ABSTRACT
Background: Even after three decades of implementation of the Universal Immunization Programme in India, cases of diphtheria continue to occur. It is pertinent to study the social and epidemiological determinants of diphtheria. Aims & Objective: The present study was undertaken to investigate epidemiological and social determinants of Diphtheria outbreak in a district in Central India and to understand response of health care system to this outbreak. Materials and Methods: Explanatory case study method, a qualitative method was employed involving interviews with stakeholders including family members of the affected children, specialists from tertiary care teaching hospital who treated these cases, health workers, public health functionaries at primary care and district level. Results: Both cases belonged to migratory community and non-immunization was identified as the chief proximal reason. Both, knowledge and utilisation of immunisation was poor in these communities and was limited to pulse polio immunization. Epidemiologically, the two cases were possibly linked. Vaccination drive to immunize all unimmunized children was conducted in the district where the cases were identified but not in the district where possibly the cases have originated. Conclusion: Social determinants including poverty, migration, poor access to health care all contributed in creating epidemiological situation where transmission of disease agent was easy, resulting in an outbreak. Migration creates vulnerability and our health systems should gear up themselves to address this vulnerability; appropriate strategies and micro-planning should be in place to cater to the needs of this underprivileged community. Strong surveillance system with adequate public health response addressing outbreaks is necessary.
ABSTRACT
Background: Laparoscopic Subtotal Cholecystectomy has successfully brought down the conversion rate to a very low in difficult patients where the only option was conversion to open. Aims & Objective: To determine a new classification of Laparoscopic Subtotal cholecystectomy and their various types/variants like Type-I, Type-II and Type III and determine the use of port positions in LSC. Materials and Methods: The patients were recruited from specialized hospitalized which is recognized training centre for Laparoscopic Surgery. The 661 subjects were enrolled in the study. Both males and females were included in the study. All 14485 patients were subjected to Laparoscopic Cholecystectomy during the past 2 years and 5 months from February 2009 to June 2012. All surgical procedures were performed at a single tertiary level hospital. Among them, 661 patients (4.46%) with various types of cholecystitis were treated by Laparoscopic Subtotal Cholecystectomy and were included in the study. Results: The 48 patients belonging to Laparoscopic subtotal cholecystectomy-Type-I, only 4 ports were used in all 48 (100%) patients. No extra port was required. 591 patients belonging to laparoscopic subtotal cholecystectomy-type-II, 4 ports were used in 546 (92.39%) patients, 5 ports in 42 (7.10%) patients and 3 ports in 3 (0.50%) patients. Of 22 patients belonging to laparoscopic subtotal cholecystectomy-Type-III, only 4 ports were used in all 22 (100%) patients. No extra port was required. In all, in 616 (93.19%) procedures, 4 ports were used. In 42 (6.35%) procedures 5 ports were used (all Laparoscopic Subtotal cholecystectomy -Type-II), and in 3 (0.45%) procedures only 3 ports were used (all Laparoscopic Subtotal cholecystectomy -Type-II). Conclusion: In this study. Laparoscopic subtotal cholecystectomy has been further classified into Type-I, Type–II, Type–III. Laparoscopic subtotal cholecystectomy Type-I is used for difficult gall bladder bed. Laparoscopic subtotal cholecystectomy Type-II in difficult hilum, and laparoscopic subtotal cholecystectomy Type-III for difficult hilum with difficult gall bladder bed. In this study, laparoscopic subtotal cholecystectomy Type-III has been newly classified and this has helped us to bring down the conversion rate and other complications like bleeding and injury to biliary tree.
ABSTRACT
Introduction : Services are being provided by health functionaries to the community with the objective of fulfilling their satisfaction but sometimes this do not working for the target population. Objective : To assess the satisfaction of patients receiving some MCH services in rural areas of Wardha district. Material and Methods : It was a longitudinal study from June 2007 to September 2009, comprising of 205 participants (i.e. registered pregnant women of < 16 weeks of gestation), they were given 8 visits by investigator. Outcome variables of the study were socio - demographic profile, selective obstetrical history and some maternal and child health services. Data was collected based on preformed questionnaires, a modification of PHC MAP module guidelines for assessing the quality of service-module 6-user’s guide. The response (quality) of each service during entire visit was quantified as acceptable (ACQ), average and worst (WQ). Results : Patient satisfaction or ACQ of ANC services was 51.49% and PNC services was only 22.64 %, only 18.53% participants received counselling for hospital delivery in all the five visits. WQ observed for history of consanguineous marriage 50.24%, height measurement 47.31% and breast examination 91.21% during ANC. Among all the services of PNC, counselling for immunization of baby was highest but 40.97%. It was observed WQ for weight recording 42.43% and counselling for birth registration 76.09 % during PNC. Conclusion : An overview of patient satisfaction receiving some MCH services were shown in this study and needs to be strengthened from care providers side.