Door-to-door health camps versus traditional health camps in rural areas of Himachal Pradesh – A comparative analysis

Background: Health camps are effective medical intervention, especially in inaccessible terrains. However, because of age, health, and COVID-19 fear, many patients avoid visiting these camps because of crowding. Door-to-door health camps could be a solution to this. National Medical Commission has also introduced early clinical exposure and family adoption for medical undergraduate students. Aim and Objectives: The authors had planned to conduct this research to study the advantage of door-to-door health camps involving medical undergraduate students as camp team members as compared to traditional health camps regarding patient satisfaction and student satisfaction. Material and Methods: This study was done in rural hilly areas of Himachal Pradesh. There were 8 traditional health camps and 8 door-to-door health camps also involving medical undergraduate students organized between August 2022 and November 2022. These camps were analyzed for patients’ satisfaction and students’ satisfaction. Results: Patient satisfaction was much higher in door-to-door camps as compared to traditional health camps. More patients attending door-to-door camps visited our hospital for follow-up. Students were also satisfied participating in door-to-door camps. It also improved their interest in studying medicine. Conclusion: Door-to-door health camps are more beneficial for patients, especially in hilly inaccessible terrain. Involving students in these camps improves their interest in studying medicine and can be beneficial.

Medicinal plants used by shepherds in Trans-Himalayan Rakchham-Chitkul Wildlife Sanctuary in Baspa Valley of Kinnaur district, Himachal Pradesh, India / Plantas medicinales utilizadas por los pastores en el Santuario de Vida Silvestre Rakchham-Chitkul Trans-Himalayan en el distrito de Baspa Valley of Kinnaur, Himachal Pradesh, India

The present study deals with the ethnomedicines used by migratory shepherds in an Indian Trans-Himalayan area. Shepherding depends on traditional healthcare practices. A non-probabilistic sampling technic was used for the selection of the research participants; the information was collected through 8 extensive field visits. The data was analyzed by the interpretation of the interviews since a qualitative as well as quantitative perspectives. A comparison with previous studies in the area was donebased on literature research. The results of this study show that shepherds in tribal areas are highly dependent on medicinal plants, they report the use of 58 taxa to handle their main health problems. They prefer 20 taxa, to treat; coughs, asthma, colds, throat complaints, general pain, fever, dysentery, diarrhea and urinary infections, which are the main reported illnesses. Mainly they use the fresh plant juices of these taxa. Two health issues are remarkable highblood pressure and jaundice.

El presente estudio trata sobre las etnomedicinas utilizadas por los pastores migratorios en una zona india transhimalaya. El pastoreo depende de las prácticas sanitarias tradicionales. Se utilizó una técnica de muestreo no probabilístico para la selección de los participantes de la investigación; la información se recopiló a través de 8 extensas visitas de campo. Los datos fueron analizados mediante la interpretación de las entrevistas desde una perspectiva tanto cualitativa como cuantitativa. Se realizó una comparación con estudios previos en el área basada en la investigación de la literatura. Los resultados de este estudio muestran que los pastores en áreas tribales son altamente dependientes de las plantas medicinales, informan el uso de 58 taxones para manejar sus principales problemas de salud. Prefieren 20 taxones para tratar; tos, asma, resfriados, molestias de garganta, dolor general, fiebre, disentería, diarrea e infecciones urinarias, que son las principales enfermedades reportadas. Principalmente utilizan los jugos de plantas frescas de estos taxones. Dos problemas de salud son la hipertensión arterial y la ictericia.

Insecticide susceptibility status of malaria vectors in Himachal Pradesh, India

Background & objectives: The state of Himachal Pradesh is one of the hilly forested states of India. Warming of climate has been evidenced in the state due to the ongoing climate change which may cause the upsurge/introduction of mosquito-borne diseases. To curb disease transmission, an effective vector control strategy will be required. Methods: Insecticide susceptibility status of available malaria vectors was determined using the standard WHO method in six districts Kangra, Una, Mandi, Bilaspur, Solan and Mandi of the state. An. culicifacies and An. fluviatilis were tested against DDT (4%), malathion (5%) and deltamethrin (0.05%) using WHO insecticide susceptibility kits. Results: Overall, An. culicifacies was found resistant to DDT in all the six districts, susceptible to malathion in all districts except Bilaspur and Solan where it showed possible resistance. It was susceptible to deltamethrin in all the study districts. An. fluviatilis was resistant to DDT and susceptible to malathion and deltamethrin in Kangra and Una districts. Interpretation & conclusion: At present, indoor residual spraying (IRS) is not being undertaken in Himachal Pradesh. However, with the information generated through the present study, the state government can plan evidence-based IRS at least for focal spray in limited foci reporting malaria incidence.

Diversity of ethnomedicinal plants in Churdhar Wildlife Sanctuary of district Sirmour of Himachal Pradesh, India

Himachal Pradesh has a great altitudinal range (300–7,000 masl), with varied species, habitats, communities,populations, and ecosystems. There are more than 3,400 different species of plants are reported to be found inHimachal Pradesh. In the state, excess of thousand plant species identified as aromatic and medicinal appear intemperate forests, Shiwalik hills, alpine and sub-alpine pastures. Majority of the inhabitants in Himachal Pradeshbelong to different communities and cultures, with specific traditional knowledge. In the remote areas, especiallyhigh-altitude regions are contemporary medical amenities, and therefore tribal and rural society mainly depends onnative medicinal plants. Herein, we compiled 41 medicinal plant species belonging to same or different families usedby migratory shepherds in Churdhar Wildlife Sanctuary of district Sirmour in Himachal Pradesh. This survey will helpthe medicos, pharmaceutical industry for refining the public healthiness amenities, and maintenance of wild medicinalplant prosperity of the studied zone.

A Clinico-epidemiological Scenario of Leprosy at a Tertiary Care Centre in Sub-Himalayan Region: A Seven Year Retrospective Study

Despite leprosy being an eliminated disease from most of the countries in the world including India, it continues to remain as a major burden on public health expenditure. The purpose of this study was to determine the current clinico-epidemiological profile of leprosy at tertiary care health institution in Himachal Pradesh. This retrospective study was conducted in the Department of Dermatology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. All patients registered from April 2010 to April 2017 were included in this study. Hospital records of 221 patients were analysed according to age, gender, region of permanent residence, history of contact with leprosy patients, number of patients within state or immigrants from nearby state/country, type of disease-multibacillary (MB) or paucibacillary (PB), type of lepra-reactions and grade of disability patient developed. Out of a total 221 patients majority were in the younger age group of 15-30 years (38.9%), with male predominance (male:female ratio 2.7:1). Majority had MB leprosy (85.5%), and had significant proportion of grade II disability (G2D) compared to national and global data. In clinical disease spectrum, Lepromatous Leprosy (LL) and Borderline lepromatous (BL) leprosy were the most common presentations. Migrants from other states or immigrants from neighbouring country constituted a significant proportion (44/221, 20% approximately). Pure-neuritic disease was diagnosed in 7 (3.2%) patients, childhood cases were only 5 (2.3%) patients, indeterminate leprosy in 3 (1.4%) patients and histoid leprosy in 1 patient (0.004%). To know the exact status of leprosy in the country, knowledge and understanding of the epidemiological profile is an essential pre requisite as it will assess and address public health needs and will help in efficient programme planning and management of leprosy cases in the country. High proportion of MB cases and very high disability percentage shows the need to increase the awareness in the community as well as health care workers so that cases report early, are diagnosed early and managed appropriately so that disabilities become zero in near future. Partnerships among different medical institutions in the state are expected to strengthen the quality referral services and research aimed at eradication.

“Population Growth in Himachal Pradesh 2001-2011: A Spatial Analysis”.

Population growth is one of the important indicators of the level of socio-economic development because it is the level of socio-economic development that determines the rate of population at any given time. The analysis of population growth is an important element to the understanding not only of a region’s problems but potentials (providing food, schooling, employment, health facilities, housing etc.) and for future planning. Therefore, it is useful to study the pattern of population growth of any region. The present study attempts to study the growth of population in Himachal Pradesh at tehsils/sub-tehsils level during 2001 to 2011. The study is mainly based on the secondary data collected from Directorate of Census Operations. The simple percentage method and choropleth technique have been used to highlight spatio-temporal variations in growth of population. The peculiar topographical characteristics of the state resulted into great spatial variation in growth pattern. The study reveals that about one-third of the tehsils/sub-tehsils witnessed a decadal growth rate, higher than the state average. There is an equal number of tehsils/sub-tehsils, where the decadal growth rate was below the state average.

Linking Lifestyle of Marginalized Gujjar Population in Himachal.

It was a qualitative enquiry conducted amongst Gujjar population of Shimla district, Himachal Pradesh (HP). The study was carried out to link various lifestyle factors of the Gujjar population with the 2002 outbreak of plague in HP. Focus Group discussions guide was prepared beforehand which had information about education, livelihood, dietary pattern, relationships, personal hygiene and habits and health care utilization. It was emerged out of the study that the population has poor literacy levels, poor personal hygiene, overcrowding in hutments, closely-knit social structure, lack of awareness about common diseases, and frequent visits to forests and living in caves during their visits. Further, government health care facilities are not routinely utilized by the Gujjar community. These factors might lead to increased proximity and exposure to wild rats among Gujjar population, thus increasing their susceptibility to plague. They are, therefore a potential link between any source of infection in forests and in native population of HP and other states. The government agencies should take various measures to increase health care access of such vulnerable population through outreach health care programs.

Pattern of retinal diseases in hilly terrain of Himachal Pradesh, India / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To study the pattern/distribution of retinal vascular diseases in the hilly terrain of Himachal Pradesh (altitude ranging from 500-4500m above sea level). METHODS: lt is a retro/prospective study of patients with retinal diseases attending the general ophthalmology clinic of a tertiary care facility at Shimla from August 2008 to April 2013. Out of 5600 subjects, 4323 were taken as a sample. The data were taken from the hospital records and thereafter analyzed to determine their age, sex distribution and diagnosis. All patients underwent visual acuity, refraction, slit lamp examination and fundus evaluation. The diagnosis was confirmed from fundus clinic records and evaluation of fundus photographic records retro/prospectively. The photographs were taken on the fundus camera (Kowa Fundus Camera VX-10) and fundus fluorescein angiography done where ever indicated. RESULTS:Out of the 4323 patients, there were more males 2563 ( 59. 29%) than females 1760 ( 40. 71%) with retinal diseases. Out of the 525 ( 12. 14%) diabetic retinopathy ( DR) subjects, mild non-proliferative diabetic retinopathy was present in 133 (3. 08%), moderate non-proliferative diabetic retinopathy in 156 (3. 60%), severe non-proliferative diabetic retinopathy in 120 (2. 78%) and proliferative diabetic retinopathy in 116 (2. 68%) subjects. Amongst the 393 (9. 10%) subjects of hypertensive retinopathy, hypertensive retinopathy-grade 1 ( was present in 130 ( 3. 01%) , hypertensive retinopathy - grade 2 in 111 (2. 57%), hypertensive retinopathy-grade 3 in 131 (3. 03%) and hypertensive retinopathy - grade 4 in 21 ( 0. 49%) subjects. Of all the 660 (15. 27%) subjects of other retinal vascular disorders, branch retinal vein occlusion ( BRVO) was present in 229 (5. 30%), central retinal vein occlusion (CRVO) in 55 (1. 27%), hemi central vein occlusion in 8 (0. 19%), central retinal artery occlusion ( CRAO) in 20 (0. 46%), branch retinal artery occlusion in 4 (0. 09%), ocular ischaemic syndrome in 1 (0. 02%), retinopathy of prematurity in 9 (0. 21%), retinal artery macroaneurysm in 5 (0. 12%), juxtafoveal telangiectasia in 6 (0. 14%), anaemic retinopathy in 16 (0. 37%), leukemic retinopathy in 10 (0. 23%), preretinal haemorrhage in 52 (1. 20%), Coats disease in 8 (0. 19%), cilioretinal artery occlusion in 1 (0. 02%), Eales disease in 10 (0. 23%), vasculitis in 17 (0. 39%) and clinically significant macular edema in 209 (4. 83%) subjects. CONCLUSlON: DR was the most common retinal vascular disorder. Retinal disorders appear to be a major public health problem in lndia. The present study shall help us in planning the management of such disorders in the hilly state of Himachal Pradesh to reduce the visual morbidity arising out of such disorders.

Profile of lung cancer in predominantly bidi smoking rural population of northern Himachal Pradesh.

Background. Lung cancer is a leading cause of morbidity and mortality among both genders. The histopathological patterns of lung cancer in different parts of India appear to be variable. Objective. To study the profile of lung cancer in northern Himachal Pradesh. Methods. Patients of all age groups and either gender with history and complaints suggestive of lung cancer were subjected to further investigations to study the histopathological types of lung cancer over a period of 14 months. Results. Out of 105 histopathologically confirmed patients with lung cancer (mean age 62.7±11.6 years; 96 males), 89.5% were “ever smokers” and 82.9% were “current smokers”; 92% of current smokers were bidi smokers. Most common presenting complaints were chest pain (46.7%) and cough (35.2%). Mean duration of longest presenting complaint was 64 days. The histopathological types included squamous cell carcinoma (37.1%), adenocarcinoma (36.2%), small cell carcinoma (8.6%), un-classifiable (16.2%), and other types (1.9%). Conclusions. Majority of the lung cancer patients in northern Himachal Pradesh were bidi smoking males from rural areas and the incidence of adenocarcinoma and squamous cell carcinoma is almost equal.

The Sandflies of the Satluj river valley, Himachal Pradesh (India): some possible vectors of the parasite causing human cutaneous and visceral leishmaniases in this endemic focus.

valley in Himachal Pradesh (India) lies in north-western Himalayas (30°N, 70°E). This endemic focus of leishmaniasis appears peculiar where localized cutaneous leishmaniasis (LCL) co-exists with visceral leishmaniasis (VL), and Leishmania donovani is predominant pathogen for LCL whereas only a few cases have been due to Leishmania tropica. This study was carried out to collect sandflies, identify and delineate their habitat and role in transmission of human leishmaniasis in this endemic focus. Methods: During June 2003 to September 2007, 142 (M–22, F–120) sandflies were collected with aspirators from 10 endemic villages of Kinnaur and Shimla districts. Results & conclusion: Sixty-two of the identified sandflies caught belonged to the genus Phlebotomus species, including some species that are known to act as vectors of the parasites causing human leishmaniasis. The Phlebotomus (Adlerius) chinensis longiductus (Parrot), 1928 (28 sandflies), P. major (8 sandflies), P. (Larroussius) kandelakii burneyi (Lewis), 1967 (8 sandflies) were identified. The identification of the main species of vector sandfly in the region is complicated because it is still uncertain which Leishmania species cause(s) the local human leishmaniasis. Circumstantially it seems likely, however, that Phlebotomus (Adlerius) chinensis longiductus is the main vector. Other species found, such as P. major and P. (Larroussius) kandelakii burneyi, may also be responsible for some cases. A more elaborate study is recommended.