Iodine deficiency disorder in children aged 6-12 years of Ambala, Haryana.

We conducted this study to assess the prevalence of goitre among 2700 children (6-12 yr) of district Ambala in Haryana. Children were examined as per standards laid by National iodine deficiency disorder control programme (NIDDCP). Multi stage cluster sampling method was used. Urine and salt samples were also studied for iodine concentration. The overall prevalence of goitre in the studied subjects was 12.6%. The median urinary iodine excretion in the study sample was more than 100 ug/L Iodine content was found to be adequate in 88% of salt samples. We conclude that there was a high prevalence of goitre in young children despite iodine repletion. This calls for identification of factors to strengthen NIDDCP and the need to emphasize use of iodized salt in Haryana.

Women and AIDS: awareness and attitudes in a peri-urban setting in Punjab.

Women account for 39.3% of HIV/AIDS infection in India. There are many biological and socio-cultural factors which make her highly vulnerable to HIV infection. Knowledge regarding HIV/AIDS can help her in protecting herself from the disease. This study was conducted to the level of awareness of young females with respect to knowledge of the HIV/AIDS, its modes of transmission, methods to prevent it, availability of testing and treatment and attitudes in relation to HIV/AIDS. A cross sectional study was done in a peri-urban setting in Patiala, Punjab among 1044 females in the age group 15-24 yrs using a self designed semistructured questionnaire. 93.9% had heard about AIDS. Television was the most common source of information (79.7%). Knowledge about the different modes of transmission was high (68-78%), but knowledge about preventive methods especially condom use was low (34-54%). Increase in educational status was seen to significantly increase the knowledge of the modes of transmission and preventive methods (p < .001). Knowledge of symptoms of HIV was low. (2-15%). Only 28.5% knew about the availability of HIV testing facility. 33.8% knew about treatment available for HIV. The study subjects were having favorable attitude towards people living with HIV/AIDS. There is a need to focus the education programs and the mass media towards preventive methods rather than just the knowledge of the modes of transmission. Greater emphasis needs to be placed on making people aware about the existence of HIV testing facility and availability of treatment.

Maternal depressive symptoms and low literacy as potential barriers to employment in a sample of families receiving welfare: are there two-generational implications?

This study examines the role of maternal depressive symptoms and low maternal literacy in predicting outcomes in two generations in families receiving welfare: mothers' employment and children's development. The sample consists of 351 African-American families, each with a preschool-age child, in which the mother had applied for or was receiving welfare. Close to the start of the study, 52.6 percent of the mothers in the sample had scores indicating lower literacy, 39.5 percent reported moderate to high levels of depressive symptoms, and 24.6 percent had a co-occurrence of these. Using continuous scores, in multivariate analyses of variance, neither level of literacy, extent of depressive symptoms, nor the interaction of these, were found to predict two measures of subsequent employment (any employment across the two year follow-up period, and current employment at the time of the follow-up). However, when cut points were used (low literacy; moderate to high depressive symptoms), mothers with low literacy were found less often to be employed approximately two years later. Multivariate analyses of variance examining the set of child outcomes (cognitive school readiness and behavior problems) in light of mothers' depressive symptoms and literacy level found a statistically significant interaction of literacy level and extent of depressive symptoms: children of mothers with more depressive symptoms had less favorable developmental outcomes only in the presence of low maternal literacy. Structural equation models provide evidence that parenting behavior mediates the relationship between the predictor variables and child outcomes, and that the pathways from depressive symptoms through parenting to child outcomes are stronger when maternal depressive symptoms co-occur with low maternal literacy.

Awareness of hypertension among a north Indian population.

Developing countries are going through a demographic transition. Non-communicable diseases like hypertension are emerging in epidemic proportions. Education and awareness among people is the key to reduce the burden of the disease. To see the levels of awareness and characteristic of aware and unaware hypertensives, 7630 employees in Shimla town were screened for hypertension. Hypertension was detected in 2535 cases of which 559 (22.05%) were aware. The aware hypertensives were predominantly symptomatic and had higher age and blood pressure than the unaware hypertensives. The aware hypertensives were predominantly overweight. This low level of awareness highlights the need for a comprehensive hypertension education programme to be taken up at the national level.

Immunization coverage among urban and rural children in the Shimla hills.

A cross sectional study was carried out to assess immunisation coverage among 257 urban and 339 rural children aged 13-36 months who were vaccinated at pulse polio booths in Shimla hills. 84.37% urban children and 57.59% rural children were fully vaccinated. BCG scar was negative in a large number of children, especially from rural areas. Increasing maternal education was associated with complete immunisation. OPV I-III dropouts were 3% among urban children and 15% among rural. The corresponding dropout rates for DPT I-III were 1% and 8% respectively. The immunisation coverage in this region was higher than others. Sustained efforts are required to achieve full immunisation coverage and eradicate polio and measles.

PIP: In India, where the universal immunization program launched in 1985 has dramatically reduced the incidence of preventable childhood diseases, pockets of low immunization still exist in the country's tribal and hilly areas. To obtain an accurate picture of immunization coverage in Shimla district, a cross-sectional study of 257 urban and 339 rural children 13-36 months of age from 30 urban and 30 rural clusters was conducted. Study participants were recruited at pulse polio booths in Shimla hills on a national immunization day in 1995. 286 (84.37%) urban and 148 (57.59%) rural children were fully vaccinated. The drop-out rates for oral polio vaccine were 3% among urban children and 15% among rural children; for diphtheria-pertussis-tetanus vaccine, these rates were 1% and 8%, respectively, and for measles vaccine, they were 94.1% and 81.3%, respectively. Complete immunization was positively associated with maternal education. Sustained efforts are required to achieve full immunization coverage in India.

Integrated community-based screening for cardiovascular diseases of childhood.

A screening programme in northern India, principally aimed at detecting and controlling rheumatic fever and rheumatic heart disease (RF/RHD) in children, also picks up individuals with congenital heart disease and other cardiovascular conditions, who are then referred for consultation and treatment. This strategy is clearly more ethical and cost-effective than screening programmes concerned exclusively with the control of RF/RHD.

PIP: Rheumatic fever and rheumatic heart disease (RF/RHD) and congenital heart disease cause considerable disability and mortality among children, especially in developing countries. In the Shimla Hills of northern India, integrated first-level symptom-based screening for cardiovascular diseases has been conducted in 15,080 schoolchildren aged 5-16 years, with good results. Histories of fever, sore throat, swollen or painful joints, breathlessness, fatigue, and involuntary movements were noted. A physician then looked for objective evidence of RF/RHD, congenital heart disease, or functional murmur in all of the children. When any of those conditions was suspected, the cases were referred to a cardiologist at a tertiary care center, where detailed investigations were conducted. There were 45 cases of RF/RHD, 912 of functional murmur, and 34 of congenital heart disease. Traditional secondary prophylaxis programs for RF/RHD usually exclude congenital heart disease cases even though they also need treatment. This strategy used in Shimla Hills is more ethical and cost-effective than screening programs concerned exclusively with the control of RF/RHD.

Prevalence of NIDDM in the general population (> 40 years) in Shimla.

A random survey for determining the prevalence of NIDDM was conducted in the population aged 40 years and above of Shimla town. 1195 subjects were screened for estimation of NIDDM prevalence from seven randomly selected wards. The prevalence of NIDDM in age group 40 years and above was 4.86% (5.17% in males and 4.38% in females). NIDDM was found to be positively associated with increasing age, BMI, WHR, family history of diabetes and negatively with physical activity. Stress should be on early detection of diabetes to reduce the heavy burden of morbidity and mortality caused by diabetes.

Age during breast feeding and timely suckling.

A cross sectional study of 398 mothers and infants was conducted to assess the age at first breast feeding, and its determinants, in Shimla. We found that the timely first suckling rate was 0.10 in urban group and 0.11 in rural group. The median age at initiation of breast feeding was five hours among urban cases and four hours among rural cases. Most of the infants were breast fed by the age of 24 hours which is a positive sign and is higher than previous studies. Absence of definite trend vs mother's education may be due to other factors. A community-based educational programme to promote early breast feeding is required, along with training on lactation management counselling for health workers. This will help in achieving healthy child development through prevention of childhood malnutrition.

An epidemiological study of obesity in Shimla Town.

A cross sectional study of 888 randomly selected subjects in Shimla town was done to determine prevalence of obesity, its relation to age and physical activity. The prevalence of obesity was 21.5% using cut off levels of BMI 25. The prevalence of obesity rose significantly with age. Obesity was less in those having moderate physical activity as compared to those with low and high activity. Primary prevention is required to tackle this disease risk factor through health education focussing on promotion of moderate regular physical activity.

Epidemiological survey of rheumatic heart disease among school children in the Shimla Hills of northern India: prevalence and risk factors.

STUDY OBJECTIVE: To determine the prevalence of rheumatic heart disease (RHD) and study the relationship of this disease to factors such as age, sex, housing, and socioeconomic status in Shimla town and the adjoining rural area. DESIGN: A cross sectional survey, carried out by a specially trained examiner in cardiology. SETTING: The study involved high risk school children (5-16 years of age) from Shimla town and the adjoining rural area of Kasumpti-Suni Block in the period 1992-93. SUBJECTS: A total of 15,080 children on the school register (8120 boys and 6960 girls) were examined generally and specifically for evidence of RHD. MAIN RESULTS: Of the 15,080 children screened, the prevalence of rheumatic fever (RF)/RHD was 2.98 per thousand with no significant difference between the age groups of 5-10 and 11-16 years or in either sex (p > 0.05). The prevalence was significantly greater in rural schools (4.8/1000) than in urban schools (1.98/1000) (p < 0.05). There was overcrowding and poor housing in most cases. There were fewer cases of RHD with severe valvular lesions in the younger age group than in the older children. The mitral valve was the valve most commonly affected by RF/RHD. CONCLUSIONS: RHD continues to be a serious health problem. Regular surveys are needed to identify cases early and to ensure secondary prophylaxis with penicillin is given thereby preventing recurrence of RF and progression of the severity of the valvular lesion. Echocardiography is necessary to identify cases of RF/RHD. Strategies for preventing RHD should involve primary prevention to avert the first attack of carditis and strengthening of secondary prophylaxis through improved education and motivation of patients, parents, and physicians.

Congenital heart disease among school children in Shimla hills.

A stratified random sample of 15,080 school going children out of 40,950 children in the age group of 5 to 16 years were screened for the prevalence of congenital heart disease and rheumatic fever/rheumatic heart disease. Thirty children were found to be suffering from definite congenital heart disease giving a prevalence of 2.25 per thousand. Atrial septal defect was the commonest lesion (38.2%) with a prevalence of 0.87 per thousand followed by ventricular septal defect (32.2%) with a prevalence of 0.73 per thousand. The prevalence of congenital heart disease was found to be significantly more in female (3.3 per thousand) than in male children (1.4 per thousand) (p < 0.05). Three (8.8%) cases had a family history of congenital heart disease. Rheumatic fever/rheumatic heart disease was found to have a significant prevalence among cases with congenital heart disease (8.8%) as compared to children without congenital heart disease (0.3%) (p < 0.001). The findings suggest the need for screening of family members of those suffering from congenital heart disease and that special attention be paid to the occurrence of rheumatic fever/rheumatic heart disease in cases of congenital heart disease.

Problems and prospects of a traditional source of potable water in hilly terrains.

During epidemic investigation, water sources were tested for quality for drinking purpose. Out of 30 khatris tested, water of 86.7% khatris was fit for human consumption and fecal coliform was not found in any of them. Modification of these khatris was stressed by respondents.