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Background: Acute malnutrition (severe and moderate) is a major public health problem in India and especially Rajasthan. National family health surveys now provide prevalence of SAM children till district level but there’s an undenying need for data at even more granular, like block level, to assess the field reality in more depth. The present study tries to demystify the same at block level by studying data collected from a community-based SAM management program i.e., AMMA (acute malnutrition management action) program in Dungarpur.Methods: As part of AMMA program, block wise data from 20 districts of Rajasthan was collected monthly during implementation and its dedicated MIS was used as the source of this data. The data includes information of all children screened in the age-group of 6-59 months in Dungarpur district which was subsequently analyzed and studied till block level. The SAM prevalence is assessed, using Mid Upper Arm Circumference (MUAC) of 6-59 months children. <12.5 cm of MUAC was considered as acute malnutrition while <11.5 cm of MUAC was considered as SAM as per WHO standards.Results: A total of 1,13,547 children were screened (84.91%) in the study period. A total of 4829 children (4.25%) were found with Acute Malnutrition, out of which 4622 were identified with moderately acute malnutrition (MAM) and 207 are identified with SAM. Out of total 207 children with SAM, 118 were girls (57%) while 89 (43%) were boys. The prevalence of SAM children in the district came out as 0.18% whereas state prevalence is 0.9%. Among blocks the SAM prevalence varied from as low as 0.02% in Dowda and Chikhali to as high as 0.63% in Jothari block.Conclusions: Prevalence of SAM in Dungarpur district is low at 0.18% but block-wise analysis helped in further disaggregating the burden. To identify all children with acute malnutrition in the district there’s an urgent need to do screening based on WFH Z-score instead of complete reliance on MUAC tape.
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Objective To understand the effects of standardized community-based management of hypertension in urban and rural areas in China and related influencing factors.Methods The study subjects were the hypertension patients aged ≥35 years who were recruited in 2011 from the participants of 2010 national chronic and non-communicable disease surveillance project.The hypertension patients were diagnosed in community health centers or higher level hospitals and included in community based hypertension management project.By face-to-face questionnaire survey and health examination,the information of the subjects' demographic characteristics,risk factors,complications,involvement in community-based management of hypertension,anti-hypertension treatment,blood pressure,body height,waistline and body weight were collected.In this study,Rao-Scott x2 test was used to compare the variations among sub-groups.Taylor series linearization method was used to estimate the prevalence rate.The complex sampling and unconditional multivariate logistics regression analysis was conducted to identify the influencing factors for the control of hypertension.Results A total of 5 120 subjects were recruited in the analysis.The proportion of those receiving management for more than two years was 36.57％,and it was higher in urban area (44.56％) than in nural area (31.79％,P＜0.05);In the past 12 months,6.17％ and 14.46％ of the patients received no blood pressure measurement and drug therapy advice respectively,but there were no significant differences between urban group and rural group (P＞0.05);In the past 12 months,the proportions of the patients receiving diet and physical activity advice were 84.25％ and 84.90％ respectively,and the proportions were higher in urban group than in rural group (P＜0.05);In the past 12 months,the proportions of the subjects receiving tobacco and alcohol use advice were 78.41％ and 77.80％ respectively,and the proportions were higher in rural group than in urban group (P＜0.05).In urban area,the subjects receiving standardized management had lower SBP (142.79 ± 17.39) mmHg,lower DBP (84.26 ± 9.49) mmHg and higher blood pressure control rate (49.77％) than those receiving no standardized management (P＜0.05);while in rural area,no difference was found in BP control between the patients receiving and receiving no standardized management (P＞0.05).In urban area,the influencing factors for BP control among the subjects receiving community based management were educational level,annual income,body weight,hypertension management mode,times of receiving BP measurement,times of receiving antihypertensive medicine advice and receiving physical activity advice;while in rural area,the influencing factors for BP control among the subjects receiving community based management were annual income,body weight,family history of hypertension,antihypertensive medicine awareness,times of receiving antihypertensive medicine advice and receiving diet advice.Conclusion The effects of community-based standardized management of hypertension were better in urban area than in rural area,and the quality of the services of community-based hypertension management was lower in rural area than in urban area.
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Objective To understand the effects of standardized community-based management of hypertension in urban and rural areas in China and related influencing factors.Methods The study subjects were the hypertension patients aged ≥35 years who were recruited in 2011 from the participants of 2010 national chronic and non-communicable disease surveillance project.The hypertension patients were diagnosed in community health centers or higher level hospitals and included in community based hypertension management project.By face-to-face questionnaire survey and health examination,the information of the subjects' demographic characteristics,risk factors,complications,involvement in community-based management of hypertension,anti-hypertension treatment,blood pressure,body height,waistline and body weight were collected.In this study,Rao-Scott x2 test was used to compare the variations among sub-groups.Taylor series linearization method was used to estimate the prevalence rate.The complex sampling and unconditional multivariate logistics regression analysis was conducted to identify the influencing factors for the control of hypertension.Results A total of 5 120 subjects were recruited in the analysis.The proportion of those receiving management for more than two years was 36.57％,and it was higher in urban area (44.56％) than in nural area (31.79％,P＜0.05);In the past 12 months,6.17％ and 14.46％ of the patients received no blood pressure measurement and drug therapy advice respectively,but there were no significant differences between urban group and rural group (P＞0.05);In the past 12 months,the proportions of the patients receiving diet and physical activity advice were 84.25％ and 84.90％ respectively,and the proportions were higher in urban group than in rural group (P＜0.05);In the past 12 months,the proportions of the subjects receiving tobacco and alcohol use advice were 78.41％ and 77.80％ respectively,and the proportions were higher in rural group than in urban group (P＜0.05).In urban area,the subjects receiving standardized management had lower SBP (142.79 ± 17.39) mmHg,lower DBP (84.26 ± 9.49) mmHg and higher blood pressure control rate (49.77％) than those receiving no standardized management (P＜0.05);while in rural area,no difference was found in BP control between the patients receiving and receiving no standardized management (P＞0.05).In urban area,the influencing factors for BP control among the subjects receiving community based management were educational level,annual income,body weight,hypertension management mode,times of receiving BP measurement,times of receiving antihypertensive medicine advice and receiving physical activity advice;while in rural area,the influencing factors for BP control among the subjects receiving community based management were annual income,body weight,family history of hypertension,antihypertensive medicine awareness,times of receiving antihypertensive medicine advice and receiving diet advice.Conclusion The effects of community-based standardized management of hypertension were better in urban area than in rural area,and the quality of the services of community-based hypertension management was lower in rural area than in urban area.
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Background: Children with severe acute malnutrition (SAM) have nine times higher risk of dying than well- nourished children. Child malnutrition can be managed by community based approach (80-85% SAM children) and institution based approach (10-15% SAM children). The objective of the study is to know the effectiveness of the mixed interventions to improve the nutritional status of the children (0-6 yrs), to decrease the prevalence of malnutrition in the children attending ICDS in Rajkot city for combating child malnutrition. Methods: A baseline survey of total registered 26578 children was carried out at 330 anganwadis and 701 SAM children were identified till the end of June 2014. A model of mixed interventions i.e. i) Community based management consisting of special food program, monthly health checkup and treatment and health education to parents, ii) Institution based management of SAM children with complication was planned and implemented since July 2014. Results: 701 children were identified as SAM at the beginning of the intervention while 160 children were SAM at the end of March 2015. The difference in the proportion of SAM children before and after intervention was statistically significant. An improvement of 80.9% in the status of SAM children was seen among boys while 74.1% was seen among girls. Conclusion: Convergence of Health and ICDS activities, high risk approach, community based and institutional management and community awareness in combating the malnutrition showed significant effect. This model can be replicated elsewhere and sustainability may be ensured for long term results.
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Objective To evaluate different hypertension management models in communities and their impact on incidence of cardio-cerebrovascular disease in hypertensive patients. Methods A total of 1 578 hypertension patients in several communities in Pudong New Area were recruited in the study ( August 2008 to December 2012 ) according to the inclusion criteria and randomly divided into two groups.The control group was given routine hypertension management and the study group was given detailed hypertension management, while health commissioners and community physicians were in charge of the follow-up and data collection. Results The incidence of cardio-cerebrovascular disease (1.33%) in study group (1.33%) was significantly lower than that of the control group (4.22%) ( P <0.05). Multivariate logistic regression analysis showed that age, male, course-of-disease, patients with hypertension family history, increase in SCr and LDL-C increased the risk for getting ardio-cerebrovascular disease (P <0.05).The risk of study group was 0.348 times the control group ( P <0.05). Conclusion Compared with control group, detailed hypertension management model conducted in study group has the advantages that effectively reduced the rate of cardio-cerebrovascular disease.
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Objective To investigate optimum pathway of community based management for diabetes. Methods The optimum pathway was based on service of health examination, clinical follow-up, and health education. Between A and B community based management,we compared the difference in frequency of doctors' office visiting in one year, fasting blood glucose and blood fat, the diabetes knowledge, improvement of life style and patient's willingness. Results ①The frequency of doctors' office visiting in one year in observation group were significantly higher than that of the control group, but were lower than control group in over Second-class Hospital and high-risk patients. ②The fasting blood glucose and blood fat in observation group were significantly lower than that of the control group(P<0.05). ③The awareness rate about the blood glucose level, diabetes diet,chronic complications and blood sugar monitoring in in ob-servation group were significantly higher than control group(P<0.05);In improvement of life style and patient's willing-ness,the observation group was better than control group of blood checks,diet control and medication(P<0.05). Conclu-sion Because of the optimum pathway of community based management for diabetes,the diabetes patient has more knowledge in diabetes , positive attitude and healthy behavior,so at last, it is good for treatment.