Monitoring of presterile disposable syringes and needles marketed in Pune.

Out of hundred syringes and hundred needles (both presterile, disposable) tested, 41 syringes (41%) and 6 needles (6%) showed aerobic growth. Forty of the above syringes were tested simultaneously for fungi and anaerobes. Fungi isolated were 5.7% and no anaerobe was grown. Fifty glass syringes and fifty needles autoclaved in the departmental laboratory served as controls and did not show any growth. As a preventive measure, proper disposal of used disposable material should be made mandatory so that it does not find its way into the market. Or has the time come to switch back to the former conventional practice of using in house autoclaved articles?

Disaster management knowledge attitude & practice of urban slum dwellers.

A KAP study was done in the area of Disaster Management in urban slums of Pune City. The Youth Organisations' members and the members of Mahila Mandals were the study subjects. It was found that there was marked improvement in the knowledge and attitudes of these subjects towards disasters. It is recommended that members of Mahila Mandals and members of Youth Organisations can act as 'frontline workers' in the situations of disasters after imparting some training in disaster management.

Retrospective prediction of birth weight by growth velocity curves during neonatal period.

In this prospective study, birth weight of 304 babies born at Kamla Nehru Hospital Pune during study period was recorded. From these 304 babies, babies with birth weight above 2000 grams were selected (260 babies) to prepare growth velocity curves. Daily weight of these 260 babies was recorded for 30 days. The mean birth weight of study population was 2742.5 grams. Among the daily weight recorded babies, all the babies lost weight ranging from 92 to 218 grams (mean 121 grams) after birth. The weight loss continued upto 5 days. Days required to gain weight equal to birth weight ranged from 5 to 13 days. Total weight gain observed in 30 days was 734.7 grams. Predictive value of these curves was tested in 49 infants. Deviation upto 50 grams of predicted birth weight from actual birth weight was observed in 90% of babies on day-2, 79% on day-4, 65% on day-8 and 39% on day-30.

Community-based projects in rural internships: an alternative approach.

Supervision of medical interns posted to various primary health centres and rural health training centres by specialists in preventive and social medicine and other clinical disciplines is becoming less and less effective for a number of unavoidable reasons. Because of lack of proper and timely guidance, interns feel that during the 6-month rural internship they do not get enough experience of rural life. In order to provide them with learning experiences in community medicine and orient them in the social dynamics of the community, a new approach involving interns in small community-based projects, probably for the first time, was tried on a pilot basis at the Rural Health Training Centre (RHTC), Sirur, a field practice area of B.J. Medical College, Pune, Maharashtra, India. Interns working at RHTC Sirur completed these community-based projects successfully. Identification of problems, study design analysis and drawing conclusions, based on observation, were all undertaken by the interns under the guidance of the staff of the Department of Preventive and Social Medicine, B.J. Medical College. The opinion poll at the end of the rural internship revealed that 76% of interns considered this experience valuable for improving their knowledge and skills, and 56% though that interaction during these projects was beneficial to the community as well. This experience with community-based projects for interns during their rural posting provides them with an opportunity for interaction with the community.

Epidemiological aspects of school dropouts in children between 7-15 years in rural Maharashtra.

A study on school dropouts from primary and secondary school children was undertaken in September '91 from 16 schools at the headquarters of 8 Primary Health Centres, where 172 school dropouts were identified. A home visit was paid and information about socio-economic and cultural aspects was collected and a psychological screening was undertaken. Although there was no significant difference in overall dropout rates for both sexes, it increased sharply at 11 years of age in girls. The majority of children dropped out due to financial problems or unsatisfactory scholastic performance, and 142 (82.5%) of the 172 children studied were poor performers in one or more function tests. Maximum difficulty was observed in concept formation 87 (50.5%), followed by numerical ability in 78 (45%). Identification of children with learning difficulties and intervention using special educational methods within the framework of existing network of primary and secondary schools in rural areas is suggested.

Infant mortality in rural India: a strategy for reduction.

PIP: A risk-approach-strategy project sponsored by WHO was undertaken in 22 villages of Surur, Pune, by BJ Medical College. All births in the study population of 47,000 were followed, comparing the 3 cohorts born between January 1981 to December 1983. Female village health guides were trained in screening for 11 maternal risk factors, infant risk factors, infant monitoring, and basic health support such as maternal nutrition, rest, breastfeeding and home cleaning, heating, humidifying and infant isolation. There were 123, 97 and 87 infant deaths in the 1981, 1982, and 1983 cohorts, giving infant mortality rats of 91.2, 72.3 and 67.3 respectively. The proportion of neonatal deaths remained at 61 to 62.1% over the period. The most common risk factors seen were illness, low birth weight and growth retardation, often associated with illness. Incidence of low birth weight and prolonged labor both decreased significantly over the duration of the program. Mortality was high among infants with feeding problems and prematurity. 40% of deaths were due to infections, 28% to low birth weight and prematurity, and 9% to birth asphyxia. The lower infant mortality rate achieved here is comparable to urban levels reported in India. These results show that primary health workers are capable of referring and managing risks, and risk management could be applied on a larger scale.^ieng

Perinatal mortality in rural India: a strategy for reduction through primary care. I Stillbirths.

In a prospective community based study of the distribution and determinants of stillbirths in a rural area of Maharashtra, India, that was carried out for two years, 3129 singleton and 22 twin births were recorded in a population of 47 000. Of the 3173 babies, 85 singletons and five of the twins were stillborn giving a stillbirth rate of 28.4/1000 births. The causes of stillbirths are analysed and the possibility of reducing the unacceptably high stillbirth rate by adequate training of grassroot level workers in screening pregnant women for detection of "at risk" mothers and their timely referral is discussed.

Perinatal mortality in rural India: intervention through primary health care. II Neonatal mortality.

Early neonatal mortality is unacceptably high in most developing countries. A large majority of births in rural areas of these countries occur at home, attended by relatives or traditional birth attendants and without easy access to skilled professional care. Under these circumstances cause of death has to be based on lay descriptions of terminal events. Analysis of cause of death shows that 74% of the early neonatal deaths are amenable to intervention. Admittance to hospital of the "at risk" neonates is not practicable. Intervention through primary health care can be effective if based on scientific principles and offered through female community health workers. Objectives of domiciliary care given by these workers should be to educate and guide the mother to protect the delicate newborn from the effects of adverse environmental conditions, to ensure adequate nutrition, and to prevent infections. Interventions supporting beneficial traditional cultural practices as well as simple techniques for care of the newborn are discussed.