Pattern and burden of animal bite cases in a tertiary care hospital in Haryana.

Rabies is an endemic disease in both developed and developing world and is responsible for a large number of morbidities and mortalities in humans. Limited supply of vaccine hampers the accessibility of life saving treatment. In our study carried out in a tertiary care hospital in Haryana showed that there were 3617 animal bite cases reported in a year with an average of 9.91 new cases per day. The average economic burden related to management of these bite cases is 3.5 lacs per month. This cost along with vaccine demand can be substantially reduced if intradermal schedule is introduced.

Competency-based instruction in critical invasive skills improves both resident performance and patient safety.

BACKGROUND: Correct performance of invasive skills is essential, but residents often undertake such procedures after no or minimal instruction. METHODS: We instructed eight postgraduate year 1 (PGY1) residents in the cadaver laboratory using a competency-based approach (CBI). Each resident had been evaluated before the laboratory during patient encounters. Group instruction in endotracheal tube insertion (ET), venous cutdown (VC), and chest tube insertion (CT) was followed by individual pretesting and hands-on teaching, with 100% competency the goal. Failure was considered an inability to perform the task correctly or within 120 seconds. After the laboratory, residents were evaluated for correctness and rapidity of performance. RESULTS: Prelaboratory failures consisted of ET, 7; CT, 5; VC, 7. Postlaboratory failures were 0 for all. Prelaboratory complications consisted of ET, 3.3 +/- 1.1; CT, 1.9 +/- 1.0; VC, 3 +/- 1.0. Postlaboratory complications were 0 for all. Prelaboratory times (seconds) were ET, 66.5 +/- 30.8; CT, 104 +/- 4.1; VC, 116.3 +/- 0.7. Postlaboratory times were ET, 25 +/- 7; CT, 65.5 +/- 10.7; VC, 81.3 +/- 2.5. Changes were statistically significant for all (P < .03, nonparametric). Residents performed 20 CTs with 1 pneumothorax, 80 ETs with 2 failures, and 20 VCs with no complications. Initial trauma resuscitation time decreased from 25 to 10 minutes. CONCLUSIONS: (1) Residents' skills rapidly improve with CBI; (2) skills learned through CBI in the laboratory can be translated to and sustained in the clinical setting; (3) CBI produces competent residents who perform skills rapidly and with minimal complications.

Participation of pregnant and lactating mothers in ICDS programme in rural area.

PIP: In the Integrated Child Development Services (ICDS) project Chiri in India, interviews with 363 pregnant and lactating mothers and an examination of household records were conducted to learn the extent of their participation in the ICDS Programme activities and to identify obstacles to under- or non-utilization of these services. 62% of the women were currently involved in the ICDS Programme. 23.7% had never used ICDS services. The most frequented services were supplementary nutrition (97.3%), tetanus toxoid prophylaxis (89.3%), and iron and folic acid prophylaxis (87.1%). 62.8% of the women participating in the supplementary nutrition program participated more than 20 days/month. Since tetanus toxoid prophylaxis and iron and folic acid prophylaxis occurred one day/month with high participation, the workers could have used this day for group meetings, individual counseling, discussions, and demonstration, but the opportunity was missed for prenatal care, contraception, growth monitoring, and health and nutrition activities. 89.8% of women participating in the supplementary nutrition program took the food home to share with family members. Participation rates were less than 50% for organized radio listening (9.3%), Mahila Swasthya Sangh meetings (20.4%), birth spacing (40.4%), health and nutrition education (40.4%), family planning (46.2%), and prenatal care (47.4%). The major reasons for never using ICDS services were: could not spare time (53.5%) and working outside the household for long hours (50%). 15% were never approached by an anganwadi worker and were therefore not aware of ICDS services or the workers did not have an encouraging attitude. Other possible contributing factors to under- or non-utilization were high illiteracy (61%) and insufficient awareness of ICDS services among heads of households (94.9%).^ieng

Problem of mortality in women of reproductive age in rural area of Haryana.

PIP: To learn the extent of mortality among women of reproductive age, data was analyzed on causes of death, as reported by anganwadi workers and heads of households, for all maternal deaths in 1992 in Haryana, India. The community was comprised of 300,907 persons and 58,961 women (19.6%) of reproductive age. 9894 live births were recorded, which is higher than the national average. 219 women died in 1992 from maternal and nonmaternal causes (3.7 per 1000 women). In the study blocks (Rohtak, Chiri, and Kathure) the range of mortality was from 3.4 to 4.1 per 1000. 78.5% (172 deaths) were considered nonmaternal deaths. Mortality was 20.9% among mothers 15-20 years old, 25.6% among mothers 20-25 years old, and 18.6% among mothers 25-30 years old. 65.1% of women died at home. 58.1% sought medical care prior to death. 1.2% of deaths were certified. 36.7% of deaths were to literate women, and the remaining 63.3% were illiterate. Causes of nonmaternal death included accidents, respiratory disorders, poisoning, and digestive disorders. Slightly over 20% of accidental deaths were due to burns and suicide. 21.46% (47 deaths) were maternal deaths (475 per 100,000 live births). Maternal mortality ranged from 46 to 488 in the 3 blocks. Rohtak had the highest maternal mortality. Maternal mortality was highest among women 30-44 years old (996 per 100,000), followed by women 15-20 years old (575 per 100,000). 21.3% died during labor and delivery, and 68% died during the postpartum period. 57.4% died at home, and 25.5% died at the Medical College Hospital. 61.7% used prenatal services. 36.2% did not seek medical care prior to their death. 55.3% of deliveries were by trained birth attendants. 25.5% died with their first births. 51.0% of women with a birth interval under 3 years died. Maternal mortality was distributed by cause as follows: postpartum hemorrhage (17.0%), puerperal sepsis (17.0%), anemia (12.8%), preeclampsia and eclampsia (14.9%), obstructed labor (6.4%), hemorrhage antepartum (4.25%), abortions and MTP (10.6%), and indirect causes (12.8%). Improvement is needed in literacy, contraception, women's empowerment, and prenatal care in order to reach the goal of reduced maternal mortality by the year 2000.^ieng