Awareness and Willingness Regarding Community Based Health Insurance in Urban Slums and Resettlement Colonies.

Health insurance is an efficient way to help people prepare for contingency health care. Health care would be more equitable under community-based insurance than the out-of-pocket system. Such a scheme is especially important for the marginalized population. Objective: To study the awareness and willingness to participate in a community-based scheme among the families. Study Design: Cross-sectional community based. Setting: Urban slums and resettlement colonies in East Delhi. Participants: Head of families or available adult member of 510 families. Statistical Analysis: Proportions, Chi square test. Results: Most of the families had a per capita income of Rs.200-600 per month. Average out-of-pocket expenditure on healthcare per person per month was Rs.38.50. Nearly one-fourth of the families had some hospitalization in past 6 months, with loss of man-days and loss of wages. More than three-fourths of the respondents were aware about ‘insurance’, believed that health insurance is beneficial, and expressed willingness to participate. There is a need for health insurance among this population, and with government assistance and proper planning and education, community-based health insurance can possibly help these families manage their health care costs better.

Beneficiary level factors influencing Janani Suraksha Yojana utilization in urban slum population of trans-Yamuna area of Delhi.

Background & objectives: Janani Suraksha Yojana (JSY), a conditional cash transfer scheme introduced to improve the institutional delivery rates and thereby reduce the maternal and infant mortality was implemented in all States and Union Territories of India from 2007. The present study was carried out to identify the beneficiary level factors of utilization of JSY scheme in urban slums and resettlement colonies of trans-Yamuna area of Delhi. Methods: A cross-sectional community based survey was done of mothers of infants in the selected areas of the two districts by stratified random sampling on a population proportionate basis. Socio-demographic factors, antenatal services availed and distance of nearest health facility were studied. Outcome variable, a beneficiary, was a woman who had ever interacted with the ASHA of her area during the antenatal period of previous pregnancy and had child birth in an institution. Descriptive tables were drawn; univariate analysis followed by multiple logistic regression was applied for identifying the predictors for availing the benefits. Results: Of the 469 mothers interviewed, 333 (71%) had institutional delivery, 128 (27.3%) had benefited from JSY scheme and 68 (14.5%) had received cash benefits of JSY. Belonging to Hindu religion and having had more than 6 antenatal check ups were the significant predictors of availing the benefits of JSY. Conclusion: There is a need to improve the awareness among urban slum population about the utilization of JSY scheme. Targeting difficult to access areas with special measures and encouraging more antenatal visits were essential, prerequisites to improve the impact of JSY.

Impact of NGO run mid day meal program on nutrition status and growth of primary school children.

Objective. To study the impact of wholesome mid day meal (MDM) program run by an NGO on the growth of the primary school students in rural area of Mathura district. Methods. This intervention study involved children enrolled in Government run rural primary schools in Mathura district in Uttar Pradesh from March 06 through August 07. A wholesome, nutritionally balanced MDM provided by an NGO for the students in the 6 primary schools was selected as intervention group. Control group consisted of children in 8 schools which received locally prepared MDM by village panchayats. Height, weight, change in height/month, change in weight/month, prevalence of protein-energy malnutrition and prevalence of signs of vitamin deficiencies, were measured. Results. Food was provided for 221 days in one year. Within group and between groups repetitive measures were compared using generalized estimating equation (GEE). Within both intervention and control groups height and weight had significantly increased (p < 0.05), while there was no significant difference between the groups. There was no change in prevalence of malnutrition within either of the groups. Reduction in vitamin A deficiency signs was 38% more in intervention group (p < 0.001). Prevalence of Vitamin D deficiency reduced by 50% more in intervention group. No such differences between groups were observed for vitamin B complex and vitamin C. Conclusions. MDM provided by the NGO has no better impact on growth of the primary school children, however, it reduced prevalence of vitamin deficiency significantly in comparison to the MDM run by Village Panchayats.

Impact of Health Education and Condom Distribution on Incidence of RTI/STI among The Newly Married Urban Poor Women in Delhi.

This study was carried out to find out the impact of a specially designed preventive intervention on menstrual and sexual hygiene practices and incidence of RTI/STI among the newly married women. A community based intervention study with controls was conducted in two resettlement colonies of Delhi. Total 74 subjects in intervention group and 71 subjects in the control group were studied. Each subject was followed up for 9 months every three monthly. The intervention package included education about menstrual and sexual hygiene, RTI/STIs and contraceptive usage, and packets of condoms. RTI/STI was diagnosed using syndromic approach. Only 2 and 8 subjects in the intervention and control group respectively used condoms (p>0.05 after adjustment). Practice of washing genitals improved in the intervention group (p<0.05 both with and without adjustment). 19 (25.68%) women in intervention and 22 (30.99%) in the control group (p=0.478) reported RTI/STI symptoms during study period; after adjusting for other variables OR=0.37 (p=0.007). 57.89% of RTI/STI patients consulted doctor in intervention group as compared to 18.18% in control group (p<0.05). Increasing awareness and providing intervention at the very beginning of sexual life of newly married women can modify some of the high risk behaviors and thus reduce the risk of acquiring RTI/STIs.

Reproductive health of newly married women residing in a resettlement colony of Delhi: A longitudinal study.

During the period immediately after marriage, women are neither assessed for their reproductive health nor given any intervention for the same. A community based longitudinal study was done to assess the status of reproductive health of newly married women in which 71 newly married women were followed for 9 months. Mean age at marriage was 20.24 (19.74-20.74) years. 76.06% were anemic. With time, proportion reporting menstrual complaints and RTI symptoms increased significantly (P<0.05). 29 (40.85%) reported menstrual complaints and 22 (30.99%) RTI symptoms. Only 14 (19.72%) subjects used contraceptive methods. 79% conceived within 9 months of marriage. Only 25% pregnancies got registered in first trimester. Reproductive and nutritional status of the newly married women was unsatisfactory.

Glycated hemoglobin--a public health perspective.

The burden of diabetes mellitus across the world especially in India is substantial, and much of the morbidity and mortality is due to development of diabetic complications. Control of blood glucose is important to reduce occurrence of these complications. Measurement of glycated haemoglobin values provides valuable information about long term glycemic control, and is recommended for routine monitoring by several clinical guidelines on diabetes. Monitoring and appropriate management have been shown to improve outcomes in patients with diabetes in other parts of the world. However, the adoption of glycated hemoglobin as part of routine monitoring of diabetes patients in India will need to answer issues of availability, affordability and accessibility.

Socio-demographic profile of leprosy patients in two districts of western Uttar Pradesh.

Despite achieving the goal of national elimination of leprosy, it remains a serious public health problem in the high prevalence states of Uttar Pradesh, Bihar and Orissa. A significant percentage of newly detected cases are Multibacillary. It underscores the importance of developing a more effective strategy to combat the disease in high prevalence pockets of the country. A glance into sociodemographic profile of the leprosy patients of one the high prevalence states might help in understanding the current ground situation better. A questionnaire based study was conducted at health care center of two districts of Uttar Pradesh (Rampur and Moradabad).Data on demographic profile of leprosy patients attending these centers were collected. The leprosy patients were more frequently males (63.8%). The duration of time before presentation was significantly longer for semiskilled workers (Kuppuswami Scale classification), p = 0.029. Patients with multibacillary disease were younger (mean age 31.04 yrs) as compared to paucibacillary leprosy (mean age 38.7yrs), p value = 0.041. These observations suggests that a specific population based approach is required to detect new cases early. Certain groups of the population might benefit from active surveillance.

Immunization in urbanized villages of Delhi.

OBJECTIVE: To assess the immunization coverage of BCG, DPT, OPV, Measles, MMR and Hepatitis B vaccines in two urbanized villages of East Delhi and study the factors affecting the coverage. METHODS: Children of age 24-47 months were selected using systematic random sampling. Information on socio-demographic factors and immunization status was obtained by house-to- house visit. Immunization coverage of all vaccines was computed and analysis of association between immunization coverage and socio-demographic factors was done. RESULTS: The coverage levels were 82.7% for BCG, 81.5% for DPT/OPV 1, 76.8% for DPT/OPV 2, 70.7% for DPT/OPV 3 and 65.3% for measles vaccine. It was 41.4% and 41.6% for DPT booster and MMR vaccine. Higher education of mother (OR=1.96) and father (OR=1.80), father's occupation (OR=1.86), residential status (OR=1.76), place of birth (OR=2.64) and presence of immunization card (OR=5.8) were significant determinants for complete immunization on univariate analysis. On regression analysis mother's education (OR=1.43), presence of immunization card OR=2.05 and place of birth (OR=3.80) remained significant. CONCLUSION: Immunization evaluation surveys have shown a wide variation across regions, states and different strata of the society.

Hypogonadism in male Leprosy patients--a study from rural Uttar pradesh.

Hypogonadism in male patients with Leprosy is common and may identify patients with future risk for bone loss and osteoporosis. In the present study, we evaluated gonadal function in 71 male patients with Leprosy both clinically and by estimation of serum testosterone levels. The patients belonged to selected rural areas of Uttar pradesh, with majority aged less than 50 yrs (74.6%), Hindus (66.7%), illiterate (60.9%), and of low socioeconomic status (58% with per capita income < Rs.500 per month). Most patients had multibacillary Leprosy (83.1%), duration less than 2 years (75.4%) and had received antileprosy drugs for less than a year (95.6 %).Seven patients (9.9%) had clinical features of hypogonadism such as gynaecomastia, decreased sexual hair and infertility. Serum testosterone levels, estimated in 31 of the patients, revealed low values in 25.8% (8/31) patients (Mean 4.65+/-3.37 ng/ml). Age, duration of Leprosy and socioeconomic status but not type of Leprosy or treatment duration affected hypogonadism significantly. The results of the present study indicate a high frequency of hypogonadism among rural male Leprosy patients that warrants routine screening to identify patients at risk for osteoporosis and possible prevention with testosterone replacement therapy.

Study of operational aspects of pulse polio booths during Intensified Pulse Polio Immunisation Campaign in assembly segments of East Delhi.

The study was undertaken with the objective of observing operational aspects of 609 pulse polio booths established during Intensified Pulse Polio Campaign in East Delhi on National Immunisation Days (NID) during 2001-2002 through well designed format. The average number of persons present on duty at polio booths was 3.73 against a recommendation of 4 per booth. All the booths had vaccine carriers but some of them were not following the guidelines laid for maintaining the cold chain. One sixth "(15.4%)" of the booths needed fresh supplies of vaccine carrier. There is need for deployment of motivated trained manpower at polio booths to ensure the success of Pulse Polio Campaign. Maintenance of cold chain and quality assurance of vaccine administered to children in the field remain a challenge. More than half (55.7%) booths did not have any volunteer. Absence of volunteers from the community in more than half of the booths warrant for strengthening the linkages between the governmental agencies and the community.

Knowledge, attitudes, beliefs and practices regarding measles in a rural area of Delhi.

387 mothers in Mehrauli block of Delhi were interviewed regarding their knowledge, attitudes, beliefs and practices regarding measles. 98.4% enumerated one or the other symptoms, fever being the commonest. 77.5% were aware of the infectious nature and 97% had favourable attitude regarding feeding the child during measles. The commonest foodstuff given was cowmilk and khichdi. 95.1% of the respondents intended to apply local herbs on eruptions. There was a variety of local medicines for home treatment and Laung, Tulsi leaves and Kishmish being the practice in descending order of preference. 98.4% respondents favoured giving special nutritional care during the attack of measles to their children.

Determinants of pregnancy in adolescents in Nepal.

OBJECTIVE: Social factors and prevalent norms in the community determine the proportion of teenage pregnancy in the community. In the light of high risk associated with teenage pregnancy, the socio-cultural determinants, which influence the conception among teenagers in Nepal, need to be understood. These determinants may be modified by suitable interventions to reduce teenage pregnancy. Aim of this study was to examine the socio-cultural determinants of teenage pregnancy in eastern Nepal. METHODS: A case-control study design was selected for comparing the education, economic status, family support and freedom towards conception among teenagers as compared to higher age group women. RESULT: Seventy adolescent pregnant women were compared with seventy primigravida women in the 20 to 29 years age group. The teenage pregnant women were less educated, had poor economic background, more likely to have accidental pregnancies as compared to the other group and more likely to have love marriages. Husbands were more likely to decide about continuation of pregnancy. They had less psychological and social support from the family. CONCLUSION: Marriage at young age and pregnancy during teens are associated with less social acceptance and poor support in the family.

EPI vaccination in Nepal.

A number of surveys, small or large, have been undertaken by various agencies for coverage evaluation of immunization programs. The most commonly used design is the WHO-30 cluster sampling method. Other new methods are the Institute for Refresh Medical Statistics (IRMS) New Delhi method and the lot quality assurance sampling method. This paper describes the National Immunization Day (NID) method to evaluate the immunization coverage of the Expanded Program on Immunization (EPI) vaccines in the Sunsari district of Nepal. A total number of 3,332 respondents (69.4% females and 30.6% males) were interviewed regarding the immunization status of their children during NID. The children with complete immunization (BCG, measles and three doses of DPT and OPV) were 65.7%. The individual coverage by EPI vaccines (except OPV III and measles) was more than 80%. The result shows that there is positive relationship between immunization coverage and educational level of the respondents.