ABSTRACT
Background: Rabies is a preventable neglected public health problem and associated with multiple cultural, religious, and social practices, myths in our country. There is a lack of organized surveillance system to measure the incidence of animal bite and human rabies as well as to evaluate cost‑saving of different routes, regimen, and types of antirabies vaccines (ARV)/immunoglobulin available in India. Objectives: The objective of this study is to know dropout rate in intradermal (i.d.) ARV regimen among animal bite and to analyze the utilized volume of ARV by a different route of vaccine administration. Methods: A total of 250 animal bite victims were followed up at ARV Clinic (ARVC). Volume utilization of i.d. route over intramuscular (i.m.) route was analyzed among the patients who attended ARVC during the past 2 years. Total dropout and delayed compliance rates of ARV regimen among different group were compared by Chi‑square test. Results: The i.d. route was about five times more volume and cost‑saving than i.m. route. The majority of victims belonged to 15–30 years (27.60%) and children <15 years (26.40%) and had wound at their lower limbs (85%) mainly bitten by dogs (98%). Thirty‑four percent total dropout and 31.5% delayed compliance observed particularly during the last dose of i.d. regimen. There was no significant difference in dropout rates among different demographic groups. Half of the victims practiced wound toilet on the same day of bite. Only 68% received the first dose of ARV within 24 h of the exposure. Conclusion: Children and young adults are at higher risk of having dog bite. I.d. ARV regimen is more volume and cost‑saving than i.m. one and proper counseling and follow‑up should be arranged to complete the vaccination schedule.
ABSTRACT
Background: Provision of good quality care is the crux of the RCH Programme. Good quality of care ensures satisfied clients, who in turn come back for services and become advocates for others. Quality has not been given adequate attention in Government Health Care facilities, because of which there is underutilization of RCH services. Aims & Objective: The present study is an attempt to assess the perception of clients (women who delivered in last one year) regarding various aspects of maternal and child health care delivery components. Material and Methods: It was a community based cross sectional study carried out in ten primary health centre areas. Study subjects were the women delivered in last one year. Sample size was calculated considering the proportion of pregnant women who received at least three antenatal check-ups in district level household survey – 3. One hundred fifty such women were interviewed using pretested proforma from subcenter of each randomly selected PHC area. Data were entered and analyzed in epi info software version 3.3.2. Results: Majority of the women (80%) opined that the behaviour of health care providers was good while 21% of women felt that the communication skills of attending doctor / FHW were not good. Only two third of the women were satisfied with the quality of services provided to them at health facility. RCH indicators were better among the women who were satisfied with the behaviour and communication skills of the health care providers. Conclusion: Present study revealed that women’s perception about various indicators of quality of care, behaviour and communication skills of the health care providers affect the overall satisfaction of the women and in turn it significantly affects utilization of RCH services.
ABSTRACT
Background: Integrated Child Development Services (ICDS) is one of the world’s largest community based schemes running in India for over three decades. Frequent evaluations of the scheme have been conducted to make it more effective to promote early childhood care. Objectives: Comprehensive assessment of services provided under ICDS in urban slums of Jamnagar city of Gujarat state. Methods: It was decided to study 15% of the total 297 AWCs of the city through Simple Random Sampling technique. The AWCs visited were evaluated with respect to infrastructure facility of the centre, record keeping activity & knowledge of AWWs, availability of essential drugs & logistics. Results: A total of 48 centers were evaluated. 24 centers operated from Kutcha or semi-pucca buildings and toilet facilities were lacking at 20 of the centers. Only about 44% of the enrolled 3-6 years children were present at the AWC on the day of visit. Nearly 40% of the enrolled children had varying grades of malnutrition. Unavailability of medicine kits & other logistics, was observed. Three fourth of the AWW described providing non-formal preschool education & supplementary nutrition as their only responsibilities forgetting other essential components of their service. One fourth of the AWW did not know proper time to initiate Breast Feeding and over one third (37.5%) of them did not know the Universal Immunisation Program schedule fully. Less honorarium & poor quality of supplementary food were their main difficulties. Conclusion: the AWC currently acts merely as a food distribution centre with minimal provision of other services. Regular growth monitoring of the children along with supervision of the services provided would be far more effective in improving the nutritional status of the children than supplementary nutrition alone.