Awareness and willingness to pledge for eye donation among adult population of an urban re-settlement colony of Delhi

Blindness is one of the major public health problems in India. Visual rehabilitation by corneal transplantation remains a major treatment option in those who are already blind due to corneal diseases. To combat with shortage of corneal donation in India, spreading awareness among masses regarding eye donation becomes important. Objectives: (1) To determine the awareness regarding eye donation amongst adults (>20 years) in an urban re-settlement colony of Delhi. (2) To assess their willingness to pledge for eye donation. (3) To determine the factors influencing their decision for eye donation. Material and Methods: This was a cross sectional study, conducted in the urban health centre attached to a medical college of Delhi between October to December 2013. Systematic random sampling was used and every alternate adult patient >20 yrs attending the UHC was recruited. Data entry and analysis was done using SPSS by a single investigator. Results: Majority (84.4%) had heard of eye donation. Only 21.2% were aware about contraindications for donating eyes. A little over quarter (27.6%) had heard of eye bank facility. When asked whether the retrieved eye can be stored before transplantation, majority (59.2%) didn’t know. More than half (54%) didn’t know which part of eye is removed. Mass media was major source of information in three forth respondents (74.9%). 45.5% were willing to pledge their eyes, a similar proportion was not willing (44.1%), five (2.4%) had already pledged and 17 (8.1%) were yet undecided to pledge. Conclusion: While majority of participants had heard of eye donation, but their knowledge regarding certain aspects of eye donation was found to be poor.

Universal health coverage in relation to antenatal care services and its correlates

Universal health coverage (UHC) means all people receiving the health services they need, of sufficient quality to be effective while at the same time ensuring that the use of these services does not expose the user to financial hardship. So, we did this study to assess the extent of UHC in relation to antenatal care services in Palam area of Delhi. Objectives: 1) To study the extent of coverage of antenatal services in Palam area of Delhi. 2) To assess the correlates of coverage of antenatal services among mothers. Material and methods: study type- a community based descriptive study was conducted between September 2015 to March 2017, among 250 mothers who delivered during the year 2015. A pretested, self-designed, semi-structured interview schedule and health records was used to collect information. Data was analysed using software – statistical package for social sciences (SPSS) version 20. Results: Out of 250 study participants, complete coverage of antenatal care services was seen in only 28.8% women. Literacy and presence of complication in previous pregnancy found to have statistically significant correlation with the extent of coverage of antenatal services. Conclusion: Women need to be educated about their health needs and services available to them, in order to increase the demand of maternal health services and improve utilization of available services.

Childhood Morbidity and Mortality in India – Analysis of National Family Health Survey 4 (NFHS-4) Findings

National Family Health Survey (NFHS)-4 report was recently released for health-related data. This review compares the child healthindicators across NFHS-3 and NFHS-4 with a background of existing health programs catering to child health. Reports of NFHS-4 andNFHS-3, along with ministry reports and existing literature were reviewed to understand the current status of child health. Child healthindicators were compared between the two rounds of NFHS and among Empowered Action Group states of India. National Health Policy2017 and National Health Programs related to child health were also analyzed. There has been an improvement in almost all child healthindicators from NFHS-3 to NFHS-4. The infant mortality rate has reduced to 41 per 1000 live births. The immunization rate is 62%, andhas almost doubled in the states of Uttar Pradesh, Rajasthan and Madhya Pradesh. Despite existence of many health programs, there isstill a substantial lack of achievement in most of the indicators.a

Level of suboptimal adherence to first line antiretroviral treatment & its determinants among HIV positive people in India.

Background & objectives: National Anti-retroviral treatment (ART) programme in India was launched in 2004. Since then, there has been no published country representative estimate of suboptimal adherence among people living with HIV (PLHIV) on first line ART in public settings. Hence a multicentric study was undertaken in 15 States of India to assess the level of suboptimal adherence and its determinants among PLHIV. Methods: Using a prospective observational study design, 3285 PLHIV were enrolled and followed up to six months across 30 ART centres in India. Adherence was assessed using pill count and self-reported recall method and determinants of suboptimal adherence were explored based on the responses to various issues as perceived by them. Results: sSuboptimal adherence was found in 24.5 per cent PLHIV. Determinants of suboptimal adherence were illiteracy (OR-1.341, CI-1.080-1.665) , on ART for less than 6 months (OR-1.540, CI- 1.280-1.853), male gender (OR for females -0.807, CI- 0.662-0.982), tribals (OR-2.246, CI-1.134-4.447), on efavirenz (EFA) regimen (OR- 1.479, CI - 1.190 - 1.837), presence of anxiety (OR- 1.375, CI - 1.117 - 1.692), non-disclosure of HIV status to family (OR- 1.549, CI - 1.176 - 2.039), not motivated for treatment (OR- 1.389, CI - 1.093 - 1.756), neglect from friends (OR-1.368, CI-1.069-1.751), frequent change of residence (OR- 3.373, CI - 2.659 - 4.278), travel expenses (OR- 1.364, CI - 1.138-1.649), not meeting the PLHIV volunteer/community care coordinator at the ART center (OR-1.639, CI-1.330-2.019). Interpretation & conclusions: To enhance identification of PLHIV vulnerable to suboptimal adherence, the existing checklist to identify the barriers to adherence in the National ART Guidelines needs to be updated based on the study findings. Quality of comprehensive adherence support services needs to be improved coupled with vigilant monitoring of adherence measurement.

Two-year treatment outcomes of patients enrolled in India’s national first-line antiretroviral therapy programme.

Background. We aimed to analyse treatment outcomes of patients receiving first-line antiretroviral therapy (ART) through the national AIDS control programme of India. Methods. Using routinely collected programme data, we analysed mortality, CD4 evolution and adherence outcomes over a 2-year period in 972 patients who received first-line ART between 1 October 2004 and 31 January 2005 at 3 government ART centres. Cox regression analysis was used to identify independent predictors of mortality. Results. Of the 972 patients (median age 35 years, 66% men), 71% received the stavudine/lamivudine/nevirapine regimen. The median CD4 count of enrolled patients was 119 cells/cmm (interquartile range [IQR] 50–200 cells/ cmm) at treatment initiation; 44% had baseline CD4 count <100 cells/cmm. Of the 927 patients for whom treatment outcomes were available, 71% were alive after 2 years of treatment. The median increase in CD4 count was 142 cells/ cmm (IQR 57–750 cells/cmm; n=616) at 6 months and 184 cells/cmm (IQR 102–299 cells/cmm; n=582) at 12 months after treatment. Over 2 years, 124 patients (13%) died; the majority of deaths (68%) occurred within the first 6 months of treatment. Those with baseline CD4 count <50 cells/cmm were significantly more likely to die (adjusted hazard ratio 2.5, 95% confidence interval 1.3–3.2) compared with patients who had baseline CD4 count >50 cells/cmm. Over the 2-year period, 323 patients (35%) missed picking up their monthly drugs at least once and 147 patients (16%) were lost to follow up. Conclusion. Survival rates of HIV-infected patients on first-line ART in India were comparable with those from other resource-limited countries. Most deaths occurred early and among patients who had advanced disease. Earlier initiation of HIV treatment and improving long term treatment adherence are key priorities for India’s ART programme.

Status of speciality training in ophthalmology in India.

PURPOSE: To systematically evaluate the quality of ophthalmology training in India. METHODS: Questionnaires were sent to existing medical schools and accredited training institutions. Institutions were followed up thrice to obtain responses. Data were analysed using Stata 8.0. RESULTS: Responses were received from 128 (89.5%) of the 143 institutions. Each year, 900 training slots were available across the country. Faculty: student ratios were better in accredited training institutions than in postgraduate medical schools. Fifty three (41.4%) of 128 institutions subscribed to more than 2 international journals. Fewer than 1 in 6 institutions conducted research projects. 11 (8.6%) institutions reported more than five publications in international peer-reviewed journals over three years. Only a third of the responding institutions had a wet lab. CONCLUSIONS: There is a need to improve the training facilities and optimally utilise the infrastructure available in postgraduate medical schools.

Human resources and infrastructure for eye care in India: current status.

BACKGROUND: An ophthalmic workforce and infrastructure planning survey was undertaken to provide a valid evidence base for human resource and infrastructure requirements for elimination of avoidable blindness. This is the first time that such an extensive survey has been done in India. METHODS: Pre-tested questionnaires were administered to all district-level blindness officials and ophthalmology training institutions during April 2002-March 2003. Supplementary data sources were used wherever necessary. Data analysis was done in Stata 8.0. Projections of the existing ophthalmologists and dedicated eye beds were made for the entire country using the mean, median and range for each individual state. RESULTS: The response rate was 89.3%. More than half the eye care facilities were located in the private sector. Sixty-nine per cent of the ophthalmologists were employed in the private and non-governmental sectors; 71.5% of all dedicated eye beds were managed by these two sectors. Five states (Maharashtra, Uttar Pradesh, Karnataka, Andhra Pradesh and Tamil Nadu) had half the practising ophthalmologists in India. There was a wide disparity in access to ophthalmologists and dedicated eye beds across the country. Using the median to obtain medium projections, it is estimated that there are 9478 practising ophthalmologists and 59 828 dedicated eye beds in India. CONCLUSIONS: India will be able to meet the requirements for trained ophthalmologists and dedicated eye beds to achieve the goals of Vision 2020. Some states will need special attention. Instead of an across-the-board increase in ophthalmologists and eye beds, regions which are deficient will need to be prioritized and concerted action initiated to achieve an equitable distribution of the available resources.