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kumar R, Rai S, Kant S, Anand K, Dar L, Singh U. HIV prevalence and MDR TB among DOTS attendees in a rural area of Haryana, India. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.1812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Nongkynrih B, Anand K, Pandav CS, Kapoor SK. Introducing regular behavioural surveillance into the health system in India: its feasibility and validity. THE NATIONAL MEDICAL JOURNAL OF INDIA 2010; 23:13-17. [PMID: 20839586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Illness is affected by human behaviour. However, in most developing countries the risk behaviour of the general population is not assessed. We developed a surveillance system to assess the 'risk factors' at the community level using the routine healthcare system. METHODS The Comprehensive Rural Health Services Project at Ballabgarh, Haryana, provides healthcare to a population of 82,933 through 2 primary health centres and 24 health workers. Information on behavioural risk factors for communicable and non-communicable diseases was collected by health workers during the annual health census from December 2003 to February 2004. The information collected pertained to maternal and child health, and household and individual behaviour. We compared the data related to individual behaviour with that ofa survey of non-communicable diseases risk factors done in the same area. RESULTS Data were collected from (i) mothers who had delivered during the preceding year (n=1625), (ii) a random sample of individuals (n=2865), (iii) and all households (n=7488). The response rate was 85% for mothers, 91%/ for households and 95% for individuals. Approximately 80% of the households had access to drinking water, 32% to sanitary latrines, 28% of women increased their dietary intake during pregnancy, and 50% of adult men used tobacco. Comparing these results with those from the survey of risk factors for non-communicable diseases revealed no significant differences. CONCLUSION It is feasible for health workers to do behavioural surveillance by usingthe routine healthcare system.
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Lakshmi Narasimhan R, Srinivasaraman G, Amol G, Suriyakumar G, Anand K, Rajamani V, Muthu T, Balakrishnan P. PO06-MO-11 Neuro anatomical correlates of MR/CT Fusion FDG PET in dementia. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jamatia B, Anand K, Kapoor SK, Pandey RM. Behavioral risk factors for non-communicable disease among factory employees in Faridabad; Haryana. JNMA J Nepal Med Assoc 2009; 48:203-208. [PMID: 20795458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION In developing countries like India, in addition to the infectious diseases, non-communicable diseases are emerging as significant causes of morbidity and mortality. Workplaces present a setting which is appropriate for intervention for adults in a community. The aim of this study is to assess the knowledge, attitude and prevalence of selected risk factors for non-communicable diseases. METHODS A cross sectional study was conducted among the regular employees of the factories. Smoking, alcohol consumption, dietary intake and physical activity were measured through interview schedules and height, weight and blood pressure were also measured by standard instrument. An awareness generation program was pre-tested. RESULTS A total of 545 employees were interviewed. Among them 307 (56.3%) and 238 (43.7%) were manual and non-manual workers respectively. Most of the employees knew [smoking as a risk factor for hypertension (55.2%), heart attack (61.1%) and cancer (78.7%); Alcohol as a risk factor for hypertension (72.1%), heart attack (73.9%), cancer ( 54.9%); Physical inactivity as a risk factor for hypertension (82.6%), heart attack (78.5%), diabetes (60.4%) and high fat diet as a risk factor for hypertension (67.2%), heart attack (64.8%)] that these risk factors lead to different non-communicable diseases. The prevalence (95% CI) of the risk factors is as follows: male current smoker [40.7% (36.4-45.3)], current alcohol consumption [31.0 % (27.2 - 35.1)], sedentary activity [41.2% (37.0 - 45.5)], high fat intake [93.7% (90.2 - 95.5)], over weight [26.9% (23.2 - 30.9)]; and hypertension [21.0% (17.62 - 24.6)] CONCLUSIONS This study showed that the risk factors for non-communicable diseases are prevalent in factory employees. Implementation of the risk factors control programme is desirable and there is an interest among employees and management.
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Patra S, Baridalyne N, Anand K. Managing non-communicable diseases at a secondary level hospital. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2009; 57:86. [PMID: 19753770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Sankar S, Subramanian M, Arunkumar T, Venu N, Anand K. Large duodenal GIST with massive liver secondaries melting under Imatinib: a case report. CASES JOURNAL 2008; 1:197. [PMID: 18826633 PMCID: PMC2570680 DOI: 10.1186/1757-1626-1-197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 09/30/2008] [Indexed: 01/07/2023]
Abstract
Gastrointestinal stromal tumors(GIST) have become a well established entity and its taxonomy is no more ambiguous. Better understanding of the cell of origin and immunohistochmical markers have made this possible. Their treatment has been revolutionized with the advent of targeted molecular therapy, namely Imatinib mesylate. Herein we report a rare and interesting case of a thirty year old South Indian Lady with an extremely large Duodenal GIST with massive Liver secondaries. The phenomenon of metastatic GIST responding to Imatinib mesylate is not new. What is interesting in this case is the enormous tumor load at the time of presentation as exemplified by the cross sectional images. This kind of tumor response and patient survival deserves documentation
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Patra S, Anand K. Homelessness: a hidden public health problem. Indian J Public Health 2008; 52:164-170. [PMID: 19189843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Homelessness is a problem, which affects not only the people who are homeless but the whole society. This problem is not well recognized among the public health professionals. This paper attempts to discuss the issues in the context of homelessness starting from the definition used to methodology of estimation of their numbers as well as their health problems and health care needs. There is lack of data on the health problems of homelessness from India. There is no special health or social programmes or services for this subsection of the society. The existing number of shelters is inadequate and as there are multiple barriers, which prevent them to have proper access to the existing health care system. With the changing social and economic scenario, homelessness is likely to increase. We need to recognize homelessness as a public health problem and attempt to target this group for special care in order to promote equity in health system.
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Padmesh TVN, Vijayaraghavan K, Anand K, Velan M. Biosorption of basic dyes ontoAzolla filiculoides: equilibrium and kinetic modeling. ASIA-PAC J CHEM ENG 2008. [DOI: 10.1002/apj.157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Nongkynrih B, Acharya A, Ramakrishnan L, Anand K, Shah B. Profile of biochemical risk factors for non communicable diseases in urban, rural and periurban Haryana, India. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2008; 56:165-170. [PMID: 18697632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Globalisation and increasing urbanisation in most developing countries including India raises concerns of possibility of a major increase in NCDs in these countries. WHO has recommended a STEPwise approach for NCD risk factor surveillance since risk factors of today are diseases of tomorrow. This paper presents the estimation of biochemical risk factors for NCDs undertaken as a part of the ICMR six centre study. OBJECTIVE To estimate the prevalence and levels of bio-chemical risk factors (fasting blood glucose, total cholesterol, HDL and triglyceride levels) in urban, rural and periurban locations in Ballabgarh, Haryana. METHODOLOGY A community based cross-sectional study was carried out in urban, rural and periurban areas. A total of 1513 subjects were enrolled (501 in urban, 504 in periurban and 508 in rural areas) with equal distribution by area of residence, sex and age group. Fasting blood glucose and lipids were estimated using enzymatic kits. RESULTS The mean levels of fasting blood glucose, cholesterol, TGL and low HDL were the highest in the urban area, though there was not much difference in the rural and periurban areas. There was also an increasing trend of all the parameters as age increased in both men and women. 11.4% of men in urban areas had fasting blood glucose above the cut off levels and 44.3% of urban men and women had high cholesterol levels. CONCLUSION This study documents a high burden of biochemical risk factorsnot only in urban areas but also in the periurban and rural population. It has also brought out some technical and operational issues for carrying out biochemical risk factors surveillance in the community. There is a need to scale up from surveys to surveillance mode using appropriate tools and application of this information for policy planning and programme implementation.
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Nongkynrih B, Anand K, Kusuma YS, Rai SK, Misra P, Goswami K. Linking undergraduate medical education to primary health care. Indian J Public Health 2008; 52:28-32. [PMID: 18700718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Under graduate medical education aims at producing doctors who are competent in preventive, promotive and curative knowledge and skills. The community medicine curriculum in All India Institute of Medical Sciences, New Delhi has been designed with this objective in view. Students are given community oriented training in urban and rural settings whereby students are taught to carry out various activities under the guidance of faculty members. This curriculum has evolved over many years and provides ample exposure to the students to understand the health problems, and health system of the country especially at the primary and secondary level. There is a sequential teaching of community medicine, which starts from fourth semester through internship. Successful training in community medicine lies outside the walls of the department and the involvement of other partners like the community, health systems etc contribute largely.
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Anand K, Lakshmy R, Janakarajan VN, Ritvik A, Misra P, Pandey RM, Kapoor SK, Sankar R, Bulusu S. Effect of consumption of micronutrient fortified candies on the iron and vitamin A status of children aged 3-6 years in rural Haryana. Indian Pediatr 2007; 44:823-829. [PMID: 18057478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To assess the efficacy of micronutrient fortified sugar candies in improving the iron and vitamin A status in children aged 3 to 6 years. DESIGN Triple blind randomized controlled trial. SETTINGS Anganwadis and preparatory schools in rural Haryana. METHODS 410 children were randomized in four groups. One group received full dose candy (vitamin A 1000 IU and 14 mg elemental iron) daily, the second group received full dose candy for 3 days a week, the third group received half dose candy (vitamin A 500 IU and 7 mg elemental iron) daily and the fourth received placebo. The candies were provided to children under supervision of field workers. Hemoglobin, S. ferritin, S. retinol and S. retinol binding protein levels were estimated at baseline and after 13 weeks of intervention. RESULTS The increase in hemoglobin was least in the placebo group (0.3 g/dL) as compared to the two full dose groups (1.15-1.18 g/dL, P < 0.001). Among anemic children, the increase in hemoglobin was about 2 g/dL in the full dose group and 0.7 g/dL in the placebo group (P < 0.001). S. ferritin levels increased significantly only in the full dose daily group (p < 0.05). The prevalence of anemia decreased from around 50% at baseline to 9.6% in the full dose daily group (p < 0.01). Based on the S. retinol levels, the study area was not vitamin A deficient and the intervention did not result in a significant improvement in the vitamin A status of the children. CONCLUSION Micronutrient fortified candies were effective in improving the hemoglobin level and decreasing anemia prevalence. It could serve as a suitable vehicle for micronutrient supplementation in children and other target groups.
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Lal V, Goswami A, Anand K. Self-medication among residents of urban resettlement colony, New Delhi. Indian J Public Health 2007; 51:249-251. [PMID: 18232170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
A cross-sectional survey on the practice of self-medication was carried out in September 2005, among 1928 residents of urban resettlement colony in New Delhi. Prevalence of self-medication among those who had suffered some illness episode in the last one month was 31.3%. Head/ joint/body ache were the most common symptoms for which self-medication was practiced. Chemists were the main source of prescription for self-medication. Time and money factor were identified as the major reasons for not seeking doctor's advice and taking self-medication instead. It was of concern that about 87% users were not aware of side effects of self-medication.
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Anand K, Shah B, Yadav K, Singh R, Mathur P, Paul E, Kapoor SK. Are the urban poor vulnerable to non-communicable diseases? A survey of risk factors for non-communicable diseases in urban slums of Faridabad. THE NATIONAL MEDICAL JOURNAL OF INDIA 2007; 20:115-20. [PMID: 17867614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Non-communicable diseases have modifiable risk factors, which are easy to measure and can help in planning effective interventions. We established a community-based sentinel surveillance to estimate the prevalence and level of common risk factors for major non-communicable diseases as part of a joint Indian Council of Medical Research/WHO initiative. METHODS This survey was done from February 2003 to June 2004 and included 1260 men and 1 304 women 15-64 years of age living in urban slum areas of Ballabgarh block, Faridabad district, Haryana. A list of all slums in Ballabgarh block was obtained from the Municipal Corporation of Faridabad. Slums were selected by stratified cluster sampling. All households in the selected slums were visited and men and women interviewed in alternate households. The study instrument was based on the STEPS approach of WHO. It included questions related to tobacco use, alcohol intake, diet, physical activity, and history of treatment for hypertension and diabetes mellitus. Height, weight, waist circumference and blood pressure were measured. To estimate prevalence at the population level, age adjustment was done using the urban Faridabad population structure from the 2001 Census of India. RESULTS The age-adjusted prevalence of smoking among men was 36.5% compared with 7% in women. Bidi was the predominant form of smoked tobacco used. The use of smokeless tobacco was reported by 10.2% of men and 2.9% of women. While 26% of men reported consuming alcohol in the past 1 year, none of the women did. The mean number of servings per day of fruits and vegetables was 2.7 for men compared with 2.2 for women. Overall, only 7.9% and 5.4% of men and women, respectively took > or = 5 servings per day of fruits and vegetables. Women were more likely to be physically inactive compared with men (14.8% v. 55%); 67% of men and 22.8% of women reported mean physical activity > 150 minutes per week. The mean body mass index (BMI) was lower in men than in women (20.9 v. 21.9 kg/m2). The prevalence of overweight (BMI > or = 25 kg/m2)) was 16% among men and 21.9% among women. The prevalence of hypertension (blood pressure > or = 1 40/> or = 90 mmHg or on an antihypertensive drug) was 17.2% in men and 15.8% in women. CONCLUSION The high prevalence of risk factors for noncommunicable diseases across all age groups in this urban slum community indicates the likelihood of a high future burden of illness. Immediate action for prevention and control is required to prevent the situation from worsening.
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Abstract
OBJECTIVE The data on these risk factors in school age population is deficient in India. The present study was conducted to evaluate the prevalence of lifestyle associated risk factors for non-communicable diseases in apparently healthy school children in an urban school in Delhi using standard criteria. METHODS The study was carried out among 510 students of classes 9th-12th of a school in New Delhi and in the age group of 12 to 18 years. The students were surveyed through an age appropriate modified GSHS (Global School Based Student Health Survey) self administered questionnaire. Height and Weight were measured using standardized equipment and procedure. The blood pressure was measured using OMRON electronic B.P apparatus which were standardized daily against a mercury sphygmomanometer. The statistical analysis was done using Epinfo ver.3.3 and SPSS ver11.5. RESULTS The study documents the inappropriate dietary practices (fast food consumption, low fruit consumption), low physical activity, higher level of experimentation with alcohol and to a lesser extent smoking, high prevalence of obesity and hypertension in the school children. The study also showed an association between BMI, systolic and diastolic blood pressures amongst children and other lifestyle factors. CONCLUSION School based interventions are required to reduce the morbidity associated with non-communicable diseases.
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Rastogi A, Monga S, Khurana C, Anand K. Comparison of epilenticular IOL implantation vs technique of anterior and primary posterior capsulorhexis with anterior vitrectomy in paediatric cataract surgery. Eye (Lond) 2006; 21:1367-74. [PMID: 16763657 DOI: 10.1038/sj.eye.6702451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare the functional outcome of epilenticular intraocular lens (IOL) implantation vs the technique of anterior continuous curvilinear capsulorhexis (ACCC), posterior continuous curvilinear capsulorhexis (PCCC) with vitrectomy and in-the-bag IOL implantation in paediatric cataract surgery. METHODS Forty eyes of 33 children with developmental or traumatic cataract, whose mean age was 2-12 years, were randomly divided into two groups A and B. Group A patients underwent epilenticular IOL implantation while in group B patients, ACCC, PCCC with anterior vitrectomy with in-the-bag IOL implantation was performed. Equal number of eyes (10 each) with developmental cataracts (subgroups A1 and B1) and traumatic cataracts (subgroups A2 and B2) were allotted to both the groups. Postoperative visual acuity, opacification of the visual axis, and possible complications were observed and analysed. RESULTS Four eyes in subgroup B2 had fibrous or ruptured capsules, and were managed by epilenticular IOL implantation technique. One eye in subgroup B2 developed central posterior capsular opacification and hence required a secondary capsulotomy. All cases in group A maintained a clear visual axis at the last follow-up. Minimal postoperative inflammation was noticed in all groups, which subsided with anti-inflammatory medication. At the last follow-up, all eyes in group A gained visual acuity >/=6/18. Whereas in group B, visual acuity >/=6/18 was obtained in 85.7% cases with the epilenticular IOL implantation technique and in 83.3% cases with ACCC and PCCC with anterior vitrectomy technique. CONCLUSION Epilenticular IOL implantation offers a safe and effective alternative for management of paediatric cataract. In selected cases of traumatic cataract, it is the preferred treatment modality.
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Pandav CS, Rai S, Lal V, Yadav K, Anand K. National rural health mission: from idea to action. Indian J Public Health 2005; 49:111-2. [PMID: 16468272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
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Kumar S, Priyadarshni A, Kant S, Anand K, Yadav BK. Attitude of women towards family planning methods and its use--study from a slum of Delhi. Kathmandu Univ Med J (KUMJ) 2005; 3:259-262. [PMID: 18650588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND To predict the need of family planning methods, family planning managers often rely on unmet need derived from measure of contraceptive demand. However women's intention and her background knowledge of family planning methods not received as much attention as a measure of family planning methods demand. OBJECTIVE To know the attitude of women regarding use of family planning methods and to find out the factors that restricts its use, and the change in pattern of use over a period of one year. METHODS This was a prospective study. One (Block G) out of eight blocks was selected randomly. Using convenient sample method, families were selected starting from a point in the selected block (Block G). 40 women of childbearing age group (15- 49 years) were enrolled. All women were followed for a period of one year. RESULTS Weakness was narrated as the commonest side effect from all family planning methods. More than 70% women told that irregular menstruation from Oral Contraceptive pills and ill health from tubectomy as the other side effects. Demands for more children and for son preferences were the leading reason for not using any methods followed by afraid of side effects and health problems. There was negligible change in the use of family planning methods during the period of the study. CONCLUSION Effective family planning methods use should be advocated through adequate counseling about the correct use, side effects and their proper management and their benefit in the back ground of custom and belief.
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Bardia A, Paul E, Kapoor SK, Anand K. Declining sex ratio: role of society, technology and government regulation in Faridabad district, Haryana. THE NATIONAL MEDICAL JOURNAL OF INDIA 2004; 17:207-11. [PMID: 15372767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND A declining sex ratio at birth has been documented during censuses in India. The decline is especially more in the northern states of Haryana and Punjab. We attempted to assess the role of society (preference for a male child, awareness and acceptability of the practice of sex determination), technology (availability and affordability) and government regulation in the adverse ratio for girls in the Ballabgarh block of Haryana in northern India. METHODS The population (about 80 000) in the Ballabgarh block has been under constant demographic surveillance for the past 30 years and the data are stored electronically. This was used to determine the sex ratio at birth in the area since 1990. The data on availability of ultrasound machines was collected from the district authorities, as registration of these machines was made mandatory under the Prenatal Diagnostic Techniques Act, 1994. We interviewed 160 mothers and grandmothers to determine the awareness and acceptability of sex determination methods and practices. RESULTS The demographic data for the past 10 years showed a declining sex ratio-from 881 in 1990-91 to 833 in 2000-01. The data support the view that in the initial part of this period, ultrasound was used for sex determination of all-order births but subsequently was used more in higher-order births. Our interviews with the mothers and grandmothers of the area showed that the practice of sex determination is prevalent and the attitude of the society is ambivalent. The increased availability of ultrasound machines in the area in the past 10 years corresponded to the decline in sex ratio. When the government made the practice illegal, the sex ratio improved only to fall again as the law was not implemented. Later years saw a more stringent implementation of the law and the sex ratio improved again. CONCLUSION There is a 'demand' for sex determination technology and, therefore, this would continue to be 'supplied'. At most the 'supply' can be regulated. Social engineering efforts need to be targeted at reducing the demand if the sex ratio is to be improved.
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Anand K, Sankar R, Kapoor SK. Cost of syrup versus capsule form of vitamin A supplementation. Indian Pediatr 2004; 41:377-84. [PMID: 15123867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The study was done to estimate the cost of each dose of vitamin A (2,00,000 Units) to the health system when delivered as a capsule, applicap or as syrup form. The cost of distribution of vitamin A supplements was estimated for the manufacturers, district and delivery level. The lowest cost per dose was for capsules in plastic jar (Rs. 0.99) and the highest was for the syrup in glass bottle (Rs. 1.29), the option currently being practiced. The distribution costs were least for the capsule, which compensates for its higher production cost. The cost of syrup was also more due to high degree of wastage compared to capsules. While cost is an important issue, other operational factors need also to be considered.
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Anand K, Patro BK, Paul E, Kapoor SK. Management of sick children by health workers in Ballabgarh: lessons for implementation of IMCI in India. J Trop Pediatr 2004; 50:41-7. [PMID: 14984169 DOI: 10.1093/tropej/50.1.41] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to determine the impact of training of health workers in the management of pediatric morbidity in terms of reduction in infant mortality rate (IMR) a 2-year period in rural Ballabgarh with a present IMR of 37 per 1000 live births. The study was designed as a pre- and post-intervention trial. The intervention was started in November 1999 and the outcome measured for the years 2000 and 2001. A sample size of 4000 was estimated for a power of 80 per cent at 5 per cent significance level. The training of the workers was for 4 days and included didactics, video-films, patient demonstrations, etc. Data on under-fives' deaths and their causes using a verbal autopsy tool was done as a part of the routine data collection system. The workers management of pediatric morbidity was assessed based on the post-training knowledge gain, forms filled by them, and referrals seen at the secondary level. The knowledge of the workers on disease and their management improved after the initial training but reached a plateau at a 50 per cent score. A review of 948 forms showed that the workers' disease classification and management was not satisfactory, especially for pneumonia and sick neonates. It was better for fever, measles, dysentery, and diarrhoea. A review of 11 cases referred by workers confirmed this. There was no impact on IMR. A look at the cause of death revealed that malnutrition, diarrhoea, and pneumonia to be the main causes among post-neonatal deaths and birth-asphyxia and prematurity as the main cause of deaths in the neonates. While implementing Integrated Management of Childhood Illnesses (IMCI) in India through the health workers, increased emphasis needs to be placed on training and supervision. Community level issues, such as healthcare seeking, female neglect, etc., may limit the scope of reduction in IMR due to implementation of IMCI.
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Nongkynrih B, Anand K, Kapoor SK. Use of verbal autopsy by health workers in under-five children. Indian Pediatr 2003; 40:766-71. [PMID: 12951380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
We conducted this study to ascertain whether health workers can routinely administer verbal autopsy (VA) to determine the cause of death in their area. The health workers were trained to administer verbal autopsy tool on the deaths occurring in the population under them. All the verbal autopsies of under-five deaths between January 2000 to December 2001 were reviewed by a pediatrician. There were 262 deaths of children under five years in this period, and 71% of them were infants, out of which 34% were neonatal deaths. The health workers reported PEM, fever, pneumonia, and diarrhea as the leading causes of death, based on the existing system of obtaining information provided by the family members. Verbal autopsy forms reviewed by a pediatrician also showed that apart from fever, the first three causes of death were the same i.e., PEM, diarrhea and pneumonia. This study shows that health workers can be trained to use the verbal autopsy to ascertain the cause of death.
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Kapoor SK, Anand K. Nutritional transition: a public health challenge in developing countries. J Epidemiol Community Health 2002; 56:804-5. [PMID: 12388563 PMCID: PMC1732057 DOI: 10.1136/jech.56.11.804] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ray TK, Pandav CS, Anand K, Kapoor SK, Dwivedi SN. Out-of-pocket expenditure on healthcare in a north Indian village. THE NATIONAL MEDICAL JOURNAL OF INDIA 2002; 15:257-60. [PMID: 12502135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Information on healthcare expenditure at the family or household level is important for the planning and management of health services. It is particularly relevant for health insurance agencies to estimate the amount of premium for initiating a universal health insurance system. METHODS Of 800 families in a village, 160 were selected by systematic random sampling. Of these, 156 families were followed up for a period of 12 months (September 1998 to August 1999) by making monthly visits. Responses from each family, as given by the head of the family, were recorded with the help of an interview schedule administered in the local language. The interview schedule covered any morbidity among the family members in the past one month and the out-of-pocket expenditure incurred on the same. RESULTS The private health sector was utilized in 59.4% of total episodes. Utilization of the private sector was directly associated with a higher socioeconomic status (p = 0.002). Of the total expenditure on non-hospitalized cases, 83.6% was incurred in the private sector. The mean per capita annual out-of-pocket expenditure on health was Rs 131. The median expenditure per episode was Rs 15. CONCLUSION Our study shows that out-of-pocket expenditure is more than the government expenditure on health. There is a need for systems such as health insurance to protect the poor from high medical costs.
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Shankarkumar U, Devaraj JP, Ghosh K, Karnad D, Anand K, Mohanty D. HLA associations in P. falciparum malaria patients from Mumbai, western India. INDIAN JOURNAL OF MALARIOLOGY 2002; 39:76-82. [PMID: 14686115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
In the present study, HLA associations among the cohort of 171 severe P. falciparum malaria patients were compared with that of 101 normal sex, age and ethnically matched control samples. All these individuals lived in Mumbai in an area of low and seasonal P. falciparum transmission. HLA A, B, DRB1 and DQB1 antigens were serologically (A and B) and molecularly (DRB and DQB) determined using isolated lymphocytes and genomic DNA following the microlymphocytotoxicity assay and PCR-SSP techniques. Significant differences were observed between patients with malaria and controls in the following groups of alleles: A3, B27, B49, DRB1*04, and DRB1*0809 were increased, while A19, A34, B18, B37, and DQB1*0203 were decreased. HLA B49 and DRB1*0809 were found to be positively associated with the complicated severe malaria patients (OR = 13.88; p < 0.0001). HLA A19, B5 and B13 were protective in patients with high parasite index (> 2%). These observations revealed the importance of ethnic background, which has to be taken into consideration while developing an ideal malaria vaccine. Further, when compared to HLA associations of other world populations the present study indicates the relative importance of different HLA alleles that may vary in different populations.
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Anand K, Palm G, Mesters J, Ziebuhr J, Hilgenfeld R. Crystal structure of a coronavirus main proteinase: TGEV Mpro. Acta Crystallogr A 2002. [DOI: 10.1107/s0108767302088268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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