Internal migrants' experiences with and perceptions of frontline health workers: A nationwide study in 13 Indian cities.

The role of frontline health workers is crucial in strengthening primary health care in India. This paper reports on the extent of services provided by frontline health workers in migrants' experiences and perceptions of these services in 13 Indian cities. Cluster random sampling was used to sample 51 055 households for a quantitative survey through interviewer-administered questionnaires. Information was sought on the receipt of health workers' services for general health care overall (from the head/other adult member of the household) and maternal and immunization services in particular (from mothers of children <2 years old). Purposively, 240 key informants and 290 recently delivered mothers were selected for qualitative interviews. Only 31% of the total respondents were aware of the visits of frontline health workers, and 20% of households reported visits to their locality during past month. In 4 cities, approximately 90% of households never saw health workers in their locality. Only 20% of women and 22% of children received antenatal care and vaccination cards from frontline health workers. Qualitative data confirm that the frontline health workers' visits were not regular and that health workers limited their services to antenatal care and childhood immunization. It was further noted that health workers saw the migrants as"outsiders." These findings warrant developing migrant-specific health-care services that consider their vulnerability and living conditions. The present study has implications for India's National Urban Health Mission, which envisions addressing the health care needs of the urban population with a focus on the urban poor.

Biochemical iodine deficiency in selected schools of aligarh.

The goiter prevalence reflects the iodine deficiency in past while urinary iodine excretion levels (UIEL) gives the current status of iodine nutrition. The study was conducted to assess the status of biochemical iodine deficiency in school children of 1st-5th standard (6-12 years). A total of 907 students of seven schools were included using probability proportional to size method. About 10% of urine samples from total children were tested for UIEL. Statistical analysis was done using SPSS version 20 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). UIEL values lower than 100 µg/L were observed in 23.3% of samples. The proportion of children with UIEL of <20 µg/L was nil in 6 years. Out of 13 students who were consuming salt with nil iodine content, 46.2% had <20 µg/L UIEL. The prevalence of iodine deficiency, calculated by the proportion of children having UIEL of <100 µg/L, was 23.3%. Based on UIEL values, the area would be categorized as having "no biochemical iodine deficiency."

Assessment of Directly Observed Treatment in Revised National Tuberculosis Control Programme: A Study from North India.

INTRODUCTION: Directly observed treatment short-course (DOTS) strategy is one of the vital components of Revised National Tuberculosis Control Programme (RNTCP) came into existence in 1997. Directly observed treatment providers (DOT providers) are the grass root level link between program and clients. AIMS: This study was undertaken to assess the quality of DOTS and facilities available at DOT centers and association between program input and outcome. MATERIALS AND METHODS: This prospective study was carried out to evaluate RNTCP in a North Indian District. Totally, 42 DOT providers providing treatment to registered RNTCP patients in four designated microscopy centers were included in this study. Program input was assessed based on a ten-point questionnaire regarding processes and facilities followed DOT center. Treatment outcome of 302 patients receiving DOTS under these providers was also assessed. STATISTICAL ANALYSIS: Data were analyzed using SPSS version 20. Categorical variables such as age group, sex, religion, location, work experience of DOT providers are measured in frequency and percentage. Chi-square was used to find association between quality of DOTS and outcome of treatment. P < 0.05 was considered statistically significant. RESULTS: The basic principle of DOTS was followed only in half (47.6%) of the DOT centers, counseling was not being done by 40.5% of the providers. Formal training of DOTS was given to two-thirds of the providers. The treatment outcome of patients was significantly associated with program input at DOT center level (Chi-square = 4.02, P < 0.05). CONCLUSIONS: There are few gaps in DOT practices such as administration of DOTS, patient counseling, and tracing of follow-up. This study also concluded that improved program input can enable to get a better outcome.

A study on nutritional status of school-going adolescents in Aligarh, India.

Adolescence is a highly vulnerable period for malnutrition. This study was based on a Global School Health Survey methodology in the 13-15-year age group; employing WHO AnthroPlus to evaluate the nutritional status, find the prevalence of both extremes of malnutrition, compare with the growth curves and to find its sociodemographic correlates. A total of 1456 students were sampled and the mean BMI for age Z score was found to be -0.11. The prevalence of overweight and obese were 11.95% and 2.27%, respectively, whereas 2.75% suffered from thinness, defined as BMI for age <2 standard deviations. The prevalence of being overweight and obese was associated with a higher standard of living, a higher education of father or mother, working mothers and father's occupation being service/business. The evident double burden of malnutrition presages a large public health burden in future, requiring interventional attention.

Is small town India falling into the nutritional trap of metro cities? A study in school-going adolescents.

INTRODUCTION: There has been an increasing secular trend in the prevalence of overweight and obesity in developing countries. The prevalence reported among children and adolescents of some metro cities in India are comparable to that in some developed countries. Westernization of culture, rapid mushrooming of fast food joints, lack of physical activity, and increasing sedentary pursuits in the metro cities are some of the reasons implicated for this. The nutritional changes in small town school children might be following the same pattern of larger cities. AIMS AND OBJECTIVES: To study the prevalence of overweight and obesity among school-going adolescents of Aligarh and to study the sociodemographic and behavioral correlates of the same. MATERIALS AND METHODS: A cross-sectional study done in two affluent and two nonaffluent schools in Aligarh, taking 330 adolescents from each group (total-660). Study tools included a predesigned and pretested questionnaire, Global Physical Activity Questionnaire, and anthropometric measurement. Overweight and obesity were defined based on World Health Organization 2007 Growth Reference. Chi-square test and multiple logistic regression analysis were done. RESULTS: Prevalence of overweight and obesity was 9.8% and 4.8% among school-going adolescents. The difference in prevalence of overweight and obesity among affluent schools (14.8% and 8.2%) and nonaffluent schools (4.8% and 1.5%) was significant. Risk factors for overweight and obesity were affluence, higher maternal education, parental history of obesity, frequent fast food intake, and television (TV) viewing more than 2 h/day. CONCLUSION: Overweight and obesity among school-going adolescents is a crisis facing even smaller cities in India. Behavior change communication should be focused to adolescents, especially of the affluent section, toward restricting fast food intake, and TV viewing.

Role models and occupational ambitions of in-school male adolescents.

BACKGROUND: A role model is perceived as worthy of imitation, their selection can indicate significant elements of psychosocial health and self-projection in adolescents. Patterns of behavior and lifestyle choices established during adolescence can have immediate and lasting effects on health. MATERIALS AND METHODS: Cross-sectional study was undertaken in the schools of Aligarh, Uttar Pradesh, India. The sample frame was 2347, out of which a sample of 390 students was studied. Data collected were entered and analyzed by SPSS for Windows version 10%). RESULTS: Majority (62.7%) of adolescents revealed that their role models were Film Star (34.8%) and their Teachers (27.9%), Parents (14.3%), Sportsman (12.0%). Politicians as the role models were opted by least proportion (1.2%). Desire of future occupation was Businessmen (27.9%), Doctor (18.6), and Engineer (14.4%). CONCLUSION: Nearly all adolescents had a role model. There is greater impact of cinema on the minds of adolescents, which resulted in choosing film actors as their role model. Aspiration of future occupation was not related to the characteristics of the role model.

Influence of behavioral determinants on the prevalence of overweight and obesity among school going adolescents of Aligarh.

Obesity has reached epidemic proportions globally and the prevention of adult obesity will require prevention and management of childhood obesity. A study was conducted to determine the prevalence and behavioral determinants of overweight and obesity in school going adolescents. A total of 660 adolescents from affluent and nonaffluent schools were taken. Overweight and obesity was defined as per World Health Organization 2007 growth reference. Prevalence of overweight and obesity was 9.8% and 4.8%, respectively. Prevalence of both overweight and obesity was higher among males. Statistically significant difference was found in prevalence of overweight and obesity among affluent schools (14.8% and 8.2%) and nonaffluent schools (4.8% and 1.5%). Important determinants of overweight and obesity were increased consumption of fast food, low physical activity level and watching television for more than 2 h/day. The prevalence of obesity is high even in small cities. Dietary behavior and physical activity significantly affect weight of adolescent children.

All Slums are Not Equal: Maternal Health Conditions Among Two Urban Slum Dwellers.

BACKGROUND: Pregnant women inhabiting urban slums are a "high risk" group with limited access to health facilities. Hazardous maternal health practices are rampant in slum areas. Barriers to utilization of health services are well documented. Slums in the same city may differ from one another in their health indicators and service utilization rates. The study examines whether hazardous maternal care practices exist in and whether there are differences in the utilization rates of health services in two different slums. MATERIALS AND METHODS: A cross-sectional study was carried out in two urban slums of Aligarh city (Uttar Pradesh, India). House-to-house survey was conducted and 200 mothers having live births in the study period were interviewed. The outcome measures were utilization of antenatal care, natal care, postnatal care, and early infant feeding practices. Rates of hazardous health practices and reasons for these practices were elicited. RESULTS: Hazardous maternal health practices were common. At least one antenatal visit was accepted by a little more than half the mothers, but delivery was predominantly home based carried out under unsafe conditions. Important barriers to utilization included family tradition, financial constraints, and rude behavior of health personnel in hospitals. Significant differences existed between the two slums. CONCLUSION: The fact that barriers to utilization at a local level may differ significantly between slums must be recognized, identified, and addressed in the district level planning for health. Empowerment of slum communities as one of the stakeholders can lend them a stronger voice and help improve access to services.

Home-based management of acute diarrhoeal disease in an urban slum of Aligarh, India.

INTRODUCTION: Diarrhoea is a major cause of morbidity and mortality in children. Most deaths are caused by dehydration and are easily preventable by using oral rehydration therapy. Early management and recognition of danger signs are key strategies in treating diarrhoeal diseases at home. This study assessed the knowledge and health-care seeking behaviour of families regarding diarrhoeal illness in children aged under five years. METHODOLOGY: The study was undertaken during June and July 2009 in an urban slum of Aligarh, Uttar Pradesh, India. Mothers of children (n = 101) suffering from diarrhoea with at least one episode in the last two weeks prior to the interview were included. Information was gathered on a predesigned and pretested questionnaire. RESULTS: Overall prevalence of diarrhoea in children under five was 36%. Life-threatening symptoms which the mothers knew were watery stool (85%) and repeated vomiting (54%). Two thirds (69%) of the mothers continued breastfeeding their children during the episode, while the remaining either withheld or interrupted breastfeeding. The majority visited a nearby unsanctioned health practitioner. Less than half (46.5%) of the mothers knew about oral rehydration salt solution and only 29.8% of those knew the correct method of preparation. Only 38.7% of the respondents knew about suitable fluids available at home, out of which salt sugar solution was the choice in most cases. CONCLUSION: The study highlights that the mothers' knowledge is not adequate. Educating mothers and caretakers regarding early home-based case management of childhood diarrhoea may substantially decrease morbidity and mortality due to diarrhoea.

Determinants of vitamin A deficiency amongst children in Aligarh District, Uttar Pradesh.

OBJECTIVES: To determine the prevalence and determinants of xerophthalmia among children aged 0-60 months . METHODS: This cross-sectional study included 3571 children under 5 years of age from six villages and four periurban areas. Children with xerophthalmia were identified and severity graded using the WHO classification. The main outcome measures were socio-demographic, nutritional and comorbidity related risk factors of xerophthalmia. A pretested questionnaire carrying information on the above factors was administered to the caregivers. Univariate and multivariate binary logistic regression analyses were performed to examine the association of each of these factors with xerophthalmia. RESULTS: The overall prevalence of xerophthalmia was of serious public health importance at 9.1%. Prevalence of both mild (night blindness, and Bitots spots) and severe forms (corneal changes) of xerophthalmia increased with age. Bitots spots and night blindness were the commonest manifestations. Rural dwelling, lower social class, maternal illiteracy and occupation outside home were significant antecedent socio-demographic risk factors on univariate analysis. Multivariate analysis revealed low intake of proteins and vitamin A containing foods as well as predominant maize diet to be significant dietary factors. Nutritional wasting and a preceding history of measles were significant comorbid determinants (P<0.05). None of the socio-demographic variables emerged significant on multivariate analysis. CONCLUSIONS: Vitamin A deficiency remains a significant public health problem in Aligarh district. The proximal factors in a child's milieu viz nutrition and comorbidities were more significantly associated with xerophthalmia than the distal socio-demographic factors, thereby making a case for their cost effective prevention. The high magnitude of the problem calls for intensification of existing prophylactic measures in these areas.

Childhood leprosy: lest we forget.

Leprosy remains an important public health and social issue in South Asia, particularly in India. Its presence in childhood is an immense social burden because of the associated disabilities and widely prevalent misconceptions regarding communicability and treatment potential. The prevalence of leprosy among children suggests a possible gap in the national programmes aimed at leprosy elimination. This article reports a 10-year retrospective study of childhood leprosy in a tertiary care hospital setting (2000-2009) along with an analysis of selected socio-epidemiologic correlates. We stress the importance of early detection and the application of appropriate prophylactic measures in susceptible children.

Leprosy: down but not out.

Leprosy is a chronic disabling disease and there are areas of high endemicity in India. Case findings and management strategies suffer a setback when disease manifestations are not picked up in time by health-care providers. This article attempts to estimate the annual incidents of leprosy and to study the confounding factors which may potentially cause delays in diagnosis in an office-based, tertiary health-care setting.

Lifestyle and gallstone disease: scope for primary prevention.

OBJECTIVE: To study the antecedent risk factors in the causation of gallstone disease in a hospital-based case control study. MATERIALS AND METHODS: Cases (n = 150) from all age groups and both sexes with sonographically proven gallstones were recruited over a duration of 3 months from the surgical wards of a tertiary care teaching hospital. Modes of presentation were also noted among cases. Age- and sex-matched controls (n = 150) were chosen from among ward inmates admitted for other reasons. Univariate and multivariate logistic regression analyses were performed for selected sociodemographic, dietary, and lifestyle-related variables. RESULTS: Females had a higher prevalence of gallstone disease than males (P < 0.01). Among males, the geriatric age group (<60 years) was relatively more susceptible (28%). Prepubertal age group was least afflicted (3.3%). Univariate analysis revealed multiparity, high fat, refined sugar, and low fiber intakes to be significantly associated with gallstones. Sedentary habits, recent stress, and hypertension were also among the significant lifestyle-related factors. High body mass index and waist hip ratios, again representing unhealthy lifestyles, were the significant anthropometric covariates. However, only three of these, viz., physical inactivity, high saturated fats, and high waist hip ratio emerged as significant predictors on stepwise logistic regression analysis (P < 0.05). CONCLUSION: Gallstone disease is frequent among females and elderly males. Significant predictor variables are abdominal adiposity, inadequate physical activity, and high intake of saturated fats; thus representing high risk lifestyles and yet amenable to primary prevention.

Global developmental delay and its determinants among urban infants and toddlers: a cross sectional study.

OBJECTIVE: To estimate the prevalence of global developmental delay among children under 3 years of age and study the determinant factors. METHODS: Cross sectional descriptive study was conducted in field practice areas of the Department of Community Medicine, JN Medical College, Aligarh, India. A total of 468 (243 boys and 225 girls) children aged 0-3 years were included. Developmental screening was performed for each child. A multitude of biological and environmental factors were analysed. RESULTS: As many as 7.1% of the children screened positive for global developmental delay. Maximum delay was observed in the 0-12 months age group (7.0%). Undernutrition and prematurity were the two most prevalent etiological diagnoses (21% each). Stunting and maternal illiteracy were the microenvironmental predictors on stepwise binary logistic regression while prematurity and a history of seizures emerged significant biological predictors. CONCLUSIONS: Developmental delay can be predicted by specific biological and environmental factors which would help in initiating appropriate interventions.

Routine immunization coverage in underserved children of Aligarh (India): an effort with UNICEF.

The aims of the study were to find out the routine immunization coverage in under-five children; and to impart correct health education regarding the importance of complete immunization. This hospital- and outreach-session-based cross-sectional study was carried out by the interview method in two underserved areas of Aligarh city. Two thousand five hundred and thirty-one under-five children and their mothers or family members were included in the population sample. Statistical analysis was done by proportions and chi-square test. In Shahjamal area, a maximum 86.5 percent of children were immunized with DPT, OPV (86.5%) first doses followed by BCG (84.9%). DPT and OPV second and third doses were given in 64.5 percent and 54.8 percent respectively. Measles and DPT booster coverage was low at 39.0 percent and 11.4 percent respectively. Similarly, in Bhojpura, 99 percent of children received DPT and OPV first doses followed by BCG (94.1%). DPT and OPV second and third doses were given in 67.7 percent and 47.4 percent of children respectively. Measles and DPT booster coverage was low as 31.9 percent and 6.7 percent respectively. The results reveal high coverage of DPT1, OPV1, BCG, DPT2 and OPV2 in both areas. Immunization services need to be strengthened beyond infancy.

Poor perinatal care practices in urban slums: possible role of social mobilization networks.

BACKGROUND: Making perinatal care accessible to women in marginalized periurban areas poses a public health problem. Many women do not utilize institutional care in spite of physical accessibility. Home-based care by traditional birth attendants (TBA) is hazardous. Inappropriate early neonatal feeding practices are common. Many barriers to perinatal care can be overcome by social mobilization and capacity building at the community level. OBJECTIVES: To determine the existing perinatal practices in an urban slum and to identify barriers to utilization of health services by mothers. STUDY DESIGN: This is a cross-sectional descriptive study. SETTING AND PARTICIPANTS: The high-risk periurban areas of Nabi Nagar, Aligarh has a population of 40,000 living in 5,480 households. Mothers delivering babies in September 2007 were identified from records of social mobilization workers (Community Mobilization Coordinators or CMCs) already working in an NGO in the area. A total of 92 mothers were interviewed at home. Current perinatal practices and reasons for utilizing or not utilizing health services were the topics of inquiry. STATISTICAL ANALYSIS: Data was tabulated and analyzed using SPSS 12. RESULTS: Analyses revealed that 80.4% of mothers had received antenatal care. However, this did not translate into safe delivery practices as more than 60% of the women had home deliveries conducted by traditional untrained or trained birth attendants. Reasons for preferring home deliveries were mostly tradition (41.9%) or related to economics (30.7%). A total of 56% of the deliveries were conducted in the squatting position and in 25% of the cases, the umbilical cord was cut using the edge of a broken cup. Although breast-feeding was universal, inappropriate early neonatal feeding practices were common. Prelacteal feeds were given to nearly 50% of the babies and feeding was delayed beyond 24 hours in 8% of the cases. Several mothers had breastfeeding problems. CONCLUSION: Barriers to utilization of available services leads to hazardous perinatal practices in urban slums.

Prevalence of common ocular morbidities in adult population of aligarh.

AIMS AND OBJECTIVES: To determine the prevalence of common ocular morbidities (cataract, refractive errors, glaucoma, and corneal opacities) and their demographic and sociocultural correlates. SETTINGS AND DESIGN: The present cross-sectional study was conducted in the field practice areas of the Department of Community Medicine, JNMC, AMU, Aligarh, for a period of one year, from September 2005 to August 2006. MATERIALS AND METHODS: Systematic random sampling was done to select the required sample size. All adults aged 20 years and above in the selected households were interviewed and screened using a 6/9 illiterate 'E' chart. Those who could not read the 'E' chart were referred to the respective health training center for a complete eye examination by an ophthalmologist. STATISTICAL ANALYSIS: Chi- square test. RESULTS: The prevalence of visual impairment, low vision, and blindness, based on presenting visual acuity was 13.0, 7.8, and 5.3%, respectively. The prevalence of cataract was 21.7%. Bilateral cataract was present in 16.9% of the population. Cataract was significantly associated with age, education, and fuel use. The prevalence of myopia, hypermetropia, and astigmatism was 11.5, 9.8, and 3.7%, respectively. Glaucoma was diagnosed in six patients, giving a prevalence rate of 0.9%. All the six patients of glaucoma were aged above 40 years. The prevalence of corneal opacity was 4.2%. CONCLUSION: There is a high prevalence of treatable or preventable morbidities such as cataract, refractive errors, and corneal opacity.

Knowledge of diarrhea management among rural practitioners.

OBJECTIVE: To determine diarrhea management in rural practitioners. METHODS: This study was conducted among the RMP's of 4 blocks of Aligarh. Pre-coded questionnaire was completed and educational programme followed. 91% were prescribing ORS in various combinations, but only 9.8% were advising ORS and feeding as standard management of diarrhea. Only 12.8% could name a WHO ORS brand and 50% were giving wrong instructions for preparation. 95% were advising inadequate amounts of ORS. Only 43.5% were advising feeding during diarrhea but 86.6% were advising to continue breastfeeding. On an average every 3rd to 4th patient was administered IVF's. 52% felt that drugs should be prescribed. RESULTS: 90% and 55.3% of RMPs could identify diarrhea and key signs of dehydration. CONCLUSION: There is a need for hands on training for the practitioners and education of the masses regarding proper management of diarrhea.