ABSTRACT
Background: India has around 240 million under-five children and contributes close to 25% of under-five mortality. About 70% of such deaths are due to diarrhea, pneumonia, measles, malaria or malnutrition and often a combination of these conditions. These are also the diseases that are seen to afflict three out of every four sick children seeking care at a health facility. Aim of the study: To evaluate the utility of the WHO / UNICEF guidelines for “Integrated Management of Neonatal and Childhood Illness” among children aged two months to five years attending an Urban center. Materials and methods: This Prospective observational study was did in the outpatient department and emergency room, The Institute of child Health and Hospital for Children, Egmore, Chennai. Children attending the outpatient department and emergency room aged between 2 months and 5 years for the first time for a fresh complaint due to any illness were included in the study. Each study subject was assessed and classified according to IMNCI guidelines and the treatment options were identified and recorded in a proforma. Each child was evaluated using IMNCI algorithms for high Venkatesh Periasami, Senthilkumar Palanivelu. Evaluation of the utility of IMNCI algorithm in predicting illness, hospitalization, and management of children aged 2 months to 5 years in a tertiary referral centre. IAIM, 2019; 6(3): 73-82. Page 74 malaria risk areas and low malaria risk areas. The IMNCI algorithm was split into four modules dealing with specific complaints (cough/breathing difficulty, diarrhea, fever, ear problems) and the classification and treatment options arrived at for each child on applying the specific split algorithms guided by the presenting complaints were also noted. Results: 517 complaints were reported by the parents/other caregivers accompanying the children enrolled in the study; an average of 1.72 complaints per child. depicts the frequency of these symptoms. Over 43% (227) of such complaints comprised of respiratory problems such as cough or difficulty in breathing. One-fourth of all presenting complaints (125) were fever and another 10% (56) consisted of loose or bloody/mucoid stools. Other complaints frequently reported were convulsions (15, 2.9%), vomiting everything (14, 2.7%), lethargy/unconsciousness (11, 2.1%), not being able to drink/breastfeed (11, 2.1%) and ear problems (9, 1.7%). Conclusion: Multiple diagnoses are the rule than an exception in under five sick children. Hence vertical, disease-specific algorithms are inappropriate in the evaluation and management of a sick child. Integrated approaches must be preferred. The IMNCI algorithm can address most complaints that sick children present with. When implemented by health workers with appropriate training, the referral criteria of IMNCI are fairly good predictors of serious illness which requires medical attention.
ABSTRACT
Ceramic factory workers are potentially at risk to develop occupational respiratory diseases due to chronic inhalation of dust particles generated in the ceramic factory. A cross-sectional descriptive study was carried out to assess the respiratory and other health problems among the workers of Mirpur Ceramic Works Limited, Dhaka, Bangladesh during the period of April to June, 2011. Among 200 participants, 132 (66%) were males and 68 (34%) were females. Less than one-third of the workers were habituated to use personal protective equipments (PPE), while more than two-third were not habituated. Nearly half (45.5%) of the workers were suffering from at least one respiratory problem and of them 86.8% (P = 0.001) had problems after joining the factory. Of the respiratory sufferers 27% had chronic bronchitis, 20% bronchial asthma, 1% pulmonary tuberculosis, and 0.5% had silicosis. A significant numbers (60.5%) of workers were suffering from other health problems along with or without respiratory problems, in terms of musculoskeletal pain, back pain, headache, dermatitis, anaemia and fever. The prevalence of respiratory problems was significantly higher among non-users of PPE than PPE users (P = 0.006), and it was found to be higher with the increased of job duration. The study showed the notable higher prevalence of respiratory problems among the workers exposed to ceramic dust, although the other potential environmental confounding factors could not be ruled out in the analysis. Obligatory use of PPE by all workers and health education to increase awareness among the workers might have role to reduce the prevalence.
ABSTRACT
Background. A case-controlled study was undertaken to find out the possible relationship of biomass fuel and pulmonary tuberculosis. Methods. Ninety-five non-smoking females with sputum positive tuberculosis (TB) and 109 healthy controls were interviewed using a questionnaire to obtain detailed information on type of fuel used in homes, duration of cooking, passive smoking, location of kitchen, socio-economic status, adequacy of ventilation, number of people per room and respiratory symptoms occurring during cooking. Odds ratio (OR) was ascertained by logistic regression analysis. Results. The cases were from a low socio-economic status and the kitchens used by them were inadequately ventilated. Controls had less smoke accumulation in the rooms while cooking and cases had associated respiratory symptoms more often. Logistic regression analysis revealed that TB was significantly influenced by the location of the kitchen (OR 0.201, 95% confidence interval [CI] 0.08-0.51) and the presence of respiratory symptoms while cooking (OR 10.70, 95% CI 2.90- 39.56). The odds of having TB did not differ significantly among various fuel types either on univariate (OR 0.99, 95% CI 0.45- 2.22) or multivariate analysis (OR 0.60, 95% CI 0.22-1.63). Conclusions. No association was found between type of fuel used and TB. However, low socio-economic status, smoky rooms, location of the kitchen, ventilation and associated respiratory symptoms during cooking are likely to be important contributors.