Evaluation of mass drug administration for elimination of lymphatic filariasis in Goa, India.

Background: The most practical and feasible method of controlling lymphatic filariasis is the rapid reduction of microfilarial load in the community by annual mass drug administration (MDA) of a single dose of diethyl Carbamazine Citrate. The objective of the study aimed at the trends in coverage and compliance of Mass Drug Administration with Diethyl Carbamazine Citrate (DEC) for elimination of lymphatic filariasis in Goa. Methods: Cross-sectional population surveys were conducted after every yearly round of MDA with DEC for the years 2006, 2007, 2008 and 2010 as part of independent assessment of MDA. Four clusters were selected from each district, each cluster having 30 households. A pretested questionnaire was used to interview the study participants and the responses were recorded in pre-designed formats. The data was analysed using SPSS package. Coverage rate, compliance rate, coverage-compliance gap and effective coverage rate were calculated. Results: The total coverage ranged from a high of 95.55% in the year 2007 and a low of 84.94% in 2006. The total compliance rate fluctuated between a low of 64.68% in 2010 and a high of 93.47% in 2006. Total coverage–compliance gap ranged from a high of 35.31% in the year 2010 and a low of 6.52%. Overall coverage and compliance rates were consistently higher in rural areas compared to urban areas for all the years under study. Conclusion: Coverage, compliance, coverage-compliance gap and effective coverage rate were found to be consistently lower in urban areas compared to rural areas. For the state to reach elimination targets, the MDA strategy implementation would require thorough review and revamping. Action on this front would ensure that gains made in filarial elimination are sustained eventually leading to elimination of lymphatic filariasis in the state of Goa.

Prevalence of diabetes mellitus in a rural population of Goa, India.

Background. We aimed to estimate the prevalence of diabetes mellitus and study the associated factors in a rural population in Goa, India. Methods. A cross-sectional study was done in the rural area of Mandur, Goa. Participants >20 years of age were selected by systematic random sampling. They were interviewed with the help of a structured, pretested questionnaire. This was followed by clinical examination, anthropometry and relevant laboratory investigations. Diabetes mellitus was defined as per the American Diabetes Association (ADA) criteria. Statistical analysis was done using the SPSS software package (version 14.0). Results. The prevalence of diabetes mellitus in the study population was 10.3% (130/1266) with a prevalence of 8.4% among men and 12% among women. On bivariate analysis, the prevalence of diabetes mellitus was found to be significantly associated with age, occupation, family income, family history of diabetes, smoking, obesity, hypertension, and high serum cholesterol and triglycerides levels. Multiple logistic regression analysis identified age, family history, hypertension, smoking, total cholesterol and triglyceride as the independently associated variables for diabetes mellitus. Conclusion. Innovative community outreach programmes are required to create awareness, and for screening and treatment of diabetes mellitus to curb the growing epidemic of diabetes in the population.

Study of needle stick injuries among health care workers at a tertiary care hospital.

A cross-sectional study was conducted among health care workers at a tertiary care hospital in Goa to study the problem of needle stick injuries. A structured questionnaire was used to interview the study participants at their work place. Participants were asked to recall needle stick injuries in the preceding 12 months. Factors such as work experience, type of procedure, action taken following injury etc were also studied. Statistical analysis was done with SPSS software. Around 34.8% (200/575) of the Health care workers had experienced a needle stick injury in the last one year. Needle stick injuries were equally distributed across different work experience periods. Hollow bore needles were responsible for 77.5% of needle stick injuries followed by suturing needles (19.2%). As far as use of personal protection was concerned only 58% of the health care workers were wearing gloves at the time of the injury. There is therefore an urgent need at the hospital level to have a uniform needle stick injuries policy covering safe work practices, safe disposal of sharps, procedures in event of needle stick injury, training including pre-employment training, monitoring and evaluation of needle stick injuries and procedures for reporting needle stick injuries.

Prevalence of human cysticercosis and taeniasis in rural Goa, India.

A cross sectional study among 450 individuals selected by strafified random sampling was carried out in rural Goa to find out the prevalence of cysticercosis and taeniasis, as well as to study the role of various factors associated with this diseases. The study participants were administered a pre-tested structured questionnaire and subsequently blood and stool samples were examined. SPSS software was used to analyze the data statistically. The sero-prevalence of cysterosis was 22.4%, which increased with age. Prevalence of taeniasis was 9.7% by stool examination. Individuals with taeniasis were thrice more likely to have cysticercosis; however no association between sero-positivity for cysterosis and pork consumption as well as religion could be established. The study confirmed a high sero-prevalence of cysticercosis in Goa underscoring the need to general awareness about good cooking habits and sanitation.

Bed utilization indices at a tertiary care hospital in Goa: an eight year trend analysis.

A retrospective data analysis of records from medical records department of Goa Medical College Hospital was done to analyse the trends of various bed utilisation indices from 1999 - 2006. Average length of stay, bed occupancy rate, turnover interval and bed turnover ratio were the indices calculated. During the eight year period from 1999 to 2006, the average length of stay for the entire hospital registered a small decline from 6.23 to 5.51 days, the overall bed occupancy rate increased from 72.13% to 83.12% and the bed turnover interval declined from 2.41 days to 1.12 days. The Orthopaedics ward had the highest increase in bed occupancy and also fastest decline in turnover interval in 2006. Bed utilization indices are an objective measure of the efficiency of the hospital management system.

Conceptual framework of a geographical information system for environment--public health surveillance in Goa.

This paper proposes a conceptual framework for establishing a multidiscipline Geographical Information System for environment public health surveillance in the state of Goa. Sectors networking for the Geographical Information System encompass Directorate of Health Services including peripheral health setup, Public Works Department, State Pollution Control Board, Irrigation Department, Inspectorate of Factories and Boilers, Town and Control Planning Department, Meteorological Department etc. the applications of which would predict potential outbreaks / epidemics of water borne diseases, malaria, diseases linked to pollution and would support disease control activities. In addition to health applications, the data generated would be used by the respective sectors for their other planning and programming needs.

Sexual risk behaviors and HIV/AIDS awareness among males in a rural community in Goa.

To study the heterosexual risk behaviors and to study the level of HIV/ AIDS awareness among males in a rural community in Goa. Survey was cross-sectional and community based. A sample of 300 males aged 15-49 years selected by stratified random sampling. An "UNAIDS protocol for measurement of HIV/STD prevention indicators" was used. SPSS software package was used for statistical analysis. One hundred and ninety eight (66%) males reported ever having sexual intercourse, of these 17% were single. Fifty three (17.7%) males reported intercourse with a non-regular partner in the past 12 months, of these 90.6% had intercourse with strangers, 92.5% had paid for sex and only 43.4% had used a condom for the last sexual encounter with a non-regular partner. Less educated males (<10th class), single and those employed have higher sexual indulgence with non-regular sexual partners. The level of knowledge about HIV/ AIDS was very high in all areas of causation and prevention. Although the awareness about sexual risk behavior was high, condom use was very low resulting in high risk behavior related to HIV/ AIDS and STDs among males. The study highlights the need for more effective behaviour change communication (BCC) strategies in the community as well as innovative methods like village level peer education.

Short colon variant.

A one day old neonate with a short colon, associated exomphalos minor; bifid scrotum and ileovesical fistula is reported.

Primary repair or colostomy in the management of civilian colonic trauma.

BACKGROUND: Management of civilian colonic trauma remains controversial. AIM: To determine prognostic factors in patients with civilian colonic trauma undergoing different modes of therapy. METHODS: Sixty-five patients with colonic injuries were retrospectively analyzed. RESULTS: Right and left colon injuries were present in 30 and 35 cases respectively. Colon-related complications occurred in 27.7%. One death (1.5%) was directly due to colonic injuries. Left sided colon injuries led to a higher incidence of complications and longer duration of hospital stay; a higher number of complications occurred in relation to colostomy than primary closure. CONCLUSIONS: Primary repair can be done in more cases than is routinely done. The presence of multiple abdominal injuries or shock does not exclude primary repair. The site of injury may affect the outcome, but does not exclude primary repair. Gross fecal contamination, extensive colonic damage and type of feces in affected colon should be considered as indications favoring colostomy.

Fibrolamellar hepatocellular carcinoma.

Fibrolamellar hepatocellular carcinoma, a histological variant of hepatocellular carcinoma, distinct pathological and clinical features and a better prognosis than other types of hepatocellular carcinoma. We report here a patient who was treated on successful surgically.

Total hepatic vascular exclusion for major hepatic resection.

Use of vascular occlusion techniques during hepatic resection has besides decreasing blood loss improved the feasibility of surgical extirpation of large hepatic tumors. We report successful use of this technique to resect a large hepatoma in the right lobe of the liver. The hemodynamic and biochemical changes in the perioperative period are documented.