Determinants of utilization of services under MMJSSA scheme in Jharkhand 'Client Perspective': a qualitative study in a low performing state of India

Preventing maternal death associated with pregnancy and child birth is one of the greatest challenges for India. Approximately 55,000 women die in India due to pregnancy- and childbirth- related conditions each year. Increasing the coverage of maternal and newborn interventions is essential if Millennium Development Goals (MDG) 4 and 5 are to be reached. With a view to accelerate the reduction in maternal and neonatal mortality through institutional deliveries, Government of India initiated a scheme in 2005 called Janani Suraksha Yojna (JSY) under its National Rural Health Mission (NRHM). In Jharkhand the scheme is called the Mukhya Mantri Janani Shishu Swasthya Abhiyan (MMJSSA). This paper focuses on community perspectives, for indentifying key areas that require improvement for proper implementation of the MMJSSA in Jharkhand. Qualitative research method was used to collect data through in-depth interviews (IDIs) and focus group discussions (FGDs) in six districts of Jharkhand- Gumla, West Singhbhum, Koderma, Deoghar, Garhwa, and Ranchi. Total 300 IDIs (24 IDIs each from mother given birth at home and institution respectively; two IDIs each with members of Village Health and Sanitation Committees (VHSC) / Rogi Kalyan Samitis (RKS) from each district) and 24 FGDs (four FGDs were conducted from pools of husbands, mothers-in-law and fathers-in-law in each district) were conducted. Although people indicated willingness for institutional deliveries (generally perceived to be safe deliveries), several barriers emerged as critical obstacles. These included poor infrastructure, lack of quality of care, difficulties while availing incentives, corruption in disbursement of incentives, behavior of the healthcare personnel and lack of information about MMJSSA. Poor (and expensive) transport facilities and difficult terrain made geographical access difficult. The level of utilization of maternal healthcare among women in Jharkhand is low. There was an overwhelming demand for energizing sub-centers (including for deliveries) in order to increase access to maternal and child health services. Having second ANMs will go a long way in achieving this end. The MMJSSA scheme will thus have to re-invent itself within the overall framework of the NRHM.     

Timing of first sex before marriage and its correlates: evidence from India

While several studies have documented the extent of pre-marital sexual experience among young people in India, little work has been done to explore the factors that are correlated with the timing of pre-marital sexual initiation. This paper examines age at initiation of pre-marital sex, circumstances in which first sex was experienced, nature of first sexual experience and correlates of age at initiation of pre-marital sex. Life table estimates suggest that pre-marital sexual initiation occurred in adolescence for 1 in 20 young women and 1 in 10 young men. For the majority of these young people, their first sex was with an opposite-sex romantic partner. First sex, moreover, was unprotected for the majority and forced for sizeable proportion of young women. A number of individual, family-, peer- and community-level factors were correlated with age at first pre-marital sex. Moreover, considerable gender differences were apparent in the correlates of age at first pre-marital sex, with peer- and parent-level factors found more often to be significant for young women than men.     

Insecticide-treated bed nets in rural Bangladesh: their potential role in the visceral leishmaniasis elimination programme

Objective To analyse the feasibility, acceptability and effectiveness of insecticide‐treated bed nets with slow‐release insecticides (KO Tab 123) as an option for kala‐azar vector management in Bangladesh. Methods Intervention study involving an insecticide dipping programme through village health workers supervised by public health officers covering 6967 households in Mymensingh and 8287 in Rajshahi district. In a subsample of households, sandfly densities at baseline, 1, 12 and 18 months were measured with CDC light traps both in intervention and control areas. Bioassays were performed for determining the bioavailability of the insecticide and tests of chemical residues in the treated bed nets were undertaken. Satisfaction surveys and direct observation of use of treated bed net use were conducted. Results The dipping programme was feasible with the help of communities and public health staff, was well accepted, reached a coverage of 98.2% and 96.2% in the two study sites within 4 weeks and was effective in terms of a significant reduction in sandfly densities (approximately 60%) for a period of 18 months. Bioassay results were satisfactory (>80% sandfly mortality) and the average chemical content of the treated bed nets was sufficient for killing sand flies at the end of the observation period. Conclusion Bed nets treated with slow‐release insecticides can be an important complementary measure for sandfly control in the visceral leishmaniasis elimination programme.     

Single Injection Technique Prolotherapy for Hypermobility Disorders of TMJ Using 25 % Dextrose: A Clinical Study

Introduction

Hypermobility disorders of the Temporomandibular joint (TMJ) can be treated by both conservative and surgical approaches. Conservative approaches should be considered as first line treatment for such disorders. Prolotherapy with 25 % dextrose being injected into the posterior pericapsular tissues is one such treatment modality with favorable outcomes.

Aim

To study the efficacy of single injection of 25 % dextrose in pericapsular tissues in the management of hypermobility joint disorders of TMJ as first line treatment.

Patients and Methods

We have studied a total of 23 patients suffering from either chronic recurrent dislocation or subluxation of the TMJ who were treated with the single injection technique prolotherapy with 25 % dextrose into the pericapsular tissues along with auriculotemporal nerve block and found encouraging results.

Results

Overall success rate in our study was 91.3 % (21/23) with a minimum follow up period of 13.9 months. Number of successfully treated patients requiring one injection was 7 (30.4 %), two injections was 8 (34.7 %) and requiring three injections was 6 (26.1 %). There were no permanent complications.

Conclusion

Hence the use of 25 % dextrose as a proliferant to treat hypermobilty disorders of the TMJ is recommended by us as a first line treatment option as it is safe, economical and an easy procedure associated with minimal morbidity.

     

Anatomical Factors Influencing the Outcome of Intracerebral Hemorrhage - A Study From North Bengal

Today in our tensionful lifestyle cerebrovascular accident is in its escalating rampage. A total of one hundred and forty cases were studied in an attempt to find out the anatomical factors which can influence the outcome of stroke patients due to intracerebral hemorrhage in different age groups in both the sexes. CT scan has been used as a diagnostic tool to detect the site of lesion and the anatomical factors specially the intraventricular extension (IVE) and herniation/midline shift (MLS). Intraventricular extension (IVE), midline shift (MLS) and sensorium of the patient were assessed as important parameters in determining the outcome in patients of intracerebral hemorrhage.     

Structure-toxicity relationship of chloroacetanilide herbicides: Relative impact on soil microorganisms

The research was carried out to ascertain the effect of three chloroacetanilide herbicides, alachlor, butachlor and pretilachlor on soil microbial biomass growth and activity. Laboratory experiments were performed in a silty clay loam soil to relate changes of soil enzymatic activity to the herbicide persistence under laboratory condition up to 42 days at three application rates. The results showed that all the three herbicides caused enhancement of dehydrogenase activity. Higher concentrations of herbicide resulted in enhancement of the enzymatic activity. In addition, a similar trend was observed in β-glucosidase and acid phosphatase activity, although urease activity decreased upon incubation for 42 days as compared with initial soil incubation values. Based on the extent of impact for dehydrogenase activity in soil, the order was pretilachlor>alachlor>butachlor; whereas in case of urease activity, the order changed to pretilachlor>butachlor>alachlor. The soil half-lives of alachlor, butachlor and pretilachlor respectively, were 9.3, 12.7 and 7.3 days, which could be accounted for in terms of their respective chemical structures, as well as variable adsorption, degradation, differential effects of the agents on soil microbes. Soil management practices and the differing physicochemical properties of the herbicides may contribute to their rates of decay in soil.     

Evaluation of in vitro antioxidant,anticancer and in vivo antitumour activity of Termitomyces clypeatus MTCC 5091

Context: Termitomyces clypeatus (Lyophyllaceae) is a filamentous edible mushroom, having ethnomedicinal uses. However, information about the antioxidant, anticancer and antitumour properties of this mushroom remains to be elucidated.

Objective: The study examines the in vitro antioxidant, anticancer and in vivo antitumour activity of T. clypeatus.

Materials and methods: Antioxidant activity was evaluated with seven in vitro assays. Cytotoxicity of T. clypeatus was tested against a panel of cancer cells lines including U373MG, MDA-MB-468, HepG2, HL-60, A549, U937, OAW-42 and Y-79 using MTT assay. The antitumour activity of aqueous extract was evaluated against Ehrlich ascites carcinoma (EAC) tumour model in Swiss albino mice.

Results: HPLC analysis of aqueous extract revealed the presence of sugar entities. Termitomyces clypeatus showed excellent in vitro antioxidant activity. Termitomyces clypeatus was found cytotoxic against all cancer cells, among which it showed higher activity against U937 (IC₅₀ 25?±?1.02?μg/mL). Treatment of EAC-bearing mice with varied doses of aqueous extract significantly (p?<?0.01) reduced tumour volume, viable tumour cell count and improved haemoglobin content, RBC count, mean survival time, tumour inhibition and % increase life span. The enhanced antioxidant status in treated animals was evident from the decline in the levels of lipid peroxidation, increased levels of glutathione, catalase and superoxide dismutase.

Discussion: The analyzed data indicate that the aqueous extract of T. clypeatus exhibits significant antitumour activity, which might be due to the antioxidant effects on EAC bearing hosts.

Conclusion: Termitomyces clypeatus possesses anticancer activity, valuable for application in food and drug products.