Endline assessment of knowledge about sickle cell disease among the tribal community of Chhotaudepur district of Gujarat

Sickle cell disease (SCD) is a significant public health concern in India, with one of the highest disability burdens worldwide. For the success of the disease prevention and control program that aims to reduce prevalence through health promotion and screening, the public's prior knowledge of the disease is important. Hence, this study was conducted to assess baseline knowledge of the disease and effects of health education and community mobilization program in the SCD endemic tribal community of Gujarat. This quasi-experimental study was conducted in three phases at Chhotaudepur district of Gujarat, India. Knowledge of the community was assessed through the administration of pretested quantitative questionnaire in 1646 and 1631 individuals respectively during formative and evaluation phases. Differences between the proportions of two phases were statistically assessed by chi-square tests. Despite 75.3% of respondents having heard of SCD before, only 20% could perceive the correct cause. It was improved by 42% post-intervention. During the evaluation, 83% respondents recognized the most common symptom of extreme pain, whereas 86.8% identified the correct diagnostic method. Seventy-seven percent respondents reported modern medicine as a treatment for SCD at endline. Knowledge and awareness about SCD were found inadequate in the community. However, health education intervention strategies effectively improved knowledge related to the disease and its causes, diagnosis, and treatment. Hence, urgent action is required to incorporate community mobilization and awareness generation strategies to mitigate the disease burden.

Study on Factors Associated with Depression among Elderly and Comparison of Two Scales Used for Screening

Background:

Depression is one of the most frequent illnesses found among the elderly. ICD-10 scale and Geriatric Depression Scale (GDS) are used commonly for screening and hence it is important to identify the scale which can be used more effectively in community settings.

Objectives:

(1) To analyze the factors responsible for the elderly depression and (2) to compare two scales used for the screening (ICD-10 and GDS).

Materials and Methods:

A cross-sectional house-to-house survey was carried in Sayla taluka of Surendranagar district by directly questioning the subjects after oral and written consent. The selection of taluka was done using simple random sampling and sample size was calculated on the basis of estimated geriatric population. 306 subjects were interviewed using a predesigned, pretested, and validated questionnaire.

Results:

GDS showed the prevalence of 16% whereas ICD-10 showed 22%. The factors associated with depression were physical health, poor economical situation, and avoidance by family members. The agreement between the 2 scales using Cohen's kappa statistic showed excellent agreement.

Conclusion:

Community-based multiphasic screening programs is needed for early diagnosis of geriatric depression. ICD-10 having lesser number of questions can be used in the 1^st phase of screening and those found positive can then be tested by GDS.

Out-of-Pocket Expenditure and Opportunity Cost of Leptospirosis Patients at a Tertiary Care Hospital of Gujarat, India

INTRODUCTION

The study investigates the cost incurred by leptospirosis patients as either out-of-pocket expenditure (OOPE) or opportunity cost (OC) and recommends accordingly for the national program on leptospirosis in India.

OBJECTIVES

The objective of this study is to determine leptospirosis-related OOPE and OC at a government tertiary care hospital and to disaggregate the total OOPE into contributing cost domains.

MATERIALS AND METHODS

The OOPE data were collected by the personal interview of confirmed leptospirosis cases who took complete treatment at the hospital in year 2009 using a prestructured questionnaire. The patients were interviewed daily until discharge to know daily OOPE.

RESULTS

The mean OOPE per patient was Rs. 2157/-, Median: Rs. 1880/-, 25^th-75^th percentile: Rs. 1446 - Rs 2587.5). The lowest quintile for OOPE was Rs. 1330/- and the highest quintile was Rs. 2874/-. Loss of daily wages was 68% (Rs. 1458.9/-) of the total OOPE. Other major expenditure included cost of drugs Rs. 308.8/- (14%), expenditure on food Rs. 173/- (8%), and travelling expenses Rs. 204.4/- (9%).

CONCLUSIONS

Rs. 2157/- is significant OOPE, and hence, important factor in understanding health-seeking behavior and compliance of leptospirosis patients. The OC (loss of daily wages) amounts to 68% of total OOPE which has to addressed by the government to realize universal health coverage.

Infant Deaths - Data Disparity and Use of Ante, Intra and Post-natal Services Utilization: An Experience from Tribal Areas of Gujarat

Background:

Infant death depends upon the care during the infancy and also upon the service utilization during antenatal and intra-natal periods and with its decline, it is necessary to find the under-reporting if any and identify the most appropriate agency for its reporting.

Objectives:

(1) To document disparities between different reporting systems about infant deaths and find out the under-reporting if any and identify the most appropriate agency and (2) To identify utilization of health services during ante, intra and post-natal period for all infant deaths.

Materials and Methods:

Study was conducted in 51 villages of 3 Primary Health Centers (PHCs) from a tribal dominated Taluka (block) of South Gujarat during September - November 2005. Information was gathered for 1 year (1 September 2004 to 31 August 2005) from 4 sources namely health care system, Integrated Child development services (ICDS) scheme, Civil Registration System (CRS) and Investigator himself (Gold standard). Data was collected in a designed verbal autopsy questionnaire by house to house survey and analyzed in Epi Info.

Results:

A total of 48 infant deaths were recorded by investigator against reported 2, 10 and 8 infant deaths by CRS, Health System and ICDS respectively. While profiling these 48 infant deaths it was found that only 29.2% mothers received full antenatal care (ANC) and 60.4% delivered at home (by untrained personnel). Not a single delivery was done at PHCs or its sub centers (SC). In 25% cases there was poor cord care. 39.6% mothers did not breastfeed and 35.4% gave pre-lacteal feeding.

Conclusions:

There was gross underreporting of infant mortality in all 3 agencies. The utilization of ANC and post natal care (PNC) services was poor in these death cases. Health system and ICDS need to be sensitized to work in coordination to provide quality ANC, INC and PNC to prevent such avoidable infant deaths.