Accessibility and Utilization of Emergency Obstetric Care in Rural Settings of Wardha District- Beneficiaries Perspective

In India, Emergency Obstetric Care services were started under RCH-II with the goal to reduce MMR to less than 100/lakh live births, and increase institutional deliveries to 80% by 2010. Strategy was to enhance availability and access to EmOC, for averting unpredictable death during pregnancy and childbirth. We wanted to determine the perception of beneficiary women about accessibility and utilization pattern of EmOC at peripheral health care facilities. METHODSThe present qualitative study was conducted in one of the eight blocks of Wardha (Maharashtra) from May to October-2017. Data was collected by in-depth interview of service users (21 beneficiaries). Notes were transcribed and then translated into English. Respondents’ verbatim that are significant and illustrative as per theme of study were used for analysis.RESULTSFacilitators for EmOC were found to be birth preparedness, promotion of institutional delivery, registration for JSY/JSSK through health workers along with provision of some EmOC services. Socio-cultural beliefs, leading to delay in recognition of danger signals to access care, transportation delay due to poor access of ambulance and identified vehicles along with insufficient coverage of JSSK program, were the main barriers. Beneficiaries who required EmOC were dissatisfied due to frequent referral & travelling, expenditure on transport & food, loss of daily wages, managing dependent family members and domestic work.

A rare case of blood stream infection due to Candida ciferii in an immuno-compromised patient

Invasive infections related to yeast are increasingly observed in immune-compromised patients in hospitals.Fungal infections have increased morbidity and mortality and prolonged hospital stay which can lead to rise in medical care costs. Non-albicans Candida species have been increasingly found as causative agents in human infections with important therapeutic implications. We present a case of a 37-year-old, female patient, known case of B cell Acute Lymphoblastic Leukaemia admitted in a tertiary care hospital in central India for supportive care and chemotherapy. Patient was responding well to chemotherapy. On post induction day 20, she complained of high-grade fever with abdominal pain.Two sets of blood culture were sent to Microbiology Diagnostic Laboratory for diagnosis. She was started on Injection Magnex Forte (Cefoperazone-Sulbactum) empirically.The Gram stain of positive blood culture showed Gram positive budding yeast like cells in all four bottles.The organism was identified as C. ciferrii on Vitek 2 with 95% identification.Antibiotic susceptibility testing showed sensitive to Amphotericin B MIC ?0.25 and voriconazole MIC ?0.12. It was resistant to fluconazole MIC ?64 ?g/ml.

A study of clinico-microbiological profile of surgical site infections in a tertiary care hospital

Background: Surgical Site Infection (SSI) is the 3rd most commonly reported infection accounting for 14-16% of all Health care associated infections among hospitalized patients. Surgical Site Infections are responsible for an increased economic burden to healthcare systems, including additional postoperative hospital stay and costs. The present study was conducted in a tertiary care hospital to study the incidence, risk factors and associated pathogens of Surgical Site Infection.Methods: A total of 100 patients operated of clean and clean-contaminated surgeries from Orthopaedics, Surgery and Obstetrics and Gynaecology Department of AVBRH, Sawangi were included.Results: Overall infection rate was 6%. Patients in the age of above 71 years showed maximum rate of infection (14.28%) followed by 61 to 70 years (10%) and 51-60 years (10%). Surgical site infection rate was 4.65% (2/43) in clean operative wounds and 7.02% (4/57) in clean contaminated operative wounds. Escherichia coli and Klebsiella pneumonia were the most common organisms causing SSI. None of the risk factor was found significantly associated with the development of SSI.Conclusions: This study gave a better understanding of microbial pathogens of our institute which may have epidemiological and therapeutic implications. It will act as a pilot study to conduct further such larger research.

An investigation of Dengue outbreak: Impressions from a rural community.

Dengue is an acute mosquito-borne viral infection that places a significant socioeconomic and disease burden on many tropical and subtropical regions of the world.[1] Globally, 2.5 billion people live in areas where dengue viruses can be transmitted and the incidence of dengue has increased dramatically in recent decades. In India, a total of 22,092 cases and 74 deaths were reported till August 2013.In September 2013, we investigated an outbreak of Dengue fever in a village Aanji, of Wardha district (Maharashtra).

Assessment of Sociodemographic Factors Affecting Immunization Status of Children in Age Group of 12-23 Months in a Rural Area.

Background: Immunization is a powerful and cost effective weapon against vaccine preventable diseases. In India ‘Expanded Programme of Immunization, (EPI) was launched in 1978. But today also immunization coverage in India is comparatively low and far from satisfaction. Objectives: 1. To assess immunization status of children in age group between 12-24 months. 2. To study the sociodemographic factors affecting immunization status. Method : 30*7 cluster sampling method was used to assess sociodemographic factors affecting immunization status of children in age group of 12-23 months in rural area of Beed district (Maharashtra) in India. Results : Out of total 210 children surveyed, 165 (78.57%) were fully immunized, 43(20.48%) were partially immunized and 2(0.95%) were unimmunized. Immunization status of child was found not to be associated with the gender and type of family of child. It was significantly associated with religion, place of birth and availability of immunization card. Immunization status of children went on significantly improving as their mother’s education level increased (p<0.05), but fathers education had no influence. Immunization status of children was found directly related to their socioeconomic class and inversely to birth order. The highest (86.25%) coverage for complete immunization was among the children having birth order II. Immunization status went on decreasing as birth order increased and was the lowest (50.00%) among those having birth order V. Conclusion : To improve immunization coverage in rural area improvement in female literacy and female education is necessary. Similarly improvement in socioeconomic status, limiting the family size and increasing hospital deliveries will lead to improvement in immunization coverage. Also parents should be encouraged to preserve immunization cards of their children as long as possible.

"Human immunodeficiency virus serostatus disclosure-Rate, reactions, and discrimination": A cross-sectional study at a rural tertiary care hospital.

Background: From the moment scientists identified Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), social responses of fear, denial, stigma, and discrimination have accompanied the epidemic. Aims: To assess the rate of disclosure of HIV serostatus, reactions by the HIV/AIDS patients and their spouse, and discrimination faced by the patients. Methods: The present cross-sectional study was conducted at Antiretroviral Therapy (ART) center of a rural tertiary care hospital, situated in Marathawada region of Maharashtra state from November 2008 to October 2010. Totally, 801 HIV-positive patients coming to ART center for treatment were included after ensuring confidentiality and taking informed consent. A preformed questionnaire was used to enquire about reaction after diagnosis, disclosure, and discrimination faced by the patients. The data analyzed using descriptive statistics and Chi-square test. Results: The most common immediate reaction by the HIV patients after getting diagnosed as seropositive was fear (593, 74.03%) followed by depression (385, 48.06%) and suicidal thoughts (98, 12.25%). Out of 801 patients, 769 (96%) had spouse and of these maximum number of patients (653, 84.92%) had disclosed HIV status to their spouses. Most common immediate reaction by spouse after disclosure was crime (324, 42.13%) followed by horror (294, 38.23%) and anger (237, 36.29%). Maximum number of patients were discriminated by friends (120, 71.01%) followed by discrimination at workplace (49, 67.12%), by neighbors (32, 56.14%), and by relatives (53, 43.80%). Conclusion: Male positives were granted greater acceptance, care, and support by their spouses. More percentage of females discriminated by neighbors, relatives, and friends and at workplace which might be due to factors like customs, morals, and taboos.