Knowledge, attitude, and practices about disaster preparedness among resident doctors in a tertiary care teaching hospital in Delhi, India: A cross-sectional study.

BACKGROUND: Disasters pose various challenges to hospitals' functioning during calamities. Resilient health system is the need of the hour. To work as a safe hospital even during disasters, it is important to sensitize, orient, and train doctors and other medical professionals towards disaster preparedness. This study was conducted to study the knowledge, attitudes, and practices about disaster preparedness among resident doctors. METHODOLOGY: It was a cross-sectional study conducted amongst 363 resident doctors of a tertiary care teaching hospital in Delhi, India. A pretested self-administered semistructured questionnaire was used to gather information. Analysis was done using the SPSS version 21.0 and employing descriptive -statistics. RESULTS: Mean age of the participants was 28.1 ± 2.8 years. Ninety-four (25.9 percent) study participants were found to have good/excellent knowledge about disaster preparedness, only 16.5 percent (60) had good awareness about the hospital's disaster preparedness, and 306 (84.3 percent) study participants had a favorable attitude towards disaster preparedness. Age and educational qualification were found to be significantly associated with knowledge about disaster preparedness. Only 11.6 percent (42) resident doctors attended any mock drill for disaster preparedness in the past 1 year and less than one-fifth (68, 18.7 percent) received training in disaster preparedness. CONCLUSION: A majority of study participants had a favorable attitude in spite of inadequate knowledge and aware-ness about disaster preparedness. There is a need to address this mismatch between knowledge and attitude through regular sensitization and retrainings along with frequent practical drills and simulation exercise.

Etiological & clinical spectrum of Liquefied Petroleum Gas (LPG) related burns: A three-year study from a tertiary care burn centre in New Delhi.

Burns, an endemic public health problem has had a dynamic epidemiology in India, in sync with economic and social changes. In the last decade a major shift of kitchen fuel usage from kerosene to the Liquefied Petroleum Gas has resulted in an increase in the incidence of burns from LPG mishaps. This prospective descriptive study conducted in a tertiary care burn centre in an urban area aims to determine the causes of LPG related burns, its injury profile, identify the population at risk and also to determine the level of knowledge of users regarding the safety issue with LPG usage. In the study LPG burns accounted for 52.3% of the admitted flame burns. On the whole there were 33 incidents of LPG mishaps involving multiple victims. Most common age group affected was 26-50 years. Leakage from larger cylinders was more common and malfunction of valve/regulator was the most common cause. Level of knowledge was dismally low across all socioeconomic strata. Our study highlights impact of changing socioeconomic pattern of the country on burns epidemiology and the glaring lack of public awareness regarding safe management principles.

Epidemiological profile of tuberculosis patients in Delhi, India: A retrospective data analysis from the directly observed treatment short-course (DOTS) center.

BACKGROUND: Tuberculosis (TB) has been a public health menace for decades. India harbors its highest burden globally. The present study was conducted to study the epidemiological profile of patients taking treatment from a directly observed treatment short-course (DOTS) center in Delhi, India. METHOD: Retrospective analysis of past 1-year treatment records of a total of 227 patients undergoing treatment in DOTS since June 2014-2015 was undertaken. Socio-demographic information, data related to disease status, and HIV testing were collected and analyzed. RESULTS: The majority of cases were new (77.1%) and pulmonary TB (69.2%). The highest disease burden was found in the 20-60 year age group (72.2%) and males (58.6%). Genitourinary TB was present only among females. None of the patients was HIV positive. A significant association was found between the age group of 20-60 years and relapse and loss to follow-up cases (P < 0.05). CONCLUSIONS: A higher proportion of adult males aged 20-60 years constituted the majority of patients treated in the DOTS center. Focussed interventions can be designed for this age group in future public health policies to reduce disease burden in the total population. Further research is required to be undertaken in exploring reasons for higher prevalence among males and productive age group and role of age, gender in disease causation.

Determinants of Drug Resistance in Previously-Treated Pulmonary Tuberculosis Patients Registered at a Chest Clinic in South Delhi, India.

Introduction  Drug-resistant tuberculosis (DR-TB) is a major concern to effective control of tuberculosis (TB) in India and the likelihood of drug resistance increases with repeated exposure to anti-TB drugs. India has emerged as one of the leading contributors of DR-TB in the world posing a major threat to TB control. In the current study, we aim to find the burden and factors associated with drug resistance in previously treated pulmonary TB patients. Methods  A cross-sectional study was conducted among 230 previously treated pulmonary TB patients registered with Directly Observed Treatment, Short-course (DOTS) centers under Nehru Nagar Chest clinic in Delhi, India. The participants were selected consecutively as they registered with the chest clinic. A predesigned, pretested, semi-structured questionnaire in the Hindi language used to collect socio-demographic data and factors associated with the development of drug resistance. Physical examination of all the participants was done (height, weight, pallor). Data were analyzed using SPSS version 21. Binary logistic regression analysis was used to identify independent risk factors of drug resistance. Results  Of 230 previously treated pulmonary TB patients, 80 (34.8% (95% CI:28.7-40.9%)) were drug-resistant. Age (p=0.021), ever consumption of alcohol (p= 0.001), pallor (p=0.06), BMI (p=0.028), fasting blood sugar (p=0.001), treatment failure (p=0.005) and the number of prior courses of anti-tuberculosis treatment (ATT) taken (p=0.004) were significantly associated with drug resistance. On applying binary logistic regression analysis, independently associated factors with drug resistance were ever consumption of alcohol, pallor, high fasting blood sugar level, previous treatment failure patients and the number of prior courses of ATT (p<0.05). Conclusion  The findings of this study revealed that patients who had pallor, high fasting blood sugar, treatment failure and who had two or more prior courses of ATT were more likely to have DR-TB. Identifying the risk factors for drug-resistant TB is essential in facilitating the government to draw public health interventions. Further research is warranted to explore the causal associations.

Psychosocial Determinants of Tobacco Use among School Going Adolescents in Delhi, India.

Background. Tobacco use is one of the major preventable causes of premature death and disease in the world. Many psychosocial factors were found to influence tobacco use. Therefore the present study was designed to determine the role of psychosocial factors associated with tobacco use among school going adolescents in Delhi, India. Methods. Cross-sectional study was conducted from February 2013 to September 2013 in four government schools in South district of Delhi, India. The questionnaire contains questions adapted from GYTS (Global Youth Tobacco Survey) to find the prevalence and pattern of tobacco use among adolescents. Data were analyzed using SPSS version 21. Results. The prevalence of ever and current tobacco use was found in 16.4% and 13.1%. Current smoking and current tobacco chewing were found in 10.2% and 9.4% students, respectively. The risk of current tobacco use was found to be higher among males (P value = 0.000) and in those who got higher pocket money (P value = 0.000). Psychosocial factors like lower general self-efficacy and maladjustments with peers, teachers, and schools were also found to be significant predictors of current tobacco use. Conclusion. The study has revealed higher prevalence of ever and current tobacco use among adolescent students in Delhi, India.

The unusual presentation of a usual organism - the changing spectrum of the clinical manifestations of Plasmodium vivax malaria in children: a retrospective study.

BACKGROUND: Malaria is a major public health problem in the south-east Asian region. Among all countries in the SE Asian region the highest number of cases and deaths are reported from India. Children below 14 years of age contribute to approximately 42% of all the deaths. A majority of the deaths are attributed to severe malaria which is caused by Plasmodium falciparum. It is considered that causes a benign causing febrile illness without significant complications. However, in recent years, the spectrum of is shifting from being the cause of benign fever, to more severe complications. There have been case reports of complications like thrombocytopaenia, cerebral malaria, a disseminated intravascular coagulation, the acute respiratory distress syndrome, hepatic dysfunction and renal involvement. Most of the case reports are from the adult population, with an occasional occurrence of paediatric cases. OBJECTIVE: To highlight the increasing number of severe manifestations in P.vivax malaria in the children who were admitted in the malaria transmission season of 2011, at a tertiary care hospital. DESIGN: A descriptive, cross-sectional study. STUDY SUBJECTS: Children with an acute febrile illness of a duration of < 7 days, which was confirmed as Plasmodium vivax positive malaria by testing the peripheral smears and/or by Rapid Diagnostic Testing, who were admitted in the paediatric ward of a tertiary care hospital in New Delhi (India), during May 2011 to October 2011, Case records of context cases were analysed retrospectively. STATISTICS: The data was summarised by calculating the rates, ratios, proportions, means, standard deviations and the 95% confidence intervals. The Chi square test was applied to assess the significant difference between two qualitative variables. RESULTS: Among the case records of 54 patients, 40.7% were below 5 years. 61% were males and 38.9% were females. Besides hepatomegaly and splenomegaly which were the most common symptoms, which were seen in 81.5% and 72.2% children respectively, the various unusual manifestations seen were severe thrombocytopaenia (37%), jaundice with deranged LFT values (25.9%), abnormal bleeding (18.5%), impaired consciousness with a GCS of < 9 (18.5%), severe anaemia (14.8%), hypotension (11.1%), repeated convulsions (7.6%), pulmonary oedema/ARDS (5.6%) and ascites (5.6%). One case each showed haemoglobinuria, and pleural effusion. CONCLUSION: Plasmodium vivax is emerging as a cause of severe malaria. There is a further need to study the pathophysiology, virulence factors and the molecular mechanisms which are involved in malaria.