Determinants of low birth weight: A case control study in a district hospital in Karnataka.

A Case-control study was conducted in District Lady Goschen hospital, Dakshina Kannada district, Southern Karnataka. Subjects were mothers who underwent normal delivery and their neonates. A total of 150 cases and 300 controls were selected. Significant risk factors identified in univariate analysis included pre pregnancy maternal weight (<45 kgs)(OR=6.77), anaemia in pregnancy (Hb<11gm%) (OR=3.11), age less than 20 years (OR=2.96) and maternal height (<145 cms) (OR=2.79). Multiple logistic regression analysis revealed that pre pregnancy maternal weight (<45 kgs)(OR=7.02), anemia in pregnancy (OR=4.37) and maternal age less than 20 years (OR=3.96) were the significant risk factors of low birth weight of term babies. The strategy needs to focus attention on nutrition education to facilitate better weight gain during adolescent period. Discouraging teenage pregnancy is also essential in order to reduce the burden of LBW babies.

Utilisation of integrated counselling & testing centre (ICTC): a comparative study between a tertiary care teaching hospital and a government district hospital in Karnataka.

A study was undertaken during November 2005 to October 2006 to assess about utilization aspects of ICTC at a tertiary care teaching hospital and a government district hospital in Karnataka. The average monthly numbers of persons visiting ICTC per month at the tertiary care teaching hospital (509) were higher than that of Government district hospital (222). However, the average monthly number of direct walk-in persons and follow up, attending the centre at district hospital were higher than that of teaching hospital. Thus optimal use of information, education and communication (IEC) techniques needs to be strengthened to improve the utilization of ICTC services at the tertiary care teaching hospital.

Role of Acute Illness Observation Scale (AIOS) in managing severe childhood pneumonia.

OBJECTIVE: In the perspective of integrated management of childhood illness (IMCI) strategy and recent evidence favoring use of oral antibiotics in severe pneumonia, a generic illness severity index--Acute Illness Observation Scale (AIOS)--was prospectively validated in children with severe pneumonia in a civil hospital in remote hilly region. METHODS: AIOS was used in quantifying overall severity of illness for eighty-nine consecutive children (age, 2-59 months) hospitalized with community-acquired severe pneumonia. A detailed clinimetric evaluation of scale was carried out and logistic regression analyses predicted the following outcomes: 1) mode of initial antimicrobial therapy (oral vs. parenteral); and 2) need for intravenous fluids at admission. RESULTS: Majority of children (80.9%) with severe pneumonia scored abnormally (AIOS score> 10) at initial evaluation. Children with abnormal AIOS scores (>10) had significantly greater severity of respiratory distress and higher incidence of radiological pneumonia. Outcome measures i.e. time to defervescence and length of hospital stay were also positively and significantly correlated with the scores. The six-item scale had good internal consistency (Cronbach's alpha 0.81); and its factor analysis yielded a single latent factor explaining 54% of variance in illness severity at admission. Furthermore, logistic regression analyses revealed an independent predictive ability of AIOS in aiding clinician to decide the mode of initial antimicrobial therapy (oral or parenteral), as well as need for intravenous fluids. CONCLUSION: Authors study indicates the clinimetric validity of AIOS in managing, Severe childhood pneumonia and suggests its role in further enriching IMCI strategy.

Wheezing--associated lower respiratory infections in under 5-year-old children: study in Takhli District Hospital.

Wheezing was detected in 251 of the 421 (59.6%) children under 5 years old suffering from acute lower respiratory infections (LRI) treated at the Takhli Hospital, Nakhon Sawan Province from November 1998 to October 2000. Bronchitis and pneumonia accounted for 55.0 per cent and 40.6 per cent of LRI with wheezing. Most of the patients, 162 of 251 (64.5%) cases were children under 2 years old. The wheezing symptom declined significantly in children older than 4 years of age. In this study, LRI with wheezing was found all year round but was more frequent in the rainy season similar to other respiratory infections. As the respiratory syncytial virus (RSV) infections were mainly found during the rainy season (July-October), the association of wheezing and RSV infections in the rainy season was evaluated. RSV causing LRI with wheezing in the rainy season revealed 54.7 per cent and 39.4 per cent in the first and second studied year, respectively. The two-year follow-up of 121 cases of LRI with wheezing showed that 37 cases (30.5%) had repeated episodes of wheezing. In conclusion, LRI with wheezing caused by RSV was commonly found in children under 2 years old. The occurrence was all the year round but predominantly in the rainy season.

Health care options in childhood ARI before hospital care.

A cross sectional study was conducted, to examine the pattern of health care options, exercised before seeking care at the district hospital in the event of ARI in under fives. One hundred fifteen under fives selected through systematic sampling technique, from two district hospitals were the subjects of study. Respondents were the care providers, who accompanied children to the Hospitals. Time delay in initiating care and reaching the district hospital was also recorded. Reasons for preferring a particular source as first choice were enquired. District Hospitals stood out as the most preferred source, as 52 (45.2%) of the children used it as the first step. Other sources of health care were Health Center (10.4%), Home Care (25.2%) General Practitioners (10.4%) and Drug Stores (8.7%). On an average a child took 1.8 steps before coming to the district hospital. Children experienced 13 unique treatment patterns. Children initially offered home care followed longer sequence and more variable pattern. Convenience (62.6%) and cost (37.4%) were the main factors in choosing a source of treatment. Children who received home care were brought to district hospital earlier than others.

Patient-led partner referral in a district hospital based STD clinic.

CONTEXT: Sexual communication and appropriate treatment of sexual partners is critical to the success of STD and HIV/AIDS prevention and control. AIMS: To understand factors influencing intention of STD patients to inform their regular sexual partners and identify predictors influencing actual return of the partners. SETTINGS AND DESIGN: A non-randomised survey of patients attending STD clinic in a district hospital between May and November 2000. METHODS AND MATERIAL: 182 patients were administered structured questionnaires to understand their intention to notify their regular sexual partners and encouraged to refer their regular sexual partners to the clinic for management. Factors related to intent to notify partners and actual partner referral were analysed. Statistical analysis used: Chi square test and forward stepwise logistic regression. RESULTS: Of the 182 STD patients 77.47% expressed their positive intention to notify their regular sexual partners. However, overall partner return rate was 40.65%. Patients from a better economic class (p=0.014), those who had sex since having the disease (p=0.001), those who felt it was easy to tell their partners (p=0.047) and perceived the necessity of investigating their partners (p<0.001) were more likely to have an intention to notify their partners. Independent predictors of actual return of sexual partners were patients' perception of partners' susceptibility (p=0.044), positive intention to notify partners (p=0.001), partners already informed before clinic visit (p=0.030) and presence of genital ulcerative diseases (p=0.033). CONCLUSIONS: STD clinic counselling and education should focus on risk reduction, partner susceptibility, role of STDs in HIV transmission and improving spousal communication.

Non-fatal injuries sustained in road traffic accidents: a pilot study in provincial hospitals in Chon Buri, Thailand.

The characteristics of patients with non-fatal road traffic injuries who received care from non-referral hospitals are described; an assessment of the difference between the characteristics of patients who received care at a referral hospital and those of patients who were treated at non-referral hospitals is made. A retrospective study, conducted in Chon Buri Province, Thailand, reviewed information from two sources: 324 records from eight non-referral hospitals and the 1999 Injury Surveillance Report of Chon Buri Hospital, a referral hospital. A data collection tool was designed to retrieve information from the non-referral hospitals. Data were analysed descriptively and analytically. The majority of the patients of the non-referral hospitals were male (71.1%) motorcyclists (84.2%), and received ambulatory care (83.9%). Young patients had a higher risk of being admitted to these hospitals. Non-motorcyclists, pedestrians, and nonlocal persons were more likely to receive care from the referral hospital. The results were similar to those of previous studies. The different characteristics of patients who receive care at referral--and non-referral hospitals need to be taken into account when designing traffic accident reduction programs.

Yavatmal District Blindness Control Society: a case study.

PURPOSE: To retrospectively study the records and reports available at the District Blindness Control Society (DBCS), Yavatmal in terms of target fixation, performance and utilisation of manpower and equipment. METHODS: All the available records, reports, correspondence, and proceedings of meetings from 1981-98 were scrutinized and analyzed. RESULTS: The performance records and reports showed that over the last 10 years the target achievement of DBCS is close to 100%. However, the fixed facility (District hospital/Tertiary hospital where cataract surgeries are being performed under strict aseptic conditions) performance does not match the targets. The district mobile unit camp performance achieved 35-40% of the target in the last quarter of the financial year. CONCLUSION: The target fixation is irrational and needs improvement, and it is necessary for the program managers in the district to undertake analysis of the available data to ensure performance improvement.

Epidemiological study of urinary stones based on operative theater data at regional hospitals and general hospitals of public health region-5, Thailand.

A prospective descriptive study of urinary stone patients based on operative theater data of one regional hospital: Maharat Nakhon Ratchasima Hospital and four general hospitals: Chaiyaphum Hospital, Buriram Hospital, Si Saket Hospital, Surin Hospital of the public health region-5 Thailand from October 1992 to June 1993 a duration of nine months was carried out. There were 468 patients (42.7%) from Maharat Nakhon Ratchasima Hospital, 111 patients (10.1%) from Chaiyaphum Hospital, 123 patients (11.2%) from Buriram Hospital, 240 patients (21.9%) from Si Saket Hospital and 155 patients (14.1%) from Surin Hospital. There were 40 patients (3.65%) aged 15 years old or younger and 1,057 patients (96.35%) aged more than 15 years old. 711 patients (64.8%) had renal calculi, 171 patients (15.6%) had ureteral calculi. 190 patients (17.3%) had vesical calculi and 25 patients (2.3%) had urethral calculi. Surgical procedure: Stones were surgically removed -664 patients (60.5%). Nephrectomy -119 patients (10.9%). Basket removed stones -5 patients (0.4%). Cystolitholapaxy -95 patients (8.7%) and ESWL -214 patients (19.5%).

An intervention model for breast feeding in Maharat Nakhon Ratchasima Hospital.

To promote breast feeding and/or prevent further decline of adverse infant feeding practices, we developed an integrated comprehensive breast feeding promotion program, and implemented it in Maharat Nakhon Ratchasima Hospital in 1987. The program provided sound knowledge and attitudes toward breast feeding to all mothers at the Antenatal Care Unit, delivery room, the Postnatal Care Unit, and the Outpatient Department. The program activities included early bonding, assistance with initiation of breast feeding, rooming-in, provision of a breast feeding corner in the special care unit, collecting breast milk for sick babies, a lactation clinic and home visits. The impact of the program was evaluated in 1992. Altogether 1,428 mothers were interviewed using structured questionnaires. The results were highly encouraging. A majority of the mothers were of low socioeconomic status, 60 percent of them worked outside the home, and 40 percent were housewives. Compared with baseline data reported in 1986, breast feeding in infants aged 0 to one month increased from 85 to 90 percent, and the practice in the nine- to 12-month old group increased from 39 to 47 percent. However, the acute drop of the practice from 90 percent at birth to 50 percent at the one- to two-month old stage observed was similar in the two studies. The main reasons given by mothers for prematurely stopping breast feeding were the mothers' working outside the home (46%), and insufficient milk (23%). Provision of breast feeding education, along with improved maternal nutrition, extension of maternity leave, and availability of nurseries at the work place, may sustain a longer period of breast feeding.

Human behavior in relation to selection of malaria treatment.

People in rural areas usually help themselves when malaria attacks by using a drug preparation under the name of "ya-chud" bought from the grocery in the village. The objective of this study was to determine the behavior towards malarial treatment of local inhabitants in two malarious areas in eastern Thailand. Groups of 271 and 131 local inhabitants in villages in Pong Nam Ron and Bo Thong Districts, respectively, aged more than 15 years were interviewed regarding health behavior in seeking care when they became ill with malaria. Forty-two percent of the population at Pong Nam Ron and fifteen percent at Bo Thong went to drug-stores or groceries when they developed minor illness, while 85.2% of the subjects interviewed at Bo Thong went to the local health center. However, when they became severely ill, treatment-seeking patterns were similar in the two study areas. Ninety-four percent of the subjects interviewed at Bo Thong and eighty-seven percent at Pong Nam Ron gave a history of having used ya-chud in the past. On average, a set of ya-chud for malaria infection consists of 3-5 drugs: antimalarial drugs together with others such as analgesic-antipyretics, steroids, anti-histamines, vitamins and antimicrobial agents (tetracycline). The price of one ya-chud varied from 3-9 baht. Such improperly use of antimalarial drugs in malarious areas can result in treatment failure and cause the development of drug resistance, which is a problem in the malaria control program in Thailand.

Disease profile in respect of health services of Upazila health complex.

This study was carried out to identify the disease profile in relation to medical services at upazila health complex. Thirty different types of diseases were identified. Diarrhoeal diseases were found to be highest (53%), the second highest was intestinal worms (44%). About ninety seven percent patient attended the OPD and only 2% were attended in the emergency Department. On average 172 patients were admitted per month and the highest of admission was found in the months of September and October. The average length of stay in the hospital was 11.6 days. Among the patients admitted 55% were male, and 45 were female. 5% pregnant mothers attended in U.H.C. for antenatal checkup and 2% mother were admitted into the hospital after delivery. Metronidazole was the drug of highest consumption followed by B-Complex and Penicillin.