Where and How Breastfeeding Promotion Initiatives Should Focus Its Attention? A Study from Rural Wardha

Background:

In India, the practice of breastfeeding is almost universal, but initiation of breastfeeding is generally quite late and colostrum is discarded. Integrated Management of Neonatal and Childhood Illness (IMNCI) strategy recommended systematic assessment of breastfeeding and emphasized counseling of the mother on proper positioning and attachment of infant to the breast.

Objective:

To assess breastfeeding among mothers of below six months children in rural Wardha.

Materials and Methods

The present cross-sectional study was undertaken in surrounding 23 villages of Kasturba Rural Health Training Center (KRHTC), Anji. Two Auxiliary Nurse Midwives (ANMs) trained in IMNCI paid house visits to 99 mothers during the study period and undertook the assessment of breastfeeding using IMNCI assessment form for young infants. Auxiliary Nurse Midwives observed and recorded the positioning and attachment of infant to the breast as per IMNCI guidelines. The data were entered and analyzed using Epi_Info (version 6.04d) software package.

Results:

Most of the deliveries 94 (94.9%) took place in the healthcare facilities. Majority 61 (61.6%) newborn babies had received breastfeeding within half an hour. About half of the mothers had any of the feeding problems like feeding less than eight times in 24 h, giving any other food or drinks or is low weight for age. Significantly more mothers with feeding problems had problems in positioning and attachment of infant to the breast as compared with those mothers who did not have any feeding problems.

Conclusions:

In the settings, where practice of institutional delivery is high, the staff of healthcare facility should ensure education of the mothers regarding position and attachment of infant to the breast before discharge from the healthcare facility. At the village level, Village Health Nutrition Day (VHND) can be utilized for health education of future mothers and support for the breastfeeding mothers. The IMNCI assessment form for young infant should also include assessment of positioning of infant.     

Unmet Family Planning Need: Differences and Levels of Agreement Between Husband-Wife, Haryana, India

Research question:

Is there agreement between husbands and wives regarding unmet need of family planning?

Hypothesis:

The unmet need of family planning is perceived more by women then their husbands.

Objective:

1) To ascertain the unmet needs of family planning for husbands and wives. 2) To ascertain the level of agreement between husbands and wives regarding unmet needs of family planning.

Design:

A cross-sectional survey

Setting:

Dayalpur village in Intensive field practice area of Comprehensive Rural Health Services project (CRHSP), Ballabgarh, Haryana.

Study Period:

July 2003- June 2005.

Participants

included 200 married couples selected by simple random sampling.

Statistical Analysis:

Level of agreement between husbands and wives was analyzed using Kappa statistics.

Results:

Unmet need for family planning was 11% (22 out of 200) for husbands and 17.5% (35 out of 200) for wives. The difference was seen both in unmet need for spacing (M-3.5% vs. F-6%) as well as limiting family size (M-7.5% vs. F-11.5%). Overall, 93.5% concordance was observed amongst husbands and wives. In all the cases where disagreement was seen (6.5%), wives reported having unmet need for contraception whereas their husbands perceived none. The unadjusted Kappa statistic was 0.73 and prevalence adjusted Kappa was 0.88.

Conclusion:

Unmet need for family planning was significantly higher for wives compared to husbands. Despite high degrees of agreement amongst the couples, the nature of disconcordance reinforces the need for policy makers to take into account the perspective of men.     

Spousal Communication, Changes in Partner Attitude, and Contraceptive Use Among the Yorubas of Southwest Nigeria

Objective:

This paper highlights the relevance of spousal communication on males'' attitude towards their partners'' contraceptive use.

Design:

This was a cross-sectional study.

Materials and Methods:

Data for the study were obtained from a survey carried out in three states, Oyo, Osun, and Ondo, mainly inhabited by the Yorubas.

Results:

The results show that men have a significant role to play in the adoption of contraception. About 37% of the respondents reported joint decision making on when to have another child, 40.8% on whether to stop having children, and 44% on what to do to stop childbearing. Communication between a husband and wife on reproductive matters was also recognized as a factor that may influence male participation in family planning.

Conclusion:

This study has shown that the male partner may be highly motivated to obtain contraceptives. The results therefore suggest that male involvement in family planning should be encouraged through inter-spousal communication.     

A Study of Dysmenorrhea During Menstruation in Adolescent Girls

Research question:

What is the prevalence of dysmenorrhea severity and its associated symptoms among adolescent girls?

Objectives:

(1) To study the prevalence of dysmenorrhea in high school adolescent girls of Gwalior. (2) To study the evidence of severity of the problem with associated symptoms and general health status.

Study design:

An explorative survey technique with a correlational approach.

Setting and Participants:

Nine hundred and seventy adolescent girls of age 15 to 20 years, studying in the higher secondary schools (Pre-University Colleges) of Gwalior.

Statistical analysis:

Percentages, Chi-square test, and Test-Retest Method.

Results:

The prevalence of dysmenorrhea in adolescent girls was found to be 79.67%. Most of them, 37.96%, suffered regularly from dysmenorrhea severity. The three most common symptoms present on both days, that is, day before and first day of menstruation were lethargy and tiredness (first), depression (second) and inability to concentrate in work (third), whereas the ranking of these symptoms on the day after the stoppage of menstruation showed depression as the first common symptoms. Negative correlation had found between dysmenorrhea and the General Health Status as measured by the Body surface area.     

Molecular Diagnosis of Trichomoniasis in Negative Samples Examined by Direct Smear and Culture

Background

Trichomoniasis is an extremely common sexually transmitted infection (STI) worldwide and is associated with important public health problems, including amplification of HIV transmission. This disease is in forms of symptomatic and asymptomatic in women and may depend on host as well as parasite variables. Most of the studies reported from females are based on examination of vaginal secretions and urine samples by direct smear and culture in modified Diamond''s media. The aim of this study was checking the samples, which were negative by direct smear and culture, with PCR technique.

Methods

The urine samples and vaginal discharge of patients attending Gynecology Clinics of Mazandaran Province, Iran with different symptoms rechecked for Trichomonas vaginalis by PCR technique using primers targeting a conserved region of the beta-tubulin genes of the parasite. Data were analyzed by Epi Info software program

Results

Out of 161 negative samples by direct smear and culture, seven samples (4.3%) were positive by PCR technique.

Conclusion

Diagnosis of trichomoniasis by PCR is a sensitive and specific method that could play important role to help the physicians for properly treatment and control of infection.     

Male Behavior Toward Reproductive Responsibilities in Sikkim

Background:

Failure to assess the impact of men''s perceptions on reproductive health decisions has weakened reproductive health care programmes.

Objectives:

We evaluated husbands’ knowledge and practices with regard to the use of conventional contraceptives as manifested through reproductive health and sexual decisions.

Materials and Methods:

A population-based cross-sectional study was conducted in a rural setting of Sang PHC and Pakyong PHC area in Sikkim, India. Five hundred and ninety-six currently married men whose names were included in the eligible couple registers were selected by multistage random sampling. Information regarding knowledge and practice of contraceptive use was obtained from the participants by interview.

Results:

Out of the 596 male participants, the majority (55.87%) opined that they were in favor of using a contraceptive method after one child. Most participants (55.54%) said that their main source of information on contraceptive methods were the government health staff, while 24.84% acknowledged that most of their information came from the mass media. Eighty-two percent reported currently using some kind of the contraceptive method. Condom was used as a temporary method by only 16.27% of the responders, with the permanent method of vasectomy being opted for by only 4.87%. The method most widely used by their partners was the oral contraceptive pill (43.41%), followed by tubectomy (15.77%) and IUD (4.19%).

Conclusions:

This research found that awareness and prevalence of contraceptive use among married men in a rural community in the East District of Sikkim were quite high. Nevertheless, female contraceptive methods continue to be the dominant method used in the community. Researchers and health care providers often ignore the sociodemographic significance of men and their role in the acceptance of contraceptive practices in the community.     

General Morbidity Prevalence in the Delhi Slums

Research Question:

What is the sickness prevalence in the slums of a metropolitan city?

Objectives:

To estimate the morbidity prevalence with reference to a socio-economic and demographic perspective of the slum population of Delhi.

Study Design:

A cross-sectional study was conducted and data were collected by a two-stage random sampling method. In the first stage, slum locations were selected and in the second stage households were selected.

Participants:

Data were collected from 1049 households consisting of 5358 individuals'' information.

Results:

The overall morbidity prevalence is 15.4%. It is 14.7 and 16.3% for males and females, respectively but the differences are not statistically significant. The reported higher morbidity prevalence and the illiteracy status are significantly associated. Diseases of the respiratory system appear to be very high among slum dwellers.

Conclusion:

From this study, it can be concluded that the number of years of staying in the slum area, presence of a separate kitchen, type of house, it being Pucca or Kuccha, types of toilet pits or open defecation are the important environmental factors for the reports of higher morbidity patterns from the slum area.     

Development and Standardization of Dot – ELISA for Detection of Neospora caninum Antibodies in Cattle and Comparison with Standard Indirect ELISA and Direct Agglutination Test (DAT)

Background

Neospora caninum is a protozoan parasite from phylum apicomplexa and an important agent causing abortion in cattle which produce notable economic loss all around the world.

Methods

Dot-Elisa was set up performing checker board procedure and then 178 sera of cattle examined with commercial indirect ELISA and direct agglutination test (DAT) were also evaluated by dot-ELISA afterwards.

Results

Kappa statistical analysis revealed that Dot-ELISA has good agreements with ELISA as well as the DAT and also, Mc Nemar’s analyzing showed that this procedure has acceptable ability to discriminate positive results. Relative sensitivity and specificity of Dot-ELISA were respectively 92.63% and 89.16% and 93.4% and 90.8% in comparison with ELISA and DAT.

Conclusion

Since the dot-ELISA is easy, inexpensive and not needed high experience to interpret the results, it is superior to ELISA and DAT when we aim to screen the cattle on the farm and slaughterhouses or when the laboratory equipment is not available.     

Barriers for an effective communication around clinical decision making: an analysis of the gaps between doctors' and patients' point of view

Background

There are doubts on whether patients feel that they have sufficient information for actively participating in clinical decisions.

Objective

To describe the type of information that patients receive. To determine whether patients consider this information sufficient, and whether it contributes or not to improve clinical safety. To identify the barriers for patient participation in clinical decision making.

Study Design

Cross‐sectional study with 764 patients and 327 physicians.

Study Setting and participants

Fourteen health centres belonging to three primary care districts and three hospitals in Spain.

Principal Findings

Just 35.1% (268) (95% CI 32.2, 39.1%) of patients preferred to have the last word in clinical decisions. Age (39 vs. 62%, P < 0.001) and severity of illness (38 vs. 46%, P = 0.002) increased the tendency to take a passive role. In 85.1% (650) (95% CI 83.3, 88.3%) of the cases, patients reported having received sufficient information. Lack of consultation time (29.6%, 95% CI 25.8, 32.5%) and patients'' use of Internet or other sources (19.2%, 95% CI 16.4, 22.2%) were identified as new obstacles to doctor–patient communication by the patients. Only 19.6% (64) (95% CI 15.4, 24.2%) of doctors considered that they could intervene to involve patients in the decisions.

Discussions and Conclusions

The majority of patients prefer the decisions to be made by their doctor, especially those with more severe illnesses, and older patients. Patients are not normally informed about medication interactions, precautions and foreseeable complications. The information provided by general practitioners does not seem to contribute enough to the patient involvement in clinical safety.     

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.     

Assessment of Immunization Status in the Slums of Surat by 15 Clusters Multi Indicators Cluster Survey Technique

Research Question:

What is the immunization status of children in the slums of Surat and what changes has it undergone in recent times?

Objective:

To assess the immunization status of children between the ages of 12 and 23 months in the slums of Surat and to compare it with the MICS from previous years.

Study Design:

This was a community-based cross-sectional study conducted in 15 clusters.

Settings:

15 urban slums selected out of a total of 299 slums using the cluster sampling method.

Study Tool:

The Multi Indicator Cluster Sampling (MICS) method was used for sample selection and the proforma designed by UNICEF was used as a study tool.

Statistical Analysis:

Simple proportions and a Chi-square test.

Results:

Only 25% of the children between the ages of 12 and 23 months were fully immunized; coverage was highest for BCG (75%) and lowest for measles (29.9%). As far as the dropout rate is concerned, it was 60.2%, 31.9%, and 31.5% for BCG to measles, DPT₁ to DPT₃, and OPV₁ to OPV₃, respectively. Vitamin A was taken by only 28.9% of the subjects. Between the two, female children were more disadvantaged in terms of vaccination. When compared with the coverage of 1997 and 1998, the current coverage is poor, more so in relation to DPT and OPV.     

Development of a model to guide decision making in amyotrophic lateral sclerosis multidisciplinary care

Background

Patients with amyotrophic lateral sclerosis (ALS) face numerous decisions for symptom management and quality of life. Models of decision making in chronic disease and cancer care are insufficient for the complex and changing needs of patients with ALS .

Objective

The aim was to examine the question: how can decision making that is both effective and patient‐centred be enacted in ALS multidisciplinary care?

Setting and participants

Fifty‐four respondents (32 health professionals, 14 patients and eight carers) from two specialized ALS multidisciplinary clinics participated in semi‐structured interviews. Interviews were transcribed, coded and analysed thematically.

Results

Comparison of stakeholder perspectives revealed six key themes of ALS decision making. These were the decision‐making process; patient‐centred focus; timing and planning; information sources; engagement with specialized ALS services; and access to non‐specialized services. A model, embedded in the specialized ALS multidisciplinary clinic, was derived to guide patient decision making. The model is cyclic, with four stages: ‘Participant Engagement’; ‘Option Information’; ‘Option Deliberation’; and ‘Decision Implementation’.

Discussion

Effective and patient‐centred decision making is enhanced by the structure of the specialized ALS clinic, which promotes patients'' symptom management and quality of life goals. However, patient and carer engagement in ALS decision making is tested by the dynamic nature of ALS, and patient and family distress. Our model optimizes patient‐centred decision making, by incorporating patients'' cyclic decision‐making patterns and facilitating carer inclusion in decision processes.

Conclusions

The model captures the complexities of patient‐centred decision making in ALS. The framework can assist patients and carers, health professionals, researchers and policymakers in this challenging disease environment.     

Noncompliance to DOTS: How it can be Decreased

Background:

Tuberculosis is a communicable disease requiring prolonged treatment.The therapeutic regimens as recommended by WHO have been shown to be highly effective for both preventing and treating tuberculosis but poor adherence to medication is a major barrier to its global control.

Aim:

The aim was to elicit reasons of treatment default from a cohort of tuberculosis patients treated under Directly Observed Treatment Short course chemotherapy.

Settings and design:

Thiscross-sectional study was conducted in Agra city using the multistage simple random sampling.

Materials and Methods:

A total of 900 patients attending DOTS centres of the selected designated microscopy centers (DMCs) were included in the study from January 2007 onward. The information was obtained from treatment cards of patients and those who defaulted were further interviewed in community.

Statistical analysis:

Chi-square test was applied to observe the significance of association using the Epi Info software (version 6).

Results:

More default was observed among the age group of >45 years (22.8%), male (18.7%), business men (30.6%), and retired and unemployed patients. Other factors associated with higher default were pulmonary disease (18.2%), retreatment cases (30.6%) and category II patients (26.4%). Important reasons of default were side effects following medication (43.2%), improvement in symptoms (14.4%), and lack of time (13.5%). No relief in symptoms and lack of awareness were other important reasons.

Conclusions:

Noncompliance was found to be mainly due to side effects of medicines, lack of time, and unawareness. So educating the patient about various aspects of tuberculosis and some measures to decrease side effects are of utmost importance.     

Parents' experiences of living with a child with hydrocephalus: a cross‐sectional interview‐based study

Background

Shunts, the main treatment for hydrocephalus, are problematic because they frequently malfunction. Detecting shunt malfunction is challenging because symptoms are similar to those of common childhood illnesses, particularly viral infections. Parents are responsible for identifying shunt malfunction and responding accordingly. Understanding parents'' experiences has the potential to improve parent–professional collaboration and the management of the child''s condition.

Aim

To explore parents'' experiences of living with a child with hydrocephalus and their decisions when they suspect shunt malfunction.

Design and methods

A cross‐sectional interview‐based survey using qualitative methods was undertaken. Twenty‐five parents participated in the interviews. Framework approach underpinned data analysis.

Findings

Three concepts, ‘uncertainty’, ‘developing expertise’, and ‘a normal life’, were identified. These concepts were dynamic in nature as parents learned through experience, adapted to changes in their child''s health status and made decisions about their needs. Uncertainty because of the unpredictability and life‐threatening nature of shunt malfunction dominated parents'' accounts. Through experience, parents learned to differentiate between symptoms that suggested a shunt problem and those of other childhood illnesses, but perceived their expertise was not always valued by health professionals or used to inform clinical decisions. Decisions about where or when to seek advice related to prior experiences of health‐care services and minimizing disruption for the whole family.

Conclusion

Parents can recognize illness symptoms suggestive of shunt malfunction and want to collaborate with health professionals about the management of their child''s condition. Collaboration with parents requires health professionals to listen to parents'' concerns and value their experiences.     

Characterization of Eimeria Species in Commercial Broilers by PCR Based on ITS1 Regions of rDNA

Background

Coccidiosis is an intestinal disease of chickens caused by various species of protozoan parasites within the genus Eimeria. Diagnosis and genetic characterization of different species of Eimeria are central to the prevention, surveillance, and control of coccidiosis. The aim of this study was to detect different chicken Eimeria species from several areas in Khuzestan, southwest Iran.

Methods

From February to September 2008, PCR assay as well as parasitological examinations was applied for the identification of field isolates of Eimeria parasites around Ahvaz, center of Khuzestan, southwest Iran. Data were analyzed by the Kappa statistic test.

Results

Eimeria maxima, E. necatrix, E. tenella, E. acervulina and E. mitis were detected in this study. The prevalence of Eimeria spp. was 31.5% (126 of 400) and E. tenella was the most prevalent species in Khuzestan. Based on the Kappa statistical test, a good correlation between the results of PCR and traditional biometrical methods was only observed for E. maxima.

Conclusion

The present study is the first on the prevalence of Eimeria species in Khuzestan, based on the molecular findings. We believe that traditional methods are not sufficiently reliable for specific diagnosis of Eimeria species in chickens and PCR based amplification of DNA sequence of parasite, could resolve this problem.     

Study of Clinical Profile and Antibiotic Sensitivity Pattern in Culture-positive Typhoid Fever Cases

Background:

Salmonella enteric serotype Typhi has created a significant therapeutic problem as these strains have developed resistance to the commonly used antimicrobials for the treatment of typhoid fever.

Objectives:

To assess the clinical profile and sensitivity patterns to anti-typhoid drugs.

Materials and Methods:

A retrospective analysis of 106 culture-positive typhoid cases admitted in a tertiary care hospital during the years 2005-2008.

Results:

Records of 106 patients were evaluated, 83 (78.3%) males and 23 (21.7%) females. Fever was present in all patients. Headache in 63 (59.4%) patients and generalized body ache in 53 (32.5%) patients were the most common symptoms, while spleenomegaly in 47 (44.3%) patients and hepatomegaly in 42 (39.6%) patients were the common presenting signs. A maximum sensitivity of 96.6% was observed with cephalosporins, whereas a resistance of 29.2% was seen with fluoroquinolones.

Conclusion:

A high degree of sensitivity was noted to chloramphenicol, ampicillin and sulphonamides, showing a trend of roll-back of sensitivity to conventional antibiotics.     

Tobacco Use Among Adolescent Students and the Influence of Role Models

Background:

Seventy per cent of premature deaths among adults are due to behavioral patterns that emerge in adolescence, including smoking.

Objective:

The objective was to study the prevalence of tobacco use among adolescent students in South Delhi and its epidemiological correlates.

Materials and Methods:

This was a cross-sectional study.

Setting:

Three schools and two colleges of South Delhi were chosen. There were 550 adolescent students aged 14-19.

Statistical Analysis:

Statistical analysis was done using proportions, the chi-square test, and multivariate logistic regression.

Results:

A total of 88 (16.0%) students reported having ever tried cigarette or bidi smoking. The prevalence of current smoking was 7.1%. Exactly 10% (55) of the students reported having ever used smokeless forms of tobacco. The prevalence of tobacco use overall was found to be 20.9%, and was significantly higher (P=0.016) among the males than the females. Tobacco use was found to be significantly associated with having seen a brother/sister smoke (OR 5.15), best friend smoke (OR 2.92), and belonging to a nuclear family (OR 1.96).

Conclusions:

Tobacco use is still an important risk behavior among adolescent students. This study found a strong association of tobacco use by the adolescents with their having seen various role models ever smoking.     

Serological,Clinical, and Epidemiological Profile of Human Brucellosis in Rural India

Background:

Brucellosis is an important but neglected zoonotic disease in India. Due to frequent animal contact, high prevalence of this disease, though expected in rural population, has not been much studied.

Aim:

The study was carried out to determine serological, clinical, and epidemiological profile including associated risk factors for human brucellosis in rural India.

Materials and Methods:

In this cross-sectional study, serum samples from 1,733 individuals residing in rural areas were screened for the presence of anti-brucellar antibodies by Rose Bengal Plate test (RBPT), Serum Agglutination test (SAT), and 2-Mercaptoethanol test (2-ME). Clinical symptoms, epidemiological data including risk factors and knowledge about brucellosis were evaluated by personal interview using a structured questionnaire.

Results:

Of the 1,733 individuals, 998 had direct contact with animals, whereas 735 had no direct contact. The overall positivity rates by RBPT, SAT, and 2-ME test were 10.50% (182), 7.32% (127), and 5.88% (102), respectively. Clinical symptoms resembling brucellosis were seen in 151 (8.71%) subjects. Animal contact especially during milking, parturition/abortion was the major risk factor, followed by raw milk ingestion. None of the participant knew about brucellosis.

Conclusion:

Regular surveillance of the disease with awareness programs emphasizing prevention and control are needed.