Measuring Patient Satisfaction: A Case Study to Improve Quality of Care at Public Health Facilities

Objective:

The main objective of the study is to measure the satisfaction of OPD (Outpatient Department) patients in public health facilities of Madhya Pradesh in India.

Materials and Methods:

Data were collected from OPD patients through pre-structured questionnaires at public health facilities in the sampled eight districts of Madhya Pradesh. The data were analyzed using SPSS.

Settings:

Outpatient Departments of district hospital, civil hospital, community health centre, and primary health centre of the eight selected districts of Madhya Pradesh.

Results:

A total of 561 OPD patients were included in the study to know their perceptions towards the public health facilities, choosing health facility, registration process, basic amenities, perception towards doctors and other staff, perception towards pharmacy and dressing room services. It was found that most of the respondents were youth and having low level of education. The major reason of choosing the public health facility was inexpensiveness, infrastructure, and proximity of health facility. Measuring patient satisfaction were more satisfied with the basic amenities at higher health facilities compared to lower level facilities. It was also observed that the patients were more satisfied with the behavior of doctors and staff at lower health facilities compared to higher level facilities.     

Mass Measles Rubella Immunization Campaign: Bhutan Experience

Background:

Bhutan has attained universal child immunization since 1991. Since then, immunization coverage is maintained at high level through routine immunization, periodic National Immunization Days, and mop up campaigns. Despite high immunization coverage, every year, significant numbers of clinically suspected measles cases were reported.

Objective:

To assess the cause of continuing high “suspected measles cases” and take appropriate public health measures.

Materials and Methods:

Febrile rash outbreaks occurred in several districts in 2003. These episodes were investigated. Simultaneously, a retrospective data search revealed evidence of congenital rubella syndrome (CRS) in the country.

Results:

Thirty five percent of the tested samples were positive for rubella but none for measles. There were evidences of the presence of CRS. This was discussed in the annual health conference 2004, amongst health policy makers and district heads who recommended that a possibility of inclusion of rubella as an antigen be looked into. A nationwide measles and rubella immunization campaign was conducted in 2006 followed by introduction of rubella vaccine in the immunization schedule.

Conclusion:

Febrile rash can be caused by a host of viral infections. Following universal measles immunization, it is pertinent that febrile rash be looked in the light of rubella infections. Following the introduction of rubella vaccination in the national immunization schedule, there has been significant reduction of febrile rash episodes, cases of rubella, and congenital rubella syndrome.     

Case Based Surveillance for Measles in Lagos,South Western Nigeria,September 2011

Objective

The objective of this study was to describe the performance of the measles surveillance in Lagos, characterize the epidemiologic pattern of measles infection and determine the measles vaccine efficacy.

Introduction

Measles is a vaccine preventable disease that has been successfully eliminated in some parts of the world. It causes high morbidity and mortality with the potential of large outbreaks. About a third of reported measles cases involve one or more complications including diarrhea, pneumonia, otitis media, blindness, post infections encephalitis and subacute sclerosing panencephalitis. It is however, one of the leading causes of childhood morbidity and mortality in Nigeria despite availability of safe and effective vaccines

Methods

We obtained the measles surveillance data for all the 20 Local Governments Areas (LGAs) in Lagos and reviewed all the measles case based investigation forms between the period 1st January to 31st December 2010.The WHO Recommended Surveillance Standards for Measles was used. Data was analyzed using EPI INFO version 3.5.3.

Results

Of the 615 suspected measles cases, 63(10.2%) were laboratory confirmed (measles IGM+) and 3(0.5%) clinically confirmed. Cases investigated within 48 hours was 222 (36%) (target ≥ 80%), 510 (83%) had adequate blood sample collected (target ≥ 80%) and 595 (97%) of sample results were received from the lab within 7 days (target ≥ 80%). The surveillance system sensitivity was 6.5/100,000 (target >2/100,000) with a predictive value positive of 10.73%. The overall attack rate was 0.73/100,000 population with 1 mortality (case fatality rate 1.5%). The Under 1 year attack rate (8.33/100,000) was higher than the 1– 4 years attack rate (3.48/100,000) (p= 0.01). Those vaccinated with at least 1 dose of measles vaccine had a 3 times lower risk of measles infection than the unvaccinated. The proportion of unvaccinated cases was 36%. The measles vaccine efficacy was 60%.

Conclusions

The quality of surveillance need to be strengthened by improving the time lapse between notification and investigation of suspected cases. Measles is still a significant cause of morbidity particularly among the under 1 year age group.The proportion of unvaccinated cases is also high, suggesting a low vaccine coverage among susceptibles.Prompt investigation of cases, good vaccine coverage and high vaccine efficacy are all vital in eliminating measles from Nigeria.Morbidity and Mortality rates

Sero-Surveillance to Assess Immunity to Rubella and Assessment of Immunogenicity and Safety of a Single dose of Rubella Vaccine in School Girls

Background:

Rubella vaccination is not yet included in National Immunization Schedule in India. Serosurvey is frequently used to assess epidemiologic pattern of Rubella in a community. Serosurveys in different parts of India have found that 6–47% of women are susceptible for Rubella infection. The present serosurveillance was conducted in Jammu, India, in two public schools.

Objective:

To determine serological status of Rubella antibodies of school girls and assessment of immunogenicity and reactogenicity of Rubella immunization in seronegative girls.

Materials and Methods:

The current study was conducted to determine Rubella serostatus in peripubertal schoolgirls aged 11–18 years and also to assess immunogenicity and safety of Rubella vaccine (R-Vac) of Serum Institute of India Ltd., Pune, in seronegative girls. For screening, pre-vaccination serum Rubella IgG antibodies were determined and to assess immunogenicity of the vaccine, post-vaccination IgG antibodies were compared with pre-vaccination levels. Safety assessment was done for a period of 8 weeks, post-vaccination.

Results:

A total of 90 (32.7%) seronegative girls were vaccinated. All girls (100%) became seropositive, post-vaccination. Clinically relevant and statistically significant increase in anti-Rubella IgG titres was observed. The adverse events were mild and self-limiting.

Conclusions:

R-Vac vaccine used in the study demonstrated an excellent safety and immunogenicity profile.     

Reaching the poor with adequately iodized salt through the Supplementary Nutrition Programme and Midday Meal Scheme in Madhya Pradesh,India

Problem

In India, adequately iodized salt needs to be made accessible to the most marginalized.

Approach

In an effort to provide adequately iodized salt to the most vulnerable, in 2009 Madhya Pradesh launched a state-wide initiative through two national flagship nutrition programmes: the Supplementary Nutrition Programme of the Integrated Child Development Services and the Midday Meal Scheme. Programme staff members were taught how to correctly store salt and monitor its iodine content. Field monitors assessed the iodine content of the salt in the common kitchens of participating schools and anganwadi centres monthly.

Local setting

Madhya Pradesh, a state in central India, is home to a substantial proportion of India’s poor. In 2009, household coverage of adequately iodized salt in the state was nearly 90% among the richest but only about 50% among the poorest.

Relevant changes

Two hot meals prepared with adequately iodized salt were served daily for more than 21 days per month to approximately 89% of the 12 113 584 children aged 3 to 6 years enrolled in anganwadi centres (June 2011 to March 2012). One meal on school days was served to 78% of 5 751 979 primary-school children and to 79% of 2 704 692 secondary-school children (April 2011 to March 2012). Most of the kitchens visited in 2010 (79%) and 2011 (83%) were consistently using adequately iodized salt to prepare hot meals.

Lessons learnt

India has large-scale social safety net programmes for the poorest. Both national and state policies should mainstream the use of adequately iodized salt in these programmes.     

Community Based Maternal and Child Health Nutrition Project,Uttar Pradesh: An Innovative Strategy Focusing on “At Risk” Families

Research Question:

Use of community based volunteers, frequently reaching and counseling a selected group of prioritized families, can make a substantial difference in improving maternal and child care practices and in reducing child undernutrition.

Setting:

Program Rural Uttar Pradesh, India.

Study Design:

A comparison of baseline and endline surveys following 4 years of community based project intervention

Participants:

“At risk” undernutrition families comprising mothers of under twos, newlyweds, and severely undernourished children below 6 years.

Intervention:

Mapping and counseling of “at risk” families. Measuring impact on maternal-child care practices, underweight status.

Results:

Trained community mobilizers identified and counseled selected “at risk” families. Following 4 years of implementation in 907 villages of 8 blocks of four districts, significant improvement was noted in practices of early initiation of breastfeeding, feeding colostrum, timely introduction of complementary feeding, and washing the hands after defecation. Percentage of mothers exclusively breastfeeding at 6 months was only 2.1% with 78% receiving prelacteal feeds. A small increase in normal and mild malnutrition and a significant reduction of 43% in severe malnutrition was noted.

Conclusion:

Frequently counseling by accredited social health activists by focusing on selected defined “at risk” families of under twos and those with severe malnourished children could result in increasing acceptability of correct child health, feeding, and care practices and in contributing to improving nutritional status scenario.     

Awareness about Human Papilloma Virus and its Vaccine Among Medical Students

Background:

Cancer of the uterine cervix is the most common malignancy amongst women in India. Identification of its pre-cancerous lesions and prevention by HPV vaccine may go a long way in decreasing the incidence.

Aim:

The aim was to study the awareness about the various aspects of the HPV infection and vaccine among medical students.

Settings and Design:

It was a cross-sectional study conducted in a tertiary care hospital of Delhi.

Materials and Methods:

150 medical students aged between 18-25 years were requested to complete a 35 point questionnaire regarding cervical malignancy, HPV infection, HPV vaccine and the answers were then analyzed.

Results:

None of the students knew the correct incidence of cervical cancer in India and 18% of them did not know that the HPV vaccination prevents cervical cancer and 50% thought that vaccination induces false sense of security. Fifty percent were unaware of HPV infection and its association with other STD''s and cervical cancer. The information regarding the mechanism of action, dosage, schedule and cost of the HPV vaccine was lacking in majority of them. The limitation of this study is that it does not reflect the knowledge or awareness of a layman or full-fledged medical doctor.

Conclusions:

To conclude gaps in knowledge regarding HPV infection and vaccination existed amongst the medical students and a more integrated teaching regarding HPV carcinogenesis, vaccination and cervical cancer needs to be introduced.     

Association of Blindness and Hearing Impairment with Mortality in a Cohort of Elderly Persons in a Rural Area

Background:

Studies in developed nations have reported an association of blindness and hearing impairment with mortality in elderly persons.

Objectives:

To study the association of blindness and hearing impairment with mortality in a cohort of elderly persons in rural north India.

Materials and Methods:

This community-based prospective study was conducted in eleven randomly selected villages, in Ballabgarh block, Haryana. A cohort of 1422 participants, of age 60 years and above, was examined at baseline, for their visual and hearing status. Data on the sociodemographic factors, various comorbidities, activities of daily living, and self-rated health were recorded. Baseline data was collected for the period May 2008 to August 2008. Follow-up data collection for mortality was completed in December 2009. The median follow-up period was 518 days.

Results:

One hundred out of 1422 elderly (7.0%) participants died during the follow-up period. Significant hazard ratios were found after adjustment for various comorbid conditions. On adjustment for sociodemographic factors (age, sex, and literacy), neither blindness nor hearing impairment was found to be significantly associated with mortality. After adjustment for all covariates in the study, hearing impairment (Hazard Ratio = 2.13; 95% CI, 1.29 – 3.54) was found to be significantly associated with mortality in the age group ≥70 years.

Conclusions:

This study demonstrated that hearing impairment was an independent risk factor for mortality in people aged ≥70 years. Similar studies with a longer period of follow-up are required in India, to guide public health interventions.     

A Study on Risk Factors of Breast Cancer Among Patients Attending the Tertiary Care Hospital,in Udupi District

Background:

Cancer has become one of the ten leading causes of death in India. Breast cancer is the most common diagnosed malignancy in India, it ranks second to cervical cancer. An increasing trend in incidence is reported from various registries of national cancer registry project and now India is a country with largest estimated number of breast cancer deaths worldwide.

Aim:

To study the factors associated with breast cancer.

Objectives:

To study the association between breast cancer and selected exposure variables and to identify risk factors for breast cancer.

Materials and Methods:

A hospital based Case control study was conducted at Shirdi Sai Baba Cancer Hospital and Research Center, Manipal, Udupi District.

Results:

Total 188 participants were included in the study, 94 cases and 94 controls. All the study participants were between 25 to 69 years of age group. The cases and controls were matched by ± 2 years age range. Non vegetarian diet was one of the important risk factors (OR 2.80, CI 1.15-6.81). More than 7 to 12 years of education (OR 4.84 CI 1.51-15.46) had 4.84 times risk of breast cancer as compared with illiterate women.

Conclusion:

The study suggests that non vegetarian diet is the important risk factor for Breast Cancer and the risk of Breast Cancer is more in educated women as compared with the illiterate women.

Limitation:

This is a Hospital based study so generalisability of the findings could be limited.     

Association of Poultry Farms with Housefly and Morbidity: A Comparative Study from Raipur Rani, Haryana

Background:

Large poultry belt is located in the residential areas of rural Haryana in North India. Housefly problem has become a big nuisance in this area. Policy makers require evidence of the association of poultry farming with houseflies and its possible impact on the health of the population.

Materials and Methods:

Across-sectional two-group comparison study was conducted. Six villages within 3 km and another six villages beyond 5 km from any poultry farms were selected as the study and the control villages, respectively. We measured indoor and outdoor housefly density and family morbidity in the last 1 month and observed the poultry hygiene and manure management practices.

Findings:

The mean fly density was 1737 (95% CI 697-2778) houseflies in study villages compared to 100 (95% CI 2-197) houseflies in the control area. The mean all-cause morbidity was also significantly higher in study village families compared to control village families. Poultry farm hygiene and use of insecticides and growth regulators were inadequate.

Interpretation:

Poultry farms are associated strongly with high fly density and high infectious morbidity in this area.Monitoring and regulation for poultry manure management practices and insecticide use practices need to be strengthened.     

A Clinical Study of Vitiligo in a Rural Set up of Gujarat

Introduction:

Vitiligo is an acquired depigmentary condition caused by inactivation or destruction of melanocytes in epidermis and hair follicle. Worldwide incidence of 1% has been reported; similar to various dermatological clinics in India. Widespread prejudice, ignorance, taboos, lack of scientific appraisal, and confusion of vitiligo with leprosy makes it an immense psychological stress.

Aim:

To know the clinical profile of vitiligo patient with associated cofactors.

Materials and Methods:

Total 1,010 patients of vitiligo attended in outpatient department at Shree Krishna Hospital (SKH) and Matar camp, Gujarat over 1 year period from August 2011 to July 2012 were included in this study. Detail history and clinical examination of patients were done.

Results:

Out of 1,010 patients 57.3% were females and 42.7 % were males. Most cases developed vitiligo by 2^nd decade of life. Progressive course was found in 60.9 % of patients. Vitiligo vulgaris (57.8%) was most common morphological type. Most common site of onset (41.5%) and involvement (75.7%) was lower limb. Family history was present in 20.4%.

Conclusions:

Vitiligo constitutes important dermatological disease especially in India. The data suggest that local epidemiological behavior of vitiligo need not be the same across different regions. Vitiligo differs substantially in various clinical aspects.     

Impact of Indoor Residual Spray with Synthetic Pyrethroid in Gandhinagar District, Gujarat

Background:

Indoor residual spray (IRS), with appropriate insecticide, is an effective weapon for the control of malaria. Two rounds of indoor residual spray, with synthetic pyrethroid, are given in highly malaria endemic areas. It aims to prevent transmission of malaria by adult vector mosquitoes.

Aims:

To assess the impact of indoor residual spray in the highly malaria-endemic villages of Kalol taluka in Gandhinagar district.

Design:

High risk population for malaria, based on last three-year malaria situation.

Setting:

Malaria endemic rural areas in Gandhinagar district where indoor residual spray was undertaken with synthetic pyrethroid in 2006 and 2007.

Study Variables:

Exploratory - Rural areas; Outcome - coverage, acceptance.

Analysis:

Percentage and proportions.

Results:

Prior to the introduction of synthetic pyrethroid, in 2005, the annual parasitic incidence of the sprayed villages was 33.4. It came down to 8.8 in 2006. Continuation of this strategy in the same villages further brought down the annual parasitic incidence to 1.5 in 2007. A similar trend of steady decline was observed in actual numbers of cases and other malariometric indices as well.

Conclusion:

IRS, it still has a major role in the control of malaria if implemented with proper supervision, better coverage and community participation.     

Absence of endemic measles transmission in a highly vaccinated population from 1999 to 2008: Implications of sustained measles elimination in Taiwan

Background

Measles remains a leading vaccine-preventable cause of child mortality worldwide. The impact of vaccination programs can be seen in the increasingly low incidence of measles. However, cases of measles continue to occur in low numbers every year in Taiwan. We assessed the epidemiology of measles in Taiwan from 1999 to 2008 with a focus on domestic versus imported cases.

Methods

We analyzed the data reported to surveillance systems at the Taiwan Center for Disease Control, where viral isolation was performed.

Results

A total of 84 measles cases were reported from 1999 to 2008 in Taiwan with the incidence of measles varying from 0 to 1.5 per 1,000,000 people per year, peaking in 2002 and again in 2008. The incidence decreased with increasing age in both males and females. Among the 84 reported measles cases, 39 (46%) originated internationally, 8 (10%) were epidemiologically linked to imported cases and the source was unknown in 37 (44%) of the cases. The unknown-source cases were analyzed for potential evidence of endemic measles transmission. Most of the measles cases that occurred in Taiwan from 1999 to 2008 were associated with imported cases. No endemic transmission of measles in Taiwan was identified.

Conclusions

This study suggests that maintaining the high rate of vaccination coverage is needed to prevent future outbreak and sustain the elimination of measles in Taiwan.     

Internal Evaluation of National Leprosy Elimination Program in Tribal Gujarat

Background:

The government launched a National Leprosy Eradication program in 1983, to eliminate leprosy from India. A Modified Leprosy Elimination Campaign was started with the view to early case detection and treatment. In April 2004, a vertical program of leprosy was merged with the general health services and case detection was conducted by the general health workers in India.

Materials and Methods:

Internal evaluation of leprosy was done in the Panchmanal district of Gujarat through a rapid survey of the 10 Primary Health Care units in the high and low endemic areas. Active and passive surveillance data and records were verified according to the indicators.

Results:

Analysis of the data and record verification revealed that there was a decrease in the prevalence rate of leprosy, but it had not reached the elimination status. The MB ratio had decreased, but the child ratio remained consistent for the last five years. The disability ratio had also decreased in five years.

Conclusion:

The National Leprosy Elimination Program had a favorable impact, but at the same time to reach the elimination status there was a need for more stringent Information, Education, and Communication (IEC) activities to be promoted in the community. Active surveillance should be initiated so that hidden cases are not missed in the community.     

Providing monovalent oral polio vaccine type 1 to newborns: findings from a pilot birth-dose project in Moradabad district, India

Problem

Poliovirus transmission remained a public health challenge in western Uttar Pradesh, India in late 2005 and early 2006. In 2006, the India Expert Advisory Group for Polio Eradication concluded that, given the peak incidence of polio among children 6 to 12 months of age, a targeted birth dose of oral polio vaccine may be necessary to interrupt intense poliovirus transmission in high risk areas.

Approach

The Government of Uttar Pradesh, the National Polio Surveillance Project and the United Nations Children’s Fund (UNICEF) implemented a pilot birth-dose project aimed at identifying and vaccinating all newborns with a dose of oral polio vaccine within 72 hours of birth in an effort to evaluate operational feasibility and potential impact on population immunity.

Local setting

The project was piloted in Moradabad district: zone 7 in Moradabad City (urban setting), Kunderki block (rural setting) and in select birthing hospitals.

Relevant changes

Between July 2006 and February 2007, 9740 newborns were identified, of which 6369 (65%) were vaccinated by project personnel within 72 hours of birth. Project coverage (for total newborns vaccinated) ranged from 39% (in zone 7) to 76% (in Kunderki block) of the estimated number of newborns vaccinated during previous supplemental immunization activities.

Lessons learned

Birth-dose coverage among newborns was lower than expected. Expansion costs were estimated to be high, with marginal impact. The project, however, provided opportunities to strengthen newborn tracking systems which have increased the number of newborns and young infants vaccinated during supplemental immunization activities and enrolled in routine programmes.     

Profile of Home-based Caregivers of Bedridden Patients in North India

Background:

Caregiving to bedridden patients in India is set to become a major problem in future.

Objective:

To ascertain the profile of caregivers for the adult bedridden patients in Chandigarh, India.

Materials and Methods:

This cross-sectional study was conducted on 100 purposively selected bedridden people. The Katz Index of the activities of daily living was used to ascertain their degree of disability. Patients and families were interviewed about the patterns of care provision.

Results:

The mean age of subjects was 69 years. A majority (68%) of them lived in joint families. All of them required assistance in bathing, dressing, toileting, and transfer. In 54% of the cases someone was hired to look after the subjects. A majority of the caregivers (82%) were family members. All caregivers were untrained. In 35% of the cases unqualified practitioners were consulted, while in 59% of the cases government hospitals were consulted. Most patients (78) were given medicines on time. Complications like urinary tract infection (39%) and pressure ulcers (54%) were reported; 57% of the patients reported satisfaction with the care provided.

Conclusion:

The main source of caregivers for the bedridden was the family. Bedridden people had high rates of medical complications. There is a need for formal training for the caregivers.     

Domestic Violence against Nurses by their Marital Partners: A Facility-based Study at a Tertiary Care Hospital

Background:

In recent times, domestic violence against women by marital partners has emerged as an important public health problem.

Objectives:

1. To determine the prevalence, characteristics and impact of domestic violence against nurses by their marital partners, in Delhi, India. 2. To identify nurses’ perceptions regarding acceptable behavior for men and women.

Materials and Methods:

A facility-based pilot study was conducted at All India Institute of Medical Sciences (AIIMS), New Delhi. Data were collected using self-administered standardized questionnaire, among 60 ever married female nurses working at AIIMS hospital, selected by convenience sampling. The principal outcome variables were controlling behavior, emotional, physical and sexual violence by marital partners. Data were analyzed using SPSS 12 software. The test applied was Fisher''s exact test and 1-sided Fisher''s exact test.

Results:

Sixty percent of nurses reported marital partner perpetrated controlling behavior, 65% reported emotional violence, 43.3% reported physical violence and 30% reported sexual violence. About 3/5^th of nurses (58%) opined that no reason justified violence, except wife infidelity (31.67%). Of the physically or sexually abused respondents, 40% were ever injured, and 56.7% reported that violence affected their physical and mental health.

Conclusion:

There is a high magnitude of domestic violence against nurses and this is reported to have affected their physical and mental health.     

Attracting Doctors to Rural Areas: A Case Study of the Post-Graduate Seat Reservation Scheme in Andhra Pradesh

Background:

Attracting doctors to rural posts is an ongoing challenge for health departments across different states in India. One strategy adopted by several states to make rural service attractive for medical graduates is to reserve post-graduate (PG) seats in medical colleges for doctors serving in the public sector.

Objective:

This study examines the PG reservation scheme in Andhra Pradesh to understand its role in improving rural recruitment of doctors and specialists, the challenges faced by the scheme and how it can be strengthened.

Materials and Methods:

Qualitative case study methodology was adopted in which a variety of stakeholders such as government officials, health systems managers and serving Medical Officers were interviewed. This was supplemented with quantitative data on the scheme obtained from the Health, Medical and Family Welfare Department in Andhra Pradesh.

Results:

The PG reservation scheme appears to have been one of the factors responsible in attracting doctors to the public sector and to rural posts, with a reduction in vacancies at both the Primary Health Centre and Community Health Centre levels. Expectedly, in-service candidates have a better chance of getting a PG seat than general candidates. However, problems such as the mismatch of the demand and supply of certain types of specialist doctors, poor academic performance of in-service candidates as well as quality of services and enforcement of the post-PG bond need to be resolved.

Conclusion:

The PG reservation scheme is a powerful incentive to attract doctors to rural areas. However, better monitoring of service quality, strategically aligning PG training through the scheme with the demand for specialists as well as stricter enforcement of the financial bond are required to improve the scheme''s effectiveness.     

An Epidemiological Study of Filariasis in a Village of District Datia, MP

Background:

District Datia has been known to be endemic for filariasis. A number of cases have been reported in recent past. The present study was an epidemiological investigation carried out in village Barganya, Datia in the month of Sept 2004.

Aims and Objectives:

The objectives of this study were to confirm the epidemic in village Barganya and to study the causes of the present epidemic.

Materials and Methods:

The study was a cross sectional study carried out through house to house survey, covering a population of 1512.

Result:

A total of 78 clinically confirmed cases were reported. The study calculated a microfilarial rate of 6.9% and 1.65% in males and females respectively. The microfilarial density among confirmed cases ranged from 3.1 to 10.6 per 20 cmm.

Conclusion:

The study concluded that majority of the cases were males who worked in open field and there was a lack of proper management of these cases at village level.