmentof hypertension then CCB + β blocker (30%) and only 9% ofpatients were treated on ACEI based FDCs. Only 44% ofpatients were prescribed with drugs mentioned in the nationallist of essential medicine (NLEM). Prescribing drug from NLEMshould be encouraged to reduce the burden of treatment coston the patients. ARB were the most preferred drug for thetreatment of hypertension may be because of low toxicity andfewer side effect, easily available in the market.