Microbiological Investigation In Dead Bodies For Prevalence of Tuberculosis.

Despite the availability of effective treatment for most cases, tuberculosis is still a cause of death in our country. Some cases of active tuberculosis are not identified until after the patient had died and an autopsy has been performed. This study was done to determine the prevalence of tuberculosis in autopsy cases.We aimed to determine the infection with Mycobacteriumtuberculosis using Tuberculosis culture in samples that were obtained from lungs of forensic cases whoseautopsies had been performed in the mortuary of our institution.In our autopsy study, out of the 168 tissue samples that were obtained from lungs over a period of three years, only 9 (5.36%) were positive for Tuberculosis in Lowenstein-Jensen medium. For this reason, we think that autopsy workers have to be carefulabout tuberculosis during their autopsy working. Awareness of tuberculosis and its high prevalence in India is essential for minimising missed diagnoses. Absence of suspicion and delayed diagnosis mean increased risk in health care and at autopsy. Although this is a burning issue but the forensic medicine departments in India seem to be taking it lightly.

Pre-testing Screening for HIV before Conducting Post-mortem Examinations.

The concern about contracting an infectious disease during the course of an autopsy is great, a concern heightened when the devastating infections that could be transmitted are considered. The fear and concern, however, appear out of proportion to the actual incidence of such disease transmission. In our autopsy study, out of the total 328 blood samples tested, only 2 (0.6%) samples were found to be HIV seroreactive, over a period of three years. A comparison with similar studies abroad, reveals varied results, which do not represent the population data. However more such studies will be needed in different regions of countries to find any significant pattern or correlation. Although this is a burning issue but the forensic medicine departments in India seem to be taking it lightly. The association of the department with a microbiologist is essential in saving its staff.

Euthanasia revisited: The aruna shanbaug verdict.

Euthanasia and its procedure have long history of locking horns as a vexed issue with laws of countries across the world. Every human being of adult years and sound mind has a right to determine what shall be done with his/her own body. It is unlawful to administer treatment to an adult who is conscious and of sound mind, without his consent. In patients with Permanently Vegetative State (PVS) and no hope of improvement, the distinction between refusing life saving medical treatment (passive euthanasia) and giving lethal medication is logical, rational, and well established. It is ultimately for the Court to decide, as parens patriae, as to what is in the best interest of the patient. An erroneous decision not to terminate results in maintenance of the status quo; the possibility of subsequent developments such as advancements in medical science, the discovery of new evidence regarding the patient’s intent, changes in the law, or simply the unexpected death of the patient despite the administration of life-sustaining treatment, at least create the potential that a wrong decision will eventually be corrected or its impact mitigated.

Use of hair root sheath for barr body determination.

Determination of sex is useful in Forensic Medicine. Barr bodies can be seen hair root sheath cells. The presence of barr bodies indicates that sex of the person is female. They are inactive X chromosome. The Barr bodies are also known as sex chromatin. Hair can present in the crime scene. Hair is trace evidence. The stain used was aceto-orcein. The percentage of barr bodies was found to be 28-49 %. The study was carried out for eight months and it was found that barr bodies persisted for eight months. It can be present anywhere at the crime scene. Hair of the accused can be present in hands of victim due to cadaveric spasm. Hair of victim can be found on the clothes of the accused. There is average fall in percentage of barr bodies with the passage of time due to the start of decomposition changes in the root sheath cells.

The responsibility on the shoulders of courts and doctors to provide proper legal protection to rape victim.

Rape is not only a crime against the person of a woman; it is a crime against the entire society. It destroys, as noted by the Supreme Court [1], the entire psychology of a woman and pushes her into deep emotional crisis. It is a crime against basic human rights, and is also violative of the victim's most cherished of the Fundamental Rights, namely, the Right to Life contained in Article 21 of the Constitution of India, 1950. The low rate of convictions in cases of rape raises serious questions about the workings of the law. The amendments seem to have had little effect and merit closer examination. There is reluctant recognition of the amendments and its swamping under pre-conceived notions. After more than two decades since legal reforms gave rape victims more leverage in the courtroom; we need to change society’s attitude towards rape.

Critical appraisal of dying declaration.

Dying declaration is very important documentary evidence. It is hearsay evidence but even then it is given a lot of weightage in the court proceedings. Recording of dying declaration is very important. If it is recorded properly by the proper person keeping in mind the essential ingredients of the dying declaration it retains its full value. Missing any single ingredients of dying declaration makes it suspicious and offenders are likely to get the benefits of its shortcomings.

Is education a determinant of knowledge about malaria among Indian tribal population?

Malaria is a major public health problem in tribal villages of India, where 8% of the country's population lives. Literacy level among tribal population is very low. This study aims to examine the relation between education status and knowledge about malaria among Indian tribal communities. 125 randomly selected tribal respondents from one tribal village each of 17 states were administered a close ended questionnaire by trained interviewers to assess their knowledge about various aspects of malaria. Effect of educational status on the level of knowledge was analyzed using chi square test. Stratified analysis was performed using Mantel Haenszel chi square test to eliminate gender bias. 2125 respondents', randomly selected from 17 tribal villages in as many states, findings were analyzed. Fifty seven percent male and 72% female respondents were illiterate. Only 2% respondents had college level education. Educated females were more knowledgeable than their male counterparts. Mantel Haenszel chi square analysis showed that educated respondents were more knowledgeable than the illiterates, after adjusting for sex of respondents. However, there was gross lack of knowledge regarding diagnosis and treatment of malaria and use of insecticides irrespective of gender and educational status. Improvement in literacy status of tribal population will help in increasing awareness about malaria. Opportunities for disseminating information about various aspects of malaria should be utilized during treatment of malaria cases by health workers.

Long-term nutritional effects of ICDS.

Nutritional status of 1243 children (636 boys and 607 girls) in the age group of 7-13 years was assessed in relation to utilisation of Integrated Child Development Services (ICDS) during their childhood. All the houses in every 10th Anganwadi selected by systematic random sampling were surveyed in the ICDS project, Nand Nagri in East Delhi. Information regarding utilisation of ICDS facilities, sociodemographic details, general awareness etc. was collected by interview technique and anthropometric and clinical examination of every child was done and Anganwadi attendance score was calculated for each child. It was found that most of the children were non-beneficiaries (59.1%). On univariate analysis Anganwadi attendance score, age, sex of the child and education status of the father showed statistically significant association (p < 0.005) with malnutrition. On Multiple logistic regression analysis higher age (OR 1.4155 for grade 1 malnutrition and 1.6913 for grade 4 malnutrition) and being female (OR 1.5214 for Grade 4 malnutrition) remained significant risk factors for development of malnutrition for all grades. Anganwadi attendance score did not show any statistically significant association for decreasing the risk of getting malnourished for any grades of malnutrition in 7-13 years age group. There is special need to take special care for girls as well as to continue the special nutrition care even at an higher age. More in depth studies are needed so as to formulate effective nutritional policies for children.

HIV/AIDS related knowledge, risk perception, attitude and sexual behavior of working women staying in hostels.

HIV infection poses a formidable threat to women's health. Already, in India, women account for 21.3% of all AIDS cases. In metropolitan cities women living alone in hostels and having independent income, may have a liberal life style and chances of practising high risk sexual behaviour is greater. This study was conducted to assess the risks and risk perception of such women. Among eighty-nine hostel residents, AIDS awareness was 92.1%. Very few respondents had adequate knowledge about modes of transmission and methods of prevention. Risk perception was poor, however high risk behaviour was less commonly practised by this group.

Measles, immunisation and disease: rapid epidemiological assessment in two trans-Yamuna villages of Delhi.

A community investigation was conducted in 2 villages of east Delhi, having 15,000 population. Ten per cent households were selected from both the villages by systematic random sampling and all the under 3-year children in selected households were included in the study. A total of 126 under 3-year children from 360 households were investigated. Total children immunised against measles were 86. Most of the 86 immunised children were vaccinated between 9 and 11 completed months. Of the 80 children aged 12 months or above, 12(15%) were unimmunised. Main reason behind non-immunisation was parental apathy. Of the total 126 surviving under 3-year children, 12(9.52%) had a history of probable measles. Two of these children had already measles before they could be eligible for measles vaccination as per the current schedule.

Assessment of availability and working components of school health services in Delhi.

A total of 204 schools of different types and geographical zones were surveyed. Principals of the selected schools were interviewed to generate data regarding availability and working components of school health during last one year. School health services were non existent in 56 (27.45%) of the total schools and in another 27%, the visits made by school health team were only three or less during last one year. The situation was much better in NDMC and MCD schools but in Govt. of Delhi group, 40 of the 82 schools did not have any school health services. In most of the schools having some form of school health services (govt. or private), all the essential areas of health appraisal viz. anthropometry, general health check-up, vision testing, ENT check-up and dental examination were covered. In 21.62% of such schools no health education activity was done by the school health team. Even in the schools having some form of school health services, referral-follow up system did not seem to be working well. In this situation health check-ups merely satisfy administrative requirements and end up with some data for storage. School health services in Delhi, like other health services, are administered through multiple agencies with somewhat overlapping areas and responsibilities. This has more disadvantages than benefits. An integration of various school health schemes in Delhi with uniform system and standards should be attempted.

Structural and organizational features of school health schemes in Delhi.

The magnitude of work and existence of multiple agencies makes the task of providing school health services to all pupils of the State of Delhi with uniform standards, a very complex job. The present article looks at the matter from the provider's end, illustrates the structural and organizational features of various school health schemes in Delhi and tries to come out with some suggestions for improvement. This study was based on qualitative research methods. Besides the three major agencies involved i.e. Govt. of Delhi, MCD and NDMC, a host of private and other agencies were also contributing significantly in covering a total of approx. 3700 schools with around 19 lakh children. Organizational and other features of school health services varied widely according to the providing agency. There is a need for integration between various school health schemes in Delhi. Since MCD school health scheme appeared to be better organized, its features can be adopted while developing uniform standards. About the components of services, promotive inputs and follow-up of health appraisals are the areas that need to be strengthened. Proper maintenance of cumulative health records, central documentation and timely dissemination of reports are also equally important and need strengthening.

Impact of a multi-method promotional package on awareness and knowledge about STD and AIDS among the trainees of an industrial training institute in a resettlement colony of Delhi, India.

To design and apply a multi-method promotional package for enhancing awareness and knowledge on STD and AIDS among ITI trainees, and evaluate its impact, an intervention study, using pre and post assessment of the subjects for comparison was carried out. The study was carried out in the Industrial Training Institute (ITI), in a resettlement colony of Delhi. Urethral/vaginal discharge, genital ulcer and pain on micturition were identified as symptoms of STD by a significantly higher number of respondents in the post package sample. A sizable number of subjects included inguinal swelling and lower abdominal pain also as STD symptoms. The IEC intervention showed a significant improvement in knowledge about all four major routes of transmission of HIV/AIDS. Using condoms and avoiding sex with Commercial Sex Workers were reported as measures to prevent STD/AIDS by a significantly higher number of subjects after the intervention. A sizable number of subjects also included other measures (using safe blood/not sharing needles etc.) as well. There was a significant decline in the subjects preferring self treatment or treatment from a chemist shop in case one suffered with an STD. A significant increase was observed in those preferring treatment from govt. facilities or private allopathic doctors. However, the intervention did not seem to result in preference for alternative systems of medicine. The study demonstrated that exposure to intensive promotional intervention, even for a brief period can significantly raise awareness and knowledge of young people even on sensitive topics like STD and AIDS.

Perceptions of teachers regarding sex education in National Capital Territory of Delhi.

A cross sectional study was conducted to find out the knowledge and attitudes of school teachers regarding sex education. Information was collected from 476 senior secondary school teachers belonging both to the government and public schools, selected randomly in National Capital Territory of Delhi using pre-tested close ended questionnaires. A majority of school teachers (73%) were in favour of imparting sex education to school children. Regarding contents of sex education, 90% agreed to the inclusion of reproductive anatomy, physiology including menstruation and birth control measures like condoms and oral pills. However, a majority of school teachers did not want sex education to include topics like abortion, premarital sex and masturbation etc. Fourteen years of age was considered to be the most appropriate for imparting sex education by 28.6% of school teachers. School teachers and doctors were considered by 69.4% and 63.6% of the respondents respectively to be the most appropriate persons for providing sex education.

Breast feeding patterns in an urban resettlement colony of Delhi.

Studies on duration and patterns of breast feeding based on recall may lead to a bias about the exact feeding status. The present study was designed to overcome this bias using the 'current status analysis method'. Mothers of 650 infants from 0 to 12 months of age attending a Health Centre were interviewed about the current feeding patterns of the infants and other socioeconomic variables. Month-wise prevalence of feeding patterns was determined. It was observed that breast feeding was maintained at a high level (more than 90%) throughout infancy while exclusive breast feeding showed a rapid decline. At 1 month, 74% and at 4 months, 46% of infants were exclusively breast-fed. The median duration of exclusive breast feeding was 3.83 months. Mothers with lesser education and lower family income were more likely to exclusively breast feed (p < 0.05). The time interval between birth and first breast feed was 24-48 hours in most (48.9%) of the infants. Majority (76.9%) of the infants received pre-lacteal feeds. Hospital-born infants received their first feed earlier and were less likely to receive pre-lacteal feeds as compared to those born at home (p < 0.001). Thus, the practice of exclusive breast feeding has to be promoted amongst pregnant and lactating mothers by health personnel. Also knowledge regarding infant feeding has to be imparted in schools and colleges.

Process evaluation of pulse polio immunisation in Delhi.

The aim of the study was to assess the functional aspects and the staffing at Pulse Polio immunisations posts. Interns and medical students conducted the survey in eighty seven pulse polio immunisation posts scattered all over National Capital Territory of Delhi on 18th January 1997. A pre-tested structured format containing information pertaining to dose utilisation and staffing was filled. Number of children given pulse polio was on an average 459.2 per immunisation post (474.7 rural, 516.35 slums and 435.0 urban). Average number of neonates (below one month) per immunisation post given polio drops was 5.1 (1.1%). The break-up for rural area, slums and urban area was 3.0 (0.63%), 6.7 (1.30%) and 4.9 (1.13%) respectively. By 12 pm, 67.8% and by 2 pm 88.7% of the doses had been administered. Staffing at most of the immunisation posts was adequate for all categories of staff except doctors (0.48 per booth).

Knowledge, attitude and practices related to dengue in rural and slum areas of Delhi after the dengue epidemic of 1996.

To assess the knowledge and attitudes about dengue and practice of prevention followed by the residents of a rural area and an urban resettlement colony of East Delhi, an interview based cross sectional KAP study was undertaken in Jan 97 to Feb 97, a few months after the dengue epidemic in rural area and urban areas of East Delhi. A pre-structured and pre-tested format containing the relevant questions was administered to the subjects. A total of 687 subjects (334 rural and 353 urban) were interviewed. Nearly four fifth (82.3%) of these were aware of Dengue. Audiovisual media was the most common source of information in both the areas. Knowledge about the disease was fair to good. Fever was the commonest symptom of the disease known to 92% urban and 83% rural respondents followed by symptoms of bleeding and headache. Mosquito was known to spread the disease to 71% rural and 89% urban respondents. More than two third respondents in urban and two fifth in rural areas had used some method of mosquito control or personal protection during the epidemic.

Knowledge of fresh medical graduates about immunization: impact of posting in community medicine.

Immunization being the most cost effective health intervention rightly forms an integral part of MCH health activities spectrum. Of late medical colleges in the country are directly involved from the planning to evaluation stages in the immunization programmes in their respective catchment areas. Immunization knowledge of 91 interns during their course of involvement in community work, was tested on the first day and last day of their three months posting in the Community Medicine Department. The study showed positive impact of training in the Department of Community Medicine on the performance levels of interns. This was found mainly attributable to effective interaction of interns with the community in the field and taking independent decisions as per the case requirements.

Childbirth spacing in a rural community of Delhi: profile in various marriage cohorts by decades.

Complete retrospective fertility histories of 843 ever married women of two villages in Delhi, obtained through house to house survey, were analysed to study various marriage cohorts by decades for trends of child birth spacing over a period of 60 years from 1921 to 1980. Spacing between consummation of marriage and first child birth gradually declined over the last 6 decades. For all other subsequent livebirths remained constant at an average of nearly 30 months. Irrespective of the reasons for such a trend, much more efforts are required to be put in to increase child spacing.