ABSTRACT
Introduction : Rashtriya Bal Swasthya Karyakram (RBSK) is a systemic approach of 4‘D’s (Defect, Diseases, Deficiency, Developmental delay) for early identification and linkage with care, support and treatment. (1) Document utilization of RBSK services within a year of referral, (2) Assess reasonsObjectives : for non-utilization of services and (3) Assess out of pocket expenditure (OOPE) among users and non-users of the program. Retrospective Cohort Study was conducted at an Urban Health Centre (UHC) takingMethod: two cohorts of children referred for 4‘D’s during April 2018-March 2020 under RBSK. A total of 102 cases were sampled. Probability Proportionate to size (PPS) method was used to ensure proportionate representation of each of 4‘D’s in the sample. Required number of participants in each category were selected randomly. Out of 102 sampled cases, 97 were covered. Utilization of services was 50.5%; majorResults: reasons for non-utilization were preference for private providers and reluctance to stay at Comprehensive Malnutrition Treatment Centre (CMTC). Mean OOPE in users was Rs. 21545, significantly less (p <.05) than Rs. 70198 in non-users. After referral by RBSK team, only half utilized the services. Among users,Conclusion: OOPE was less for total cost incurred and also for direct cost incurred like consultation charges, medicines, consumables etc. Counselling those parents whose children are detected with any of 4Ds, to visit Child Malnutrition Treatment Center (CMTC)/ District Early Intervention Center (DEIC) remains a challenge.
ABSTRACT
The present study was carried out to have understanding of characterisation including symptoms, signs and laboratory parameters which are associated with fatality of malaria cases on arrival to hospital which may lead to early recognition and improved management. Information about deaths due to Malaria, as reported to malaria Department of Ahmedabad Municipal Corporation by municipal corporation hospitals and civil hospital from January 07 to December 07, was used to locate details of those deaths in respective hospitals by obtaining indoor case papers and death reports of those cases from Medical Record Section of respective hospitals and were analyzed by using appropriate statistical software. Total 57 malaria deaths occurred in the above mentioned 4 hospitals. Overall Case Fatality Rate was 3.03% for indoor malaria cases. Complete information could be obtained about 42 cases. Mean age of cases was 36.50 years. 45.23% of patients falling in the age group >=40yrs. There were 57.1% males and 42.9% females. 55 cases were positive for P. falciparum, 1 case for P. vivax and 1 case was having mixed infection. Average duration of Hospital stay was 2.87 days and average total duration of illness was 6.82 days. The most common presenting symptom was intermittent fever with vomiting & altered sensorium in 38.88% & most common complication was Acute Renal Failure in 45.2% of cases. Paired t-test was applied on the investigations carried out on the day of admission and those carried out on the day or before a day of death and found significant for the levels of Haemoglobin, Blood Urea & Serum Billirubin. Malaria still remains one of the important causes of admission and mortality. In view of changes in anti-malarial drug policy and introduction of costly artemisinin combination therapy accurate, rapid diagnostic tools are necessary to target treatment to people in need.