ABSTRACT
This study was conducted over 2 years period at two leprosy centers of a Tertiary Care Service Hospitals one located in Eastern Uttar Pradesh and second in northern India to assess the factors resulting in pre-mature termination of anti-leprosy treatment in patients. A total of 124 patients, undergoing treatment for leprosy who consumed MDT for at least a month, then stopped it and thereafter reported to us for various reasons, were included. It was observed that 41.1% (51/124) patients dropped out on MDT. 33% (41/124) of the patients who stopped the medication were not formally educated. Most common disease forms observed in these patients was Borderline Lepromatous (BL) and Lepromatous Leprosy in 41.1% (51/124). 49.1% (61/124) patients completed 2-5 months of therapy with MDT prior to stopping it and 38.7% (48/124) patients reported back to us within 2-5 months after suspension of MDT. Reason for reporting in 31.4% (39/124) of these patients was development of deformities while 25% (31/124) reported due to weakness of hands and feet. 23.3% (29/124) developed lepra reaction becoming the reason for their reporting to us for review. Social stigma was the most common factor leading to termination of drug therapy against advice in 25.8% (32/124) patients, 21.7% (27/124) cited loss of occupational hours while 11.2% (14/124) patients felt there was no need to take MDT. To conclude non-compliance to multi drug therapy for leprosy is one of the major obstacles in achieving a leprosy free world and we need to look into all the personal, health care related and social factors responsible for it. Although these factors may vary depending upon the region, society, efficiency of the health care system and the individual commitment level of the patients, the need for better communication at professional and user level is apparent. Focus should be on psychological counselling, motivation of patients, their families and a receptive society to reduce the source of infection, complications and deformities which are otherwise largely preventable and adherence to treat will also prevent of emergence of resistance to MDT. Modified strategy(ies) addressing the factors as identified in this study well in time can make a difference.
ABSTRACT
Background: Infectious diseases are a major cause of morbidity and mortality in children. One of the most cost-effective and easy methods for child survival is immunization. The objective of study was to assess the immunization coverage in the rural area of Dhule.Methods: A community based cross-sectional study was conducted by using WHO 30x7 cluster sampling technique in Primary Health Centre, Kheda catchment villages among children aged 12-23 months on the day of survey. The total sample size was found out to be 210. Identification of clusters was done as per WHO manual on 30×7 cluster survey. Interviews were conducted as per a structured interview format in households with eligible children. Data feeding was done in MS Excel sheet.Results: Full immunization coverage (FIC) was found out to be 58.6%. Drop-out rate was calculated to be 22.95%. The main reason for not completing the immunization was unaware to return for subsequent vaccine doses.Conclusions: Coverage evaluation of vaccines was found out to be 58.6%. Drop-out rate is high.
ABSTRACT
Background: Immunization is till now most safe, cost effective and powerful intervention that has decreased the burden of vaccine preventable infectious diseases all over the world. The aim of this study was to estimate the immunization coverage among children aged 12-23 months in district Srinagar of Jammu and Kashmir.Methods: The study sample included 30 clusters from district Srinagar selected as per the 30×7 cluster sampling method.Results: It was found that fully immunized children were 87.14% and 12.26% of children were partially immunized and none was unimmunized. Regarding the individual vaccine coverage, it was highest for OPV1 (99.52%) followed by BCG and OPV0 (99.05%) and lowest for Hepatitis birth dose (95.24%). The dropout was found highest (6.22%) for OPV1-OPV3 and lowest (1.47%) for LPV1 - measles/MCV (1.47%).Conclusions: The immunization of district Srinagar is above 85% and this gives a positive hope for better future to reach coverage of 100%.
ABSTRACT
Kerala shows women favourable demographic data. Rising feminisation among Kerala medicos was reported recently. Scientific studies on sex representation at various levels of medical education are scanty. This study is first of its kind from Kerala. Registration details of admitted students to various medical courses conducted by all colleges affiliated to KUHS in 2011 were examined for sex distribution. The sex ratio– number of females per 1000 males–for UG, PG Diploma, Degree and Super–specialities were calculated. The PG students were further grouped as preclinical and clinical; and medical, surgical, Paediatrics or Gynaecology. The data is presented in the table and sex ratio is presented in graphs. The sex ratio was 2099 for MBBS, 1847 for PG Diploma, 1107 for PG Degree and 139 for PG Super–specialities. Progressive fall in women favourable sex ratio from UG to super–speciality levels observed. It dropped from PG non–clinical to PG clinical subjects, but increased from surgical specialities to Medical specialities; in Paediatrics and sharply in Gynaecology. Female doctors suffer more gender discrimination than male doctors. They integrate family responsibilities with career, necessitating flexibility of work. Today’s medical profession may be a male–favoured one. Perhaps empowerment of women starts from the lower strata of society and progress up. Drop out of women lead to lose of potential talent. Alternative work schedules, optimization of maternity leave and child care opportunities are required to support women in medicine. Changes in health care policies are needed to balance between work and home. This study was based on already available data. More focussed studies with robust methodologies are suggested.
ABSTRACT
@#The aim of the study was to assess the status of routine immunization status and reasons for drop-outs in five districts in Bihar India. A community based cross sectional rapid survey in five districts in Bihar was undertaken from 11th January to 5th February 2013. Of the 38 districts in Bihar, 5 districts prioritized by the state government for intensive routine immunization support were selected purposively for the rapid assessment. Samples of primary health centres, Health sub centres, villages were chosen for the study using geographic and performance criteria. Twenty households having babies 0 to 36 months old from each village were randomly selected. A total of 7,500 households were taken from the 5 study districts. Apart from household survey, cold chain points where vaccines are stored and vaccination session sites were also assessed for service delivery and community participation. The assessment findings revealed high access resulted in good coverage of the initial vaccination such as BCG and DPT1, while low utilization due to drop out of children from DPT1 to DPT3 (15%) and BCG –measles dropout (27%). The coverage was inequitable, with 12% difference in full immunization among children below poverty line and scheduled caste and tribe children. The reasons for low vaccination coverage were both related to demand and supply side. Lack of awareness on immunization, lack of correct information about the place and time of immunization, illness of the child at the time of immunization session, irregular session timing and fear of adverse effects were found to be the major causes for almost 60% of households. The health staff ascribed it mainly to erratic supply of vaccines and logistics, poor planning, insignificant role of media or past experience of Adverse Effect Following Immunization (AEFI) as major causes. Based on the assessment of cold chain and vaccination session facility and key informant interviews, it was recommended that special emphasis should be given to due list preparation and tracking of beneficiaries using local volunteers, self-help groups and mobilizers especially in hard to reach areas. In addition, to ensure regular vaccine and logistic availability, Microplanning to include disadvantaged communities like Scheduled Caste (SC)/Scheduled Tribe (ST) & Below Poverty Line (BPL) households and intensive monitoring using both internal and external supervisors for regular monitoring of the routine immunization activities