Delay in diagnosis and treatment among registered TB patients in Directly Observed Treatment Short Course cum Designated Microscopy Centres in South Delhi

Background: Knowing delays in treatment seeking and subsequent treatment initiation among the TB patients is important and its detailed understanding is crucial in modifying the treatment seeking behaviour which can help in reducing the TB burden and the transmission in the community. Aim & Objective: To study the treatment seeking behaviour including the delays in initiation of treatment along with its determinants; among tuberculosis patients aged > 15 years in Mehrauli area of Delhi. Settings and Design: A longitudinal follow up study conducted in two randomly selected DMC cum DOTS centres in Mehrauli area of Delhi from January 2018 to April 2018. Methods and Material: Patients of both sexes of age > 15 years, registered under RNTCP from January to April 2018 in the randomly selected DOTS centres i.e. Mehrauli DMC cum DOTS and Chattarpur DMC cum DOTS centre were included in the study. Self-designed, pretested interview schedule and records of DMC were used to collect the relevant information. Statistical analysis used: Information collected in the Performa was coded and entered in Statistical Package for Social Sciences (SPSS) version 12. Results: The mean patients delay, diagnostic delay, treatment delay, health care system delay and total delay was 48.91 ± 130.38 days, 91.09 ± 155.97 days, 6.25 ± 6.29 days, 62.72 ± 119.48 days and 97.33 ± 155.06 days respectively. The median patients delay, diagnostic delay, treatment delay, health care system delay and total delay was 15 days, 45 days, 5 days, 35 days and 54 days respectively. Conclusions: The major reasons for patient’s delay were lack of awareness regarding the symptoms of TB and self-medication and for health care system delay it was treatment from private health care providers

Practitioners' Section - How the findings of national family health survey-3 can act as a trigger for improving the status of anemic mothers and undernourished children in India: A review

The national family health survey-3 (NFHS-3) reports of declining fertility rate while increasing prevalence of anemia in women and children, since NFHS-2 in 1998-99. The proportion of anemic, stunted and wasted children has also increased since the previous two rounds. NFHS trends show that the status of mother′s and child′s health indicators is continuing to deteriorate in spite of the many government-run targeted programs, e.g., integrated child development scheme (ICDS), Midday meal program. The only good sign in the findings is the favorable trend in fertility indicators and infant mortality rate. A review of the findings of NFHS surveys, the current government policies and programs targeted upon the improving of health status of women and children in India and of the published scientific literature was conducted. The aim of the review was to understand the health situation of women and children in India and to suggest measures to bring about positive changes in the health status of this population. The analysis suggests that the findings of these successive surveys are not being utilized for the necessary corrective measures. The authors argue that although the NFHS is a useful exercise, in the wake of decentralized planning, the country needs more detailed data focusing on the districts. Synchronization of the ICDS and national rural health mission (NRHM), along with entrusting the responsibility of conducting NFHS to the planning commission, is the other possible solution to tackle the problems of rising anemia and malnutrition in the country

Self Body Image and Perceived Health in Adolescents: A Facility Based Study

Introduction: Adolescence is a transitional phase between childhood and adulthood, characterized by a number of cognitive, physical, emotional and attitudinal changes. Their development through the stages of puberty in early adolescence is associated with change in body mass, leading to change in body image, and higher levels of drive for fitness and looking good. Studies suggest that adolescents who are dissatisfied with their bodies are more likely to perceive their health as fair or poor and more likely to show low self-esteem.Objective: To assess the Self Body Image and Perceived Health in adolescents of 13- 17 years attending Urban Health Centre, East Delhi and to study the relationships between Body Image and Perceived health in adolescents.Method: A cross sectional study was conducted in the outpatient department of Urban health centre, Kalyanpuri area located in East Delhi, from July to September 2013. A semi structured, pretested, proforma was administrated to collect data. Sample size of the study was 203 (98 boys and 105 girls), taken by non-probability (convenient) sampling. Proforma included questions related to the Perceived Health, Body Image, Body Satisfaction and anthropometric measurements of study subjects. Data was compiled and analyzed by SPSS version 12.Results: Girls were more likely to report bothersome health issues than boys and the probability of having issues found to be increasing with age. 21.8% of boys ‘do not feel healthy’ as compared to 56.8% that of girls. Proportion of boys who ‘do not feel healthy’ was decreasing with age as compared to that of girls. An average 53% of boys were found to be satisfied with their body as compared to 40.6% in girls. Concern for physical appearance was found to be increasing with age in both boys and girls. Older age groups more often in girls tend to follow certain diets and seem to be more dissatisfied with their weight and appearance. Subjects who were unsatisfied with their body/ physique perceived their health as ‘not good’ and the difference in the two groups was found to be statistically significantConclusion: Adolescence being a very influential phase in life, perception about body image has a role to determine the health. Access to correct information about growth, development and all other issues corroborate with their healthy behaviors. Counseling and personalized health care services would help them to deal with their perceived issues of body image

Breast Self-Examination intervention package: A boon to lesser educated women of a marginalized community

Introduction: Breast self-examination (BSE) is a noninvasive and cost-effective method that allows women to examine their breast tissue for any visual or physical changes. It is recommended that all women aged 20 years and older should perform BSE as soon as the breasts are fully developed, and this should be done every month and at the end of the menstruation cycle. The awareness levels regarding BSE among women are poor and can be enhanced by Behavior Change Communication (BCC). The objective of this study was to assess the knowledge regarding BSE pre- and post-educational intervention among adult women of the reproductive age group. Methods: A community-based interventional study was conducted among 150 adult women (18–49 years) residing in the Palam area of Delhi. A BCC intervention package was administered, and pre- and 3-month post-intervention assessment was done. Results: The mean age of the study participants was 34 ± 9.46 years. None of the women had a good score of knowledge before intervention; while after intervention, more than half (56%) achieved a good score. The association between improvement in the BSE knowledge scores with age, socioeconomic status, and tobacco usage was found to be statistically significant. Conclusion: The mean score of knowledge improved after giving the BCC and the difference in all three scores was highly significant. Such an intervention package will benefit the women belonging to marginalized communities by raising awareness levels and acceptance for BSE

Effect of Impairment and Disability on Health-Related Quality of Life of Elderly: A Community-Based Study from Urban India

Introduction: Increasing population of elderly and the emergence of epidemic of chronic or (non-communicable) diseases, which is likely to adversely affects their health-related quality of life (HRQOL), has implications on health systems in developing countries such as India. A study was conducted to know the common impairments and disabilities and their effect on HRQOL in elderly population. Materials and Methods: A community-based cross-sectional study on elderly, selected by cluster sampling from central Delhi, India, was conducted from April 2005 to February 2006. A pre-tested, semi-structured questionnaire, along with Short Form -36 (SF-36) survey was used for data collection. The data was analyzed using Chi square and student′s t test on SPSS v12 statistical software. P value of less than 0.05 was considered statistically significant. Results: A total of 200 elderly were included in the study. 71.5% subjects had at least one disability/impairment. Around 40% subjects reported their health being poor and another 50% of worsening of their health in the last 1 year. HRQOL score for people with and without chronic morbidity/disability was 51.8 and 73.5, respectively (P<0.05), with overall mean score 56.7 (±17.2). The most commonly affected HRQOL domains were Role Physical, Physical Functioning, and General Health. The HRQOL and domain scores decreased with increasing age, and females had lower mean scores than males (P<0.05). Conclusion: The HRQOL of elderly in urban India is severely affected by impairments and disabilities. There is an immediate need for specific preventive and rehabilitative measures targeted on elderly to maintain their health related quality of life. This information may be utilized for designing any policy and/or program targeted for elderly in India and in other similar settings

Awareness and practices regarding needle stick injuries among nurses in a tertiary care hospital of Delhi

Introduction: Needle stick injuries are an important occupational hazard for nursing personnel as they form an important mechanism for transmission of blood borne pathogens. Hence the knowledge of nurses about the prevention and management of needle stick injuries and practicing standard precautions is critical. Methodology: This was a hospital based cross sectional study conducted among nursing staff during the month of December, 2011. A semi structured questionnaire was administered to 320 nurses working in a tertiary care hospital of New Delhi by adopting systematic random sampling methodology. Data was entered and analysed using SPSS version 12. Percentages of categorical variables were computed. Results: Only 31.1% nurses had adequate knowledge about steps for prevention of needle stick injuries. 259(88.4%) nurses had adequate knowledge about the authority to whom they should report needle stick injuries while almost three fourth i.e. 73.4% had adequate knowledge about management of needle stick injuries. Majority of nurses (69.6%) reported the use of gloves very often before venipuncture, 80.2% never recapped needles while 77.5% disposed sharps in puncture proof containers very often. Only one fourth (24.6%) nurses always used personal protective equipment in case of emergencies. 85.7% of nurses had received all three doses of hepatitis B vaccine. 51(17.4%) had a history of needle stick injury in the last one year out of which 49(96.1%) took adequate measures immediately after the injury and 37 (72.5%) reported the incidence to the concerned authority. Conclusion:  The knowledge and practices of nurses regarding prevention and management of needle stick injuries were found to be unsatisfactor

Hypertension and its risk factors among postmenopausal women in Delhi

Background: Hypertension is the commonest cardiovascular disorder, posing a major public health challenge to population in epidemiological transition. The prevalence of hypertension increases with age and is more common in men as compared to women. But women loose this advantage after menopause due to estrogen deficiency. Objectives: 1. To assess the prevalence of hypertension and risk factors for hypertension among postmenopausal women in an urban community in Delhi. 2. To study association of risk factors with hypertension. Methodology: A community based cross-sectional study was conducted at Palam, an urbanized village in Delhi. A total 416 postmenopausal women were interviewed, examined and investigated. Results: Majority (78%) of postmenopausal women were in the age group of 45-65 years. More than three fourth 342 (82.4%) of women belonged to lower middle and upper lower socio-economic status. The prevalence of hypertension in these women was 39.6%, another one third (37%) were pre-hypertensive. All women had one or more than one risk factor for hypertension. The most common risk factors were high salt intake (82.7%), low vegetable and fruit intake (64.2%), stress (53.2%) and truncal obesity (36.1%). Risk factors like diabetes, obesity, smoking and physical inactivity were significantly more common in hypertensive as compared to non-hypertensive. Conclusion: Burden of hypertension among postmenopausal women in the present study was found to be high. Interventions integrating promotive, preventive and curative care for postmenopausal women should be provided to them

Management of vitiligo: An ayurvedic perspective

Shwitra or Shwet-Kushtha can be co-related with skin disease "vitiligo" in biomedicine. According to Ayurveda, the skin is one of the essential sense organs. Vata and bhrajaka pitta reside in the skin (called twak in Sanskrit). As the skin covers the whole body, bhrajaka pitta should be maintained in a proper state, and it needs continuous care. An imbalance in Vata and bhrajaka pitta may cause skin diseases. The first step (Step 1) in Ayurvedic management of vitiligo is purification therapies (shodhana karma) using herbal decoction of Psoralea corylifolia (bakuchi kwatha) and Euphorbia neriifolia (snuhi) aimed to induce multiple bouts of purgation. In the next step (Step 2), oil massage using oil selected on the basis of patient examination (rogi pariksa) and disease (roga). Step 3 is the exposure of lesions to the sun rays as long as the patient can tolerate (Soorya pada santhapam in Ayurveda). Herbomineral preparations include topical application of herbal Lepa, powders made up of medicinal plants (Curna), herbalized ghee preparations similar to paste (Ghrita, semi-solid preparations taken orally, by licking (Avaleha), herbalized oil preparations (Thaila), fermented solutions (Asava-Arista), and tablets (Vati/Gutika). Various minerals and metallic salts (Rasousadha) are also used. Bakuchi oil is Ayurvedic medicinal oil prepared from the dried fruits of P. corylifolia, and sesame oil is a popular therapy for vitiligo in Ayurveda that contain psoralen to stimulate melanocytes when exposed to ultraviolet light exposure. Details of above-mentioned therapy are discussed. Scientific rationale behind the use of these medications needs to be further explored with modern methods and research

Awareness and willingness to pledge for eye donation among adult population of an urban re-settlement colony of Delhi

Introduction: Blindness is one of the major public health problems in India. Visual rehabilitation by corneal transplantation remains a major treatment option in those who are already blind due to corneal diseases. To combat with shortage of corneal donation in India, spreading awareness among masses regarding eye donation becomes important. Objectives: (1) To determine the awareness regarding eye donation amongst adults (>20 years) in an urban re-settlement colony of Delhi. (2) To assess their willingness to pledge for eye donation. (3) To determine the factors influencing their decision for eye donation. Material and Methods: This was a cross sectional study, conducted in the urban health centre attached to a medical college of Delhi between October to December 2013. Systematic random sampling was used and every alternate adult patient >20 yrs attending the UHC was recruited. Data entry and analysis was done using SPSS by a single investigator. Results: Majority (84.4%) had heard of eye donation. Only 21.2% were aware about contraindications for donating eyes. A little over quarter (27.6%) had heard of eye bank facility. When asked whether the retrieved eye can be stored before transplantation, majority (59.2%) didn’t know. More than half (54%) didn’t know which part of eye is removed. Mass media was major source of information in three forth respondents (74.9%). 45.5% were willing to pledge their eyes, a similar proportion was not willing (44.1%), five (2.4%) had already pledged and 17 (8.1%) were yet undecided to pledge. Conclusion: While majority of participants had heard of eye donation, but their knowledge regarding certain aspects of eye donation was found to be poor

Assessment of menstrual hygiene among adolescent girls of East Delhi: A community-based cross-sectional research from an urban resettlement colony

Introduction: Even though menstruation is a normal physiological process, menstrual hygiene is a most neglected issue with many myths and social stigmas being associated with it. Due to unhygienic menstrual practices, young girls are vulnerable to reproductive tract infections and pelvic inflammatory diseases and other complications. Therefore, the objective of this study was to assess the knowledge, attitude, and practices of menstrual hygiene among adolescent girls. Material and Methods: This is a descriptive cross-sectional study conducted in an urban resettlement colony of Kalyanpuri, East Delhi. One hundred and five adolescent girls participated in the study. The mean age of the participants was 14.18 ± 2.13 years. Predesigned and pretested semi-structured questionnaire was used. Institutional Ethical clearance was obtained. Results: In this study, out of 105 girls, only 35.2% girls had knowledge about menstruation before they experienced menarche. Only 56.2% girls were aware that menstruation is a normal physiological process. Overall knowledge level about menstrual hygiene was unsatisfactory. Only 31.4% of girls were using sanitary pads during menstruation, 59.25% of the respondents had good practices. About 12.4% girls had positive attitude toward menstrual hygiene. Conclusion: Although practices on menstrual hygiene management among adolescents were fairly satisfactory, knowledge and attitude still need to improve. Findings indicate the need of behavior change communication campaigns along with frequent reinforcement of school health education programs