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Background: Universal developmental screening is recommended at 9, 18, 24 and 36 months. The Government of India Mother and Child Protection (MCP) card is an immunization record that is used to monitor child development, and identify children requiring further evaluation. Objectives: To determine the diagnostic accuracy of the MCP card for developmental screening, and perform its item analysis. Study design: Mixed-method study (prospective study of diagnostic accuracy and qualitative study). Participants: Mother-child dyads of children between 2-36 months of age were recruited from the outpatient department or wards of a tertiary level children’s hospital from November, 2019 to October, 2021. Children with confirmed neurodevelopmental disorders/disability, and mothers with less than 6th standard education were excluded. Intervention: Each mother was given a MCP card, and taught how to mark the items. This was followed by the researcher’s evaluation (index tool). The reference tool was a comprehensive clinical assessment (CCA) by the researcher and an expert. The CCA included clinical examination of hearing, vision, and neurodevelopment; and psychometric assessment of development and adaptive function. Each mother underwent an in-depth interview. Overall and group wise psychometric properties of diagnostic accuracy were computed. The interview transcripts were analyzed thematically. Outcomes: The proportion of children with ‘fail’ and ‘delay’ by the evaluation of the researcher with the MCP card and the expert by the CCA, respectively. Results: The study population included 213 children (40.4% females). Fifty-two (24.4%) children were identified as ‘Fail’ by the MCP card and 43 (20.2%) as ‘delay’ by the expert’s CCA. The overall sensitivity and specificity was 83.7% (95% CI 69.3-93.2) and 90.6% (95% CI 85.2-94.5), respectively. Acceptable diagnostic accuracy was found in the age-group 7-9 months, 13-18 months, and 25-36 months. Conclusions: The MCP card may be used for developmental screening at 9, 18, and 36 months.
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Purpose: To report the demographic profile of patients registered through e?Sanjeevani OPD seeking teleophthalmology services. Methods: This was a cross?sectional data analysis of patients with ocular complaints registered through the e?Sanjeevani platform at a tertiary care center. It was a doctor?to?doctor consultation, where teleophthalmology consultants provided teleconsultation services at subcenters (SCs), primary health centers (PHCs), and community health centers (CHCs). Data regarding the patient’s age, gender, residential address, provisional diagnosis, and treatment prescribed were recorded from May 2021 to February 2022 (9 months). Results: In total, 5138 patients were teleconsulted from the mean age of the patients was 37.64 ± 19.34 years. Among these patients, 44% were males and 56% were females. Most of the teleconsultation calls were made from Palwal district (19.8%), followed by Hisar (14.5%) and Sonipat. The most common provisional diagnosis was dry eyes (21%), followed by allergic conjunctivitis (18%), refractive error (15%), and cataract (14%). These constituted approximately 70% of the diagnosis made through teleconsultations. The rest of the eye problems were diagnosed as stye, blepharitis, nasolacrimal duct obstruction, pterygium, subconjunctival hemorrhage, etc., The majority of the patients were managed medically (56.6%) and approximately 11.6% of the patients were referred for surgical intervention. Conclusion: e?Sanjeevani is an effective way to provide teleconsultations to patients in remote locations. The majority of the patients seeking ophthalmology consultations can be managed conservatively. Patients requiring surgical intervention can be referred timely, thus avoiding any delay in treatment
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Background: One of the key components of national rural health mission was to create a band of female health volunteers, appropriately named “accredited social health activist” (ASHA) in each village within the identified States to act as a bridge between the rural people and health services outlets. They act as health activists in community who will create awareness on health and its determinants, counsel mothers on key healthy behaviors and mobilize the community towards local health planning and increased utilization and accountability of the existing health services. Objectives of the study was to describe the socio-demographic profile of ASHAs working in Vijayapur district and to evaluate the knowledge, attitude, practice of ASHAs towards the maternal care.Methods: A cross-sectional study on 617 ASHAs of Vijayapur district. A pre-designed, semi- structured questionnaire was prepared in English and the interview was conducted in Kannada by explaining them questions one by one.Results: Out of 617 ASHAs interviewed, 427 (69.2%) of them told a pregnant woman should have antenatal care (ANC) visits and 413 (65.3%) ASHAs opined that a minimum of four ANC visits are required. While 542 (87.2%) ASHAs told that they should accompany pregnant woman transport to health centre during labour pains and 570 (92.8%) told that they should stay with the pregnant lady until her delivery is over. Also, it was found that knowledge of ASHAs regarding maternal care was significantly associated with age and duration of service of ASHAs.Conclusions: On the whole, knowledge of ASHAs about care during pregnancy and care of new-born was cons
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Background: Accredited Social Health Activist (ASHA) workers and their activity are considered as one of the key components of National Health Mission (NHM). ASHA workers serve as an important link between community and health facilities. Objectives: The objectives of the study were to assess the work profile of ASHA workers in Kathua district of Jammu and Kashmir. Materials and Methods: The present prospective cross-sectional study was conducted in Parole Block of district Kathua in Jammu and Kashmir from February 2019 to May 2019. A total of 176 rural ASHA workers were interviewed using a predesigned, pretested questionnaire after seeking informed consent. Results: About 52.2% catered to a population of 500–1000. About 34% of the workers were educated up to 10th standard and 10.7% up to 12th standard. About 64.2% of the ASHA workers are active in supporting institutional deliveries and 88% of the ASHAs made household visits for nutrition counseling. Conclusions: ASHA acts as a first link between the community and health-care services. Thus, it is necessary to strengthen the role of ASHA on promotive and preventive health care services through regular joint training of ASHAs.
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Background: Around 66% of infant and over 50% of under-five mortality occurs in newborn period. 99% of neonatal deaths occur in low and middle income countries. Most of these deaths can be prevented by suitable interventions at various levels. The premise of the study is that the neonates who require long transportation (>1 hour) have higher chances of mortality or prolonged stay in the hospital.Methods: A retrospective retrieval of data and prospective interview was conducted in G.B Pant children’s hospital Srinagar, an associated hospital of Govt. Medical College Srinagar in North India.Results: During the period of study 1431 neonates from twelve districts of the state were referred to the hospital for treatment, out of whom, 102 (7.13%) could not be saved. Neonatal death rate was found highest (11.11%) in neonates referred from districts of category-III (>100 kms from the referral hospital), followed by category-II (50-100 kms from the referral hospital) and category-I (>50 kms from the referral hospital). Average length of stay was observed longest for the neonates referred from districts of category-III followed by category-II and category-I.Conclusions: Several other studies found that transfer of sick neonates from another health facility were associated with relatively higher probability of morbidity and mortality after controlling for other predictors. Distance no doubt is a risk factor for neonatal outcome of referred neonates as we have observed in our study. To minimize neonatal deaths it is necessary to strengthen the perinatal services sick newborn care unit {(SNCUs) in district Hospitals)}.
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The National Health Mission (NHM, previously called National Rural Health Mission) was launched by Government of India in 2005 to make architectural correction of the Health system. One of the primary Goals of the Mission was to reduce Under five Mortality rate (U5MR) vis a vis Global commitment made under Millennium development Goals especially Goal numbering 4. Although, India still contributes to about one fifth of U5MR and Maternal Mortality rate but unfortunately it contributes to one third of Global Neonatal Mortality Rate. In sheer numbers alone, these rates are alarming. However, India has achieved a faster pace of reduction in U5MR by 46.5% in comparison to 41% for the entire world. In this article, data from Sample Registration System of the Registrar General of India which is available for most of the States/UTs has been analyzed for child health indicators in the country. In the next NHM phase, focused efforts need to be made with state specific Goals so as that the desired targets could be achieved.
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Aims: The study was conducted to estimate the proportion of eligible women for Janani Suraksha Yojana and to understand the factors affecting receipt of benefits in Maharashtra State, India. Methodology: It was as comparative observational study conducted in Maharashtra State having a population of 112.37 million. Each district was divided into five strata tribal, rural, Municipal Council, slum and non-slum in Municipal Corporation. In each district about 2400 household were surveyed comprising proportionate quotas from each stratum. Surveying unit from each stratum was randomly selected. The study population consisted women delivered in 2008-2009 year. Firstly Head of household was interviewed for confirming child delivery in the reference period. Then delivered woman was interviewed for checking eligibility to JSY and then details of receipt of benefits were obtained from her. Receivers and non-receivers of benefits were compared with respect to some variables. The study was undertaken with the help of Community Medicine Department from Government Medical Colleges. Results: In the reference period 4,544 women delivered children and 41.15% were found eligible for the scheme. But only 52.57% certainly received cash benefits. About 24% surely did not receive and 23% were not sure about receipt or the scheme and hence included in non-receiver group for further analysis. Non-earning women, not delivered in public health care institutions and un-aware about the scheme were unlikely to receive the benefits. Ante Natal Care visits, immunization, receipt and consumption of Iron and Folic Acid tablets were better among beneficiaries then non-receivers of the benefits. The benefits were not received immediately after delivery. About 10% women had problems in receiving the benefits, particularly requirement of certain certificates. Conclusion: The uptake of the scheme may be slightly higher than 53% and there are many factors responsible for not reaching to entire eligible population. Modifiable risk factors like delivery in government health institution and awareness about the scheme are playing major role in receiving the benefits.