Evaluation of the rashtriya bal swasthya karyakram (RBSK): A national children healthcare program in a health district of West Bengal, India.

Background: The Rashtriya Bal Swasthya Karyakram (RBSK) was launched in 2013 to screen and manage birth defects, deficiencies, diseases, and developmental delays including disabilities in Indian children, with the help of designated mobile health teams and grassroot workers across the country. Objectives: Performance of the RBSK program in three selected blocks of a health district of a large Indian state (West Bengal) was assessed. Methods: The performance assessment was based on input, process, and output performances, using checklists based on RBSK operational guidelines. Results: While some essential evaluation tools were available in required numbers at the block level, many were unavailable. There were deficiencies in the number of health staff appointed. Although most screening camps were conducted as per microplan, some were not. Anthropometric measurements were not done in some camps; Information, Education, and Communication (IEC) materials were not used adequately. Issues with fund management were also noted. The intervention rate at higher centers (District Early Intervention Centre) was low with regard to the children referred for management. Involvement of grassroot workers such as ASHA was also found to be lacking. Conclusion: Frequent orientation training of medical officers and staff is needed along with the efforts to strengthen the referral system and the patient tracking system. Sensitizing the children and their guardians regarding the importance of the relevant health issues is also needed with the help of the proper implementation of IEC services.

Assessment of serum magnesium levels and its outcome in neonates of eclamptic mothers treated with low-dose magnesium sulfate regimen.

OBJECTIVES: Magnesium historically has been used for treatment and/or prevention of eclampsia. Considering the low body mass index of Indian women, a low-dose magnesium sulfate regime has been introduced by some authors. Increased blood levels of magnesium in neonates is associated with increased still birth, early neonatal death, birth asphyxia, bradycardia, hypotonia, gastrointestinal hypomotility. The objective of this study was to assess safety of low-dose magnesium sulfate regimen in neonates of eclamptic mothers treated with this regimen. MATERIALS AND METHODS: This was a cross-sectional observational study of 100 eclampsia patients and their neonates. Loading dose and maintenance doses of magnesium sulfate were administered to patients by combination of intravenous and intramuscular routes. Maternal serum and cord blood magnesium levels were estimated. Neonatal outcome was assessed. RESULTS: Bradycardia was observed in 18 (19.15%) of the neonates, 16 (17.02%) of the neonates were diagnosed with hypotonia. Pearson Correlation Coefficient showed Apgar scores decreased with increase in cord blood magnesium levels. Unpaired t-test showed lower Apgar scores with increasing dose of magnesium sulfate. The Chi-square/Fisher's exact test showed significant increase in hypotonia, birth asphyxia, intubation in delivery room, Neonatal Intensive Care Unit (NICU) care requirement, with increasing dose of magnesium sulfate. (P ≤ 0.05). CONCLUSION: Several neonatal complications are significantly related to increasing serum magnesium levels. Overall, the low-dose magnesium sulfate regimen was safe in the management of eclamptic mothers, without toxicity to their neonates.

Role of family and peers in the initiation and continuation of smoking behavior of future physicians.

BACKGROUND: Globally researchers have long back noted that the trend of substance use was on the rise particularly in the student population. OBJECTIVE: To find out the prevalence and determinants of smoking practices among undergraduate medical students. MATERIALS AND METHODS: A cross-sectional study was conducted among undergraduate medical (MBBS) students of a tertiary care medical college using a predesigned and pretested semi-structured self-administered anonymous questionnaire. RESULTS: Among 182 participants, 55 (30%) were smokers; 85.45% were regular smokers; majority in the age group 20-22 years (70%); mostly males (98%). No significant difference was observed among urban and rural students, and religion had no association. The practice of smoking for last 6 months to 1 year was in 43.6% and 40% smoked less than 6 months. Half of them (50.9%) smoked 5-9 cigarettes per day. Peer pressure was significantly high in smokers (83.6%); 42% had other addictions. The effect of parental smoking on smoking habits of the participants was quite evident among smokers (82%), which was significantly higher than nonsmokers (χ(2) = 63.49, P < 0.05). Peer pressure was the most important risk factor (57.69%) of initiation of smoking habit followed by parental influence (16.49%). Among morbidities of smokers, 60.6% were suffering from regular cough, 6% from bronchitis, and 2% had asthma. CONCLUSIONS: Our survey conducted on budding doctors surprisingly showed that undergraduate medical students smoke so much.