Effectiveness of Child-To-Child Approach in Preventing Unintentional Childhood Injuries and Their Consequences: A Non-Randomized Cluster-Controlled Trial.

BACKGROUND: Child-to-child approach is an innovative strategy for preventing and reducing the morbidity and mortality burden of unintentional childhood injuries. OBJECTIVES: To test effectiveness of Child-to-child Approach in preventing unintentional childhood injuries and their consequences. STUDY DESIGN: Community-based non-randomized cluster-controlled trial of parallel design. PARTICIPANTS: 397 children and adolescents. INTERVENTION: Eldest literate adolescent of selected families of intervention area were trained on prevention of injuries. They were to implement the knowledge gained to prevent injuries in themselves and their younger siblings and also disseminate this knowledge to other members of their families. OUTCOME: Data was collected from both intervention and control areas during pre- and post-intervention phases on the magnitude of injuries, time for recovery from injuries, place for seeking treatment, cost of treatment, knowledge and practice of participants and their families regarding injuries. RESULTS: During post-intervention phase, the intervention group experienced a significant reduction in incidence of injuries, increased preference for institutional treatment of injuries and increased knowledge and practice regarding injuries, in com-parison to its pre-intervention data and data of the control group in post-intervention phase. Total time for recovery and cost of treatment for injuries also decreased in intervention group in post-intervention phase, though differences were not statistically significant. CONCLUSIONS: Child-to-child approach is effective in reducing childhood injuries, improving choice of place for seeking treatment, increasing knowledge of participants, improving family practices regarding prevention of injuries and reducing expenditure on treatment of childhood injuries.

Unintentional childhood injuries and their association with activity and location at the time of injury - A case-Crossover study in Delhi.

BACKGROUND: Childhood injury has been identified as a grave public health problem globally as well as in India. Most studies have reported injuries to have occurred while the child was at home, though injuries while on road, school, or playground also commonly occurred. OBJECTIVE: The objective of the study is to find the association between unintentional childhood injury and the activity and location of the child at the time of injury. METHODS: The present study is part of a larger study for preventing childhood injuries, conducted from August 2017 to January 2019 in Delhi, and reports the activity and location of the children at the time of injury. A total of 173 injuries that occurred during the total study duration were included in the analysis. Data regarding activity and location of the subjects were collected and analyzed by case-crossover study design, during "case/hazard period" and two "control/reference periods." RESULTS: Majority of the injuries occurred while the subjects were at home and engaged in activities other than normal activity. When various locations and activities were combined, unmatched odds ratios (ORs) were raised for activity other than normal activity (statistically significant) and for location other than at home. Similar results were obtained for matched Mantel-Haenszel OR, with activity other than normal being significantly more risk for injury (P = 0.000). CONCLUSION: Majority of unintentional injuries occurred in children and adolescents, while the subjects were away from home and engaged in any activity other than normal daily activities. This indicates the importance of teaching safety behavior to children so that they can prevent being injured wherever they go and whatever activity they perform.

Preventive Health Practices among Doctors in Delhi.

INTRODUCTION: With times, increasing attention is being given to doctor's own health as it is known to influence their patient care. Little is known about preventive health practices among them. OBJECTIVE: To assess preventive health practices among doctors in Delhi. MATERIAL AND METHODS: It was a cross-sectional study undertaken amongst the doctors working in selected hospitals, dispensaries and private clinics in Delhi. A self-administered questionnaire containing items for assessment of preventive health and self-care practices was used to collect the data. RESULTS: Out of the total 160 participants, there were 118 males (73.8%) and 42 (26.2%) females. The mean age of the participants was 29.9±7.4 years. There were 55 doctors (34.4%) who were suffering from chronic diseases like vision problems, dental problems, hypertension and diabetes. Nearly half of the doctors (n=74; 46.2%) did not have any for health insurance. Majority of the doctors (n=65; 40.6%) were obese. The knowledge regarding preventive health guidelines regarding all of the tests asked for, was low among the study participants. As far as preventive health practices were concerned, only 8.8% (14) had checked their blood pressure according to recommended guidelines while none of them had their lipid profile done. While there were 9 female doctors (21.4%) who had done their self breast examination in last six months, there was only 1 participant who had undergone pap test. With respect to self-care practices when the physicians last fell ill, majority had self-managed themselves (n=108; 67.5%). CONCLUSION: Preventive health care practices among the doctors are low. There an urgent need for them to follow good health care practices which they in turn can advocate to their patients.

Effect of mHealth on modifying behavioural risk-factors of non-communicable diseases in an adult, rural population in Delhi, India.

BACKGROUND: The rising trend of non-communicable diseases (NCDs) has led to a "dual burden" in low and middle-income (LAMI) countries like India which are still battling with high prevalence of communicable diseases. The incorporation of a target specially dedicated to NCDs within the goal 3 of the newly adopted Sustainable Development Goals indicates the importance the world now accords to prevention and control of these diseases. Mobile phone technology is increasingly viewed as a promising communication channel that can be utilized for primary prevention of NCDs by promoting behaviour change and risk factor modification. METHODS: A "Before and After" Intervention study was conducted on 400 subjects, over a period of one year, in Barwala village, Delhi, India. An mHealth intervention package consisting of weekly text messages and monthly telephone calls addressing lifestyle modification for risk factors of NCDs was given to the intervention group, compared to no intervention package in control group. RESULTS: After Intervention Phase, significant reduction was seen in behavioural risk factors (unhealthy diet and insufficient physical activity) in the intervention group compared to control group. Body mass index (BMI), systolic blood pressure and fasting blood sugar level also showed significant difference in the intervention group as compared to controls. CONCLUSIONS: Our study has demonstrated the usefulness of mHealth for health promotion and lifestyle modification at community level in a LAMI country. With the growing burden of NCDs in the community, such cost effective and innovative measures will be needed that can easily reach the masses.

Decadal impact of Directly Observed Treatment Short course program on age and gender among New Infectious Tuberculosis cases in Delhi.

BACKGROUND: Burden of tuberculosis in India remains enormous. The Revised National Tuberculosis Control Programme (RNTCP), based on the Directly Observed Treatment Short course (DOTS) strategy, was launched in 1997 in India. The question of what DOTS has or has not accomplished over the past 15 years is a central technical question. OBJECTIVES: To assess the decadal impact of DOTS strategy on some epidemiological factors such as age and gender of new sputum positive (NSP) TB patients in Delhi. MATERIAL AND METHODS: Secondary Data for Delhi was obtained from the state wise performance of RNTCP (Annual Summary) for the year 2001 and year 2012. Data was analyzed in Microsoft Excel 2007. RESULTS: The population of Delhi covered under DOTS has considerably increased over the decade. The case detection rate has also shown a considerable increase from 196/100,000 population in 2001 to 306/100,000 population at the end of Quarter 3 of 2011. The number of NSP male and female patients have increased in all age groups from 2001 to 2011 except in 25-34 years age group. NSP male patients on DOTS aged 15-44 years showed a left ward shift in increase, a significant right ward shift was noted in increase in female NSP patients of similar age group. CONCLUSIONS: The decadal assessment of DOTS in Delhi on TB epidemiology has pointed towards beginning of epidemiological transition in TB control in India.

Prevalence of Dog Bites in Rural and Urban Slums of Delhi: A Community-based Study.

BACKGROUND: Rabies is a fatal disease of the central nervous system caused by the bites of warm-blooded animals. One of the important methods of controlling rabies is by interventions to limit the number of dog bites, the most common source of transmission of rabies to humans in the community. Community-based data on dog bites are rare from India. AIM: The aim of this study is to determine the prevalence of dog bites and knowledge and practices relating to its management and prevention in an urban and a rural slum of North West Delhi, India. SUBJECTS AND METHODS: A cross-sectional house to house survey of 500 households covering a population of 2887 individuals was conducted. The families were selected by systematic random sampling. A pretested and a prevalidated questionnaire was used. Chi-square test was applied for comparing proportions related to the categorical variables and t-test was used for comparing means. RESULTS: The dog bite incidence rate for the study population for the last year was 25.2/1000 population with higher rates in urban (30.1/1000) than rural (19.6/1000) slum. Two-fifths of the dog bite patients did not wash the wound with soap and water. The practice of washing the wound with soap and water was significantly higher in urban than rural slum. One-fifth of the patients did not receive anti-rabies vaccine. There was lower coverage in rural than urban slum. A majority (79.0%) of the patients did not receive anti-rabies serum. CONCLUSION: A high prevalence of dog bites coupled with poor knowledge and dog bite management practices is a worrisome trend which policy makers should take into account to make India rabies free.

Accuracy of body weight perceptions among students in a medical school in Central Delhi, India.

BACKGROUND: Body image is an important aspect of the complex creation of one's self-identity. The relationship between nutritional disorders, like obesity, and one's perception of her or his body is well documented. Obesity among medical students and health personnel is on the rise. Identifying and measuring the magnitude of distortion in body image self-perception among medical students is particularly relevant, as they are future healthcare providers. This paper assesses self-perceptions of body mass index (BMI) and physical activity among medical undergraduate students in an Indian medical school. METHODS: A cross-sectional study was conducted among 161 sixth semester medical undergraduate students in a school in Delhi, India. A pretested questionnaire was used. Anthropometric measurements were taken. The participation rate was 93.6%. RESULTS: Out of the total 161 students, there were 60.9% males and 39.1% females. Most participants were classified as normal (55.9%) according to BMI. The proportions of actual obese, overweight and underweight students were 4.4%, 30.4% and 9.3%, respectively. However, the proportion of students perceiving themselves as obese or overweight was only 37.3%. A significantly higher proportion of females (57.2%) than males (20.4%) perceived themselves as overweight (P < 0.001). The agreement between actual BMI and perceived weight was poor (kappa statistic: 0.33). Among actual overweight and obese students, only one-third were physically active. CONCLUSIONS: Students who were overweight or obese often failed to perceive themselves as such and, perhaps consequently, were not engaging in weight control practices. There is a need to develop health promotion interventions that help build healthy body habitus perceptions among this group of Indian medical students.

Attitude of medical students towards occupational safety and health: a multi-national study.

BACKGROUND: Work-related diseases contribute immensely to the global burden of diseases. Better understanding of attitudes of health care workers towards occupational safety and health (OSH) is important for planning. OBJECTIVE: To assess the attitude of medical students towards OSH around the globe. METHODS: A questionnaire assessing the attitude towards OSH was administered to medical and paramedical students of 21 Medical Universities across the globe. In the current study 1895 students, aged 18-36 years, from 17 countries were included. After having performed a principal components analysis, the associations of interest between the identified components and other socio demographic characteristics were assessed by multivariate linear regression. RESULTS: Principal component analysis revealed 3 components. Students from lower and lower-middle-income countries had a more positive attitude towards OSH, but the importance of OSH was still rated higher by students from upper-income countries. Although students from Asian and African continents showed high interest for OSH, European and South-Central American students comparatively rated importance of OSH to be higher. Paramedical students had more positive attitude towards OSH than medical students. CONCLUSION: The attitude of students from lower-income and lower-middle-income towards importance of OSH is negative. This attitude could be changed by recommending modifications to OSH courses that reflect the importance of OSH. Since paramedical students showed more interest in OSH than medical students, modifications in existing health care system with major role of paramedics in OSH service delivery is recommended.

Effect of life skills training on dietary behavior of school adolescents in Delhi: a nonrandomized interventional study.

Skill-based education has been shown to reduce high-risk behavior among adolescents, but in India, life skills have often been looked at only from the reproductive health perspective. Therefore, the current study was undertaken to assess the effect of life skills training on dietary behavior of adolescents studying in grades 9 and 11 of 2 schools in Delhi. This was a nonrandomized interventional study with a control group. A self-administered questionnaire was used for assessment of dietary behavior at baseline, 15 days, and 3 months after the life skills training. Two life skills training sessions were imparted to the intervention group, focusing on the use of life skills in making healthy choices. Participants in the intervention group (n = 180) showed significant improvement in knowledge (P < .001), attitude (P = .007), and practices (P < .001) following the life skills training. To conclude, a skills-based approach does help improve the dietary behavior in adolescents.

Hypertension and its correlates among school adolescents in delhi.

BACKGROUND: Hypertension is fast emerging as a major health problem amongst all school adolescents, particularly in urban areas. Regular screening of the students for this is required for preventing the emergence of complications later in life. Therefore, the present study was undertaken with the objective to determine the prevalence of hypertension amongst urban school adolescents and its correlation with anthropometric measurements. METHODS: A cross-sectional study was conducted in a school in Central Delhi involving all 315 students of 9(th) and 11(th) standard. A preforma was filled by the students and anthropometric measurements along with blood pressure (BP) measurements were taken for each student. Data was analyzed using Epi-info 2005 and SPSS 16.0. RESULTS: Out of the total 315 students, 208 (66%) were boys and 107 (34%) were girls and the mean age was 14.31 ± 0.96 years. Overall prevalence of malnutrition was 24% and boys were found to be more obese as compared to girls. There were 5 students (1.6%) who were found to have systolic hypertension while 17 (5.4%) were found to have diastolic hypertension while 4.1% (n = 13) of the participants were systolic pre-hypertensive and 26% (n = 82) were in stage of diastolic pre-hypertension. Body mass index and gender were found to be independent predictor for systolic hypertension. CONCLUSIONS: Prevalence of hypertension and pre-hypertension was high amongst the school children. BP check-up for children and adolescents is thus recommended to take remedial action on time.

Usage and Perceived Side Effects of Personal Protective Measures against Mosquitoes among Current Users in Delhi.

Background. Mosquito-borne diseases constitute an important cause of morbidity and mortality. The use of personal protective measures (PPM) like mats, bednets, screening, repellents, liquid vaporizers, mosquito coils, and so forth has been advocated as an effective tool in control of mosquito-borne diseases, but data about the safety profile of personal protective measures is still scarce. Objective. To study the usage and side effects of personal protective measures against mosquitoes among current users in Delhi. Materials and Methods. A community-based cross-sectional study among 350 adult individuals selected by systematic sampling method. Data was collected using pretested semistructured questionnaire after taking written informed consent. Data was analysed using SPSS version 17. Chi-square/Fisher's Exact test was used for qualitative variables to find association and P value <0.05 was considered significant. Results. Out of 350 families selected, 210 belonged to rural area and 140 to urban area. Personal protective measures were used by 219 (62.5%) subjects. Liquid vaporizer was the most preferred method (41.4%). Most common perceived side effect of personal protective measures was headache (7.7%). Other perceived side effects were cough (3.2%), sore throat (2.7%), allergy (1.3%), and eye irritation (0.9%) predominantly among coil users. Conclusion. There is a need to have a close watch for side effects of personal protective measures among users. Further research is also needed to develop safe and effective personal protective measures against mosquitoes.

Perception of stigma towards TB among patients on DOTS & patients attending general OPD in Delhi.

BACKGROUND: In India, Tuberculosis (TB) continues to be a public health problem. One of the key reasons for it is the stigma associated with the disease which affects the treatment seeking behaviour and hence the outcome. OBJECTIVES: To assess the perceived and enacted stigma among TB patients and perceptions of other patients related to TB in Central Delhi. METHODS: A cross-sectional study conducted in urban field practice area of a medical college of Delhi, using a pre-designed questionnaire containing items for assessment of stigma being faced by a TB patient in family, social life and workplace. It also contained questions pertaining to reaction of patients from general OPD to a family member who develops TB. RESULTS: A total of 100 patients on DOTS and 200 patients from general OPD were interviewed. There were 21 patients who reported to have delayed treatment seeking due to stigma. Nearly one third patients (n=34; 34%) noted negative changes in the behaviour of their family members towards them while 40% were isolated on being diagnosed with the disease. Out of the 36 employed TB patients, 65.5% (n=23) experienced negative change in the behaviour of their colleagues. In general OPD patients, significantly higher proportion of female patients said that they would not disclose the disease status of a family member suffering from TB to their neighbours (p<0.001). CONCLUSIONS: Perception of stigmatizing effect of Tuberculosis was high both amongst TB and other patients. Behaviour Change Communication (BCC) strategies are needed to address the effects of stigma like delayed treatment seeking.

ABC-VED Analysis of a Drug Store in the Department of Community Medicine of a Medical College in Delhi.

A matrix based on coupling of cost (always, better and control) analysis and criticality (vital, essential and desirable) analysis was employed for drug inventory containing 129 items of drug store in the Department of Community Medicine of a Medical College in Delhi. The annual drug expenditure incurred on 129 drug items for the year 2010-2011 was found to be Rs. 4,35,847.85. On always, better and control analysis, 18.6, 24.0 and 57.4% drugs were found to be always, better and control category items, respectively, amounting for 69.1, 20.8 and 10.1% of annual drug expenditure. About 13.2 (17), 38.8 (50) and 48.0% (62) items were found to be vital, essential and desirable category items, respectively, amounting for 18.7, 49.5 and 31.8% of annual drug expenditure. Based on always, better and control-vital, essential and desirable matrix analysis there were 37 (28.68%) items in category I, 53 (41.09%) items in category II and 39 (30.23%) items in category III, amounting for 73.0, 22.2 and 4.8% of annual drug expenditure, respectively. To conclude, scientific inventory management tools are needed to be applied in routine for efficient management of the pharmacy stores as it contributes to not only in improvement in patient care but also judicious use of resources as well.

Antepartum morbidities and health seeking behaviour among women in an urban slum of Delhi.

A cross-sectional study was conducted to assess the pattern of antepartum morbidities and its relationship with socio-economic, demographic characteristics and the health seeking behaviour among 214 women in an urban slum community of Delhi. Interviews were conducted in the households using a pretested semi-structured schedule. The age at marriage, age at co-habitation, and age at child-birth were below 18 years in 36.4%, 32.7%, and 5.1% respectively. The average number of antepartum morbidities per woman was 1.7. Commonest morbidities were: Urinary problems (11.2%), swelling over hands and feet (9.3%), fever > 3 days duration (7.5%), antepartum bleeding (7.0%), etc. The antepartum morbidities were found to be significantly higher among wives of illiterate (p = 0.01) husbands and of unskilled workers (p = 0.01). Out of 144 morbidities, consultation was sought for 101 morbidities (70.1%), mostly in a government hospital (78.2%). Main reasons for non-consultation among 43 women were: Non-availability of persons to accompany (32.6%), or to look after the children (23.3%) and feeling unnecessary to consult (23.3%). Study findings revealed the need for family support, sensitising men about women's health problems during pregnancy and education regarding identification of danger signs during pregnancy for reducing maternal morbidity and related mortality.

Expenditure audit of women with breast cancer in a tertiary care hospital of Delhi.

BACKGROUND: Breast cancer is associated with substantial medical and economic burden. This study assisted the expenditure incurred by the subjects on diagnosis and treatment till the period of follow-up. MATERIALS AND METHODS: This is a prospective study; a case series of patients studied at the time of diagnosis and followed after 6 months. The study was conducted at one of Hospitals in India, from January 2006 to December 2007. One hundred and seventy-two women with new primary breast cancer were included in the study. During the study period 69 subjects were lost to follow-up. The comparative analysis was done for 103 subjects. Cost implications of breast cancer include direct medical costs and indirect costs. Questionnaire for the data collection was used. Descriptive statistics and correlation analysis were used. RESULTS: The median total direct and indirect expenditure was Rs. 12,100 (US$ 1 = Rs 50) with the range of Rs. 0-54000. The largest component of total direct medical costs was in stage I (median Rs. 6530), total indirect costs (median Rs. 7500), and median total cost was Rs. 17,600. The total expenditures (median Rs. 13,100) were the highest in younger age group (<40). The median direct expenditure was higher in the subjects who visited private setup before coming to Hospital (Rs. 8250) than those who came directly (Rs. 4500). CONCLUSIONS: Cost of treatment for breast cancer depends on many factors, including the stages of the cancer, the woman's age, perhaps the costs of treatment, private hospital and insurance.

Risk factors with breast cancer among women in Delhi.

BACKGROUND: The incidence of breast cancer is on the rise in India, breast cancer is the second most common malignancy in Indian women. AIM: The aim of this study was to find out the association of various risk factors with breast cancer among women in Delhi. SETTINGS AND DESIGN: This was a case-control study in Lok Nayak Hospital, Delhi. METHODS AND MATERIAL: 332 women were studied. Subjects were women with breast cancer (N = 115) and age matched Control subjects (N-217) without breast cancer, attending Lok Nayak Hospital during 2006. Subjects were interviewed using a pretested questionnaire. The risk factors studied were: age, parity, socioeconomic status, marital status, breast feeding, menarche, menopause, family history. STATISTICAL ANALYSIS: Data was expressed in proportion. RESULTS AND CONCLUSIONS: Age of the patient ranged from 25 to 80 years. In this study, 69 (60%) cases and 127 (58.5%) controls were illiterate, the mean duration sum of total breast feeding for all children was 6.58 years in cases and 7.4 years in controls (OR = 1.91; 95% CI, 1.17 - 3.13) (P P P< 0.05). There was a significant difference between breast cancer cases and controls in relation to place of residence, occupation, marital status, body mass index and breast feeding.

Assessment of quality of life among HIV positive people attending tertiary hospital of Delhi, India.

As per global HIV/AIDS estimates, a total of 33 million [30.3 - 36.1 million] People were living with HIV in 2007. The world's second-most populous country, India, is experiencing a highly varied HIV epidemic, which appears to be stable or diminishing in some parts while growing at a modest rate in others. Quality of life (QOL) of HIV/AIDS patients is becoming an important component of overall assessment of health care and management in health care settings. It is one of the indicators effectiveness of management of PLHAS. The objective of this study was to determine the QOL of patients with HIV/AIDS in New Delhi. Purposive sampling was used to identify subjects from the antiretroviral therapy clinic (ART) in Lok Nayak hospital. 180 patients were interviewed with the WHOQOL-HIV instrument. This questionnaire included demographic data, multi-item scales and six domains namely physical, psychological, level of independence, social relationships, environment and spirituality religion. Study subjects were aged between 20-56 years. Mean age of all study subjects was 33.85 +/- 7.01 years, comprising of 34.4 females. More than 50% of the total subjects had received less than secondary school education. All domains have higher scores for women than men except the psychological domain. Correlation of scores of six domains with overall QOL score and among individual domains was statistically significant. Younger people showed poorer QOL and level of education correlated positively with all domains of QOL Overall results indicate that quality of life of AIDS attending Lok Nayak hospital is satisfactory.

General practitioners' knowledge of childhood asthma in Delhi, India.

OBJECTIVE: To assess knowledge of childhood asthma among general practitioners (GPs) in Delhi, India. DESIGN: In this cross-sectional study, a total of 157 GPs were interviewed using a validated questionnaire, including six questions of local and social relevance. A response rate of 78.5% was obtained. RESULTS: Although the GPs who participated in the study had adequate knowledge of the importance of appropriate treatment, the safety of inhalers/oral steroids and the role of medicines in the prevention of frequent asthma attacks, the majority lacked knowledge of symptomatology, exercise-induced asthma and inhaled corticosteroids. GPs with >5 years of practice were more likely to have significantly less knowledge about preventive drugs, certain aspects of treatment of acute asthma and misconceptions, such as 'drinking milk increases mucus production' or 'children with asthma should not consume dairy products, chilled drinks, sour or chilled food'. On the other hand, GPs with < or =5 of practice had misconceptions such as 'children with asthma have abnormally sensitive airways' and 'asthmatic children develop dependence on inhalers'. CONCLUSIONS: The gaps in knowledge about asthma and its management highlight the need to design well-structured educational strategies for health professionals.

Impact of health education intervention on knowledge and community action for malaria control in Delhi.

Malaria affects millions of people in India despite decades of efforts to control it. It has acquired greater importance in last two decades due to emergence of vector resistance, poor quality of care and low utilization of services. The study was conducted to improve the management of malaria by IEC and training activities in slum areas of Delhi. The baseline and post intervention data on knowledge, attitude, behavior and practices (KABP) regarding malaria was collected from 601 and 593 subjects respectively from two zones of Municipal Corporation of Delhi (MCD). At the same time, knowledge and skills regarding management of malaria were assessed among 15 health workers working in these two zones of MCD. An intervention package in the form of health education material for the community and training modules for the workers were designed and implemented. Post intervention data were collected. The knowledge about cause of malaria, season of malaria and breeding places of mosquito increased among community members after the intervention, which was found to be statistically significant. Similarly, more people were aware about the methods of prevention of mosquito breeding after the intervention. Methods like mosquito coil (post-64.92% vs pre-55.41%) and bet nets (post-24.96% vs pre-14.47%) were used by more people in post intervention phase. The Interval between onset of symptoms and seeking treatment decreased after the intervention from 1.66 days to 1.37 days. Among the workers, knowledge and skills regarding malaria management improved after the intervention. More blood slides were made, side effects of the treatment were explained to the patients and better compliance to treatment was observed in post intervention phase. IEC activities using attractive pamphlets to the community and on-job training of workers improves management of malaria and should be used more frequently more so in the slum areas for the success of the National Anti-Malaria Program.