Structure and Process Evaluation of Cold Chain Management and Routine Immunization Services in Rural Western Gujarat

Maintenance of cold chain points are vital for preserving potency of vaccines for immunization of children and thereby averting vaccine preventable diseases in the community. Cold chain handlers should have sufficient knowledge and skills related to cold chain equipment handling and immunization practices.  The present study aims to evaluate maintenance of cold chain facilities at primary health care centers (PHCs), related logistics and observation of Mamta Day (Immunization Day). The observations include knowledge and practice of health workers about immunization activities, their communication skills, training status etc. Methods: There are total 31 Primary Health Centers in Jamnagar district, out of which, we decided to include 50% (15) of primary health centers and observed their cold chain, and Immunization day at a subcentre or Anganwadi centre of the selected PHC to assess the quality of immunization services. We included equal number of cold chain points from each block of the district to make it representative of entire district. Results:  Average population served by a cold chain point is 21985. Vaccine related logistics like cold boxes, vaccine carriers etc. were adequate in all facilities. All cold chain equipments were placed as per standard guidelines. The posts of medical officers and pharmacists were vacant in almost one fourth of cold chain points and they were run on deputation from other facilities. The knowledge and skills of health workers related to immunization practices were found to be satisfactory. Conclusion:  We observed that routine immunization program was implementing in the district satisfactorily. The posts of medical officers and pharmacists need to be filled up at the earliest for smooth functioning of immunization program in primary health centres

Problems faced by ASHA workers for malarial services under NVBDCP: a cross sectional study

Background: About 95% of the country’s population resides in malaria endemic areas. The NVBDCP is multi-faceted public health programme in the country. The NVBDCP became an integral part of the NRHM launched in 2005. In NRHM, ASHA worker should be placed at grass root level. So role of ASHA is critical at grass root level. Problems faced by ASHA, it will affect the performance. So, ASHA workers positioned at village, Population catered by them, education, work experience, problems related to incentive and any other problems should be considered. The primary objective was to know the problems faced by ASHA workers for malarial services under NVBDCP in Jamnagar district.Methods: A cross-sectional study was conducted in rural areas of the district by using multistage sampling.Results: There was vacant post of ASHA in one village of low performing sub-centre. ASHA having work experience of less than one year was concentrated in poor performing sub-centre villages. More than one third ASHA served > 2000 population and more than half of them belonged to low performing sub centres. Around one sixth ASHA workers had difficulty in getting incentive or any problems. Majority of them belonged to low performing sub centres-villages.Conclusions: Main identified problems were some areas were far to reach by them, getting incentive for work and populations catered by them were too high. Most of them belonged to low performing sub centre-villages. All of above findings had affected the performance of ASHA workers.

An assessment of sociodemographic factors and family planning practices in Jamnagar, Gujarat, India: a cross sectional study

Background: India was the first country in the world to launch a National Family Planning Programme in 1952. It was purely a demographic programme with the sole objective of reducing the birth rate to stabilize the population. As per 2011 census population increased with the growth rate of 17.7%. Thus even after 63 years of programme & many more new advances & updates in programme, India could not reach its target of at least 60% of couple protection rate. So there would be some definite factors prohibiting its use.Methods: A cross section study of 450 reproductive age group women was conducted to find out the factors of unmet need of contraception & socio demographic profile.Results: In present study couple protection rate was 57.11%, majority being permanent sterilization. The selection of contraception was influenced by her husband in 43.24% & by mother-in-law in 62.16%.Conclusions: The study revealed that almost half of the couple population was using the contraception that included temporary as well as permanent methods of contraception

Pregnancy-related Factors Responsible for Delivering Low Birth Weight Babies: An Institutional-based Cross-sectional Study, Jamnagar, Gujarat

BACKGROUND: The WHO defines LBW as Birth weight less than 2500 grams regardless of gestational age. Being born with a low birth weight also incurs enormous economic costs, including higher medical expenditures and social service expenses, and decreased productivity in adulthood. OBJECTIVE: To study distribution of newborns\u27 according to pregnancy related factors and its association with newborns\u27 birth weight. METHODS: An institutional based cross-sectional study. New-borns delivered at study institute were considered as study participants. Estimated final sample size was 500. Guardians (mothers) were face-to-face interviewed and also recorded data were collected from the case file and Mother and Child Protection Card. RESULTS: Prevalence of LBW newborns was higher in mothers with late ANC registration,visits, chronic medical conditions, infection during pregnancy, PIH, anemia, consuming tobacco, exposure to second hand smoke, LSCS/Assisted delivery, in female newborns\u27, current pregnancy birth order number more than 2, in pre term newborns\u27 and mothers with bad obstetric history. CONCLUSION: Create awareness and adoption of suitable family planning methods. Need to do early (within 12 weeks) ANC registration with minimum four ANC visits for better pregnancy outcome. Effective tracking and suitable intervention provided to improve current pregnancy outcome. Health care professional should pay special attention to high-risk pregnancy. Develop social culture in such a way that females are neither addicted nor exposed to any tobacco containing products in their life

Assessment of utilization of child health services (under RCH program) and incorrect practices related to perinatal events in Jamnagar district, Gujarat, India

Background: India contributes to 25% of the over 6.9 million under-five deaths occurring worldwide every year with nearly half of them in neonatal period .This study is related indirectly with the causes of U5MR (e.g. Neonatal sepsis, prematurity-LBW) through focusing on service utilization related to perinatal events & incorrect practices of essential Newborn care (e.g. initiation of breast feeding and exclusive breastfeeding). Objectives: (1) Assess utilization of child health services related to perinatal events (2) Assess incorrect practices related to perinatal events (3) Assess effect of demographic variables on service utilization and association of these variables with practices.Methods: A cross-sectional study of 400 children (12 to 59 months) was done using multistage sampling technique in Jamnagar district. 120 children were selected from urban and 280 from rural areas as urban: rural ratio is 3:7 in India.Results: 93.55% children having umbilical infection. Birth weights were taken in majority of children (95.75%), 15.83% of those weighed were having low birth weight (LBW). Application on umbilical cord after birth was seen in 10.25% & prelacteal feed in about 1/3rd children. Breastfeeding immediately or within 4 hours after birth was seen in 3/4th, exclusive breastfeeding in 2/3rd children.Conclusions: Children having umbilical infection were treated indicating better utilization of curative services. Taking of birth weights in majority of children indicating good functioning of healthcare professionals but some of those weighed were having low birth weight (LBW) indicating underutilization of preventive-antenatal services indirectly affecting child health. Incorrect practices like application on umbilical cord after birth and prelacteal feed were seen in children. Recommended practices like breastfeeding immediately or within 4 hours after birth, exclusive breastfeeding were seen in children. Colostrum giving was more prevalent and low birth weight was less prevalent in rural areas compared to urban areas which indicated better health care utilization in rural areas.

Immunization Status of 12-23 Months Children of Urban Jamnagar

Background: Immunization is one of most cost effective public health intervention. Aims: (1) To assess immunization status among children of 12-23 months age group (2) To find out left out/dropout rate (3) To check association of socio demographic factors with immunization status. Material & Methods: A cross sectional study of sample 240 children aged between 12 to 23 months (using 30 cluster sampling technique) from Jamnagar municipal corporation area. Immunization of child was assessed through immunization card, presence of BCG scar & interview. Results: Out of 240 children, Coverage of BCG-99.58%, OPV0-94.58%, DPT1-98.33%, DPT2-96.67%, DPT3-95.42%, OPV1-96.67%, OPV2-95.83%, OPV3-4.58%. Coverage of HepB1, HepB2, and HepB3 were 73.33%, 70.42%, 68.75% respectively. Coverage of measles was 87.75%. Fully immunized children were 65%. Vaccine dropout of BCG-Measles was highest 11.34%, followed by DPT1-measles 10.58%. For BCG-DPT3 4.17%, DPT1-DPT3 2.96% & for HEP1-HEP3 6.25%. Fully immunized status was higher among male child as compare to female child which was statistically significant. Fully immunized children were more in Hindu religion compared to others which was statistically significant. No association found between educations of mother & immunization status of child. Socioeconomic class had no association with immunization status. Conclusion: Vaccination coverage shows gradual improvement in last decade (Fully immunized 65%) but at the same time reflects incomplete utilization (dropout rate is around 11%). Coverage was higher among male children as compared to female children which indicate the existence of gender difference in utilization of immunization services in our study areas. Utilization of immunization services was higher in Hindu community as compared to other community

Life-style practices related to health promotion among adult males in urban areas of Jamnagar city, Gujarat

Background: Many countries have adopted health policies that are targeted at reducing the risk factors for chronic non-communicable disease. These policies promote a healthy population by encouraging people to adopt healthy life style behaviour. This paper examines the life style practices related to health promotion among adult males in Jamnagar city. Material & Methods: It was a community based cross-sectional study, carried out between June to December 2012. Total 400 subjects were interviewed from all the 17 urban wards of Jamnagar city by using pre tested, semi structured questionnaires. Results: Highest numbers (39%) were in the age group of 20-30 years, 66% were graduates and 50.5% were doing service. Majority of the subjects were consuming green leafy vegetables more than 3 times in a week. High intake of oil and salt was observed in majority of the subjects. 63% of the subjects were physically inactive, 15.3% were taking smokeless tobacco products while 3.8% were smokers. Conclusion: Majority of the subjects were physically inactive, having unhealthy dietary pattern

A Study on the Pattern of Self-reported Tobacco Addiction in Hypertensive Patients in Gujarat, India

Background: Both hypertension (HTN) and tobacco addiction pose a threat to the health, environment, and socioeconomic status (SES) of the people. When tobacco use disorder exists in people with HTN, it hastens the disease progress and causes early complications. The present study aimed to study the knowledge and practice of tobacco addiction in patients with HTN and find out the correlates of knowledge and practice of tobacco addiction. Methods: A cross-sectional study was conducted for a period of one year in the Jamnagar District of Western Gujarat, India. Out of total 400 samples, 50% were collected from the five selected Community Health Centers (CHCs) by random sampling and the rest from non-communicable disease (NCD) clinics at the tertiary care hospital of the district. Findings: Most of the patients were in their fifties or above (67.0%), women (57.0%), and married (86.5%). Only 12.0% had awareness about the hazards of tobacco addiction and the prevalence of tobacco addiction was 11%. It was found that use of smokeless tobacco (SLT) among samples was the highest (72.7%) followed by dual consumption, i.e., SLT and smoking (20.5%). The frequency of consumption was ≥ 5 times/day in 54.5%, 70.4% were addicted for > 10 years, and only 15.9% had ever tried to quit tobacco while only 11.4% had successfully quit it. It was seen that those who were aged < 50 years, men, literates, employed, and those belonging to higher SES and urban residence had better knowledge of the health hazards. This was found to have significant statistical association. Conclusion: The results provide valuable insight into the tobacco addiction in patients with HTN on which non-pharmacological treatment of HTN can be based

Assessment of Ear Nose and Throat morbidities prevalent in the school going children aged 5-14 years in rural area of Jamnagar

Background: India is home to more than 400 million children forming about 35% of its total population. Upper respiratory tract infections predispose a child to complications such as otitis media, tonsillitis, and sinusitis that further contribute to morbidity leading to hearing impairment and learning disability & even RHD. Unfortunately these morbidities are either not detected or remain untreated making situation worse. Aims and objectives:1. To assess the prevalence of common Ear Nose and Throat symptoms among children aged 5-14 years and to study its relationship with socio-demographic factors 2. To know regarding health seeking behavior in relations to Ear Nose and Throat morbidities. Materials and method: A cross-sectional study was done over a period of 2 months among 300 school children aged 5-14 years of six government schools of Jamnagar district. Assessment was done through clinical examination and oral questioners. Results: Prevalence of Ear Nose and Throat morbidity was 46.66%; Ear (14.33%), Nose(28.66%) and Throat(10%).Common Ear Nose and Throat problems were– common cold(23%), cough(9.67%), sore throat(8.34%) and ear ache(8.67%). Associations of Ear Nose and Throat morbidity with age and religion were statistically significant. Only 31.40% of children had taken treatment for the problems. Mother’s education had statistically significant association on health seeking behavior of school children. Conclusion: Prevalence of Ear Nose and Throat morbidity was very high among school children, only 1/3 children had taken treatment, indicating negligence towards problems on the part of parents as well as teachers suggesting strong need for sensitization of parents and teachers