Utilisation of Maternal Health Services and its Predictors in Slum Population.

Introduction: The particularly sorry plight of disadvantaged slum population with ample scope of further research into such areas as vulnerability to health risk and access to treatment, reduced economical choice and social support besides natural disasters and emotional stress of displacement. Material & Methods: An observational (cross-sectional) study was designed on a pre designed and pre tested questionnaire to understand women’s fertility and contraceptive behavior and to study Socio behavioral Determinants of Utilization of MCH services. Results: The prevalence of <18 marriage was 78.03%.The teenage pregnancy was as high as 46.36% with 47.90% having parity of 4 or more.And of those not seeking ANC 53.42% did not feel the need for care during pregnancy. A very important finding was that 64.23% had home delivery and of these, 74% did not have any trained birth attendant. Conclusion: Levels of education in the family, caste, affordability (asset-holding) and accessibility were the factors which determined the utilization pattern. In general, those with better levels of education and those with better affordability preferred private practitioners and were willing to travel longer distances to avail health services as there was more awareness, motivation and felt need.

Does Maternal Factors Have A Bearing On The Health Of Their Offsprings.

Abstracts: Background: The development of the child is dependent on the mother and if the health of the mother suffers, the child's growth and development are in turn affected. The mother is also the first teacher of the child, and that is why the mother and child are treated as one unit. A mother is the principal provider of the primary care that her child needs during the first six years of his/her life. The type of care she provides depends to a large extent on her knowledge and understanding of some aspects of basic nutrition and health care. This begins at conception and continues until infancy, teenage and adulthood. Therefore, mothers are key players in the growth and development of children. Methodology: The study was carried out in the villages under RHTC, field practice area of Department of Community Medicine, Dehradun. A sample of 500 mothers with children in the age group of 0-36 months living in the registered population of RHTC were included, where mother's demographic profile, parity, diet during pregnancy were recorded. Results: Maternal factors as maternal age, education, parity diet & supplementary nutrition during pregnancy, emerged as significant predictors of under nutrition. Conclusion: The findings confirms the association of maternal factors with malnutrition of their children. This may involve public health enlightenment campaign discouraging teenage pregnancy and high parity of mothers which predisposes to poor nutritional status, poor diet during pregnancy which further increase the risk of poor outcomes both for the mother and the child. There is also need to increase female education as this will make them receptive to health interventions that will improve their nutritional status along with their children.

Menstrual Hygiene and Reproductive Morbidity in Adolescent Girls in Dehradun, India.

Context: In India, adolescent girls face serious health problem due to socio-economic, environmental and cultural conditions as well as gender discrimination. Avast majority of girls in India are suffering from either general or reproductive morbidities. Unhygienic practices during menstruation expose them for Reproductive Tract Infections (RTI). If not treated early, it could lead to various disabilities and consequently affect their valuable lives. This study was done with the aim of estimating the magnitude of gynaecological morbidities among unmarried adolescent girls as well as to find out the relation between menstrual hygiene and RTI. Settings and Design: Cross-Sectional Observational study conducted in two randomly selected Inter colleges (one rural and one urban) of district Dehradun, Uttarakhand state. Methods and Material: A cross-sectional study was undertaken in school going unmarried adolescent girls to know their menstrual hygiene practices as well as reproductive morbidity. Data was collected by interview method using a pretested, prestructured questionnaire after taking consent. Statistical analysis used: percentages and Chi-square test Results: Approximately 65 % of the girls reported having dysmenorrhoea and 19 % of the girls had given the history of excessive vaginal discharge with or without low backache/lower abdominal pain. Strong association was found between Reproductive Tract Infections and poor menstrual hygiene. Conclusions: Girls should be made aware of the process of menstruation and importance of maintaining its hygiene before attaining menarche. They should also be made aware about its linkages with their forthcoming reproductive health.

Screening for Hypertension and Morbidity Profile of Patients - A Primary Care "High Risk Approach".

Background: The world is ageing fast. Increased longevity is not only a triumph for society but a huge challenge for health systems which need to be prepared to address the needs of older people at the community level. Most preventative health care and early disease screening takes place in primary health centres within health systems. These centres play a critical role in the health of older people worldwide at the local level by increasing quality of life. Menace of rising burden of non-communicable diseases can be controlled by developing a model of screening at primary health care level. A study has been planned, to identify one of the major iceberg disease i.e. hypertension which acts as precursor of many other morbidities Methodology: Study was conducted at Rural Health Training Centre, Rajeev Nagar. Sample size included all the patients above 40 years of age attending (for any ailment ) OPD during one year period i.e. 1 January – 31 December 2011. Screening for hypertension was done and morbidity profile along with demographic indicators were also recorded during data entry. Results: Study subjects included females (58.2 %) and males (41.8). About one fourth (22.7 %) of the patient screened were in Pre-Hypertensive category while 12.3 % and 3.6 % were in hypertensive Stage I and II respectively. 38.6 % persons were diagnosed with high blood pressure. Most of the patients with high blood pressure were in age group of 60-69 years, followed by 50-59 years. Higher blood pressure was slightly more among males (39.6 %) as compared to females (37.9%). Locomotor (17.6%), GIT (16.0 %), respiratory (13.5 %) and skin diseases (10.1%) were the principal morbidities. Conclusion: A community based hypertension screening programme targeting older adults above 40 years of age can help in early detection of new cases of 'iceberg diseases' to initiate primary and secondary level prevention. Utilising basic health facility to screen for hypertension suggested here is promising to identify and cater vulnerable population.

A study on rural & urban differences in tobacco use and its socio-demographic determinants in district Dehradun.

Background: Today, tobacco use causes 1 in 10 deaths among adults worldwide – more than five million people a year. By 2030, unless urgent action is taken, tobacco’s annual death toll will rise to more than eight million. Material & method: A community based cross sectional study was undertaken in district Dehradun. Multistage stratified random sampling was done for selection of study area. A sample of 632 was taken for study purpose. Kish method was used for selection of respondents in selected household. Statistical analysis: Chi-square test, Mantel Haenszel Odds Ratio and Multi Variate Logistic Regression Analysis was done to develop results. Significant level was assumed at p<0.05. Results: The overall prevalence of ever use of tobacco was 24.4%. It was more (32.9%) in rural area as compare to urban area (15.8%). Tobacco use was directly proportional to age, more prevalent in Muslims and was indirectly proportional to education & socioeconomic status. Conclusion: Legislation pertaining to tobacco and alcohol sale and use does exist. However its strict enforcement is required in order to reduce the menace.

ICDS — is it the entitlement of every Indian child.

Objectives: To assess the extent of utilization of services by underthree & their mothers at AWC’s & to study the gender differences in availing the services . Methods : A cross- sectional study regarding the utilization of services by children (0-3 years) & their mothers among 11 Anganwadis in 8 villages registered under RHTC,HIHT Dehradun. The data was tabulated on Microsoft Excel sheet and analyzed using the software SPSS 17.0 for Windows. Results : Study findings showed that majority of underthree children i.e. 89.2% were enrolled in the AWCs whereas only 29.20 % went to AWCs to avail the combined benefits of vaccination, supplementary nutrition, healthcheckups followed by Immunization services(23.2%).63.55% children in the age group 0-3 years were attending the AWC to receive SN whereas only 22% of children were availing it regularly. Conclusion: The problems encountered at AWCs were under utilization of services due to lack of awareness of parents & insufficient motivation of AWW. There is a need to improve awareness about the services especially in the underthree age group so that eligible beneficiaries can avail them.

Habits and beliefs pertaining to tobacco among undergraduates of medical college in the state of Uttarakhand.

Background: Tobacco surveillance among medical students offers an opportunity to assess the preparedness for tobacco control among future healthcare professionals in India. The purpose of the present study was to evaluate the use of tobacco in the undergraduate medical students and to assess the factors influencing medical students to indulge in tobacco use. Objective: To assess the prevalence of tobacco use among undergraduate students and to assess the attitude and awareness towards participating in tobacco cessation. Material and methods: A cross-sectional questionnaire-based study to assess the prevalence of tobacco use among undergraduate students of Himalayan Institute of Medical Sciences, Dehradun (Uttarakhand State) was conducted from January 2010 to January 2011. A pre-designed structured questionnaire was used to study various correlates of the tobacco use. Data was collected and analysed. Global Health Professional Students Survey (GHPSS), questionnaire given by the Centers for Disease Control (CDC), Atlanta, USA, which is a standard pre-tested questionnaire for assessing prevalence of tobacco use among health care professionals around the world was used. Results: Overall, 386 of 400 eligible students (97%) participated in the survey. The mean age and standard deviation of the study group was 21.47 ± 3.70 years. The rates of smoking among male medical and female medical students were 38.6% and 6.5%, respectively (p < 0.001). A 6-times higher tobacco use was found among male medical students as compared to females. Out of the 386 participants, current tobacco use (last 30 days) was reported by 11.1% of students. About 21.7% of students had never used tobacco. More than 80% favoured a ban on tobacco sales to adolescents, tobacco advertising, and tobacco use in public places. Over 90% reported interest in further training in tobacco control. There was a familial aggregation of the use of tobacco. The factor initiating the use of tobacco was peer pressure in most of the cases. Conclusion: This study reflects an alarming situation and demands urgent measures to be adopted by health professionals, who happen to be health promoters and health role models for the society.

Reasons for not practicing contraception in a rural population of Dehradun District.

This study was undertaken to find out the reasons for not using the contraception among Ever Married Women aged 15-49 years in rural population of Dehradun District and to study the factors for discontinuation of contraceptive methods among women who had everusedany method. A Cross-sectional descriptive study was conducted among 2278 Ever Married Women aged 15-49 years in 20 villages from Doiwala block of Dehradun District, Uttaranchal. A multistage sampling technique was used for the selection of villages. Personal interview method with house-to-house visit was adopted as the study method. In this study, Knowledge of any method of contraception was almost universal (96.9%) among ever-married women but 61.81% of the couples had ever used while only 49.9% were currently using any method of contraception. Most common reasons for not using contraception were the desire for more children (21.5%) or particularly a male child (5.4%) followed by religious reasons (9.1%) and opposition by husband or family members (3.3%). Present study revealed that awareness about contraceptive methods is almost universal but counseling of eligible couples on importance of small families and assisting them in making informed choice is needed to remove the obstacles in practicing contraception.

Epidemiological Factors Affecting Low Birth Weight

The present study was conducted to determine the epidemiological factors influencing low birth weight. The prominent factors associated with low birth weight (LBW) such as maternal age, parity, obstetric and maternal anthropometry were studied in a rural community of district Dehradun. The average birth weight of all newborns was 2.67± 0.42 kg and 23.84% of newborns were LBW. The factors which were significant for LBW were antenatal care, parity, inter-pregnancy interval, gestational weight, and bad obstetric history. However, the relationship between maternal age and height with low birth weight was not found to be statistically significant (p>.05).