Gross Congenital Malformation at Birth in a Government Hospital.

A hospital-based cross-sectional study was undertaken to determine proportion of gross congenital malformation (GCMF) occurring at intramural births. Rate of GCMF was found to be 16.4/1000 consecutive singleton births (>28 weeks) with three leading malformation as anencephaly (44.68%), talipes equinovarus (17.02%) and meningomyelocele (10.63%). Higher risk of malformed births were noticed amongst un-booked (2.07%) in-comparison to booked (1.01%) mothers; women with low level of education (up to 8 years [2.14%] vs. at least 9 years of schooling [0.82%]); gravida status of at least 3 (2.69%) followed by 1 (1.43%) and 2 (1.0%) respectively; pre-term (5.13%) vs. term (0.66%); cesarean section (4.36%) versus vaginal delivery (0.62%). Mortality was signifi cantly higher among congenitally malformed (17.35%) than normal (0.34%) newborns. With-in study limitation, emergence of neural tube defect as the single largest category of congenital malformation indicates maternal malnutrition (especially folic acid) that needs appropriate attention and management.

Proportion of Hospitalization at a Respiratory Centre Under RNTCP.

Objective: To determine proportion of patients requiring hospitalization under RNCTP. Methodology:All area-patients registered for treatment under RNTCP at LRS Institute, New Delhi through 16 DOTS centre during the reference period (1st April 2006 to 31st Dec 2006) were listed and those patients requiring hospitalization (upto 31st Dec 2007) at LRS Institute were identified and interviewed by a single investigator using semi-structured proforma with certain inclusion and exclusion criteria’s. The data was entered into master sheet and analysis carried out using software statistical package by computing proportion (%) and chi-square test. Results: It was observed that there were 2,345 patients registered for treatment under RNTCP during the reference period, out of which, 4.22% (99) required hospitalization. The males outnumbered females in absolute numbers, however, gender related hospitalization was similar, 4.08% for males to 4.47% for females (p=0.647). Maximum case load (75.75%) was seen in economically productive age group (15-49 years). The proportion of hospitalization amongst 1- 14, 15-49, 50-60 and 61 years & above age group was 2.36%, 4.10%, 5.11% and 8.60% respectively (p=0.08); category II (7.61%) patient admissions was twice than category I (3.65%) patients (p<0.001). The proportion of hospitalization was 2.37% and 5.4% amongst patients with negative and positive sputum status respectively. Conclusion: The study was undertaken at a respiratory tertiary care centre in a metro city and within the study constraints it highlights disease severity, late presentation and minimum need for TB beds under prevailing socio-economic circumstances in the country.

Prescription pattern of tuberculin skin test (TST) in a teaching hospital.

Background: Tuberculin skin test (TST) is one of the tools for the identification of latent tubercular infection and is an ancillary test for diagnosis of active tuberculosis. Aims & Objective: The objective of this study was to assess specialty department wise prescription of Tuberculin Skin Test (TST) in a government teaching hospital. Material and Methods: Considering resource constraint and feasibility, one month was randomly selected during 2012 and two working days in each week were systematically covered i.e. Mon-Tue (first week), Wed-Thus (second week), Fri-Sat (third week) and again Mon-Tue (fourth week). Selected information of all patients reporting to receive TST on these days was recorded on a pre-structured proforma. TST was administered by a single investigator using standard protocol and results observed between 48-72 hours. Results: A total of 372 ambulatory suspect TB patients reported to received TST with mean age of 25 years (±18.13); female constituted 52.4%. Specialty department wise prescription of TST was as follows: paediatrics (29.3%); general medicine (18.0%); OBG (15.9%); surgery (12.9%); chest and TB (11.3%), orthopaedics (8.1%) and others (4.6%). The results of 227 (61.02%) patients who returned for follow up were grouped into < 10 mm (54.0%) and ≥ 10 mm (45.79%). Conclusion: Proportion of age distribution of patients in study sample was found to be similar in comparison to population structure of India. Paediatric (up to 14 years) patients were in majority (29.3%) amongst study samples where TST results could be of some significance.

Determinants of Vitamin A Deficiency amongst Children in Aligarh District, Uttar Pradesh.

Objectives: To determine the prevalence and determinants of xerophthalmia among children aged 0-60 months . Methods: This cross-sectional study included 3571 children under 5 years of age from six villages and four periurban areas. Children with xerophthalmia were identified and severity graded using the WHO classification. The main outcome measures were sociodemographic, nutritional and comorbidity related risk factors of xerophthalmia. A pretested questionnaire carrying information on the above factors was administered to the caregivers. Univariate and multivariate binary logistic regression analyses were performed to examine the association of each of these factors with xerophthalmia. Results: The overall prevalence of xerophthalmia was of serious public health importance at 9.1%. Prevalence of both mild (night blindness, and Bitot’s spots) and severe forms (corneal changes) of xerophthalmia increased with age. Bitot’s spots and night blindness were the commonest manifestations. Rural dwelling, lower social class, maternal illiteracy and occupation outside home were significant antecedent socio-demographic risk factors on univariate analysis. Multivariate analysis revealed low intake of proteins and vitamin A containing foods as well as predominant maize diet to be significant dietary factors. Nutritional wasting and a preceding history of measles were significant comorbid determinants (P<0.05). None of the socio-demographic variables emerged significant on multivariate analysis. Conclusions: Vitamin A deficiency remains a significant public health problem in Aligarh district.The proximal factors in a child’s mileu viz nutrition and comorbidities were more significantly associated with xerophthalmia than the distal socio-demographic factors, thereby making a case for their cost effective prevention.The high magnitude of the problem calls for intensification of existing prophylactic measures in these areas.

Global developmental delay and its determinants among urban infants and toddlers: A cross sectional study.

Objective To estimate the prevalence of global developmental delay among children under 3 years of age and study the determinant factors. Methods Cross sectional descriptive study was conducted in field practice areas of the Department of Community Medicine, JN Medical College, Aligarh, India. A total of 468 (243 boys and 225 girls) children aged 0–3 years were included. Developmental screening was performed for each child. A multitude of biological and environmental factors were analysed. Results As many as 7.1% of the children screened positive for global developmental delay. Maximum delay was observed in the 0–12 months age group (7.0%). Undernutrition and prematurity were the two most prevalent etiological diagnoses (21% each). Stunting and maternal illiteracy were the microenvironmental predictors on stepwise binary logistic regression while prematurity and a history of seizures emerged significant biological predictors. Conclusions Developmental delay can be predicted by specific biological and environmental factors which would help in initiating appropriate interventions.

Community rehabilitation of disabled with a focus on blind persons: Indian perspective.

India, the largest democratic country in the world, is marching ahead strongly on the growth and developmental front and is poised to be the leader in the market economy. This role creates and increases far greater responsibilities on us in ensuring that the benefit of the developmental cycle reaches each and every citizen of this country, including the able and the disabled ones. It has been enshrined in the Constitution of India to ensure equality, freedom, justice, and dignity of all individuals and implicitly mandates an inclusive society. With increase in consideration of quality parameters in all spheres of life including availability, access, and provision of comprehensive services to the disabled, it is pertinent to have a look on the contribution of government in keeping the aspiration and commitment towards common people. The article attempts to review the concept of rehabilitation for the disabled keeping a focus on the blind person, and list out the activities, programs/schemes, institutional structure and initiatives taken by the Government of India (GOI) for the same and the incentives/benefits extended to blind persons. The article concludes by reiterating the importance of individual need assessment and mentioning new initiatives proposed on Low Vision services in the approved 11th plan under National Programme for Control of Blindness (NPCB). The source of information has been annual reports, notification and the approved 11th five-year plan of GOI, articles published with key words like rehabilitation, disability, assistive devices, low vision aids, and/or blind person through the mode of Internet. Annexure provides a list of selected institutions in the country offering Low Vision services compiled from various sources through personal communication and an approved list of training institutes under NPCB, GOI offering Low Vision training.

Vitamin A-first dose supplement coverage evaluation amongst children aged 12–23 months residing in slums of Delhi, India.

Objective: To determine vitamin A-first dose supplement coverage in children aged 12–23 months and to find out its correlates with selected variables. Materials and Methods: The 30-cluster sampling technique based on probability proportional to size advocated by the World Health Organization was used to assess vitamin A-first dose supplement amongst 210 children in the age group of 12–23 months residing in slums of a randomly selected municipal zone of Delhi during October to November 2005. Results: Only 79 (37.6%) children out of 210 had received vitamin A-first dose supplement. Further analysis of 79 children was carried out with regard to selected variables like religion, gender, birth order, place of birth, immunization status and literacy of mother. These analyses showed that 71 (89.9%) were Hindu and eight (10.1%) were non-Hindu (P = 0.04). Nearly 44 (55.7%) males and 35 (44.3%) females had received vitamin A (P = 0.74). The proportion of children born in a health institution who received first dose (57%) of vitamin A supplementation was significantly higher than of those who were born at home (43%) (P < 0.001). Similarly, higher proportion of children with birth order-one (48.1%) in comparison to birth order-three or above (26.6%) received vitamin A (P < 0.001). Thirty children though fully immunized for vaccine-preventable disease up to the age-of-one year had not received vitamin A-first dose supplement, suggesting that an opportunity had been missed. The association between receipt of vitamin A by the child and literacy status of mother was found to be significant (P < 0.001). Conclusion: The study reflects low coverage of Vitamin A supplement.

Magnitude of unintentional injuries: Record based hospital study.

Unintentional injuries accounted for 43% of adolescents (1091/2545) reporting to the emergency department of a tertiary care hospital in Delhi over 3 months.

School eye screening and the national program for control of blindness.

Childhood blindness and visual impairment are as important and perhaps more devastating and disabling than adult onset blindness, because of the long span of life still remaining to be lived. Refractive errors and more particularly myopia, place a substantial burden on the individual and society. School-age children constitute a particularly vulnerable group where uncorrected refractive errors may have a dramatic impact on learning capability and educational potential. This article provides an overview of school eye screening from the perspective of National Program for Control of Blindness (NPCB), Government of India; and challenges, future directions and thrust area envisaged under the program for amelioration of childhood blindness.