Epidemiological and Clinical Profile of COVID-19 cases attending Rural HealthTraining Centre of one of the Medical Colleges of Ahmedabad, Gujarat, India

Introduction : disease is very much required for future preparedness. To assess the epidemiological andObjective : clinical profile of cases of COVID 19 Cross sectional descriptive study was carried out at a RuralMethod : Health Training Centre (RHTC). All cases reported in the month of January 2022 were included in the study. The information about the epidemiological and clinical profile was collected from RHTC records by conducting telephonic interview. Total 83 cases were reported. Among them, 43 (54.4%) casesResults : were in age group 20-39 years. Male: Female ratio was 1.37:1. There was one death and patient had ovarian cancer as co-morbidity. Total 71 patients could be contacted for telephonic interview. Fever was most common symptom and was presenting symptom on first day followed by cough/cold and sore throat. None had shortness of breath or chest pain. Hospitalization rate was 5.63% and none required oxygen supplementation or intensive care. Recovery period was 3-5 days. Out of total, 90% cases were fully vaccinated and 95.8% had knowledge of CAB. Diabetes and hypertension were most common co- morbidities and were statistically significantly more in age > 40 years. The COVID-19 cases inConclusions : the beginning of year 2022 had clinical presentation different than the earlier waves. Periodic situational analysis can guide in policy making for handling this pandemic in future.

Innovative Methods to Overcome Barriers and Improve Immunization Coverage: A Comparative Study in Two Wards of Ahmedabad City

Introduction: Immunization is one of the most cost effective public health interventions since it provides direct and effective protection against preventable morbidity and mortality. Objectives : To identify the challenges and barriers associated with immunization coverage. Also to implement innovative strategies to overcome these challenges before session of Intensified Mission Indradhanush (IMI) and compare the coverage levels in areas with versus without use of innovative Mathod: Two slum areas were selected from the South zone of Ahmedabad Municipal Corporation (AMC) and out of those one was from UHTC of AMC MET Medical College which was the intervention area in this study. Families with incomplete immunization of children <2 years were included in the study. In intervention area, personal visit by investigator, one to one health education, mobile reminders and support of local influencers was taken to increase the coverage. Data of both the areas were collected in a pre-designed and pre-tested proforma and analysed. Qualitative analysis of reasons for not accepting immunization services was also carried out Result: Coverage of BCG, fIPV 1, OPV1 and Pentavalent-1 was 100% in both the areas. Coverage of OPV2 and Pentavalent-2 was 100% and 57% in intervention and non-intervention areas respectively. Overall coverage of all other vaccines was more in the UHC Isanpur which was the intervention area. Further even in the non-intervention area, more experience of ASHA was significantly associated with better coverage. Qualitative analysis revealed not informed about IMI round, fears and religious beliefs etc. as reasons for not accepting immunization services. Conclusion: Personal visits, Involvement of community leader, Motivation and mobile reminders about the round of IMI was highly effective in improving coverage of IMI from due list

Knowledge and prevalence of sexually transmitted infections among female sex workers in Ahmedabad city.

Background & objectives: Sexually transmitted infections (STIs) continue to present major health, social and economic problems especially amongst Female Sex Workers (FSWs). Objectives : 1. To assess the knowledge of STIs among FSWs. 2. To find the prevalence of STIs among them and correlate it with various variable. Study method: A cross sectional study was carried out in the two Targeted Intervention areas working in the Ahmedabad city covering 10% of their total registered population. Results: Total 353 FWSs were covered. The mean age was 32.85+ 7.6 years. Majority was married and either illiterate or educated up to primary standards. Most common symptom of STI known to FSWs was Genital ulcer (67%) and 170 (48%) of FSWs had suffered from STI in last one year, out of them 128(75%) had taken the treatment. Eighty percent FSWs had consistently used condom in last 1 year. Risk of getting STI in 30 to 35 years age group was more than the overall risk (OR>1). The risk of STI was 7.85 times and 2.87 times more amongst the FSWs having duration of sex work < 10 years and those not using condom consistently, respectively. The difference of treatment seeking behavior with duration of sex work and knowledge of STI was highly significant (p<0.001). Conclusions: Knowledge of symptoms of STI was high. Although the condom use was claimed by the respondents still half of them suffered from STIs in last one year.

Knowledge of HIV/AIDS and HIV testing among the high risk groups (HRGs) population.

Background: Several factors put India in danger of experiencing rapid spread of HIV if effective prevention and control measures are not scaled up throughout the country. Aims & Objective: (1) To assess the level of basic knowledge about HIV/AIDS among the study population; (2) To analyze the HIV testing among them. Material and Methods: It was a cross sectional study carried out during April –May, 2010 amongst 3125 subjects of high risk groups (HRGs) comprising of IDUs (Injectable Drug Users), Female Sex workers (FSWs), MSMs (Male having Sex with Males) and Single Male Migrants (SMMs) covered by 13 Targeted Interventions (TIs) of Ahmedabad city. Ten percent of registered HRGs were assessed by systematic sampling. Data was analyzed using Epi info version 3.5.1. Results: Mean age of HRGs was 28.69 years and about half of HRGs were educated up to primary standard. More than half of them were married.85% HRGs had heard of HIV and 51% correctly knew what HIV positive means. Knowledge about AIDS was 76% and understanding of AIDS was 66% among them .About 38% HRGs knew that HIV is infectious and 72.8% knew that HIV is incurable. About 65% HRGs knew that there is no effective vaccine for HIV. About 65% HRGs had been tested ever tested and in last 6 months about 52.2% of HRGs were tested for HIV. Age and education were statistically significantly associated with the knowledge about incurability of HIV, non-existence of vaccine, and ever testing of HIV and in last six months also with disclosure of HIV positive status. Additionally age was also statistically significantly associated with infectious nature of HIV. Conclusion: Young and literate HRGs are better aware about the disease and are more concerned about their HIV status. They are also more open about disclosing their HIV/AIDS status.

Situation of P. vivax malaria in Ahmedabad city – A study in purview of national guidelines.

Background: Malaria is still the most important cause of morbidity-mortality in India. NVBDCP in urban areas is implemented through UHCs. In Gujarat, 89764 malaria cases were reported in 2011 with 127 deaths with 17.9% of them being the P. vivax (Pv) cases. Ahmedabad is at the receiving end of malaria menace due to its rapid growth. Compared to 2011, significant rise in number of Pv cases has been observed in Ahmedabad in 2012. Aims & Objective: The study was carried out to assess the Pv malaria detection modalities, relevant indices, existing radical treatment strategies and adherence to national guidelines in the urban areas of Ahmedabad. Material and Methods: Data of all 9 UHCs of south zone, catering total population of approximately 1 million and showing significant rise in Pv cases were verified clubbed with field analysis, for the corresponding quarters of March, April and May of two consecutive years–2011-2012. Concerned healthcare staff was interviewed. Guidelines and definitions of national anti-malarial guidelines and operational manual were followed. Process indicators for surveillance, case finding and disease burden were considered. Results: Out of total blood smears examined, Pv cases raised from 97 (2011) to 382 (2012). Statistically significant rise of Pv% was 0.35% and 2.79% in active and passive slide collection respectively. 71% slides were actively collected in both years. QBER rose from 1.50% to 2.41%. QPI rose from 0.12 to 0.39. Successful RT completion decreased from 59.8% to 29.1%. Knowledge regarding national-anti-malarial-guidelines was satisfactory in more than 70% of healthcare functionaries. Conclusion: Number of cases significantly increased in two years, Pv-positivity rise being 1.04%. Active slide collection is static. Rise in Pv-positivity should trigger improvement in the same. Average QBER and QPI rose in two years. QBER never reached prescribed levels. Successful RT-completion is the key towards drug-resistance and relapse prevention. Adherence to national-anti-malarial-guideline is imperative.

A study of the prevalence, pattern and health effects of passive smoking in a slum area of Ahmedabad city.

Background: According to WHO, Passive smoking/ Environmental tobacco smoke (ETS) carries serious risk especially for children & those chronically exposed. Objectives: To know the pattern of smoking, proportion of household passive smokers, subjective and health effects amongst passive smokers. Methods: The present study is a cross sectional study carried out in Shankar Bhuvan na Chhapara slum area of the Ahmedabad by using a pre-designed and pre-tested proforma. A house to house survey was carried out to collect the information as per the format. Those households which were having at least one active tobacco smoker in any form, were included in study and all members of such households were surveyed.Results: Total 118 houses out of 250 total houses had at least one smoker in them and were covered in the survey. Total population surveyed was 683 out of which 131 were smokers and 552 were non-smokers. The ratio of active versus passive smokers in the survey population was 1: 4.21. The mean age of smokers was 45.24+12.97 years whereas mean age of passive smokers was 20.13+14.44 years. The mean active smokers per family were 1.11 and passive smokers per family were 4.72. Firewood and kerosene were the most common fuels and majority of houses had no separate cooking area. Bidi was most commonly smoked stuff. Majority were chronic smokers and smoking on average 20.16+14.28 items per day. Amongst the subjective feelings unpleasant smell was present in 74% of respondents on acute exposure to tobacco smoke and coughing was the most common immediate symptom experienced by the passive smokers. Sixty nine percent children of less than 5 years of age had history of repeated Acute Respiratory Tract Infections as per mothers. Conclusions: Women and children are the victims of the exposure to ETS and indoor air pollution due to use of Bio-mass fuel and substandard housing add to this problem. Over and above that the immediate adverse subjective feelings amongst passive smokers are un-noticed and not given importance. All these are bared by the passive smokers constantly multiple times a day and may affect their mental health. The damage to physical health is a well known fact.

Presentation and Complications among the Malaria Death Cases from Municipal Corporation Hospitals & Civil Hospital of Ahmedabad during the Year 2007.

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.