Door-to-door health camps versus traditional health camps in rural areas of Himachal Pradesh – A comparative analysis

Background: Health camps are effective medical intervention, especially in inaccessible terrains. However, because of age, health, and COVID-19 fear, many patients avoid visiting these camps because of crowding. Door-to-door health camps could be a solution to this. National Medical Commission has also introduced early clinical exposure and family adoption for medical undergraduate students. Aim and Objectives: The authors had planned to conduct this research to study the advantage of door-to-door health camps involving medical undergraduate students as camp team members as compared to traditional health camps regarding patient satisfaction and student satisfaction. Material and Methods: This study was done in rural hilly areas of Himachal Pradesh. There were 8 traditional health camps and 8 door-to-door health camps also involving medical undergraduate students organized between August 2022 and November 2022. These camps were analyzed for patients’ satisfaction and students’ satisfaction. Results: Patient satisfaction was much higher in door-to-door camps as compared to traditional health camps. More patients attending door-to-door camps visited our hospital for follow-up. Students were also satisfied participating in door-to-door camps. It also improved their interest in studying medicine. Conclusion: Door-to-door health camps are more beneficial for patients, especially in hilly inaccessible terrain. Involving students in these camps improves their interest in studying medicine and can be beneficial.

Huge placental myxoid chorangioma presenting with severe antepartum hemorrhage.

A 2nd gravida presented at 27 weeks with antepartum hemorrhage. Ultrasound showed a single live fetus (parameters approximately 23 weeks) and a huge placenta with multiple cystic areas extending into the lower uterine segment; some of which showed increased vascularity on colored doppler. A diagnosis of low lying placenta with a possibility of chorangioma or a partial mole was made. The next bout of antepartum hemorrhage was severe necessitating an emergency cesarean. Histopathology of the placenta (weighing 2240 grams) revealed a myxoid chorangioma. All features in this woman are uncommonly reported in literature (large size, myxoid degeneration and severe antepartum hemorrhage necessitating a cesarean).

Epidemiological study of congenital heart disease.

A community based survey of congenital heart disease was carried out on a random sample of 11,833 children below 15 years in Delhi, India. Congenital heart disease was diagnosed on clinical history and/or clinical examination. Out of the examined sample, 50 were found suffering from congenital heart disease, giving an overall prevalence of 4.2/1000 (4.6/1000 in boys and 3.7/1000 in girls). The prevalence rate was slightly higher than other studies carried out in the country. The reason is obvious. The present study is community based while other studies were hospital or school based. The type of lesions were similar to those reported from other studies. The lesions in order of frequency were ventricular septal defect (46%), atrial septal defect (18%), patent ductus arteriosus (14%), Fallot's tetrology (10%), aortic stenosis (4%), and pulmonary stenosis (4%). Like other studies ventricular septal defect was the commonest lesion. The prevalence rate was higher in the age group 0-4 years and 5-9 years in boys whereas it was higher in adolescent age group (10-14 years) in girls.

Age- and height-specific reference limits of blood pressure of Indian children.

BACKGROUND: Blood pressure in childhood is the most powerful predictor of hypertension in adults. Norms for blood pressure in children are based on the age- and height-specific distribution of blood pressure in a reference sample of healthy children. METHODS: We performed a cross-sectional survey of school-children in the age group 5 to 14 years in south Delhi and studied the distribution of systolic and diastolic blood pressure in 8293 children (4623 boys and 3670 girls). Blood pressure was measured in all children with a mercury column sphygmomanometer using a standardized technique. The first and the fourth Korotkoff sounds were taken as indicative of the systolic and the diastolic blood pressure, respectively. Height percentiles were computed for the study sample for every one-year sex-pooled group. Multiple linear regression was then performed for every one-year group in order to estimate the 90th and 95th percentiles of systolic and diastolic blood pressure according to percentiles of height. RESULTS: Age and height, but not gender, emerged as the principal determinants of systolic and diastolic blood pressure in multivariable linear regression analyses. Age- and height-specific 90th and 95th percentile values of systolic and diastolic blood pressure were estimated, which enabled us to categorize children into 'normal', 'high normal' and 'high' blood pressure groups. CONCLUSIONS: We present age- and height-specific reference values for blood pressure of Indian children based on a large study sample. The use of these standards should aid the identification of children with high blood pressure.

An epidemiological study of blood pressure in school children (5-14 years) in Delhi.

Distribution patterns of blood pressure were studied in a randomised sample of 10,215 school children (5,709 boys 4,506 girls) in the age group 5-14 years in Delhi. The mean values of systolic and diastolic blood pressure (SBP and DBP) increased with age in both sexes. The cut-off points for high blood pressure were based on average SBP and/or DBP values of 95th percentile or greater for each age. The values for SBP ranged from 70 mm Hg to 140 mm Hg and for DBP from 36 mm Hg to 100 mm Hg for the age group 5-9 years. In the age group 10-14 years, the values for SBP and DBP ranged from 72 mm Hg to 160 mm Hg and from 46 mm Hg to 120 mm Hg, respectively. The prevalence of hypertension (systolic, diastolic or both) was 11.9 percent in boys and 11.4 percent in girls, an insignificant difference. Anthropometric variables like height, weight and body mass index showed positive correlation with systolic as well as diastolic blood pressure but the waist-hip ratio showed negative correlation coefficient with blood pressure. Family history of hypertension in one or both the parents was present in 20.4 percent children with high blood pressure compared to 6.8 percent in normotensives. Family history or diabetes was also significantly higher in hypertensive children (5.4%) than in normotensives (3.1%).

Auditory brainstem responses in high risk and normal newborns.

We studied the auditory brainstem responses of 50 high risk neonates from NICU and compared with those of 25 normal neonates in order to determine the percentage of significant auditory impairment in NICU and correlated it to various risk factors. Infants with the risk factors of low birth weight, hyperbilirubinemia, asphyxia, septicemia and meningitis were included in the study group. All the 150 ears were tested at 4 intensities 30 dB, 46 dB, 60 dB and 75 dB. The study recorded prolongation of latency of wave V and I-V Interwave interval in the study group with a statistically significant difference denoting an impaired condition. Incidence of significant auditory impairment was 18%. On follow up at 6 months incidence of persistent auditory abnormality was 4%. On the basis of this study it is suggested that all high risk neonates should undergo screening for hearing impairment.

Problems of population based epidemiological surveys.

The author had the opportunity to plan and carry out a community based epidemiological survey of Delhi urban population and rural areas of Gurgaon (Haryana) for estimation of prevalence rates and risk factors for the coronary heart disease and hypertension. Based on the experience of conducting this largest population based epidemiological study in India for coronary heart disease and hypertension, problems in conducting these studies were identified. These are discussed in this paper so that other workers may benefit from this experience.

Dietary profile of adults in an urban & a rural community.

A community based dietary survey was carried out in 906 adults (25-64 yr) from 489 families in Delhi urban population and 275 adults from 196 families in rural population of Gurgaon district (Haryana state). A combination of 24 h recall and weightment method was used to assess the individual dietary intake. Daily average intake of various nutrients was calculated. A higher intake of cereals, milk and milk products and sugar and jaggery and a lower intake of pulses, vegetables, fruits, flesh foods and oils and fats were observed in the rural population. The average total calorie intake was 1,749 kcal in the urban and 1,910 in the rural population. The average intake of carbohydrates and proteins was 257.3 g (59.0 en %) and 54.7 g (12.5 en %) in the urban population compared to 295.6 g (61.9 en %) and 63.0 g (13.2 en %) respectively in the rural group. The fat intake was the lowest in the urban low socio-economic group (45.5 g). The contribution of total fat to energy intake ranged from 24.6 en to 31.2 en per cent in different population groups. The rural group showed higher intake of calcium and iron than the urban population. Intake of retinol was higher in the high socio-economic group (urban) than other population groups. Urban/rural differences were observed in intake of retinol, thiamine, niacin, vitamin C and vitamin E. Daily dietary cholesterol intake was the highest in the urban high socio-economic group (119 mg). The fibre intake was higher in the urban than the rural population (8.0 g vs 7.4 g).

A 5-year follow-up study of hypertension in a rural community.

A follow-up study of hypertension was carried out among adults, in the age group between 25 to 64 years, in a rural population of Gurgaon district, Haryana, five years after an initial community based epidemiological survey of the same population. The progress of 77 out of 98 hypertensives detected at the initial survey could be reassessed. The treatment and severity of hypertension found at the initial survey has been compared with that observed on follow-up. The percentage of cases with blood pressure (BP) controlled on treatment increased from 2.6 percent to 45.4 percent on follow-up. An electrocardiogram could be obtained in 66 out of 77 subjects reexamined and was abnormal in 21 cases (31.8%). The electrocardiographic abnormalities found were: myocardial infarction in one, left ventricular hypertrophy in 5, left ventricular hypertrophy with ischaemic ST-T changes in 6, isolated ST-T abnormalities in 5 and conduction defects or arrhythmias in 4 cases. In a cohort of 1,334 subjects who were normotensive at the initial survey, 19 new cases were detected to have hypertension. The overall annual incidence of hypertension was 2.8/1000 (male: 3.8/1000 and female: 2.4/1000). In these hypertensives, a family history of hypertension was present in 10.5 percent and obesity in 42.1 percent.

Thymolipoma--a rare mediastinal tumour--report of two cases and review of literature.

Thymolipoma is a rare mediastinal tumour. We report two cases of thymolipoma. Our first case, a woman of 60 years, presented with an extremely rare association of myasthenia gravis with thymolipoma. Second case presented with dyspnoea productive cough in a male of 62 years. The relevant literature is briefly reviewed.

An epidemiological study of coronary heart disease in different ethnic groups in Delhi urban population.

A community based epidemiologival survey of coronary heart disease (CHD) was carried out on a random urban sample of 13,560 adults of different ethnic groups in Delhi. CHD was diagnosed either on the basis of clinical history, supported by documentary evidence of treatment in hospital/home or on the ECG evidence in accordance with Minnesota Code. The prevalence rate of CHD on clinical basis per 1000 adults was the highest in Sikhs (47.3), lowest in Muslims (22.8) and identical in Hindus (31.8) and Christians (31.2). The prevalence rate/1000 of silent CHD on the basis of ECG was high in Muslims (89.5) and Sikhs (87.3), low in Christians (25.0) and intermediate in Hindus (60.0). The Sikhs showed the highest prevalence rate of myocardial infarct (MI) (15.5) and angina (AP) (31.8) compared to other communities. The prevalence rate of CHD on clinical basis was higher in males than females in all communities. The prevalence of silent CHD was higher in females in Hindus and Sikhs but in Muslims it was higher in men (94.8) than in women (85.2). The wide variations in prevalence rates of CHD in different ethnic groups cannot be explained satisfactorily on the basis of conventional risk factors and support the multifactorial etiological character of CHD.

What is 'desirable' lipid profile.

The lipid profile of subjects with and without coronary heart disease (CHD) was studied in two epidemiological studies conducted in an urban and rural population. The prevalence of CHD was 96.7/1000 in the urban area and 27.1/1000 in the rural area. The lipid levels of the rural population, with an entirely different life style, was significantly lower compared to the urban normal population. The data suggest that if the prevalence of CHD is to be reduced in the urban population, the desirable levels of lipids should be those obtained in the rural normal population rather than the urban, CHD free, population.

An epidemiological study of obesity in adults in the urban population of Delhi.

The prevalence of obesity and its associations were assessed during a community based epidemiological survey of coronary heart disease on a randomised sample of 13,414 adults in the age group 25-64 years living in urban Delhi. Body Mass Index (BMI) > 25 was considered to be the cut off point for defining obesity. By this criterion, the overall prevalence rate of obesity was 27.8%. Obesity was found to be more common in female subjects (Male--21.3%, Female--33.4%, p < 0.001). Obesity was more frequent in male subjects with lower physical activity compared to those doing heavier physical activity (29.3 vs 17.5%, p < 0.001). Physical activity did not influence the prevalence of obesity in females. Hypertension (24.8 vs 8.2%, p < 0.001) coronary heart disease (5.3 vs 2.4%, p < 0.001) and diabetes mellitus (3.2 vs 1.6%, p < 0.001) were more common in the obese than in the non-obese subjects. Hypercholesterolaemia (65.5 vs 53%, p < 0.001) and hypertriglyceridaemia (73.3 vs 61.1%, p < 0.001) were found to be associated with obesity.

Epidemiological study of hypertension in young (15-24 yr) Delhi urban population.

A community based epidemiological study of hypertension was carried out on a random urban sample of young persons (15-24 yr) of Delhi. Hypertension was defined as systolic blood pressure greater than 140 mmHg and/or a diastolic blood pressure greater than 85 mm Hg or a history of current antihypertensive therapy. Of the 6543 subjects examined, 202 were found to be hypertensive. The overall prevalence rate was 30.9/1000 (male 41.2/1000, female 21.7/1000). Secondary hypertension was present in 4 of the 202 patients. Only 16 patients were aware of the presence of hypertension; of these 6 were on medication. Family history of hypertension was present in 87 subjects (43.1%). Of the 202 hypertensives, 67 were obese and 16 were smokers. The degree of physical activity was identical in the hypertensive and non-hypertensive subjects. Blood samples of 129 of the 202 patients were analysed for lipid levels. High values of total cholesterol were observed in nine.

Epidemiological study of coronary heart disease in Gujaratis in Delhi (India).

A community based survey of coronary heart disease (CHD) was carried out in Gujarati families settled in Delhi. The number of adults surveyed in the age group 25-64 yr was 1317. CHD was diagnosed either on the basis of clinical history supported by documentary evidence of treatment in the hospital or at home or on ECG evidence in accordance with the Minnesota Code. The prevalence rate of CHD on clinical history was 25.1 (28.2 in males and 22.4 in females) per 1000 adults (25-64 yr). The prevalence rates were slightly lower in Gujaratis than the general Delhi urban population. The prevalence rate based on both clinical history and ECG criteria was estimated at 66.8 as compared to 96.8/1000 in general urban Delhi population. The risk factors for CHD such as socio-economic status, family history, obesity, smoking, physical activity and hypertension were studied. The mean and 5th, 50th and 95th percentile values of blood lipids were also estimated in CHD patients and compared with the control group. Hypertension ranked the leading risk factor. Prevalence rate of CHD was higher in the upper socioeconomic group. The positive correlation of higher levels of serum lipids e.g., total cholesterol, low density lipoprotein cholesterol (LDL-C) and triglyceride with CHD was confirmed.

Asymptomatic coronary heart disease detected on epidemiological survey of urban population of Delhi.

A community based epidemiological study of coronary heart disease (CHD) was carried out in a random sample of 13723 adults in the age group of 25-64 years in the urban population of Delhi. The electrocardiogram (ECG) of all clinically detected CHD cases and of a sample of 5621 persons (selected on the basis of alternate household screened) without clinical manifestations of CHD, was obtained. Out of 5621 persons labelled as asymptomatic, CHD evidence of Q wave myocardial infarction (MI) was present in 80 ECGs (1.4%). Another 296 ECGs had ST & T changes vide Minnesota Code 4-1-1, 4-1-2, 5-1 and 5-2 acceptable as evidence of probable CHD. The overall prevalence rate of asymptomatic CHD was 6.7% (male 5.6%, female 7.6%). Silent MI was more common in the male patients (1.7% vs 1.1%, p < 0.001). However, ST-T changes were more common in female patients (6.5% vs 3.9%, p < 0.001). The ST-T changes showed a steady factor in asymptomatic CHD cases was hypertension in both sexes (male-45.2%, female-43.5%) p = NS. Obesity was present in 24% of male & 46.1% of female patients (p < 0.001). Family history was found in 20% cases of both sexes. Smoking was recorded in 34.9% male and 10.9% female patients with asymptomatic CHD (p < 0.001).

Epidemiological study of coronary heart disease in urban population of Delhi.

A community based survey of coronary heart disease (CHD) was carried out on a random urban sample of 13,723 adults in the age group 25-64 yr in Delhi, India. CHD was diagnosed either on the basis of clinical history supported by documentary evidence of treatment in a hospital or at home; or on ECG evidence in accordance with the Minnesota Code. The overall prevalence of CHD based on clinical history, was 31.9 (39.5 in males and 25.3 in females) per 1000 adults in this age group. The number of patients with CHD increased with advancing age in both sexes. The total prevalence rate based on both clinical history and ECG criteria (asymptomatic patients with ECG changes of definite myocardial infarction and ST-T changes suggestive of CHD) was estimated as 96.7/1000 adults in this age group. Analysis of information on socio-economic status, family history of CHD, obesity, hypertension and smoking obtained from this sample of 13,723 adults suggested that hypertension had the strongest association with CHD. Obesity, diabetes and family history were also found to be associated with CHD. It should, however, be noted that risk factor assessments in CHD can be done satisfactorily only through incidence studies.

Prevalence, awareness & treatment status of hypertension in urban population of Delhi.

A community based survey for the prevalence of hypertension was carried out on a random urban sample of 13,723 adults in the age group 25-64 yr from the Union Territory of Delhi (India). Hypertension was defined as systolic pressure greater than 160 mm Hg and/or a diastolic pressure greater than 90 mm Hg or a history of current antihypertensive medication. The overall prevalence rate/1000 adults was 127.5 (116.6 in males and 136.8 in females). Mild hypertension (diastolic pressure between 91-104 mm Hg) predominated in the whole group, the proportion decreasing with increasing age in both sexes. Fifty per cent of the hypertensives were aware of their problem, the awareness being slightly higher in females (51.8% versus 46.5%). Approximately 30 per cent of the hypertensives were on medication for high blood pressure. The status control of blood pressure was low in the population, being only 9 per cent, with little difference between the two sexes. The study emphasises the enormity of the problem of hypertension in an urban population in India and poor control of blood pressure achieved in the community.

Intensification of measles vaccination coverage.

Better coverage of susceptibles with measles vaccine has clear demonstratable impact on disease incidence. Education and strong motivation of implementors and community at large and improvement in other managerial and administrative support actions for the programme are considered essential to boost up measles immunisation coverage. It is therefore, expected that with well planned and sustained implementation of country wide campaign of measles immunisation, the disease can be brought under control. This needs strong will, determination and urgency for well planned and sustained actions if we have to achieve desired goal--"IMMUNISATION FOR ALL BY 1990". The efforts required for achieving the targets are discussed in this paper.

Malignant mesothelioma in the young (with prosthetic aortic valve an unusual association).

A case of malignant mesothelioma (MM) in a 15 year old boy is reported. He had a prosthetic aortic valve implanted in 1980 at our centre for rheumatic aortic regurgitation. Fever, weight loss and chest pain as initial symptoms suggested possibility of prosthetic valve endocarditis. Dysphagia as another initial symptom was interesting and caused further diagnostic dilemma. Role of Computerised Tomography (CT) scan in diagnosis of MM is highlighted.