Clinico-epidemiological profile of women with high-risk pregnancy utilizing antenatal services in a rural primary health center in India / Journal of Rural Medicine

Objective: Early detection and effective management of high-risk pregnancies can substantially contribute to the reduction of adverse maternal and fetal outcomes. This study aimed to determine the prevalence and clinical profile of women with high-risk pregnancies in rural areas who utilize antenatal services in a primary health center (PHC).Materials and Methods: A retrospective analysis was carried out over a six-month period by reviewing the mother and child protection cards maintained at the PHC’s Maternal and Child Health Center. During the study period, 950 pregnant women were registered, of whom 793 were included in the study based on the completeness of the records. Data analysis was performed using the licensed Statistical Package for the Social Sciences (SPSS) software version 21.0.Results: The prevalence of high-risk pregnancy among the antenatal women was 272 (34.3%) with 95% CI [31.1–37.7]. Of the 272 women, 240 (88.2%) had a single high-risk factor, while 32 (11.8%) had more than one high-risk factor. The major factor contributing to high-risk pregnancy was hypothyroidism (43.7% with 95% CI [37.9–49.6]), followed by a previous lower segment Caesarean section (LSCS) (19.1%).Conclusion: The study found that the prevalence of high-risk pregnancies was 34.3% in this rural setting. The majority of high-risk pregnancies were due to hypothyroidism, followed by more than one previous LSCS or abortion. Further research is required to track high-risk pregnancy outcomes and investigate the newborn thyroid profile of women with hypothyroidism.

Diabetes mellitus in the Tamil Nadu State—Noncommunicable diseases nurse model in diabetic retinopathy screening

Tamil Nadu is one of the states in India, where the diabetic retinopathy (DR) project was implemented in the Tirunelveli District. Aravind Eye Hospital, Tirunelveli was the mentoring institution and ophthalmology department of Tirunelveli Medical College and Hospital (TVMCH) was the implementing partner. The objective of the project was to develop a district level model for building capacity at the government health system for effective screening, diagnosis and management (primary to tertiary) of diabetic retinopathy. The DR screening, counseling, referral and follow-up tasks were included in the scope of Non- Communicable Disease (NCD) nurses at the respective Community Health Centres and Primary Health Centres using the tele-medicine platform. During the project period (December 2016 to June 2019), 8,574 people with diabetes were registered at the 18 CHCs/PHCs. 6,462 (75.4% of those registered) were screened by NCD staff. The government has agreed to scale up services in 3 more districts.

Implementation status of Janani Shishu Suraksha Karyakram in Ahmedabad district

Background: The government has launched various schemes for reduction in maternal mortality rate and neonatal mortality rate. The Janani Shishu Suraksha Karyakram (JSSK) was launched to increase the institutional delivery by providing the entitlements for mother and infants by government. Objectives: The objectives of the study were to assess the implementation status of JSSK and to identify the beneficiaries and provider perspective. Materials and Methods: The cross-sectional study was carried out during January 2014-December 2015. A total of 19 primary health centers (PHCs) and 10 community health centers (CHCs) were selected to study the implementation status of JSSK in Ahmedabad district. Results: All the PHCs and CHCs had basic infrastructure facilities. In 50% PHCs and the entire CHCs provider perceived that there was overload in the work after the implementation of scheme. Provider perceives that there was lack of awareness of entitlements among beneficiaries. Conclusion: All the PHCs and CHCs have the required infrastructure facilities to provide maternal and child health services. The laboratory services were available in all health centers, but it was inadequate.

A Comparative Study To Analyze The Cost Of Maternal And Child Health programme At Primary Health Center In Ahmedabad, India.

Abstracts: Background: Cost studies are paramount for demonstrating how resources have been spent and identifying opportunities for more efficient use of resources. The aim of this study was to determine the unit cost of maternal and child health (MCH) programme provided at Primary Health Centers (PHCs) and to examine the variation in unit cost in different PHCs. Methodology: The present study was carried out in three PHCs of Ahmedabad district namely Sanathal, Nandej, and Uperdal, between 1 April, 2006 and 31 March, 2007. For estimating the cost of a health program, information on all the physical and human resources that were basic inputs to the PHC services were collected and grouped into two categories, non-recurrent (capital resources vehicles, buildings, etc.) and recurrent resources (salaries, drugs, vaccines, contraceptives, maintenance, etc.). To generate the required data, two types of schedules were developed, daily time schedule and PHC/SC (Subcenter) information schedule. Results: Unit cost for each contact of MCH beneficiaries was Rs. 54.87 at Sanathal PHC, Rs. 87.63 at Nandej PHC and Rs. 70.01 at Uperdal PHC. Conclusion: Even though maternal and child health services are free, utilization of these services at the health centres were low, particularly for delivery, leading to high unit costs.

Evaluation, Awareness, Practice and Management of Cold Chain at the Primary Health Care Centers in Coastal South India.

Introduction: Vaccination is one of the most effective disease prevention strategies and potency of vaccines is dependent on effective management of cold chain at all levels of vaccine handling. The objective was to assess the status of cold chain at the primary health centers and to assess the knowledge and practices of medical officers at these centers regarding cold chain management. Materials and Methods: This cross sectional study was conducted at 70 primary health centers of Dakshina Kannada District of Coastal South India. Cold chain equipment and maintenance process was noted following direct observation on uninformed visits. Data regarding the knowledge and practices of cold chain management was obtained by interviewing the medical officers using structured pretested questionnaire. Results: Ice lined refrigerators and deep freezers were available in 69 (98.6%) and 67(95.8%) of centers. Dial thermometer was present in all the centers. Cold boxes, frozen packs and automated voltage stabilizers were available in 68(97.2%) centers. Improper vaccine storage was observed in 7 (10%) centers. Majority of medical officers had knowledge and correct practices in fields like ideal equipment, OPV administration, vaccine requiring diluents but only 47 (61.8%) medical officers had correct practice of defrosting the deep freezers. Conclusions: The availability of equipment is near universal. Improper vaccine storage practices and poor knowledge in some fields of cold chain management may adversely affect the quality of administered vaccine. Relevant training for those handling the cold chain is recommended.

Predictors for antenatal services and pregnancy outcome in a rural area: A prospective study in Wardha district, India.

Background :Antenatal care is essential to reduce morbidity and mortality among newborn babies and pregnant women. Aims: To study the pattern of utilization of antenatal services and to find out the potential predictors, their distributions and their association with antenatal care utilization and pregnancy outcomes. Settings and Design :A prospective longitudinal study was conducted in Deoli, a rural teaching area of a medical college of Wardha district, Maharashtra state. Materials and Methods : Medical social workers contacted all the registered 305 pregnant women in 1 month. A total of 274 women were included in the study. The response rate was 89.83%. Statistical Analysis Used : Percentages, rate ratio. Results : Mean age at marriage was 19.8±3.6 years, and the average age at first pregnancy was 21.6± 4.5 years. Of the 274 pregnant women, 156 (56.9%) were pregnant for the first time (gravida 1), and the remaining 118 (43.1%) pregnant women, gravida 2 and above, had an average of 2.1 living sons and 1.9 living daughters. Only 92 (33.6%) women had undergone the minimum recommended antenatal checkup during their current pregnancy, and 188 (68.6%) women had institutional deliveries. A large proportion of women in Deoli do not receive proper health care during pregnancy and childbirth. Conclusion : In Deoli, antenatal services, in spite of being essential to the care of pregnant women, are being poorly delivered.

Management of Nosocomial Infections in Fourteen Primary Health Centers: A Survey / 中华医院感染学杂志

OBJECTIVE To understand situation in management of nosocomial infections in primary health centers in order to provide evidence for improving the management quality.METHODS An observatory study was(conducted) in 14 primary health centers using the evaluation criteria based on the requirements of The Guidelines for Management of Nosocomial Infections and the Guidelines for Disinfection in Hospitals.RESULTS Problems were found to a different extent in all of the 14 health centers.Most alarming problems were high incidence(15.7%),high(missing report)(67.7%),frequent use of antibiotics(71.2%),low proportion of nosocomial infection(specimens) submitted for testing(12.9%),lack of surveillance system for nosocomial infections and the data(feedback),and non-qualified hand-washing equipment in wards and clinics.CONCLUSIONS Special attention to management of nosocomial infections,improvement of surveillance system,and capacity-building of professionals in management of nosomial infections is the key issues for sustained and perfect development of management of nosocomial(infections) in primary health centers.