Improving assistive technology access to students with low vision and blindness in Delhi: A school-based model

Purpose: Assistive technology (AT) has recently received considerable attention around the world. Studies have shown poor access to assistive technology for visual impairment (ATVI) in schools for the blind in India. The present article aimed at designing a school?based model to improve AT access in schools and provide hands?on training, and identify types of ocular morbidities present among students. Methods: The vision rehabilitation (VR) team of a tertiary eye?care center visited schools for the blind as a part of community? based VR services. The team conducted a basic eye examination and assessed best?corrected vision acuity (BCVA) and provided VR services. Furthermore, two schools were selected to establish an ATVI learning center as a pilot model. Results: In total, 1887 students were registered for VR and obtained their disability certificates in 2019?20. Retina problems (25.7%), globe abnormalities (25.5%), optic nerve atrophy (13.6%), and squint (12.0%) were common ocular problems identified in students. Around 50.3% of students had BCVA ³ 1/60 in the better eye who would be benefited from visual?based AT, and the remaining students with visual substitution AT. Further, 20.8% of them who had near vision between N18 to N24 would be benefitted from large print books. Two schools were provided ATVI with support from the WHO. Familiarization, demonstration, and initial training for ATVI were carried out. Conclusion: A sizable number of the students would be benefitted from visual?based AT apart from visual substitutions AT. Students were interested to have such ATVI centers in the school for academic and non?academic skills development.

Prevalence and causes of low vision in a population-based study on childhood visual impairment in North India (CHVI 4)

Purpose: The present study was a population?based study to determine the prevalence and causes of low vision in children less than 16 years in North India. Methods: This cross?sectional study was conducted in 40 clusters of urban Delhi. Children aged less than 16 years underwent visual acuity screening using age?appropriate visual acuity charts. All children with visual acuity of <6/12 in any eye in the age group between 3 and 15 years and inability to follow the light in age less than 3 years were referred for detailed ophthalmic examination in a centrally based clinic. Cycloplegic examination and best?corrected visual acuity (BCVA) were assessed. They were examined by an ophthalmologist to determine the prevalence and causes of functional low vision (FLV). The prevalence of FLV was compared with other population?based studies across India and other parts of the world. Results: Amongst 20,955 children examined for visual acuity, 789 children were referred to the central clinic for detailed ophthalmic examination. The overall prevalence of low vision was 0.62 per 1,000 children (95% confidence interval [CI] 0.12–1.90). The main anatomical cause of low vision was retinal abnormalities. Conclusion: Although the prevalence of children with low vision decreased as compared to previous population?based studies. There is an important need to create awareness among parents on appropriate and timely usage of low?vision devices (LVDs) at an affordable cost to improve the visual quality in children with low vision.

Current status of trachoma in India: Results from the National Trachoma Prevalence Survey

Purpose: In the mid?twentieth century, trachoma was endemic in the northwestern states of India. We aimed to generate recent estimates of prevalence of trachomatous inflammation, follicular (TF) and trachomatous trichiasis (TT) in ten suspected?endemic districts across seven previously hyper?endemic states and union territories for trachoma in India including Delhi, Rajasthan, Haryana, Punjab, Gujarat, Uttarakhand and the Andaman and Nicobar Islands. Methods: Population?based prevalence surveys were undertaken in 10 districts. In each of those districts, two?stage cluster sampling was used to select a sample of 2000 children aged 1–9 years and all adults aged ?15 years in the enumerated households from a total of 20 clusters per district. Consenting eligible participants were examined for trachoma by trained ophthalmologists using the World Health Organization’s simplified grading system. Data were analyzed at the district level. Results: A total of 13,802 households were surveyed in which 19,662 children were examined for TF and 44,135 adults aged ?15 years were examined for TT. District?level TF prevalence in 1–9?year?olds ranged from 0.1% in Bikaner (95% CI: 0.01–0.3) to 2.1% in Dholpur (95% CI: 1.6–2.8) and that of trichiasis ranged from 0.7 per 1000 in Pauri Garhwal (95% CI: 0.01–1.4) to 22.1 per 1000 (95% CI: 15.8–28.4) in Car Nicobar. In four districts (Car Nicobar, Dholpur, Hoshiarpur, Tonk), trichiasis prevalence in adults aged ?15 years was ?0.2%. Conclusion: TF was not a public health problem in any of the districts surveyed; thus, antibiotic mass drug administration is not needed. However, TT among adults was found to be above 0.2% in four districts; thus, further trichiasis surgery interventions at the public health level are warranted to achieve elimination. These findings will facilitate planning for elimination of trachoma as a public health problem in India.

Effect of Integrated People-Centred Eye Care (IPEC) Model on Eye Care Seeking Behaviour of Community

Background: World report on vision makes integrated people-centered eye care as care model of choice. Integrating eye care with the existing public health system makes services available, accessible, affordable, and sustainable. Being from the community, Accredited Social Health Activists(ASHAs) are better suited to improve people’s eye health-seeking behavior. Objectives: This study aims to assess the eye care-seeking behavior of community and to understand their response toward the approach of integrated vision centers (VC) with ASHA involvement. Methods: A cross-sectional descriptive study was conducted in South Delhi district where integrated VC were functional for more than a year. These centers were supervised by medical officer in?charge, under whom ophthalmic assistants, ASHAs, auxiliary nurse midwives, and pharmacist work. ASHAs were trained in community-based primary eye care. The community survey was conducted on eye health-seeking behavior and utilization of VC services. Descriptive statistics were used for data analysis. Results: Out of 1571 study participants, 998 reported any ophthalmic illness in family in the past 6 months as against 1302 who reported nonophthalmic illness in family. The majority (1461, 90%) were aware about integrated VC and half of them (748, 51.2%) visited it. Of them, 64.2% were motivated through ASHAs. ASHAs spread awareness about eye diseases, eye treatment facility, and referred patients from the community. The majority (93%) were happy with the integrated VC and 87.8% were happy with ASHAs. Conclusion: Integrated VC with ASHA engagement could pave the way for universal eye health. Understanding people’s needs and engaging community would increase the demand for eye care.

Effect of Anti?Platelet Therapy on Peri?Operative Blood Loss in Patients Undergoing Off?Pump Coronary Artery Bypass Grafting

Purpose:The purpose of this study was to review the effect of the pre?operative use of clopidogrel and aspirin on peri?operative bleeding, blood product transfusion, and resource utilization after coronary artery bypass grafting (CABG). Materials and Methods: A total of 1200 patients who underwent off?pump CABG (OPCABG) between 2010 and 2012 were retrospectively studied. Patients were divided into three groups: group 1: discontinued aspirin and clopidogrel 6 days prior to surgery (n = 468), group 2: discontinued both drugs 3 to 5 days prior to surgery (n = 621), and group 3: discontinued both drugs 2 days prior to surgery (n = 111). The bleeding pattern and blood product transfusion were studied and compared between the groups. Patients having history of other drugs affecting the coagulation profile, other organ dysfunction, on?pump CABG, and the combined procedure were excluded from the study. Results: Group 2 patients had a higher rate of bleeding and a reduced mean value of hemoglobin (Hb) as compared to other groups. The same results were seen in blood and blood product transfusion. Patients of group 2 and group 3 were associated with higher blood loss in terms of drainage at 12 and 24 hours. Post?operatively, this was statistically significant. Re?exploration was statisitically significant in group 3 patients (9.01%) than in group 2 (2.58%) and group 1 (1.07%) patients. Conclusion: The pre?operative use of clopidogrel and aspirin in patients undergoing OPCABG showed limited clinical benefits; however, its use significantly increased the risk of bleeding and blood transfusion, thus increasing morbidity and resource utilization. Hence, clopidogrel and aspirin should be stopped at least 6 days prior to surgery.

Vascular Access Complications in Patients Undergoing Veno-Arterial ECMO and Their Impact on Survival in Patients With Refractory Cardiogenic Shock: A Retrospective 8-Year Study

Introduction:Veno-arterial extracorporeal membrane oxygenation (ECMO) is well-recognized treatment modality for patients with refractory cardiogenic shock. Uncomplicated cannulation is a prerequisite and basis for achieving a successful outcome in ECMO. Vascular access is obtained either by surgical cut-down. Common vascular access complications are bleeding and limb ischemia. Objective: To evaluate cannulation technique, the incidence of vascular complications, and their impact on the outcome. Methods: A retrospective data analysis conducted on 95 patients receiving ECMO from 2013 to 2020 was done. The patients were divided into two groups: no vascular access complications (non-VAC group) and vascular access complications (VAC group). The groups were compared related to the hospital and ICU stays and blood transfusion. Results: The patients in both groups were demographically and clinically comparable. The Non-VAC group had 75 patients, whereas the VAC group had a total of 20 patients. The main complication observed in the VAC group was bleeding from the cannulation site which required more blood transfusion than the non-VAC group (6.8 ± 1.02 vs 4.2 ± 1.26). Limb ischemia was another complication seen in the VAC group (4.2%, n = 4). Two patients had delayed bleeding after decannulation. The overall average length of stay in the hospital was statistically similar in both the groups (22 days in the VAC group vs 18 days in the non-VAC group), but the average ICU stay was more in the VAC group compared to the non-VAC group (18 days vs 12.06 days). Conclusion: Bleeding and limb ischemia are the important vascular access site complications, which increase blood transfusion requirements, ICU stay, and overall hospital stay.

Dental Considerations of Hereditary Bleeding Disorders in Children: An Overview

Introduction: Hereditary bleeding disorders are the diverse group of disorders that happen due to the inherent abnormalities in the blood vasculature preventing the blood clotting process and leading to delayed bleeding. Objectives: To review this heterogenous group of disorders and update the clinicians about their oral manifestations and dental management to prevent the onset of any complications in dental settings. Materials and Methods: Review papers, original studies, case reports published in PubMed/MEDLINE, Web of Science, Scopus, Science Direct, and Google Scholar, as well as numerous publications, were used to compile the data by four reviewers. Result and Conclusion: This review article explains the existing paradigm. Children with various hereditary bleeding disorders are a significant challenge for clinicians. Many authors have emphasized that patients with bleeding disorders can be managed safely in a dental setting if specific recommendations are followed.

Myopia prevalence in a population-based childhood visual impairment study in North India – CHVI-2

Purpose: The aim of the study was to determine the prevalence of myopia at the community level. Methods: A population?based, cross?sectional study was planned in 40 clusters among children identified with subnormal vision in the urban community of Delhi. House?to?house visits were conducted for visual acuity screening of 20,000 children aged 0–15 years using age appropriate visual acuity charts. All the children with visual acuity of < 6/12 in any eye in the age group between 3 and 15 years and inability to follow light in age group 0–3 years were referred for detailed ophthalmic examination. Results: A total of 13,572 (64.7%) children belonged to the age group of 6–15 years. Of these, a total of 507 (3.7%) were found to be having myopia (spherical equivalent of ?0.50 DS or worse in one or both eyes) with positive association with higher age groups. Conclusion: The estimated prevalence of myopia is 3.7%; the proportion of uncorrected myopia was 45%, which reflects that refractive error services need to be improved further.

A study to assess the knowledge and skills of Accredited Social Health Activists and its retention after training in community-based primary eye care

Purpose: Community volunteers like Accredited Social Health Activists (ASHAs) could be utilized for linking community and eye care services. Research is needed to effectively utilize them. This study was to assess whether ASHAs could imbibe new knowledge in eye care and conduct vision screening. Methods: Settings and Design: A pre?post?intervention study in South Delhi Integrated Vision Centres. It was conducted from January 2016 to March 2017. One day of conceptual training followed by hands?on training in vision screening was imparted to ASHAs. The knowledge was assessed thrice: before, immediately after, and following 1 year after training. The vision screening skill was assessed twice. Descriptive analysis using percentages, mean and standard deviations. Paired t?test was used for assessing the change in scores. Results: A total of 102 ASHAs were recruited. A significant increase in the knowledge score of ASHAs before (14.96) and after training (25.38) (P < 0.001) was noted. The knowledge score was sustained at 1 year (21.75). The satisfactory skill of vision screening was seen in 88 (86.3%) ASHAs after training, while 79 (77.5%) ASHAs still retained it after 1 year. Conclusion: The potential to involve ASHAs in community?based frontline eye care activities: awareness generation of eye diseases, identification of referrable conditions, and facilitating individuals to seek eye care facilities. This study informs about the duration, frequency, and content of the training. It also provides evidence on the improvement and sustainability of eye care knowledge and skills by ASHAs after conceptual and hands?on training

Effect of intravenous pulse dexamethasone versus daily oral prednisolone on bone mineral density in dermatology patients: Is it a site-specific response?

Background: The use of glucocorticoids in various forms of administration is complicated by their systemic side effects. Although intravenous pulse therapy is considered to have lesser systemic side effects, there are few studies in literature comparing the effects of intravenous pulse glucocorticoids versus oral daily glucocorticoids on bone mineral density. Aim: To compare the effects of intravenous pulse glucocorticoids and oral daily glucocorticoids on bone mineral density with the aim of finding any site-specific osteopenic side effect. Methods: The study was conducted by the department of dermatology of Postgraduate Institute of Medical Education and Research, Chandigarh, India. The study comprised of two groups of patients. Group A consisted of 28 patients with pemphigus vulgaris who received intravenous pulses of dexamethasone at 4 weekly intervals. Group B consisted of 21 patients with airborne contact dermatitis who received oral daily prednisolone therapy. All the patients had a dual X-ray absorptiometry scan at baseline, and at 3 and 6 months of follow-up. The results were analyzed as changes in bone mineral density. Results: There was loss of bone mineral density at lumbar spine and the head of radius in both the groups. At the lumbar spine, Group B showed more reduction in bone mineral density at 3 months whereas in Group A it was more at the head of radius. In patients on oral steroids, the lumbar spine was significantly more affected than the head of radius at both 3 and 6 months of follow-up. However, in patients on intravenous pulse steroids, both the sites were equally affected at 3 and 6 months. Limitations: In our study, we used different glucocorticoids in the two groups: prednisolone in the oral daily group and dexamethasone in the intravenous pulse steroids group. A similar reduction in bone mineral density in both the groups may have been due to a longer half-life or more bone-directed side effects of dexamethasone as compared to prednisolone. Conclusion: Dermatologists need to be aware of the detrimental effects of high-dose intravenous pulsed glucocorticoids on bone mineral density and assessment of this parameter should be done before the initiation of therapy and also at regular intervals thereafter. During follow up, either the lumbar spine or the head of radius can be used to assess the osteopenic effect of intravenous pulse steroids, whereas the lumbar spine is a better site for this evaluation in patients on oral steroids.

Clinicopathological Study Of Oral Cavity Mass Lesions In A Tertiary Care Centre Of North India

Background: Oral mass lesions, especially the potentially malignant and malignant lesions are a major health concern for a developing country like India. They pose a serious health and economic burden.Aims: This study was carried out to analyze the clinical profile and reaffirm the frequency of various causes causing mass lesions in oral cavity in different age-groups in a tertiary care centre of North India.Materials and Methods:All patients who had oral mass lesions and attended Departments of Otorhinolaryngology, General Surgery and the Dentistry of Hind Institute of Medical Sciences, Safedabad, Barabanki and Department of Surgery of School of Medical Sciences and Research, Sharda University, Greater Noida in two years (2015-2016) were included in the study.Statistical Analysis:All the analysis was carried out on SPSS 17.0 version (Chicago, Inc., USA). The results are presented in percentages. The Chi-square test was used to assess the associations between categorical variables. The p-value<0.05 was considered significant.Results:Of 126 cases with oral lesions, we found that 66 (52.4%) were benign, 12 (9.5%) were pre-malignant and 48 (38.1%) were malignant lesions. Squamous papilloma was the most common benign lesion followed by fibroepithelial hyperplasia. The premalignant lesions observed in our study in the decreasing order of frequency were leukoplakia, lichen planus and submucous fibrosis. The malignant lesions comprised of squamous cell carcinoma and verrucous carcinoma. Conclusion:In our study it was found that though the benign oral lesions are commoner that malignant but still these form significant numbers. Hence the origin and the nature of oral cavity lesion should not be decided on clinical assessment alone but should also take into account the histopathological evaluation of the lesion also.

Prevalence of visual impairment due to uncorrected refractive error: Results from Delhi‑Rapid Assessment of Visual Impairment Study.

Aim: To estimate the prevalence of visual impairment (VI) due to uncorrected refractive error (URE) and to assess the barriers to utilization of services in the adult urban population of Delhi. Materials and Methods: A population‑based rapid assessment of VI was conducted among people aged 40 years and above in 24 randomly selected clusters of East Delhi district. Presenting visual acuity (PVA) was assessed in each eye using Snellen’s “E” chart. Pinhole examination was done if PVA was <20/60 in either eye and ocular examination to ascertain the cause of VI. Barriers to utilization of services for refractive error were recorded with questionnaires. Results: Of 2421 individuals enumerated, 2331 (96%) individuals were examined. Females were 50.7% among them. The mean age of all examined subjects was 51.32 ± 10.5 years (standard deviation). VI in either eye due to URE was present in 275 individuals (11.8%, 95% confidence interval [CI]: 10.5–13.1). URE was identified as the most common cause (53.4%) of VI. The overall prevalence of VI due to URE in the study population was 6.1% (95% CI: 5.1–7.0). The elder population as well as females were more likely to have VI due to URE (odds ratio [OR] = 12.3; P < 0.001 and OR = 1.5; P < 0.02). Lack of felt need was the most common reported barrier (31.5%). Conclusions: The prevalence of VI due to URE among the urban adult population of Delhi is still high despite the availability of abundant eye care facilities. The majority of reported barriers are related to human behavior and attitude toward the refractive error. Understanding these aspects will help in planning appropriate strategies to eliminate VI due to URE.

Correlation of glycosylated hemoglobin with microalbuminuria to predict renal damage in diabetic patients.

Background: Regular screening of levels of glycosylated hemoglobin and microalbuminuria, diabetic nephropathy can be prevented. The aim was to assess and compare the levels of glycosylated hemoglobin, microalbuminuria and serum creatinine in type 2 diabetic patients divided in groups of those on default antidiabetic treatment compared with those on regular antidiabetic treatment and to assess its correlation in type 2 of diabetic nephropathy. Methods: Two hundred diabetic patients above 40 years of age and 200 age matched control subjects with levels of glycosylated hemoglobin < 6.5% and on regular antiglycemic therapy were selected. Fasting plasma sugar was estimated by the glucose oxidase (GOD) - glucose peroxidase (POD). Glycosylated hemoglobin and microalbuminuria level was measured by the immunoturbidimetric method and serum creatinine estimation was done by the Jaffe’s kinetic method. p value was drawn using the student’s paired t-test. Results: There is a strong correlation between the increase in the levels of glycosylated hemoglobin with the corresponding rise in the levels of microalbuminuria and serum creatinine. Conclusion: Periodic surveillance of the levels of microalbuminuria should be carried out in the type 2 diabetic patients to prevent further damage by early detection of diabetic nephropathy.

Dendrimers: a Review on Synthetic Approaches.

This review article is focused on different synthetic strategies used in dendrimer synthesis at commercial and laboratory scale. These synthetic strategies includes their own advantages and disadvantages. This review will cover divergent (from core to surface) and convergent (from surface to core) approaches used in dendrimer synthesis and the problems associated with these synthetic strategies. This article also covers the important applications of dendrimers in the field of pharmaceutical sciences. This data of review is collected from various articles, research papers and patents available on dendrimers.

Iodised Salt Consumption in Medical Colleges of India.

Objectives: To assess the knowledge regarding Iodine deficiency disorders and iodized salt among selected persons involved in providing cooked food to the doctors and students of the Medical colleges of India and to study the procurement and storage practices and iodine content of salt in kitchens of Hostels and Canteens of the Medical colleges of India Methods: Cross sectional study was conducted involving 24 medical colleges in 11 states. Knowledge assessment of 96 person responsible for purchase of salt in hostel/canteen kitchen and 97 supervisors were conducted. Salt samples from 135 hostel/canteen kitchen were tested for iodine content using titration. Results: Among the participants responsible for purchase of salt in the canteen, 80.2% have heard about iodine and 82.3% think that iodine is necessary for better health. Eighty five percent of the purchasing personnel think that it was necessary to take iodized salt. Out of the total, 85% of purchase in charge and 93% of supervisors said that they purchase only iodized salt for the hostel/canteen kitchen. Only 31.9% of the salt samples were stored in air tight containers. Eighty one percent of salt samples received were adequately iodized. Conclusions: The knowledge regarding the Iodine Deficiency Disorder and iodized salt was found to be adequate in the study and has resulted in emphasis on purchase of Iodized salt. But the existence of inadequately iodized salt in the samples collected shows the need for strict monitoring and enforcement of Prevention of Food Adulteration act.

Clinical and cone beam computed tomography comparison of NovaBone Dental Putty and PerioGlas in the treatment of mandibular Class II furcations.

Objective: The objective of this study is to compare the putty form of bioactive glass (NovaBone Dental Putty) and particulate form (PerioGlas) in the resolution of Class II furcation defects. Background: Use of bone regeneration materials is becoming common in periodontal surgeries including furcation defects and the promising role of bioactive allograft materials has encouraged their presentation in different morphologic forms with their own advantages and disadvantages giving the operator ample of choices in his/her periodontal armamentarium. Materials and Methods: A total of 28 patients with 40 Class II furcation defects were enrolled in the study and were randomly allocated to two groups with 20 sites in each group. Measurement of defects was done using clinical and cone beam computed tomography (CBCT) methods. The patients were followed-up at 6 months. Intergroup comparisons were done using Mann-Whitney U-test. Results: There was no significance between group differences in clinical parameters and defect size at the baseline. After 6 months, particulate form showed a mean resolution of 50.48 ± 16.47% and 51.11 ± 9.48%, respectively for vertical defect and horizontal defect while putty form showed a mean resolution of 43.48 ± 9.33% and 42.88 ± 11.09%, respectively. Mean resolution in furcation width was 40.15 ± 13.00% for particulate form as compared with 36.27 ± 11.41% in putty form. Statistically, there was no significant difference between two groups except for the horizontal defect fill where PerioGlas showed statistically better results. Conclusion: Putty form was comparable to particulate form for resolution of Class II furcation defects.

Clinical differences between influenza A (H1N1) pdm09 & influenza B infections identified through active community surveillance in north India.

Background & objectives: Most studies on the clinical presentation with influenza viruses have been conducted in outpatient or inpatient medical facilities with only a few studies in community settings. Clinical differences between influenza A (H1N1) pdm 09 and influenza B virus infections have importance for community-based public health surveillance. An active community surveillance at the time of emergence of pandemic influenza provided us with an opportunity to compare the clinical features among patients infected with influenza A (H1N1) pdm09 virus and those with influenza B virus co-circulating in an active community-based weekly surveillance in three villages in Faridabad, Haryana, north India. Methods: Active surveillance for febrile acute respiratory infection (FARI) was carried out in a rural community (n=16,182) in the context of an inactivated trivalent influenza vaccine trial (among children <11 yr). Individuals with FARI were assessed clinically by nurses and respiratory samples collected and tested for influenza viruses by real time RT-PCR from November 2009 to August 2010. Clinical symptoms of patients with influenza A (H1N1) pdm 09 and influenza B infection were compared. Results: Of the 4796 samples tested, 822 (17%) were positive for influenza virus. Of these, 443 (54%) were influenza A (H1N1) pdm09, 373 (45%) were influenza B and six were other subtypes/mixed infections. The mean age was lower for patients with influenza B (16.4 yr) than influenza A (H1N1) pdm09 infection (18.7 yr; P=0.04). Among children aged 5-18 yr, chills/rigours (OR 4.0; CI 2.2, 7.4), sore throat (OR 6.8; CI 2.3, 27.3) and headache (OR2.0; CI 1.3, 3.3) were more common in influenza A (H1N1) pdm09 infection than in influenza B cases. Chills/rigours (OR 2.4; CI 1.4, 4.0) and headache (OR 1.7; CI 1.0, 2.7) were associated with influenza A (H1N1) pdm09 infection in those >18 yr. No significant differences were seen in children <5 yr. Conclusion: Our findings show that the differences in the clinical presentation of influenza A(H1N1)pdm09 and influenza B infections are not likely to be of clinical or public health significance.

A community-based study of menstrual hygiene practices and willingness to pay for sanitary napkins among women of a rural community in northern India.

Background. Hygiene-related practices of women during menstruation are of paramount importance. There is a lack of sizeable literature on menstrual practices from northern India. We documented the menstrual hygiene practices of rural women and assessed their willingness to pay for sanitary napkins. Methods. A cross-sectional study was done in villages under the Comprehensive Rural Health Services Project (CRHSP), situated in Ballabgarh, Haryana. The study participants were women in the age group of 15–45 years. Nine villages were selected randomly while the number of respondents in each selected village was decided through the probability proportionate to size sampling method. The households were selected using systematic sampling. One woman was interviewed in each household using a pre-tested questionnaire. Results. A total of 995 women were interviewed. A majority of them (62%) were unaware of the reason(s) for menstruation. The role of the health sector in providing information regarding menstruation was low as only a few women (1.5%) had got information from the auxiliary nurse midwife (ANM)/health worker (HW). For the majority of women, besides religious activities, other routine activities did not suffer during menstruation. Only 28.8% of women were using sanitary napkins and of those who did not use napkins, only one-fourth (25.3%) were willing to buy them. The mean (SD) price per napkin that these women were ready to pay was `0.54 (0.43), equivalent to US$ 0.01. Conclusion. Women in the reproductive age group should be provided with appropriate information about menstruation, and they should be told about the advantages of using sanitary napkins. Health sector functionaries should play a proactive role in the delivery of such information.

Causes of death in rural adult population of North India (2002-2007), using verbal autopsy tool.

Background: With the on-going epidemiological transition, information on the pattern of mortality is important for health planning. Verbal autopsy (VA) is an established tool to ascertain the cause of death in areas where routine registration systems are incomplete or inaccurate. We estimated cause-specific mortality rates in rural adult population of 28 villages of Ballabgarh in North India using VA. Materials and Methods: During 2002-2007, trained multi-purpose health workers conducted 2294 VA interviews and underlying cause of death was coded by physicians. Proportional mortality (%) was calculated by dividing the number of deaths attributed to a specific cause by the total number of deaths for which a VA was carried out. Findings: 61% of deaths occurred among males and 59% occurred among those aged ≥60 years. The leading causes of death were diseases of the respiratory system (18.7%) and the circulatory system (18.1%). Infectious causes and injuries and other external causes, each accounted for around 15% of total deaths followed by neoplasms (6.8%) and diseases of the digestive system (4%). Among those 45 years of age, more than half of deaths were attributed to non-communicable diseases (NCDs) alone. Accidents and injuries were responsible for one-fourth of deaths in 15-30 years age group. Conclusion: NCDs and injuries are emerging as major causes of death in this region thereby posing newer challenges to public health system.