A Retrospective Cohort study on Utilization of Rashtriya Bal Swasthya Karyakra (RBSK) Services among Children Screened at an Urban Health Centre (UHC) ofAhmedabad Municipal Corporation (AMC)

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.

A cross sectional study on the evaluation of MCH services provided by “ASHA” working at Urban Health Centers of Ahmedabad City, Gujarat

Introduction: National Rural Health Mission (NRHM) was launched by Indian Government with key feature of introduction of a new designated health care worker – “Accredited Social Health Activist” (ASHA) who acts as interface between community and public health system. Objectives: To assess knowledge about MCH related functions and to estimate status of support to beneficiaries by “ASHAs”, To Assess Quality of Home Based New Borne Care performed by ASHA and to find out impact of number of modular training rounds on knowledge and practices of ASHAs. Methodology: A cross-sectional study was conducted during February 2019 to December 2020 using a mixed approach, with a combination of quantitative and qualitative research methods after approval of institutional Ethics committee. All Urban Health Centres (UHC) under Municipal Corporation in Ahmedabad were covered. From each UHC, 2 ASHAs were selected by lottery method. So, total 144 ASHAs were selected from 72 UHCs. Performance assessment was done by direct interview with ASHA and their beneficiaries. Results: All 144 ASHAs were aware about responsibilities of Antenatal-women registration and Immunization. Nearly all ASHAs (99.3%) knew about task of PNC registration. Escorting to delivery and tertiary care centre, if complications arise was facilitated by 61.8% and 29.2% ASHAs respectively. Conclusion: All ASHAs were aware of their major responsibilities related to MCH and also providing same in their field area. Statistically significant association was observed between number of rounds for modular training undertaken by ASHAs and knowledge and practice of ASHAs in context to various components of MCH care.

Cost of delivering primary healthcare services through public sector in India

Background & objectives: Public health spending on primary healthcare has increased by four times (in real terms) over the last decade and continues to constitute more than half of the total public health expenditure. The present study estimated the cost of providing healthcare services at sub centre (SC) and primary health centre (PHC) level in four selected States of India. Methods: A total of 51 SCs and 33 PHCs were selected across the four States (Himachal Pradesh, Odisha, Kerala and Tamil Nadu) of India. The economic cost of delivering health services at these facilities was assessed using bottom-up costing methodology during the reference year of 2014-2015. The cost of capital items was annualized and allocation of shared resources was based on appropriate apportioning statistics. Results: The mean annual cost of providing health services at SC and PHC was ? 0.69 million (US$ 11,392) and ? 5.1 million (US$ 83,837), respectively. Nearly 3/4th and 2/3rd of this cost at the level of SC (74%) and PHC (63%) were spent on salaries. In terms of unit cost, the costs per antenatal care and postnatal care visit were ? 221 (173-276) and ? 333 (244-461), respectively, at SCs. Similarly, the costs of per patient outpatient consultation and per bed day hospitalization at PHC level were ? 121 (91-155) and ? 1168 (955-1468), respectively. Interpretation & conclusions: The cost estimates from the present study can be used in economic evaluations, assessing technical efficiency and also for providing valuable information during scale-up of health facilities.

Clients' Perspective for Quality of Services at One of the Urban Primary Health Centres (U-PHC) at Municipal Corporation Area in One of the cities of Western India

Introduction: Client satisfaction surveys are central to quality improvement at health facility. It helps in identifying areas of low satisfaction and steps to maximize patient satisfaction. Objectives: To assess client satisfaction towards services at Out Patient Department (OPD) of at an U-PHC under Ahmedabad Municipal Corporation (AMC), identify areas of low satisfaction and suggest feasible remedial measures for improvement. Method: Out of 74 U PHCs under AMC, 1 was selected through simple random sampling. Quality of care was evaluated through client's feedback which was gathered through 10 check points (on structure, process and outcome) developed by state level quality team. Responses of 300 adult (> 18 years) subjects and their mean ± standard deviation scores were calculated. These subjects were selected nd thconsecutively as 25 cases (new cases who came first and were willing) on every 2 and 4 Mondays for 6 months (Sep 2019 – Feb 2020). Results: While availability of drugs was perceived as very satisfying that of investigations was relatively an area of concern. Overall, only 1 client rated the services as average while all rest (99.6%) rated services as very good to excellent. Conclusion: Quality of services at this U PHC was good to excellent and had wider acceptability among its client.

Stigma Experienced by Covid-19 Patients: A Descriptive Study

From the start of the Covid-19 pandemic, stigma and discrimination have fuelled the transmission of Coronavirus and has negatively impacted the people who turn Covid-positive. Stigma and its negative feelings have kept people with Covid symptoms from testing and seeking prompt treatment. Identifying the severity of its impact, taking corrective measures to treat the disease and mitigating the stigma related to this novel disease are important roles to be carried out by nurses. This study was conducted among patients discharged from a Dedicated Covid Health Centre (DCHC) in Satara (Maharashtra) to assess the level of stigma faced by them. A quantitative design using a non-probability purposive sampling technique was adopted. Sixty adults in the age group of 18 to 60 years who recovered from Covid -19, who were able to understand Marathi, Hindi or English participated in the study. The study subjects were telephonically interviewed using a self-prepared structured questionnaire. The responses received were collated and analysed. The study revealed that 16 (26.6%) experienced mild stigma, 31 (51.7%) experienced medium stigma and 13 (21.7%) experienced moderate stigma. The stigma was associated signifi cantly with age and there were no signifi cant association between variables such as marital status, gender and occupation.

Early removal of etonogestrel subcutaneous contraceptive implant at a community health centre in Pretoria

The etonogestrel subcutaneous contraceptive implant offers efficacy for three years, but some women remove it earlier than prescribed. This study discusses factors associated with the early removal of these implants at a Pretoria community health centre between 01January 2020 to 30 June 2020.Methods: A cross-sectional study using a piloted and researcher assistant-administered questionnaire.Results: Of the 124 participants who removed their etonogestrel subcutaneous contraceptive implant earlier than prescribed, most were single, unemployed, in the age group 30­39 years, Christian, with secondary level education and with parity one or more. Etonogestrel subcutaneous contraceptive implant pre-insertion counselling was given to all participants, most of whom had not previously used contraceptives. Those participants with previous contraceptive use had used injectables. Long-term contraception was the main reason for getting the etonogestrel subcutaneous contraceptive implant. Most participants did not attend post-insertion counselling. Heavy bleeding was the most common side effect and reason for early removal. Fifty-one participants kept the etonogestrel subcutaneous contraceptive implant in for a longer period of 12­23 months. From participants' responses, it seems that Etonogestrel implants may be offered from as early as 15­20 years of age. Conclusion: Women having etonogestrel subcutaneous contraceptive implants removed early at a Pretoria community health centre tended to be young, single, unemployed, Christian, with a secondary level education and with parity one or more. All participants attended the etonogestrel subcutaneous contraceptive implant pre-insertion counselling services but not the post-counselling services. Heavy bleeding was the main reason for the early removal of the etonogestrel subcutaneous contraceptive implant.Keywords: early removal; etonogestrel; subcutaneous contraceptive; implant; Pretoria; community health centre; weight gain; vaginal bleeding.

Assessing the Incidence of Depression among Patients Attending the Chronic Disease Clinic at the Campbellville Health Centre

Objective: To determine the incidence of depression among the chronic disease patients attending the Campbellville chronic disease clinic. Methods: Data were collected at the CampbellvilleHealth Centre, during the chronic disease clinic hours from the 8th–18th April, 2019. Information was collected using PHQ9 questionnaires and a demographic data collection sheet.Results:Of the 98 patients analyzed, nine (9) patients scored 10 or more points on the PHQ9 questionnaire which translated to an incidence of depression of 9.1%. Of the patients with a positive screen for depression; 6 (66.7%) were females and 3(33.3%) males, 5 (55.5%) Afro Guyanese, 4 (44.4%) were East Indians, 5 (55.5%) patients were between 50-69yrs and 4 (44.4%) were more than 70 years old. Of these patients, there were 8 (88.8%) Christians and 1(11.1%) Hindu, 5 (55.5%) were married, 2 (22.2%) single and 2 (22.2%) were widowed, while 7 (77.7%) were unemployed, 2 (22.2%) were employed and 6 (66.6%) patients were diagnosed with at least 2 chronic diseases. Conclusion: Depression is a mental health disorder that affects persons with chronic disease. The incidence of depression at Campbellville Health Centre was found to be 9.1%. The PHQ9 is a validated, free and easy to use tool for screening and follow up of these patients.Recommendations:A national screening guideline along with adequate materials to diagnose and manage depression should be made available, including access tocouncilors and medications within the primary care setting

Social acceptance and job satisfaction of ASHA workers in the Garo Hills Division of Meghalaya: a cross-sectional study

Background: ASHAs were appointed by NRHM to provide preventive, promotive and curative healthcare services in the rural including tribal villages in Meghalaya. However, their social acceptance and job satisfaction remain less studied. Hence our study aimed at it.Methods: A cross-sectional study was conducted among 140 ASHAs from randomly sampled 142 villages across 15 PHCs in five districts. To collect data, we used a semi-structured back-translated and validated questionnaire consisting socio-demographic profile of ASHAs, level of perceived social acceptance and job satisfaction. Data were analysed using SPSS version 22.0.Results: Mean and median age of ASHAs were 33.29 and 32.00 years respectively. Over 63% belonged to Garo tribes, 67% studied high school, and 91% married. Village elders selected 76% of ASHAs, and 81% were as ASHAs for at least eight years. About 86% were trained in a minimum of three modules and all found their training effective. While 92% had the medical kit always filled, 100% had registers updated, and 94.3% facilitated VHND and FHD meetings. About 97% accompanied the pregnant women, 96.4% attended PHC meetings regularly and 83.6% organized VHSNC meeting. Though 93.5% reported a high acceptance of ASHAs' services, social acceptance of ASHAs was rather to some extent for 36.4%. Almost 52% of ASHAs were dissatisfied with job and 61% were unhappy with their performance-based remuneration.Conclusions: Community must be aware of ASHAs’ role, and their job satisfaction has to be increased with a corresponding increase in incentives while developing strategies to ease the process of payments.

Screening for autonomic neuropathy using validated non-invasive scale among diabetes patients treated in the selected primary health centres of Puducherry, India: an operational research

Background: Diabetes autonomic neuropathy (DAN) is a complication of diabetes which has direct implications on the mortality of diabetes patients. American Diabetes Association (ADA-2017) guidelines recommend early recognition and treatment of DAN. In this regard, we conducted a study among diabetic patients treated in the selected PHCs of Puducherry to determine the proportion with DAN and to assess the factors associated with DAN.Methods: A cross-sectional analytical study was conducted among diabetics and information on socio-demographic details, morbidity and behavioural risk factors were elicited using semi-structured interview schedule. The COMPASS-31 questionnaire was administered to assess the autonomic neuropathy symptoms. The data was captured using EpiCollect mobile app and analysed using Stata 12.0 software. The proportion of DAN was expressed as percentage with 95% confidence interval. The association between independent factors and DAN was assessed using multivariate generalized linear models. The prevalence ratio with 95% CI was used to express the strength of association.Results: Of the total 303 individuals with diabetes, 32 {10.6% (95% CI: 7.3%-14.6%)} were screened positive for autonomic neuropathy using COMPASS-31 scale. The number of individuals with diabetes who needed to be screened (NNS) for finding one with autonomic neuropathy was 10 (303/32).Conclusions: One in ten individuals with diabetes was screened positive for autonomic neuropathy. With good yield, there is need for including autonomic neuropathy screening as a component in the comprehensive care provided to diabetes patients in the primary health centres.

Assessment of physical activity level among patients with type 2 diabetes mellitus attending rural health centre, Marappadi

Background: Insufficient physical activity is one of the ten leading risk factors for death among patients with Non- Communicable Diseases (NCDs) such as cardiovascular diseases, cancer, and diabetes mellitus worldwide. Globally, one in four adults is not physically active. More than 80% of the world's adolescent population is insufficiently physically active. Physical inactivity is very common in India with a prevalence of 54.4%. Lack of knowledge regarding physical activity leads to non-communicable diseases (NCDs) such as cardiovascular diseases, cancer, and diabetes which in turn can lead to death and disability.Methods: The cross sectional study was conducted on patients diagnosed to be diabetic visiting the Out Patient Department of Rural Health Centre Marappadi. Convenient sampling was used and the study was conducted from January 2017 to June 2018 using a pre-tested, semi-structured questionnaire.Results: The mean age of the patients was 57.00±8.747 years. Patients aged 60 years and above had a lower physical activity level. In the older age group, low physical activity was associated with obesity. Adequate motivation was found to be reason for high physical activity level in patients (60.0%).Conclusions: The physical activity levels of the diabetic patients were unsatisfactory especially in the elderly. Low physical activity was associated with poor glycaemic control in the older age group. There is a need to encourage diabetic patients to undertake regular physical activity in order to achieve good health and well-being, optimal glycaemic control and to prevent diabetic

Management of patients with obstructive lung disease in South India: a retrospective study of spirometry and bronchodilator use in an urban health centre

Background: Based on the burden of obstructive lung diseases program (BOLD), the global prevalence of chronic obstructive pulmonary disease (COPD) was 11.7% in which 90% of the deaths occur in low- and middle-income countries. India and China are estimated to account for 66% of total global COPD mortality. The Indian Chest Society (ICS) recommends spirometry to document irreversible airflow limitation in patients suspected of having COPD. However, the reported usage of spirometry among primary care physicians in India is only 10-20% as primary health care centers in India are not equipped with spirometry or inhaler devices.Methods: A retrospective study was done on patients treated for respiratory symptoms with bronchodilators at an urban health centre to document the practice pattern of primary care physicians with regards to use of spirometry in patients on bronchodilators.Results: Of the 1196 patients on bronchodilators, spirometry was documented in 15.5%. Patients on inhalers, using more than one therapy and males less than 55 years were more likely to undergo spirometry. About 52.4% of patients who underwent spirometry were found to have post bronchodilator forced expiratory volume at first second (FEV1)/ forced vital capacity (FVC) less than 0.7 of which 43% had severe disease and 44% had poor post-broncho-dilator reversibility.Conclusions: Besides diagnostic spirometry, management guidelines for COPD should be complemented by health education to change patients’ perception of respiratory symptoms, increase awareness of COPD in those with risk factors and change their health seeking behaviour along with continuous professional development activities for primary care physicians.

Challenges faced by the patients in the management of risk factors of non-communicable diseases in a government primary health care setting of Puducherry

Background: India’s current approach for intervention in non-communicable diseases (NCDs) is more in terms of early diagnosis and treatment. The focus should also be on the management of risk factors in the diseased individuals. The objectives of the study are to measure the risk factors of NCDs, lifestyle modification followed by them and to assess the challenges in reducing the risk factors of NCDs faced by the study population.Methods: The study was conducted between March and June 2017 in 2 government primary health centres (PHCs) in Puducherry. Based on systematic random sampling, 200 patients enrolled in NCD clinic with diabetes mellitus, hypertension, Stroke and myocardial infarction were selected for the study. After obtaining written informed consent, data was collected.Results: Out of 200 participants, majority of them were in the age group of 51-70 years (60%), females (71%) and living in nuclear family (83%). Among 200 participants, 23.5% of them had diabetes mellitus, 42% had hypertension and 24% had diabetes with hypertension. The risk factors that many of the participants had were excessive salt and sugar intake, overweight and obesity, less vegetable and fruits intake and alcohol consumption. Out of 200 participants, the major challenges in reducing the salt and sugar intake were lack of awareness and no family support.Conclusions: Most of the participants were oldest females who had diabetes or hypertension. The most common NCD they were suffering from were diabetes and hypertension. The major challenge in the management of NCDs is lack of awareness.

Satisfaction levels of patients visiting primary health care centers in border areas of Jammu division

Background: Patient satisfaction surveys are one of the most important feedback systems for any hospital to understand patient concern and take necessary corrective measures. The study was done in primary health centers in border areas of Jammu division to know the satisfaction among the patient and describe their socio-demographic profile.Methods: Study was cross-sectional questionnaire based study conducted among the inpatient of the primary health center, Paragwal from 01 July 2018 to 30 November 2018. Data was collected using a pre-tested questionnaire and entered in an excel sheet and analysed using SPSS 20.Results: A total of 110 respondents participated in the group. The mean age of the study subjects was 43.4±9.7 years and majority (86%) of the respondents was married, higher proportions of males (71%) and majority subjects (77%) were illiterate. According to Kuppuswamy scale, 66% of the study subjects belong to low socio-economic status (SES). There was no statistical significant association of socio-economic status, age, literacy. Female gender was associated with satisfaction regarding explanation of illness.Conclusions: In the present study, we found that majority of the participant were satisfied. However, the areas like congestion and time management needs improvement.

Developing Consensus Indicators to Assess Pharmacy Service Quality at Primary Health Centres in Yogyakarta, Indonesia

@#Background: There have been no existing performance indicators to measure the overall quality of pharmacy services, including the aspects of drug management and clinical pharmacy services, at primary health centres in Indonesia. This study aimed to obtain these indicators based on a consensus of experts. Methods: The modified Delphi method was used to obtain the consensus. The initial indicators, based on a literature review, were evaluated and assessed by members of the expert panel through three rounds of repetition until the consensus was reached. The expert panel members were selected based on their knowledge of or expertise in pharmacy service performance and geographical considerations. Analysis of the expert panel consensus level was determined by calculating the mean and interquartile range. Results: Fifteen expert panel members started the first round (93.7% of the 16 targets) with 12 of them (75%) completing the third round of the modified Delphi method. Three expert panel members were representatives of the Regency Health Office, and the others were pharmacist practitioners at primary health centres from three different regencies. The consensus results were 26 indicators of drug management, 19 indicators of clinical pharmacy services, and two indicators of overall pharmacy performance. Conclusion: The consensus indicators for measuring drug management, clinical pharmacy services, and overall pharmacy performance can be used as a reference and standard to measure the quality of pharmacy services at primary health centres. Therefore, the measurement results are more relevant if compared between one and other studies.

Urban health: Needs urgent attention

Urban population in our country has increased at an annual rate of 2.7% during the last decade and it is estimated that by 2031, there would be about 600 million people living in urban India. The fast pace of urbanization has come to stay with increasing proportion of urban poor and vulnerable with health indicators much worse than their rural counterparts. The need to provide health care to urban poor has been emphasized in the past in various health committees' reports and National 5-year Development Plans, but no significant dent was made to improve the urban health scenario of the country. The National Urban Health Mission launched in May 2013 provides us a concrete mechanism to address special health needs of urban population with focus on urban poor. There is a strong need to set up primary healthcare system in urban areas and systematically deal with urban health challenges in terms of vector-borne diseases, rising incidence of noncommunicable diseases, air pollution and acute respiratory infections, road traffic accidents, trauma, and injuries. The initiatives to address these challenges do not remain confined to health sector alone but also need to be supported by sectors other than health such as social welfare, women and child development, road transport and highways, school education, drinking water, and sanitation. We really need to address wider and social determinants of health to effectively improve the urban health scenario.

Survey on attitude to sexually transmitted disease testing among physicians in community health service centers of 20 cities in China / 中华全科医师杂志

Objective To survey the attitude to sexually transmitted disease(STD)testing among physicians in community health service centers(CHC)of 20 cities in China.Methods A cross-sectional survey using stratified random sample was conducted in September to December 2015, among 1 734 physicians from 158 CHCs in 20 cities of 6 provinces and 2 municipalities.Results The average age of participants was(39.7 ±10.6)years, the time for present position was(15.8 ±11.5)years, and 47.0%(799/1 700)were general practitioners(GPs).The survey showed that in the last month,8.1%(138/1 699)of the physicians contacted with the specific population of STD(sex worker,MSM,drug user, etc), and 18.3%(313/1 706)of them managed STD patients or provided services to suspected STD patients;62.0%(1 048/1 689)of them received the STD-related training previously;46.5%(784/1 686) thought the lack of training in STD testing as the biggest barrier for carrying out STD testing in CHC.As for the specific populations, 73.4%(1 241/1 692)of physicians thought that it was meaningful, 62.0%(1 043/1 683)of them worried about"have difficulty to deal with their STD clinically", and only 5.8%(97/1 683)of them expressed their"dislike of specific population".Conclusions Most physicians in CHCs believe that STD testing should be included in the routine tests, and it is feasible to carry out STD testing in CHCs.Lack of training is the main barrier for STD testing, so it is necessary to conduct STD testing related trainings in CHCs.

Adoption of hand hygiene practices among health care providers.

Background: Hand hygiene is the most important measure to avoid the transmission of harmful germs and prevent health care-associated infections. Hand washing with plain soap removes loose transient flora even though it does not remove pathogens from the hands of healthcare workers. Proper hand hygiene is cheap, most effective, easiest and foremost method of reducing health care associated infections. This study was carried out to know the present status of hand hygiene practices and the barriers to adherence. The objective of the study was to assess the adoption of appropriate hand hygiene practices among health care providers and to find out the reasons for non-adoption. Methods: A cross sectional study was done to assess the adoption of appropriate hand hygiene among health care providers (Doctors, nurses, lab technicians) in upgraded/ block PHCs of Thiruvallur district... The data was analysed by SPSS-16. Proportion & chi square test was used to assess the statistical significance at 5% α. Results: In PHC’s there were 32 doctors, 61 nurses and 17 lab technicians which constitute to 110 heath care providers. Hand hygiene practices were satisfactory among 40 (36%) Z = 9 and the difference is statistically significant p<0.05. Conclusions: Hand hygiene protocols will reduce the nosocomial infections. Hand hygiene is the most important measure to avoid the transmission of harmful germs.

Utilization of health facilities at primary health centre by rural community of Pondicherry.

Background: The utilization of services at Primary Health Centre (PHC) by the community differs from place to place and changes over the time based on the availability of quality of services. It is also necessary to evaluate the utilization trend of primary health centre services by the community. Objective: to know the pattern of utilization by rural community on availability, utilization and perception of facilities at primary health center. Material and methods: A cross sectional, descriptive, community based study was done during September to November 2014 in selected sample from PHC area by interviewing 300 families on various aspects at their doorstep. The date collected from each family on the aspects such as awareness, availability, utilization and perception of facilities at primary health center. Results: More than 80% were aware about the PHC, its location and more than 75% on availability of free medicines and laboratory investigations. Many preferred to visit PHC for their ailments and waiting time for treatment was less than 30 minutes and 70% of families visited the PHC at least once since last 3 months for some kind of health problems. The common ailments were respiratory problems, fever episodes and accidental injuries. Nearly 50% were aware about the contents in the display of posters on various health education topics. Conclusion: Periodic assessment of pattern of utilization of PHC is important to improve the service utilization by the community through their involvement.

Challenges to the implementation of the integrated management of childhood illness (IMCI) at community health centres in West Java province, Indonesia.

Background: The integrated management of childhood illness (IMCI) is a comprehensive approach to child health, which has been adopted in Indonesia since 1997. This study aims to provide an overview of IMCI implementation at community health centres (puskesmas) in West Java province, Indonesia. Methods: Data were derived from a cross-sectional study conducted in 10 districts of West Java province, from November to December 2012. Semi-structured interviews were used to obtain information from staff at 80 puskesmas, including the heads (80 informants), pharmacy staff (79 informants) and midwives/nurses trained in IMCI (148 informants), using semi-structured interviews. Quantitative data were analysed using frequency tabulations and qualitative data were analysed by identifying themes that emerged in informants’ responses. Results: Almost all (N = 79) puskesmas implemented the IMCI strategy; however, only 64% applied it to all visiting children. Several barriers to IMCI implementation were identified, including shortage of health workers trained in IMCI (only 43% of puskesmas had all health workers in the child care unit trained in IMCI and 40% of puskesmas conducted on-the-job training). Only 19% of puskesmas had all the essential drugs and equipment for IMCI. Nearly all health workers acknowledged the importance of IMCI in their routine services and very few did not perceive its benefits. Lack of supervision from district health office staff and low community awareness regarding the importance of IMCI were reported. Complaints received from patients’ families were generally related to the long duration of treatment and no administration of medication after physical examination. Conclusion: Interventions aiming to create local regulations endorsing IMCI implementation; promoting monitoring and supervision; encouraging on-the-job training for health workers; and strengthening training programmes, counselling and other promotional activities are important for promoting IMCI implementation in West Java province, and are also likely to be useful elsewhere in the country.

Study of rural health centre services utilization by adolescents in district Muzaffarnagar (Uttar Pradesh-India).

Background: Currently adolescents mortality and morbidity in rural areas is featured by many causes such as communicable as well as non-communicable diseases apart from accidents, suicides etc which lead to illness or premature death later in their life and their usage of rural health centre services is also emerging to be a new issue. That’s why it is important to study this area critically. Aims & Objective: To study the rural health centre services utilization by adolescents. Materials and Methods: This was prospective study carried out from 1st January 2013 to 31st December 2013. The study was carried out at the rural health and training center (RHTC), Bilaspur of Muzaffarnagar Medical College, Muzaffarnagar (UP) which covers 6 villages. All adolescents attending OPD in year 2013 according to the WHO defined criteria of adolescents (10-19 years) and who gave consent were included and enrolled in this study. Adolescents who did not attend OPD and those who did not give consent for participation in study at RHTC Bilaspur were excluded. Results: The study found that the majority of female patients utilized OPD services of RHTC (53.3%) but main health care service utilized among adolescents was Medical Problem (20.5%) whereas Obstetrical & Gynaecology problems were least (13.8%). Among the other services; most common utilized were dressing for injuries (11.3%) and least utilized were, immunization services (0.8%). Conclusion: The usage of health services utilization of RHTC suggests that there are emerging problems in different health specialties among adolescents, so this area needs further research in future studies.