Expenditure audit of women with breast cancer in a tertiary care hospital of Delhi.

Background: Breast cancer is associated with substantial medical and economic burden. This study assisted the expenditure incurred by the subjects on diagnosis and treatment till the period of follow-up. Materials and Methods: This is a prospective study; a case series of patients studied at the time of diagnosis and followed after 6 months. The study was conducted at one of Hospitals in India, from January 2006 to December 2007. One hundred and seventy-two women with new primary breast cancer were included in the study. During the study period 69 subjects were lost to follow-up. The comparative analysis was done for 103 subjects. Cost implications of breast cancer include direct medical costs and indirect costs. Questionnaire for the data collection was used. Descriptive statistics and correlation analysis were used. Results: The median total direct and indirect expenditure was Rs. 12,100 (US$ 1 = Rs 50) with the range of Rs. 0-54000. The largest component of total direct medical costs was in stage I (median Rs. 6530), total indirect costs (median Rs. 7500), and median total cost was Rs. 17,600. The total expenditures (median Rs. 13,100) were the highest in younger age group (<40). The median direct expenditure was higher in the subjects who visited private setup before coming to Hospital (Rs. 8250) than those who came directly (Rs. 4500). Conclusions: Cost of treatment for breast cancer depends on many factors, including the stages of the cancer, the woman's age, perhaps the costs of treatment, private hospital and insurance.

Assessment of Quality of Life among HIV Positive People Attending Tertiary Hospital of Delhi, India.

As per global HIV/AIDS estimates, a total of 33 million [30.3 – 36.1 million] People were living with HIV in 2007. The world's second-most populous country, India, is experiencing a highly varied HIV epidemic, which appears to be stable or diminishing in some parts while growing at a modest rate in others. Quality of life (QOL) of HIV/AIDS patients is becoming an important component of overall assessment of health care and management in health care settings. It is one of the indicators effectiveness of management of PLHAS . The objective of this study was to determine the QOL of patients with HIV/AIDS in New Delhi. Purposive sampling was used to identify subjects from the antiretroviral therapy clinic (ART) in Lok Nayak hospital. 180 patients were interviewed with the WHOQOL-HIV instrument. This questionnaire included demographic data, multi-item scales and six domains namely physical, psychological, level of independence, social relationships, environment and spirituality religion. Study subjects were aged between 20-56 years. Mean age of all study subjects was 33.85±7.01 years, comprising of 34.4 females. More than 50% of the total subjects had received less than secondary school education. All domains have higher scores for women than men except the psychological domain. Correlation of scores of six domains with overall QOL score and among individual domains was statistically significant. Younger people showed poorer QOL and level of education correlated positively with all domains of QOL. Overall results indicate that quality of life of AIDS attending Lok Nayak hospital is satisfactory.

Risk factors with breast cancer among women in Delhi.

BACKGROUND: The incidence of breast cancer is on the rise in India, breast cancer is the second most common malignancy in Indian women. AIM: The aim of this study was to find out the association of various risk factors with breast cancer among women in Delhi. SETTINGS AND DESIGN: This was a case-control study in Lok Nayak Hospital, Delhi. METHODS AND MATERIAL: 332 women were studied. Subjects were women with breast cancer (N = 115) and age matched Control subjects (N-217) without breast cancer, attending Lok Nayak Hospital during 2006. Subjects were interviewed using a pretested questionnaire. The risk factors studied were: age, parity, socioeconomic status, marital status, breast feeding, menarche, menopause, family history. STATISTICAL ANALYSIS: Data was expressed in proportion. RESULTS AND CONCLUSIONS: Age of the patient ranged from 25 to 80 years. In this study, 69 (60%) cases and 127 (58.5%) controls were illiterate, the mean duration sum of total breast feeding for all children was 6.58 years in cases and 7.4 years in controls (OR = 1.91; 95% CI, 1.17 - 3.13) (P P P< 0.05). There was a significant difference between breast cancer cases and controls in relation to place of residence, occupation, marital status, body mass index and breast feeding.

Awareness Status about HIV-AIDS among Indian Railway's Employees and their Family Members.

A house to house survey was conducted in December 2005 in the Railway Colony of Shamli, located in the state of Uttar Pradesh, India using a semistructured questionnaire to study the awareness level regarding HIV/AIDS among Indian Railway's employees and their family members. Information regarding demographic characteristics and knowledge about various aspects of HIV/AIDS was recorded by a trained staff nurse of the local Railway Medical Unit from at least one person, aged 15 years to 59 years, from each household. Among 293 individuals interviewed, majority were males (61.8%), aged > 30 years (56.6%) and literate (85.3%). Majority were aware about existence of HIV infection in India (92.5%), AIDS is a fatal disease (92.8%) and laboratory tests are available for detecting HIV infection (89.4%). Although most of them knew the correct routes of HIV transmission viz. sexual (91.5%), parentral (90.8%), perinatal route (86.3%) and blood transfusion (86.0%), misconceptions such as transmission through shaking hands (89.1%), hugging (88.4%), sharing utensils (82.6%), mosquito bite (74.1%) and using public toilets (73.4%) were also observed. Most of them were also aware about preventive measures. Knowledge about various aspects was observed to be significantly higher among females, among individuals aged < 45 years and literate individuals. The findings highlight the need of intensified health education focusing on removal of misconceptions and further improvement in awareness level of the study population.

Impact of health education intervention on knowledge and community action for malaria control in Delhi.

Malaria affects millions of people in India despite decades of efforts to control it. It has acquired greater importance in last two decades due to emergence of vector resistance, poor quality of care and low utilization of services. The study was conducted to improve the management of malaria by IEC and training activities in slum areas of Delhi. The baseline and post intervention data on knowledge, attitude, behavior and practices (KABP) regarding malaria was collected from 601 and 593 subjects respectively from two zones of Municipal Corporation of Delhi (MCD). At the same time, knowledge and skills regarding management of malaria were assessed among 15 health workers working in these two zones of MCD. An intervention package in the form of health education material for the community and training modules for the workers were designed and implemented. Post intervention data were collected. The knowledge about cause of malaria, season of malaria and breeding places of mosquito increased among community members after the intervention, which was found to be statistically significant. Similarly, more people were aware about the methods of prevention of mosquito breeding after the intervention. Methods like mosquito coil (post-64.92% vs pre-55.41%) and bet nets (post-24.96% vs pre-14.47%) were used by more people in post intervention phase. The Interval between onset of symptoms and seeking treatment decreased after the intervention from 1.66 days to 1.37 days. Among the workers, knowledge and skills regarding malaria management improved after the intervention. More blood slides were made, side effects of the treatment were explained to the patients and better compliance to treatment was observed in post intervention phase. IEC activities using attractive pamphlets to the community and on-job training of workers improves management of malaria and should be used more frequently more so in the slum areas for the success of the National Anti-Malaria Program.

Perception of risk and potential occupational exposure to HIV/AIDS among medical interns in Delhi.

A cross sectional study was conducted among 129 medical interns of Maulana Azad Medical College, New Delhi for assessing the perceived levels of risk of acquiring HIV infection in the health care settings among medical interns, reasons for the same and their exposure to situations having potential of HIV transmission. Majority of the interns (68.3%) perceived themselves to be at a very high/high risk of acquiring HIV infection during their medical career. The common reasons for perceived risk of acquiring HIV infection were getting injuries due to needle pricks/cuts during surgical procedures (32.4%), frequent exposure to the blood/ secretions of patients (28.5%) and insufficient availability of gloves (17.6%). Some (23.2%) were of the opinion that students in future might lose interest in the medical profession due to increasing risk of HIV infection and few (3.1%) were even considering to leave the medical profession for the same reason. Majority of the interns (72.9%) had experienced needle pricks and more than half (53.7%) of them even had had blood splashes in their eyes/ nose/ mouth during surgical procedures. The findings of the study call for efforts for bringing a reduction in the risk perception of the interns through awareness campaigns and reorientation trainings, ensuring availability of gloves and other items necessary for observing universal work precautions and proper disposal of potentially contaminated articles.

Changing profile of disease contributing to mortality in a resettlement colony of Delhi.

BACKGROUND: The past decade has seen a decline in the disability-adjusted life years (DALYs) contributed by communicable diseases while lifestyle changes and rapid urbanization have led to an increase in DALYs contributed by non-communicable diseases. We studied the causes of death in a low socioeconomic area over 11 years to help identify changes in the pattern of disease. METHODS: We did this study in Gokulpuri, a resettlement colony in East Delhi. All deaths occurring from 1994 to 2004 were analysed using a verbal autopsy questionnaire completed by trained health workers during their home visits in the area. RESULTS: A total of 515 deaths occurred during the period; 340 in men (66%) and 175 in women (34%). The six commonest causes of death were tuberculosis (24.8%), chronic obstructive pulmonary disease (11.6%), pneumonia (8.7%), accidents and poisoning (8.6 %), coronary heart disease (8.2%) and cancer (4.6%). The age-specific mortality rate was highest among people > 45 years of age. The cause-specific mortality rate due to communicable diseases showed a decline while that due to non-communicable diseases showed a rising trend in all age groups. CONCLUSION: Our study shows the coexistence of communicable and non-communicable diseases in a low socioeconomic area with a rising trend in non-communicable diseases. Surveillance for risk factors of non-communicable diseases should be done even in predominantly low socioeconomic areas. The coexistence of communicable and non-communicable diseases and the increase in non-communicable diseases among the economically deprived sections of our society suggest the need to re-prioritize components of healthcare among these sections.

Drug use among juveniles in conflict with the law.

OBJECTIVE: To study the pattern of drug use, reasons for initiation and the perception about the effects of using drugs, among juveniles in conflict with law. METHODS: A qualitative study was conducted at Prayas Observation Home for boys, New Delhi. Eight key informant interviews were conducted to find the prevalence of prior drug use among boys. Five focus group discussions were conducted with 34 children using a topic outline guide. RESULTS: The study showed that drug use was related to other criminal activities. Peer group and media were the most important influences for initiation of drug use. All kinds of drugs could easily be procured by children and there was a gradual progression from non-use to tobacco and alcohol use, to marijuana and ultimately to other drugs. Knowledge about medical and social mal-effects of consuming drugs did not seem to effect either the consumption of drugs or the desire to leave this habit. CONCLUSION: Results of the study demonstrate an urgent need for taking stringent measures in order to curb drug use among adolescents.

Medical students' perception on eye donation in Delhi.

Corneal transplantation remains a major treatment option for restoring sight among those suffering from corneal blindness. The number of corneal transplants done is far less than the actual requirement in India. This is largely due to the inadequate numbers of corneas collected. Medical students can be involved in the motivation of patients and relatives to pledge their eyes and to do grief counseling for donating eyes. The aim of the study was to assess the perception and willingness of 180 first-year medical students towards eye donation in Delhi. They were administered a pretested semi-structured questionnaire on eye donation. Data were analyzed using Epi-Info software package 6.04 version. The majority (99.4%) of students knew that eyes can be donated after death but only 41.1% knew that the ideal time of donation was within six hours of death. Most participants (87.2%) were willing to donate eyes. Nobility in the act of eye donation was the main motivational force for eye donation according to 85.5% of students. Perceived reasons for not pledging eyes by the people were: lack of awareness (32.7%), objection by family members (27.7%), unsuitability to donate because of health problem (17.7%) and the unacceptable idea to separate the eye from the body (15.5%). Mass media such as television, newspapers, magazines and posters were important sources of information on eye donation. Perceived reasons for not donating eyes need to be considered while creating awareness about eye donation in the community.

Practice and knowledge regarding prevention of tetanus among nursing personnel in Delhi.

A cross-sectional study was conducted in Delhi to assess the practices and knowledge regarding tetanus immunization among nursing personnel. Majority of the study subjects had received their last dose of tetanus toxoid injection only after injury and just 4.4% received it to complete the immunization schedule. More than 12% subjects did not know whether they had received any tetanus toxoid injection or not, another 5.5% had their last dose of tetanus toxoid more than ten years back. As many as 20 (22.2%) subjects stated that TT should be given after every injury. Of the remaining 70 subjects only 22.9% correctly knew why TT was not required. Only one third of the subjects knew the indications of anti tetanus serum.

Perception of risk and potential occupational exposure to HIV/AIDS among medical interns in Delhi.

A cross sectional study was conducted among 129 medical interns of Maulana Azad Medical College, New Delhi for assessing the perceived levels of risk of acquiring HIV infection in the health care settings among medical interns, reasons for the same and their exposure to situations having potential of HIV transmission. Majority of the interns (68.3%) perceived themselves to be at a very high/high risk of acquiring HIV infection during their medical career. The common reasons for perceived risk of acquiring HIV infection were getting injuries due to needle pricks/cuts during surgical procedures (32.4%), frequent exposure to the blood/secretions of patients (28.5%) and insufficient availability of gloves (17.6%). Some (23.2%) were of the opinion that students in future might lose interest in the medical profession due to increasing risk of HIV infection and few (3.1%) were even considering to leave the medical profession for the same reason. Majority of the interns (72.9%) had experienced needle pricks and more than half (53.7%) of them even had had blood splashes in their eyes/nose/mouth during surgical procedures. The findings of the study call for efforts for bringing a reduction in the risk perception of the interns through awareness campaigns and reorientation trainings, ensuring availability of gloves and other items necessary for observing universal work precautions and proper disposal of potentially contaminated articles.

Knowledge of general public and health professionals about tetanus immunization.

OBJECTIVE: To study the awareness among general public and health care providers about tetanus immunization in relation to injuries, and their knowledge about tetanus immunization schedules in children, pregnant females and adults. METHODS: It was a cross-sectional study done at a perfect health mela and all the government allopathic health agencies in Delhi. RESULTS: The knowledge of tetanus immunization was poor among general public as well as health care providers. A substantial proportion of them indicated tetanus injection after every injury, which was unwarranted. The knowledge of tetanus immunization schedule for adults was poor among all categories of respondents, though it was comparatively better for pregnant females, but only 75% of doctors and 51.1% of nursing personnel correctly knew the immunization schedule against tetanus in children. CONCLUSION: There is a need to upgrade the level of knowledge among health care providers so as to ensure that schedules of tetanus are followed properly and unnecessary repeated immunizations are avoided and the same knowledge is passed on to the general public also.

Economic burden of tuberculosis in patients attending DOT centres in Delhi.

Tuberculosis inflicts a negative impact on global socioeconomic prosperity. Though India carries one third of the global burden of the disease, few studies have focussed in the country on this aspect. The present study was therefore, framed to estimate economic loss amongst TB patients. A total of 156 patients attending two DOT centres were interviewed in depth, regarding economic loss due to tuberculosis, using a semi structured pretested interview schedule during a period of 5 months. More than 75% of the subjects belonged to the age group of 15-44 years of which 71.6% were males. 34.6% of patients were housewives and 10.9% were students. Mean expenditure before registration in DOT centre was Rs. 3385.5 irrespective of all socioeconomic classes. The upper lower socio-economic class of patients incurred maximum mean expenditure of Rs. 9782.0. Mean duration of wage loss was found to be 47.1 days. Study participants incurred economic loss both in terms of direct and indirect costs, more so in lower socio-economic group, besides delay in attending DOT centres for treatment. Awareness campaign focussing on treatment availability and DOT centre could help in reducing such economic loss.

Increasing access to cataract surgery in a rural area--a support strategy.

The objectives of the study were to elicit the reasons for not undergoing cataract surgery from those having cataract, aged 50 years and above, in a village community and, develop, implement and assess a support strategy for getting cataract surgery done. The leading reasons identified were monetary constraints (18.8%), transport difficulty (17.4%), lack of awareness about cataract in the eyes (17.4%) and lack of escort (14.5%). Based on the identified reasons, patients were transported in groups to a government eye hospital for free surgery after completion of required pre operative formalities at the village health center itself. Out of 65 eligible individuals, 66.2% underwent surgery. The success of the approach was evident by perceived improvement in vision in 88.4% operated patients, occurrence of only few minor complications and a satisfactory hospital experience being reported by all.

Knowledge about tetanus immunization among doctors in Delhi.

BACKGROUND: In spite of the clear-cut guidelines regarding tetanus immunization, we have observed that tetanus toxoid injection is often given after injury without considering previous immunization status. One of the reasons for this could be that the doctors themselves are not aware of the correct immunization schedules against tetanus. AIMS: 1. To assess the knowledge about tetanus immunization in relation to injuries among doctors. 2. To assess their knowledge about tetanus immunization schedules in children, pregnant women and adults. SETTING AND DESIGN: It was a cross-sectional study conducted in Delhi. MATERIALS AND METHODS: After complete enlisting of all the government allopathic hospitals and dispensaries, a representative sample (including private practitioners from the nearby area of selected dispensaries) of doctors was selected. All the doctors were personally contacted and information was collected through a pre-structured self-administered proforma. STATISTICAL ANALYSIS: Data was analyzed using a computer and wherever applicable Chi-square test/Z test or Fishers' Exact test was applied. RESULTS AND CONCLUSION: As many as 38.3% of doctors favored tetanus toxoid injection after every injury. The correct knowledge of immunization against tetanus in children, pregnant women and adults was 75%, 90.8% and 35.8% respectively. The knowledge regarding when to give boosters was even poorer. The present study showed that doctors had poor knowledge about tetanus immunization that needs to be improved.

Mental health status of runaway adolescents.

There are 47.22 million homeless and runaway adolescents roaming on the streets of our country (Voluntary Health Association of India - VHAI) of which one lakh are in Delhi.1 Very little is known about them, their needs or their experiences. OBJECTIVE: (1). To assess the psychological problems amongst the runaway adolescent boys. (2). To determine possible risk factors. METHODS: This study was cross-sectional in design and done at a child observation home for boys in Delhi. All runaway boys aged 10 to 16 years of age were included in the study. The study was conducted from 15th June to 15th July 2001. A comprehensive schedule consisting of five parts, viz identification data, hopelessness scale for children by Kazdin, Beck depression inventory, Psychological survey questionnaire and RUTTER-B2 scale were used to assess various mental health problems. RESULTS: 20.7% of children were found to have high hopelessness and 8% of children had depression. 2% of children revealed that they had attempted suicide at any point of time in life. Among children with high hopelessness, 3.2% had ever attempted suicide. 8.3% of the depressed children gave history of suicidal attempts. 38% of children gave history of physical abuse, 14.6% of sexual abuse and a large number reported substance abuse. 69.33% were found to have behavioral problems (i.e. scored above the recommended cut off score of 9). 81% of children had antisocial behavior, 7.8% were neurotic and 10.5% remained undifferentiated. CONCLUSION: Runaway adolescents suffer from a wide array of mental health problems and there is a need for a broad based psychosocial intervention programme.