Rheumatic fever and rheumatic heart disease: primary prevention is the cost effective option.

OBJECTIVE: To measure the economic output/input ratios for the various options of prevention of rheumatic fever/rheumatic heart disease (RF/RHD) and check the viability of primary prevention vis-à-vis secondary and tertiary preventions. METHODS: Cost accounting of the various prevention options was calculated for each variable as available in literature. Actual data as obtainable for the financial year ending March 2006 were computed for the Pondicherry population. Both direct and indirect costs (including community/social costs) were worked out using mostly primary data and wherever necessary, secondary data. Certain scientific assumptions were used where exact data was not available. RESULTS: Primary prevention is the definite viable economic option (1:1.56) compared to secondary (1: 1.07) and tertiary (1: 0.12) preventions. In fact, the current stress on only secondary and tertiary preventions is found to be economically unviable. CONCLUSION: It is postulated that primary prevention as a practical policy in tackling RF and RHD can be recommended.

Feeding of infants and young children in tsunami affected villages in Pondicherry.

The study was conducted to identify the problems related to feeding of children post tsunami in four villages in Pondicherry. Data were collected from 100 randomly chosen families who had an infant or a young child below 3 years of age during Tsunami. Informants were the mothers. In the population studied, 30% mothers did not exclusively breast feed for 6 months; 58% bottle fed their children and 51% fed their infants with commercial formula. The occurrence of diarrhea was three times higher among children who were fed with free breast milk substitutes (BMS) than in those who were not fed with the same. Those populations, wherein a pre-existing tradition of artificial feeding is present, infants are at further risk during a crisis situation like Tsunami. Breast feeding practices need strengthening even in routine conditions to tackle a disaster rather than intervention after the disaster.

Teaching epidemiology of acute diarrheal diseases to medical undergraduates--a new approach.

A total of 165 students of first clinical year were taught the epidemiology of acute diarrheal diseases, during three successive years using a detailed lesson plan. The usual didactic lecture was minimised and supplemented by slide shows, and transparencies based on the contents of a handout on the subject distributed to all students a day prior to the class. This was followed by participatory discussions by the students on the diagnosis and management of some case examples presented. A video clip summarising the entire lesson was screened for reinforcement. Feed-back from the students showed that the teaching methodology was rated very good by 41%, and satisfactory by 59%. While 73% of the students mentioned videoclips as a factor favouring their learning, 69% cited the handouts and 49% felt that case discussions were helpful. Objective evaluation of the performance in the sessional test showed that out of 158 students who attended the test, 75% scored above 50% marks, 21% below 50% and the remaining 4% did not attempt that question.

Unnecessary injections given to children under five years.

Adults accompanying 64 children attending a hospital out-patient clinic were questioned about treatment and injections given for illnesses in the previous month. Half the children had received injections, almost all given by private doctors: we consider most of these injections to have been unnecessary. Three girls were paralysed by aggravation poliomyelitis after unnecessary injections. Adults approved of injections although they did not know what was injected.

Infant mortality in Pondicherry--an analysis of a cohort of 8185 births.

Infant mortality rate is one of the 12 global indicators for monitoring Health for All. Reliable data on infant mortality are not available for the majority of developing countries including India. To plan strategies for bringing down the rate and, later, to evaluate them, 'Cause Specific Rates' would be necessary. Pondicherry has achieved low rates of infant mortality. A study was conducted in the Anganwadis of Pondicherry to determine the causes of infant deaths. The 8185 children born between 1-4-1987 and 31-3-1988 in Pondicherry formed the study group. The Anganwadi workers collected information on the cause of death for the 222 children dying within the first year. The infant mortality rate was 27.1 per 1000 live births. Acute respiratory infections and diarrheal diseases accounted for 45% of the deaths.

Absenteeism in leprosy patients in a rural area in Tamil Nadu.

Of the 3382 leprosy patients taking treatment in Hemerijckx Rural Centre Area, 150 randomly selected patients, who were irregular for treatment, were matched with 150 patients who were regular for treatment, by age, sex and type of disease. The characteristics and the reasons for regularity/irregularity in treatment of these 300 patients were studied. There were more Lepromatous patients (20%) among regulars. A greater proportion of irregulars belonged to backward (54%) and scheduled castes (35%). The proportion of irregulars were more (32%) in the initial phase of the disease. There were more irregular patients among the illiterate group (61%). The knowledge of the irregular patients about early sign, causation, spread, curability and duration of treatment were found to be lacking. The clinic timing was unsuitable for 33% of irregular patients. 23% of irregulars experienced some intolerance to DDS. When 94% of regulars attended clinic in order that they may be 'cured', 63% of irregulars stayed away because of 'work'.