Plastic surgery in Ladakh: a novel initiative in trans Himalaya of India

Background: The super speciality care is not available in remote places in India. But the service of the plastic surgery can be taken to the remote district hospital by arranging plastic surgery camps thereby resulting in service to the poor, capacity building of the local doctors and infrastructure development of the remote hospital.Methods: It is a retrospective study, in which the author analysed the feasibility, management, difficulties and achievement of week long, annual plastic surgery camp in remote set up of a district hospital of Ladakh over three year from 2017 to 2019.Results: A total of 341 patients were included in this study of which 108 underwent various surgical interventions. The youngest operated was 5 months old and oldest was 86 years. Wide spectrum of deformity were seen and operated upon. Complication developed in only six patients (5.5%) which were managed successfully at Leh only. The immediate and long term follow-up result show no difference in surgical result as compared to those compared operated outside with negligible financial burden.Conclusions: Keeping in view the positive outcome, it is argued through this paper that such camps should be replicated in other remote locations all over India.

Clinical profile and prognostic indicators of neurotoxic snake bite in rural India

Background: In rural India, snakebite is an occupational and environmental hazard. WHO listed snakebite as one of the neglected tropical diseases and in rural India it is underreported because of popular traditional methods of treatments and lack of healthcare facilities. This study is an attempt to look into the epidemiological, clinical and prognostic indicators of neurotoxic snake bite in rural India.Methods: This study is a prospective, descriptive study of 25 neurotoxic snake bites admitted in our hospital from January to September 2019. Clinical factors like age, sex, clinical features, management and the outcome of patients are studied.Results: Young males were common victims of snakebite in evening hours during monsoon season. All patients received traditional methods of treatment, and despite this 64% of our patients reported to the hospital within 6 hours after the bite. Overall, the mortality rate in this study was 12%. Poor outcome was also noted in cases who were having respiratory failure and needed artificial ventilation (30%). Mortality was 22.2% in patients where bite to admission time was greater than 6 hours as compared to 6.25% in patients where it was less than 6 hours.Conclusions: Author concluded that a neurotoxic snake bite is a life-threatening emergency. In preventive measures, outdoor activities in dim lights during monsoon season should be restricted. Traditional treatments are still popular and trusted methods of treatment in rural India and these healers can be educated to recognize and refer immediately all neurotoxic bites to nearby medical facilities.

Unsafe abortion: the silent scourge

Background: Unsafe abortions continue to cause maternal morbidity and mortality in developing countries. The practice of unsafe abortions by quacks needs to be checked. Our study aims to emphasize upon the unmet needs of medical termination pregnancies (MTP) services in rural India and to recognize the complications due to it and the efficient management of such cases at tertiary care center.Methods: A two years retrospective study of septic abortions from December 2009 to November 2011.Results: Among 1080 abortions reported, 44 were septic-4.07%. More commonly in the age group of >20years (81.9%). 77.3% of them were multiparous and 22.7% were nulligravidae, with an increased incidence of unmarried nulliparous pregnancies. Greater numbers occurred during 1st trimester (77.2% versus 22.7%), with 54.5%-grade I, 29.5%-grade II, 15.9% grade III in severity. Majority of cases were due to evacuation by quacks (72.7%). Among the 44 cases, emergency laparotomy was done for 5 cases of grade III severity. The mortality rates due to septic abortion were 6.25% (3) among the total of 48 maternal deaths.Conclusions: Septic abortion is totally preventable. Majority of uneducated rural women are not aware of MTP services. The reproductive and child health (RCH) services should effectively reach the underprivileged population like slum dwellers and migrants.

A study regarding availability and utilization of services of the government health facility in village Nagkalan, district Amritsar, Punjab

Background: Health care expenses induced impoverishment in the poverty stricken strata of rural India is a major issue. The government of India has come up with various services in public health facilities, but there are various factors which curtail the utilization of available services and people have to visit some private health facility. The present study deals with the extent of utilization of services of government health facility and the factors impeding the utilization.Methods: The present cross sectional study was conducted in village Nagkalan, district Amritsar, where the eldest adult members present in the house at the time of the visit, and are interviewed using a semi-structured and predesigned questionnaire. A total of 1123 families were included in the final analysis. Data was compiled, analysed and valid conclusions drawn.Results: Almost all the respondents were aware about the existence of subsidiary health centre in the village. However, out of those who were aware, 40.8% never visited the centre. Utilization was more in the lower socio economic status. Immunization services followed by treatment for common ailments constituted the top two reasons for visiting the centre. Out of those visiting the centre, 80.7% were not satisfied with the current timings of the centre; only 20.2% were attended by the doctor and 33.3% reported that the prescribed medicines were never available at the centre.Conclusions: Regular supply of prescribed medicines, availability of the doctor and appropriate timings are critical for utilization of health care services at the government health facility.

Study of knowledge attitude practices and utilisation of existing health services by families with regard to newborn health at block level in rural India: a community based, cross sectional, observational study

Background: The present study was undertaken to identify KAP gaps and the objective of the study were to assessment of utilization of existing health service infrastructure at grass route level in rural community with regard to mother and neonatal care.Methods: A community based cross-sectional observational study. About 50 mother neonate pair residing in villages under study belonging to Dewas district, Madhya Pradesh.Results: Age old customs and practices of large family (80%), adolescent marriages (30%), high fertility (50%), poor housing and sanitation (48% or more) are still widely prevalent in rural India. Positive impact of NRHM with launch of JSSY and NSSK was seen in utilization of ANC services among beneficiaries with 100% ANC registrations, 98% institutional deliveries and 100% deliveries conducted by trained health professionals, prompt referral to SNCU. Birth weight was not known in 36% neonates and 18% had not received BCG vaccination. 22% were low birth weight and 22% neonate's required SNCU care. Government emergency transport facility in form of ambulance was either absent (36%) or not utilized (26%) by majority.Conclusions: Lacunae were seen to be persisting regarding awareness and utilisation of few components of maternal and neonatal health care especially in government sector in spite of launch of third phase of NRHM. This was evidenced by, lack of awareness of Obstetric USG facility at civil hospital, non-utilisation of ambulance service for transport, not knowing neonates birth weight and no neonatal follow up care and failure to vaccinate the neonate even till 3rd or 4th week of life.

Various addiction patterns, dietary habits, associated medical problems, and socioeconomic status in gastrointestinal malignancies: A prospective study in rural area of Maharashtra, India

Background: Gastrointestinal (GI) malignancies are increasing with advancing age. Various addictions and poor dietary habits are among the major risk factors. Early detection is difficult until patient notices symptoms. Primary prevention by knowing various risk factors and early symptom awareness will help in early diagnosis and better treatment outcome. Objectives: This study is carried out to see various addiction patterns, dietary habits, associated medical problems, and socioeconomic status with various sites involved in GI malignancies, at a tertiary care teaching hospital of Western Maharashtra, India. Materials and Methods: Prospective questionnaire-based study was carried out for 11 months. A total of 100 diagnosed carcinoma cases of GI tract malignancy were taken for study. Results and Conclusions: Out of total 100 cases, 61 were male and 39 were female. The most common site involved was esophagus (41) followed by rectosigmoid, colon and cecum, stomach, and anal canal (29, 14, 13, and 3, respectively). There were 45% of cases above 60 years of age. The most common addiction was smokeless tobacco. Most of the patients belonged to lower and upper lower class (64%). Majority of cases (81%) were nonvegetarian, only 16% were pure vegetarian. Most of the cases (85%) were in advanced stage of disease (III and IV). Awareness program for harmful effects of various addictions and importance of high-fiber diet (vegetarian diet) will help in health promotion and prevention of various malignancies. Awareness about the early symptoms of GI malignancy will help in early detection of disease and better treatment outcome.

Epidemiology of confirmed coronary heart disease among population older than 60 years in rural central India—A community-based cross-sectional study

Background Three-fifths of total deaths in India are attributed to noncommunicable diseases, and coronary heart disease (CHD) is one of the dominant causes. There are only few studies available in India to find confirmed CHD by pragmatic approach. This study aims to find prevalence of confirmed CHD and its risk factors in rural community of central India. Materials and methods This was a community-based cross-sectional study during 2013–2014 involving adults ≥60 years from 13 villages in rural central India. We screened CHD on the basis of history and standard 12-lead ECG. Apart from the past documentation of CHD, we diagnosed confirmed CHD in symptomatic patients or with resting ECG changes by means of echocardiography, exercise ECG test or coronary angiography whenever needed. Results We screened 1190 of 1415 individuals ≥60 years for CHD. Five hundred eighty were men and 610 were women. Diagnosis of CHD was confirmed in 61 individuals (29 men and 32 women). The prevalence of CHD in individuals older than 60 years was 51.3 per 1000 population. Hypertension was the only independent risk factor associated with CHD, whereas association of diabetes mellitus, obesity, socioeconomic status and smoking with CHD was not significant. Conclusion Prevalence of confirmed CHD has increased in agrarian rural community in central India, which requires further studies to find out causative factors.

Multidrug-resistant Enterobacteriaceae colonising the gut of adult rural population in South India

Background: Multidrug-resistant (MDR) colonisers act as a reservoir for transmission of antibiotic resistance and are a source of infection. Exposure to antibiotics by the commensal flora renders them resistant. Antibiotic consumption and hospitalisation are two major factors influencing this. We studied, antibiotic-resistant bacteria colonising rural adult population who had restricted access to health care and presumably had low consumption of antibiotics. Aim: Detection of multidrug resistance genes of extended spectrum ?-lactamase (ESBL-CTX-M), AmpC ?-Lactamase (CIT), Klebsiella pneumoniae carbapenemase (KPC) and New Delhi Metallo ?-lactamase (NDM) in Enterobacteriaceae colonising the gut of adult population in a South Indian rural community. Methodology: Faecal samples of 154 healthy volunteers were screened for Enterobacteriaceae resistant to commonly used antibiotics by standard methods, followed by phenotypic detection of ESBL by double disk synergy method, AmpC by spot inoculation and carbapenemases by imipenem and ethylenediaminetetraacetic acid + imipenem combined E-test strips and modified Hodge test. Polymerase chain reaction was done to detect blaCTX-M,blaCIT,blaKPC-1 and blaNDM-1 genes coding for ESBL, AmpC, KPC and NDM, respectively. Results: Colonisation rate of enteric bacteria with MDR genes in the community was 30.1%. However, phenotypically, only ESBL (3.2%) and NDM (0.65%) were detected. While the genes coding for ESBL, AmpC and NDM were detected in 35.6%, 17.8% and 4.4% of the MDR isolates, respectively. Conclusions: Carriage of MDR strains with a potential to express multidrug resistance poses a threat of dissemination in the community. Awareness for restricted use of antibiotics and proper sanitation can contain the spread of resistant bacteria.

Adapting the stepped care approach for providing comprehensive mental health services in rural India: Tapping the untapped potential

Recent National Mental Health Survey (2015-16) reported a prevalence of 13.7% for any mental disorders excluding tobacco use disorders in India. Translating it into real numbers, nearly 150 million people need active mental health interventions, disproportionately more in rural areas. Major challenges in delivering comprehensive mental health services in rural India are: a) lack of a well-defined strategy; and b) lack of trained mental health manpower. To fill this gap, the global mental health community has increasingly realized the importance of Community Health Workers (CHWs) and role of stepped care approach in mental health service delivery. We propose a model of stepped care approach to fulfil the need of rural India, utilizing the existing health system components for improving mental health knowledge, reducing social stigma for mental disorders, screening for priority mental disorders at community level, ensuring compliance to treatment, timely follow-up, and community-based rehabilitation by mobilising community support for diagnosed cases. This stepped care approach will integrate mental health into Ayushman Bharat’s Health and Wellness Centres (HWCs) for the provision of comprehensive primary health care. Integration of new age technologies such as telepsychiatry, e-health, and mHealth into the proposed model will make it feasible and costefficient for inaccessible parts of the country.

Traditional Healing – At What Cost ?: A Case Report from Rural India

In rural parts of India still the “magico-religious beliefs” regarding the occurrence of the psychiatric disordersand “magico-religious treatments” of the psychiatric disorders often seen and prevail. Such beliefs andtreatments many times lead to physical as well as psychological trauma to an individual suffering from anypsychiatric disorder and may lead to delay in seeking an appropriate professional help in time. The presentcase report attempts to depict what kind of physical and psychological trauma a person with psychiatricdisorder suffered at the hands of faith healer in absence of lack of awareness about the psychiatric disordersamong family members and other villagers.

Adherence to medications among patients with diabetes mellitus (Type 2) at ballabgarh health and demographic surveillance system: A community based study

Burden of diabetes mellitus in India is on rise. Adherence to treatment is essential to diabetes control and prevention of complications. Objectives: To study the adherence to treatment of diabetes mellitus and its determinants among rural population Material and methods: A cross-sectional study was conducted in a rural community of north India. From a list of all self-reported diabetics (aged ≥18 years), 400 were randomly selected. Information about drug prescription and intake, socio-demographic factors, health seeking behaviors and disease status were obtained from the participants. Height, weight and blood pressure were recorded. Blood samples were collected to measure HbAlc levels Results: Out of 371 self-reported diabetic patients, 113 (30.4%) did not take any medication since last one month of the interview. Amongst 258 patients, who were taking treatment, 146 (39.4, 95%CI: 34.5-44.4) were found to have 100% drug adherence rate. Tobacco (p=0.03) and alcohol (p=0.04) use were significantly associated with drug adherence on bi variate analysis. Drug adherence rate was higher in group with HbA1c level more than 6.4gm%. Conclusion: A high proportion of diabetic patients were not adhering to the treatment prescribed to them by their consulting doctors. There is urgent need for awareness generation about diabetes treatment adherence and developing adherence monitoring mechanisms at community level.

Impact of community-based health insurance in rural India on self-medication & financial protection of the insured.

Background & objectives: The evidence-base of the impact of community-based health insurance (CBHI) on access to healthcare and financial protection in India is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar States of India on insured households’ self-medication and financial position. Methods: Data originated from (i) household surveys, and (ii) the Management Information System of each CBHI. Study design was “staggered implementation” cluster randomized controlled trial with enrollment of one-third of the treatment group in each of the years 2011, 2012 and 2013. Around 40-50 per cent of the households that were offered to enroll joined. The benefits-packages covered outpatient care in all three locations and in-patient care in two locations. To overcome self-selection enrollment bias, we constructed comparable control and treatment groups using Kernel Propensity Score Matching (K-PSM). To quantify impact, both difference-in-difference (DiD), and conditional-DiD (combined K-PSM with DiD) were used to assess robustness of results. Results: Post-intervention (2013), self-medication was less practiced by insured HHs. Fewer insured households than uninsured households reported borrowing to finance care for non-hospitalization events. Being insured for two years also improved the HH’s location along the income distribution, namely insured HHs were more likely to experience income quintile-upgrade in one location, and less likely to experience a quintile-downgrade in two locations. Interpretation & conclusions: The realized benefits of insurance included better access to healthcare, reduced financial risks and improved economic mobility, suggesting that in our context health insurance creates welfare gains. These findings have implications for theoretical, ethical, policy and practice considerations.

Prevalence and Predictors of Unmet Needs among the Elderly Residents of the Rural Field Practice Area of a Tertiary Care Centre from Northern India

Background: Surrogate markers simple enough to be used by primary care workers have not been closely investigated by the community experts in rural Uttar Pradesh. We assessed the physical disabilities in activities of daily living (ADL) and unmet need in physical disabilities among rural elderly. Predictors of unmet needs in physical disabilities among the elderly were also identified. Methods: A community based cross-sectional study was conducted among elderly residents of the rural field practice area of a tertiary care centre in rural Uttar Pradesh. Three hundred and thirty five (335) participants aged 60 years and above from 9 villages were selected using the Probability Proportional to Size (PPS) sampling technique. Study tools were the proforma regarding socio-demographic details, socio-economic status and Stanford Health Assessment Questionnaire. Multivariate logistic regression analysis was performed to identify predictors of unmet needs. Results: 185 (55.2%) had physical disability in one or more activity limitation. Gender wise elderly females had more physical disability in one or more ADL categories than elderly males (66.8% vs. 42.0%). Almost one third (32.5%) of subjects had unmet need for one or more physical disabilities. the predictors of unmet needs that were identified in the study were female gender (P = 0.046), elderly aged 70 years and above (P = 0.032), those living alone (P = 0.035), low monthly family income (P = 0.044), financially fully dependent elderly (P = 0.0002), and those having 3 or more physical disabilities (P = 0.033). Conclusions: The findings of the study highlight that large number of needs of the disabled are still unmet. Greater, targeted efforts are needed to identify at-risk elderly people living in the community. These predictors would act as surrogate markers and can be easily used by primary care workers to plan and provide services to the elderly people in rural communities.

Mobilizing community-based health insurance to enhance awareness & prevention of airborne, vector-borne & waterborne diseases in rural India.

Background & objectives: Despite remarkable progress in airborne, vector-borne and waterborne diseases in India, the morbidity associated with these diseases is still high. Many of these diseases are controllable through awareness and preventive practice. This study was an attempt to evaluate the effectiveness of a preventive care awareness campaign in enhancing knowledge related with airborne, vector-borne and waterborne diseases, carried out in 2011 in three rural communities in India (Pratapgarh and Kanpur-Dehat in Uttar Pradesh and Vaishali in Bihar). Methods: Data for this analysis were collected from two surveys, one done before the campaign and the other after it, each of 300 randomly selected households drawn from a larger sample of Self-Help Groups (SHGs) members invited to join community-based health insurance (CBHI) schemes. Results: The results showed a significant increase both in awareness (34%, p<0.001) and in preventive practices (48%, P=0.001), suggesting that the awareness campaign was effective. However, average practice scores (0.31) were substantially lower than average awareness scores (0.47), even in post-campaign. Awareness and preventive practices were less prevalent in vector-borne diseases than in airborne and waterborne diseases. Education was positively associated with both awareness and practice scores. The awareness scores were positive and significant determinants of the practice scores, both in the pre- and in the post-campaign results. Affiliation to CBHI had significant positive influence on awareness and on practice scores in the post-campaign period. Interpretation & conclusions: The results suggest that well-crafted health educational campaigns can be effective in raising awareness and promoting health-enhancing practices in resource-poor settings. It also confirms that CBHI can serve as a platform to enhance awareness to risks of exposure to airborne, vector-borne and waterborne diseases, and encourage preventive practices.

Needle stick injuries among health care workers in tertiary care hospital in tertiary care hospital of rural India.

Background: Health-care workers are at increased risk of infection with blood borne pathogens because of occupational exposure to blood and other body fluids. Needle stick injuries (NSIs) are major cause of blood borne infections transmitted among health care personnel. More than 90% of these infections occur in developing countries but most of these NSIs remain unreported. It is also found that 37.6% of Hepatitis B, 39% of Hepatitis C and 4.4% of HIV/AIDS in Health-Care Workers (HCWs) around the world are due to needle stick injuries. Aims & Objective: (1) To determine prevalence of needle stick injuries among health care workers. (2) To study circumstances under which they occur among health care workers in tertiary care hospital of Rural India. Material and Methods: A cross- sectional study was conducted among HCWs of rural tertiary care medical college and hospital. A total of 220 health care workers were included in the study. A self-designed, semi- structured questionnaire was used to collect data from the participants. Results: A total 130 (59.09%) HCWs reported having occupational exposure to blood and body fluid in last one year, out of these 108 (49.09%) had NSIs and 22 (10%) had history of splash of blood and body fluid. Maximum exposure of NSIs was found among nurses (50%), followed by resident doctors (25.93%). Conclusion: NSIs were common occurrence among health care workers and they are grossly underreported.

Factors associated with seeking treatment for postpartum morbidities in rural India / 한국역학회지

OBJECTIVES: To understand the prevalence of postpartum morbidities and factors associated with treatment-seeking behaviour among currently married women aged 15-49 residing in rural India. METHODS: We used data from the nationally representative District Level Household Survey from 2007-2008. Cross-tabulation was used to understand the differentials for the prevalence of postpartum morbidities and treatment-seeking behaviours across selected background characteristics. Two-level binary logistic regression was applied to understand the factors associated with treatment-seeking behaviour. RESULTS: Approximately 39.8% of rural women suffered from at least one of the six postpartum morbidities including high fever, lower abdominal pain, foul-smelling vaginal discharge, excessive bleeding, convulsions, and severe headache. Morbidities were more prevalent among poor, illiterate, Muslim, and high-parity women. About 55.1% of these rural women sought treatment/consultation for their problems. The odds of seeking treatment/consultation increased as economic status and years of schooling among both the woman and her husband increased. Poor, uneducated, unemployed, Hindu, and tribal women were less likely to seek treatment/consultation for postpartum morbidities than their counterparts were. The odds of seeking treatment/consultation decreased as the distance to the nearest private health facility increased. Most women visited a private hospital (46.3%) or a friend/family member's home (20.8%) for treatment/consultation. Only a small percentage visited publicly funded health institutions such as a primary health centre (8.8%), community health centre (6.5%), health sub-centre (2.8%), or district hospital (13.1%). Rural women from the northeast region of India were 50% less likely to seek treatment/consultation than women from the central region were. CONCLUSIONS: Providing antenatal and delivery care, and ensuring nearby government healthcare facilities are available to serve rural women might increase the likelihood of care-seeking for postpartum morbidities. Targeted interventions for vulnerable groups should be considered in future policies to increase the likelihood women will seek treatment or advice postpartum.

A retrospective observational study of obstetric care in rural Andhra Pradesh by Dangoria Charitable Trust (1979 to 2009).

Background & objectives: In India several models of health care delivery have been explored to increase access to skilled obstetric care in rural areas, where there is a lack of specialists and appropriate facilities. We present here an innovative and affordable approach to the delivery of antenatal and obstetric care provided by the Dangoria Charitable Trust (DCT) since 1979, twinning a not-for-profit hospital in rural Andhra Pradesh with a for-profit one in the capital Hyderabad. Methods: A retrospective observational study of a random sample of the deliveries performed from 1979 to 2009 by the Dangoria Charitable Trust, based on the maternity hospital birth register, was conducted. The profile of mothers, such as their age, parity and previous miscarriages, as well as type of delivery, gender and birth weight of the newborn, and frequency of stillbirths and in hospital deaths as they evolved over time were presented using simple descriptive methods. The risk of stillbirth and in hospital death over time was explored by logistic regression after allowance for selected factors. Results: From 1979 to 2009 the cumulative number of deliveries at the Narsapur maternity hospital was 9333, from a few dozens per year in the early 1980s to over 1000 in 2009. The number of primiparae significantly increased over time, while the percentage of low birth weight babies (less than 2.5 kg) did not change appreciably. Caesarean section increased significantly over time, from 8.6 per cent in the first decade to 20.3 per cent in the last. The risk of death (stillbirths and in hospital death) consistently decreased over time, reaching 15 per thousand in the last decade. The results of a logistic regression adjusted for potential confounders showed that low birth weight babies had 4 times the risk of dying as compared to those weighing 2.5 kg or above. Conclusions: Over the 30 year period the percentage of babies discharged alive from DCT improved considerably. Caesarean sections increased significantly from the first decade to the third decade. The model adopted by the DCT to improve maternal and child health in rural areas could be replicated in other rural parts of the country.

Study of Pap smear and other feasible tests among self reported symptomatic married women in reproductive age group (15-49 yrs) regarding reproductive tract infections in a rural community of Maharashtra.

Background: Reproductive tract infections (RTIs) represent a major public health problem in developing countries. Integrating RTIs/STIs management and early detection of cervical dysplasia in broader reproductive health services can improve women’s health. The objectives of the study were 1. To study the association of socio-demographic & reproductive factors among self-reported symptomatic women for reproductive tract infections. 2. To carry out clinical examination & feasible tests like PH, gram staining, VDRL for reproductive tract infections. 3. To study Pap smear among study subjects. Methods: A cross sectional study community based study was carried out in villages under ‘Parol’ Primary Health Centre of Thane district, Maharashtra, India. A total of 415 married women in reproductive age group were interviewed and examined. Pre-structured, pre-designed questionnaire was used. Clinical examination & feasible laboratory tests were done. Results were analyzed with the help of Microsoft Excel & SPSS 15. Results: A total of 415 women were interviewed, of them 263(63.4%) had one or more symptoms of reproductive tract infections. On examination, 69(35%) had cervicitis and 30(15.2%) pelvic inflammatory disease, 39(19.8%) bacterial vaginosis and candidiasis in 61(31%). Cervical erosion was present in 147(74.6%) women. On Pap smear, 20(10.2%) women had ASCUS (Atypical squamous cells of undetermined significance). Only 2(1%) women found HIV positive. No woman was found VDRL reactive. Conclusion: Routine RTI/STI screening and periodic surveys to detect the infection patterns which will helps to control HIV infections in the community is needed in the remote tribal area as the current study shows high prevalence of reproductive tract infection.

Factors Associated with the Preference for Delivery at the Government Hospitals in Rural Areas of Lucknow District in Uttar Pradesh.

For assuring safe maternal and newborn health, institutional delivery was given paramount importance. In India, in spite of several efforts, lesser than 40% deliveries are conducted at health facilities, mostly at private sector. The present cross-sectional study aimed to fi nd out the determinants of preference for delivery at government hospitals in rural areas of Lucknow, a district in Uttar Pradesh. Multistage random sampling was used for selecting villages. From them, 352 recently delivered women were selected, following systematic random sampling. Overall, 84.9% of deliveries were conducted at health institutions. Out of them, 79.3% were at government hospitals. Applying multivariate logistic regression, Hindu women (odd’s ratio [OR] = 3.205), women belonging to lower socio-economic class (OR = 4.630) and late registered women (OR = 2.320) were found to be more likely to deliver at government hospitals. Attention should be given to religion, social status and timing of registration for ensuring higher fraction of deliveries at government set-up.

Evaluation of Adjustment Methods Used to Determine Prevalence of Low Birth-weight Babies at a Rural Hospital in Andhra Pradesh, India.

Accurate reporting of prevalence of low birth weight (LBW) is important for monitoring health of a population. LBW is often underestimated in developing countries due to heaping of the data at 2.5 kg. UNICEF uses an average adjustment factor of 25% to re-classify babies listed as exactly 2.5 kg into the LBW category. From October 2009 to February 2010, we weighed 859 consecutive live births at a rural hospital in Andhra Pradesh, India, using analog and digital scales to evaluate the relative validity of the adjustment factor. Signifi cantly more babies weighed exactly 2.5 kg on analog (13.4%) versus digital (2.2%) scales, showing heaping. Percentage of LBW by digital method (29.5%) was signifi cantly higher compared to the analog method (23%) and with adjustment factors (26.4%). Conventional methods of adjusting birth-weight data underestimate the prevalence of LBW. Sensitive digital weighing machines or better adjustment methods are needed to monitor LBW in developing countries.