Moving from maternal death review to surveillance and response: A paradigm shift

In the era of the sustainable development goals, India is committed to reduce its maternal mortality ratio to less than 70 per one lakh live births by 2030. An important strategy that was adopted in the Reproductive and Child Health Programme in 2010 was maternal death review. Analysis of the progress so far has brought to light certain gaps which have prompted the paradigm shift toward Maternal Death Surveillance and Response (MDSR), which focuses on taking action on information obtained from every maternal death so as to prevent further maternal deaths. The new guidelines on MDSR were released by the Ministry of Health and Family Welfare in 2017.

India’s Story of Reducing Maternal Mortality - Achievement so far and Commitments Ahead

In the year 2000, the United Nations (UN) Member States pledged to work towards a series of Millennium Development Goals (MDGs), including the target of a three-quarters reduction in the 1990 Maternal Mortality Ratio (MMR; maternal deaths per 100 000 live births), to be achieved by 2015. This target (MDG 5A) and that of achieving universal access to reproductive health (MDG 5B) together formed the two targets for MDG 5: Improve maternal health (1).

Impact of socio-economic status, rural background and gender on the prevalence of chronic obstructive pulmonary disease.

Background: Prevalence of COPD and resistance towards drugs available for its treatment are increasing day by day. Objectives: To assess the impact of socio-economic status, rural background and gender on the prevalence of Chronic Obstructive Pulmonary Disease. Methods: This observational, prospective, open study was conducted in the Department of Chest & TB Rajindra Hospital, Patiala. A total of 250 patients were included in the study over a period of 1 year of mild to very severe stage of COPD according to GOLD guidelines for COPD 2011. Impact of rural background, household medium of cooking food, male: female ratio of disease occurrence, and patient’s socio-economic status were evaluated using modified kuppuswami grading. Results: In the rural population 100 patients out of 215 patients were males and 115 patients were females showing the rising trend of COPD in females of rural background and using biomass combustion and kerosene stove as the medium for cooking food, moreover most of the patients were living in the overcrowding. According to modified kuppuswami classification of socio-economic status, 170 patients were in the lower lower class, and 45 patients were in lower middle class socio-economic status in the rural background. Conclusion: Highest prevalence of COPD was seen in 51-60 years age group and among the patients of rural background with 215 patients (86%) affected with COPD out of 250 patients. With modified kuppuswami grading of Socio-economic status (SES), we found out that maximum patients in the rural background were from lower lower class SES thus signifying that poor socio-economic status can be a link to COPD.

Tubercular hepatic abscess--a rare presentation.

Hepatic tuberculosis is one of the rare forms of extra-pulmonary tuberculosis. The focal or nodular form presenting as tuberculoma or abscess is uncommon. Hepatic tuberculosis without involvement of lungs or other organs is even rarer. We report a rare case of primary tubercular liver abscess without involvement of any other organ of body.

Fat embolism syndrome.

Fat embolism syndrome is a rare complication occurring in 0.5 to 2% of patients following a long bone fracture. It is believed to be caused by the toxic effects of free fatty acids. Diagnosis is clinical, based on respiratory, cerebral and dermal manifestations. Treatment is only supportive, directed mainly at maintaining respiratory functions.