Modalities of Empowerment and Strengthening of Ex-servicemen.

BACKGROUND: Older people including ex-servicemen (ESM) in India are left to fend for themselves due to nuclear family system. Most children are not staying with them due to reasons such as acquiring of education or employment at distant places. These factors, coupled with deteriorating health with advancing age, change in value system and attitude amongst children who give more importance to materialism, it was felt necessary to find modalities to empower and strengthen ESM by available methods of including progressive weight training, yoga and meditation. METHODS: An interventional "Before and After" study was planned for a period of three months for in-patient ESM of a military hospital for common lifestyle diseases namely stroke, diabetes, senile depression, acute myocardial infarction and hypertension. Data of anthropometry, laboratory investigations and Hamilton rating scale for depression (HRSD) were taken before the study. These cases were then subjected to interventions (progressive weight training and spiritual health enhancement by yoga with meditation for three months) followed by same measurements again. RESULT: Statistically significant differences were observed before and after study with respect to pulse, respiratory rate, blood pressure, blood glucose, total cholesterol, low density lipoproteins (LDL), very low density lipoproteins (VLDL) and Hamilton depression score (p<0.05). The sleep pattern, sense of well being and posture while sitting to standing and walking with degree of support (stick/other person's help) improved considerably after the interventions. CONCLUSION: ESM are recommended to be trained much before retirement on progressive weight training and yoga in regimental centre/station institute. Provision to be made in existing ex-servicemen contributory health scheme (ECHS) polyclinics for employment of part time trainers for weight training and yoga. The physical and spiritual strengthening results in better capability to deal with old age and its problems.

Study of Disorders of Visual Acuity among Adolescent School Children in Pune.

BACKGROUND: Disorders of visual acuity are known to affect the learning abilities of school children. Various authors have reported varying prevalence in India and abroad. METHODS: A rapid, community based survey was conducted to assess the prevalence of disorders of visual acuity among adolescent school children in three schools in Pune Cantonment. A sample of 236 children studying in six sections were examined after random selection by a two stage sampling technique ensuring representation to each of the classes. Visual acuity was assessed for all the children available in the selected section on the date of survey. A questionnaire based study of the knowledge and attitude of the parents of the 50 affected children was also conducted. RESULT: 50 children (25 males and 25 females) were found to have errors of refraction, resulting in prevalence rate of 21.19% with confidence intervals of 15.97% to 26.40%. CONCLUSION: The study highlights significantly high prevalence of uncorrected errors of visual acuity among adolescent school children as well as the need for instituting IEC activities aimed at improving the general lack of appreciation of the seriousness of the problem by the parents and consequent neglect of urgent corrective measures.

Anthropometric Parameters of Armed Forces Personnel.

BACKGROUND: The prevalence of obesity has increased globally in the last few decades. Anthropometry is an accepted method of measuring obesity. Charts of weight for height and age as well as Anthropometric indices like Body Mass Index (BMI) are commonly used to define normal, overweight and obese individuals. Weight for height charts currently in use in the Army belong to pre-independence era. It is widely believed that these have been obtained from life insurance tables made for British / American civilian population. The World Health Organization (WHO) encourages its member countries to develop their own reference anthropometric indices. METHODS: Anthropometric measurements were recorded for 902 healthy Armed Forces personnel in the age range of 28 to 52 years selected by stratified random sampling. These measurements were used to obtain mean values, standard deviations, medians and percentiles for various anthropometric parameters. RESULT: BMI for the study subjects ranged from 14.67 to 27.90 kg/m(2) with a mean of 20.52 Kg/m(2). No individual was categorized as obese using the current international cut-off of BMI >30 kg/m(2). With the exception of height, all other anthropometric parameters like weight, BMI, waist circumference, and waist-hip ratio were found to increase with increasing age. Correlation of BMI with waist circumference and BMI with Waist Hip Ratio in the study subjects was found to be statistically significant. The weight for height and age chart developed by this study shows an increase in weight in all age and height categories as compared to the weight for height chart currently in vogue in the Indian Army. CONCLUSION: The weight for height and age chart calculated in our study, shows considerable variation when compared to weight for height and age chart currently being used in Indian Army. The average weight for majority of height and age categories was found to be higher than in the Indian Army chart. It is recommended that a large multi-centric study should be taken up to gather more evidence to replace the current chart.

Prevalence and Determinants of Hypertension in a Rural Community.

BACKGROUND: There are few epidemiological studies on prevalence of hypertension and its determinants in rural population. This cross sectional study was done to determine the same in a rural community. METHODS: A random sample of 406 people (218 men and 188 women) of 30 years and above was selected from a rural area. The pre tested proforma was used to collect the data by trained doctors. RESULT: Prevalence of smoking and tobacco use was 16%, alcohol intake 9.4 %, daily salt intake (≥ 5 gram) 34.2%, daily saturated fat intake (≥ 10 % of daily energy intake) 47 .0 % and physical inactivity (work and leisure) as 18.5%. Body Mass Index (BMI) was ≥ 25 in 18 % and ≥ 30 in 3.2% men and women. Prevalence of truncal obesity (Waist Hip Ratio: men ≥ 0.9; women ≥ 0.8) was 8.5% with higher incidence in men. Prevalence of abdominal obesity (men ≥ 102 cms; women ≥ 88 cms) was found in 15.7 % with higher incidence in men. Differences in prevalence of risk factors between men and women were statistically significant in case of smoking, alcohol consumption and abdominal obesity. 18.5% men and women were suffering from systolic hypertension (≥ 140 mg Hg) and 15 % from diastolic hypertension (≥ 90 mg Hg). Prevalence of risk factors for hypertension was significantly more among subjects suffering from systolic and diastolic hypertension than normotensive subjects. CONCLUSION: Prevalence of systolic hypertension in rural community was 18.5 % and of diastolic hypertension 15% with higher prevalence in the age group of 60 years and above, in case of men and women. There was a significant linear trend in prevalence of systolic hypertension with respect to age group in men whereas it was not significant in case of women.

Gender Inequality: Is the National Population Policy's Objective of Two Child Norm Heading the Correct Way?

BACKGROUND: Male Preference is well known phenomena world wide from ancient ages. A descriptive study was carried out to assess the attitude of women towards birth of son, use of contraception methods and sex determination methods in rural village Kasurdi in Pune district. METHODS: Univariate analysis was carried out by considering each factor determining sex preference separately as well as using a Logistic Regression Model. Adequacy of fit of the model has also been tested. RESULT AND CONCLUSION: Out of 110 respondents interviewed, 62.7% felt that male child is necessary in the family. Univariate analysis revealed that sex of first child, concern undergone for second pregnancy with regards to sex of the child, number of children in family and type of family were significant factors contributing to the son preference. The analysis under the logistic regression model revealed that sex of the first child and concern undergone in second pregnancy with respect to the sex of the second child are the most dominating and significant factors in the causation of son preference. The difference between family sizes when compared with the sex of first child was statistically significant signifying that if the first child is a male then it hardly matters whether the second child is male or female, but if the sex of first child is female then the families land up with bigger family size. On an average most of the respondents favour two children with an equal share of male and female children.

Determinants of Nutritional Status of School Children.

BACKGROUND: A cross sectional study was carried out to determine the nutritional status of school children in Army School, Pune. METHODS: Anthropometric survey of 760 school children was carried out and compared against the NCHS/WHO reference standards to determine their nutritional status. Associations of nutritional status with socio-economic status, education status of parents, mothers working status and family size were determined. RESULT: The prevalence of stunting was 13.81%, wasting 6.71% and under nutrition 9.87%. Mothers' educational level, wasting, socio economic status and family size were significantly associated with the nutritional status of the child. CONCLUSION: Maternal educational status, socio-economic status and family size are important determinants of nutritional status of school children.

Insecticide treated bednet strategy in rural settings: can we exploit women's decision making power?

Use of insecticide treated bednets in prevention of malaria is a widely propagated global strategy, however, its use has been reported to be influenced and limited by many variables especially gender bias. A cross sectional field epidemiological study was conducted in a rural setting with two outcome variables, 'Bednet use'(primary outcome variable) and 'Women's Decision Making Power' which were studied in reference to various predictor variables. Analysis reveals a significant effect on the primary outcome variable 'Bednet use' of the predictor variables- age, occupation, bednet purchase decision, women's decision making power, husband's education and knowledge about malaria and its prevention. The study recommends IEC on treated bednets to be disseminated through TV targeting the elderly women who have better decision making power and mobilizing younger women who were found to prefer bednets for prevention of mosquito bites for optimizing the use of treated bednets in similar settings.

Breast Feeding Practices among Families of Armed Forces Personnel in a Large Cantonment.

BACKGROUND: There seems to be a gap in the available literature and scientific knowledge about breast-feeding practices among families of armed forces personnel in our country, which needs to be studied. METHODS: A cross sectional epidemiological study design was undertaken on a randomly selected sample of 175 families of armed forces personnel staying in a large cantonment and having at least one child in the age group of 3-24 months. RESULT: The study observed positive association between various breast feeding practices such as feeding colostrum, demand/scheduled feeding, exclusive breast feeding for 4-6 months, partial breast feeding for 6 - 18 months and various sociodemographic variables such as age, religion, socio-economic status of mother (military rank of husband), parity and place of residence of the mother (where childhood was spent). CONCLUSION: Higher proportion of mothers feeding colostrum was observed because of better educational status of mothers and organized health education activities available to the families of armed forces personnel. Majority (89.14%) gave demand feed and only 10.86% gave scheduled feed. On the other hand a relatively smaller percentage (47.43% and 29.32%) followed the correct practice about duration of exclusive and partial breast-feeding respectively.

Inappropriate Use of Hospital Beds in a Tertiary Care Service Hospital.

BACKGROUND: The cost of medical care is continuing to rise and cost containment measures need to focus on inappropriate hospitalization. Armed Forces Medical Services ensure universal access to its consumers but continuous increase in patient load is stretching the capability of service hospitals. The present study was undertaken to determine the rate of inappropriate hospitalization in a large tertiary care service hospital. METHODS: Appropriateness Evaluation Protocol (AEP) was used to assess the appropriateness of hospital days, the study being carried out in the acute medical and acute surgical wards of the hospital on randomly selected days over a period of three months. RESULTS: Inappropriate patient days were found to be 29.48% during the study period, with 34% of acute surgical patient days and 24.4% of acute medical patient days found to be inappropriate. No statistically significant difference was observed in the rate of inappropriate hospital stay between serving personnel and ex-servicemen. 31.25% non local patients as compared to 25.81% of local patients were found to have inappropriate hospital stays, though the difference was not found to be statistically significant. 60.71% of inappropriate stays were found in the initial period of admission (1-5 days), the phenomenon being observed both in the acute surgical and acute medical wards. CONCLUSION: The study shows that the rate of inappropriate patient days is quite high among the study population and regular utilization reviews need to be carried out to conserve health care resources available with the service hospitals.

Prospective Study on the Morbidity Profile of Recruits over one year in three large Regimental Training Centres.

Keeping in view the lack of prospective epidemiological data on the incidence of major causes of morbidity specifically among recruits, the present study was undertaken among recruits of three large regimental training centres in a particular cantonment. The study period extended over exactly one training year, from 01 July 2001 to 30 June 2002. Successive batches of recruits entering the training centres during this period were followed up prospectively for hospitalisation in the local military hospital, till they completed their training. The study revealed that the major causes of morbidity were chickenpox and training injuries, including stress fractures. The major causes of invalidments were injuries, pulmonary tuberculosis and mental disorders. The findings have been compared and certain recommendations for preventing / reducing the incidence of major causes of morbidity have been submitted.

A Study of Breast Feeding Practices Among Families of Armed Forces Personnel in a Large Cantonment.

A cross sectional epidemiological study design was undertaken on a randomly selected sample of 175 families of Armed Forces personnel staying in a large cantonment and having at least one child in the age group 3 to 24 months. The mean duration of lactational amenorrhoea was found to be 6.24 months (SD ± 3.25 months) and that of breast feeding was found to be 11.14 months (SD ± 6.37 month). The present study observed positive association between the duration of exclusive breast feeding and the duration of lactational amenorrhoea, as well as between the lack of practice of exclusive breast feeding and number of spells of upper respiratory tract infection and acute gastroenteritis. Based on the findings of the study, certain measures to promote the practice of exclusive breast feeding for the first 4-6 months of life have been suggested.

AN INTRODUCTION TO ESSENTIALS OF BIO-MEDICAL WASTE MANAGEMENT.

The issue of biomedical waste management has assumed great significance in recent times particularly in view of the rapid upsurge of HIV infection. Government of India has made proper handling and disposal of this category of waste a statutory requirement with the publication of gazette notification no 460 dated 27 July 1998. The provisions are equally applicable to our service hospitals and hence there is a need for all the service medical, dental, nursing officers, other paramedical staff and safaiwalas to be well aware of the basic principles of handling, treatment and disposal of biomedical waste. The present article deals with such basic issues as definition, categories and principles of handling and disposal of biomedical waste.

DEVELOPING AN OPERATIONAL DECISION RULE FOR IDENTIFYING THE FATAL CASE DOCUMENTS AT RISK OF BEING RETURNED THROUGH MATHEMATICAL MODELLING.

Incomplete or inaccurately filled fatal case documents are often returned to the hospital by higher headquarters, causing delay in the completion of procedural formalities. A mathematical model was developed to identify those fatal case documents which are at an increased risk of being returned so that the corrective action may be taken a priori. The data was subjected to a multiple logistic regression analysis. Diagnostic test characteristics were worked out and a Receiver Operating Curve analysis was done to find out optimum operating points on the slope, and the following mathematical rule was developed: 7.06=1 (if age > 50 years) - 4.5 (if age <= 12 years) + 9.88 (if serving person) + 2.75 (if ex-serviceman) + 4.5 (if dependent son or daughter) + 6.38 (if time lag > 10 days). This rule carries a sensitivity of 53 per cent and specificity of 75 per cent.

A STUDY TO ASCERTAIN THE ADEQUACY OF OBSERVANCE OF UNIVERSAL PRECAUTIONS IN ACUTE MEDICAL AND SURGICAL WARDS OF A LARGE TEACHING HOSPITAL.

The present study was a cross-sectional analytic epidemiological design to assess the frequency of observance of universal precautions in acute care wards of a large teaching hospital and to assess the epidemiological determinants of such observance. A total population of medical officers, nurses, paramedical and ancillary workers working in acute medical and surgical wards was studied using direct observations recorded on a pre-tested, structured format. The study revealed that handwashing was more frequently practiced by medical officers and ancillary staff (68% to 93%) as compared to nurses and paramedicals (38% to 58%) (p<0.01). Significantly higher proportion of medical officers in medical wards (93%) and nurses (63.3%) and ancillary workers in surgical ward (89%) were practicing handwashing (p<0.01). The practice of usage of gloves was significantly more frequent among medical officers and ancillary workers (72% to 100%) while it was quite inadequate among nurses and paramedicals (28% to 36%), (p<0.001). However, use of gloves was significantly better among nurses in surgical ward and paramedicals in medical ward (p<0.05). A linear trend analysis of the use of protective clothing revealed that the odds of nurses adequately using the same were much lower while those of ancillary workers were much higher as compared to medical officers, the trend being highly significant in both the type of wards (p<0.001). The study reveals a definite need of stepping up educational and motivational methods for observance of universal precautions by health care workers in large teaching hospitals. In particular, nurses and paramedical workers have been identified as high risk groups, needing concerted efforts for observing these precautions.

Epidemiological study of an outbreak of cholera in Delhi cantonment.

An epidemiological study was undertaken to investigate an outbreak of cholera in Delhi Cantonment during May 1991. The study design was a hybrid design using a retrospective Case-Control method superimposed on a population based cross-sectional approach. A total of 9 cases of cholera, confirmed in the laboratory as Vibrio cholerae, 0-1, Eltor, Ogawa were identified using population based survey and compared with 33 controls from the same source population. The overall Incidence rate was 0.71% and showed a significant rising trend with age. There was no morality. Assessment of water supply, sanitary conditions of cook houses and disposal system of night soil could not provide any clue to the source of infection. Subsequently, all the food handlers were subjected to rectal swab examination. Two of them, working in the same messes from where cases had occurred, were found positive for Vibrio cholerae (0-1, Eltor, Ogawa). Immediate control measures by way of isolation and treatment of carriers promptly abated the outbreak. Role of carriers in outbreak of cholera has been highlighted.

HEALTH AWARENESS VERSUS ECONOMIC AFFLUENCE AS DETERMINANTS OF HEALTH STATUS : A COMMUNITY BASED EPIDEMIOLOGICAL ANALYSIS.

A community-based cross-sectional analytic epidemiological study was undertaken to compare the health status of school children from two villages and to see the association of the school children's health status with the level of health awareness among parents and teachers. The two villages had only one major difference, i.e., one had an agriculture-based economy and was more affluent than the other village. The study, however, revealed that the overall morbidity and nutritional deficiencies were significantly less (p < 0.01) and immunization status significantly better (p < 0.01) among school children of the less affluent village, possibly because level of health awareness was significantly higher among parents and teachers of this village as compared to the more affluent one (p < 0.01). The importance of health education has been reinforced by this study.

A BEFORE AND AFTER TRIAL OF THE EFFECTIVENESS OF NETWORK ANALYSIS IN HEALTH OPERATIONS MANAGEMENT.

An intervention trial using "before-and-after" approach was undertaken to address the question whether network analysis as a health managerial tool of control can favourably affect the delays that occur in planning and executing the antimalaria operations of a Station Health Organization in a large military station. Exposure variable of interest was intervention with a network diagram, by which the potential causes of delay along the various activities were assessed and remedial measures were introduced during the second year. Sample size was calculated using conventional alpha and beta error levels. The study indicated that there was a definite beneficial outcome in that the operations could be started as well as completed in time during the intervention year. There was reduction in time requirement in 5 out of the 9 activities, the exact 'p' value being 0.08, by both parametric and non-parametric tests. The use of network analysis in health care management has been recommended.

APPLICATION OF STRATIFIED ANALYSIS IN EPIDEMIC INVESTIGATIONS : ANALYSIS OF AN OUTBREAK OF FOOD POISONING.

The present study demonstrates the use of stratified analysis when high (or low) risk is observed for two or more food items during the investigation of food poisoning, rather than simply implicating the item showing the highest risk. In this study an outbreak of food poisoning, which exhibited a clinico-epidemiological profile of Clostridium perfringens as the possible agent, was investigated using a case-control typology. Evaluation of food histories showed a high and significant odds ratio (OR) for a mutton dish (OR = 6.45, p < 0.001) and peas dish (OR = 5.6, p < 0.001), while a legume dish showed a protective effect (OR = 0.13, p < 0.001) which proved erroneous. Stratified analysis using Mantel-Haenszel procedure indicated that the risk due to mutton persisted even after adjusting for consumption of peas (adjusted OR = 4.22) or legume dish (adjusted OR = 4.25). The use of stratified analysis in investigating epidemics has been recommended.