Utilization pattern of antenatal health care services among married women of reproductive age group in the rural area of Surendranagar district, Gujarat, India: a community based cross sectional study

Background: Maternal mortality continues to be a major public health problem. Inspite of the existence of national programmes for improving maternal and child health in India, maternal mortality and morbidity continue to be high. High quality antenatal care is the most important way to reduce the maternal morbidity and mortality. Utilization of Ante natal care (ANC) services is poor in the rural areas, causing significant impact on the health of the mother and ultimately leads to increased maternal morbidity and mortality.Methods: It was a Community based Cross-sectional study. The study was carried out through oral questionnaire method using pre-designed and pretested performa. All the information was collected, compiled and analysed by applying suitable tests. The data was analysed by Statistical Package for Social Sciences (SPSS) and Microsoft word and Excel have been used to generate graphs, tables etc.Results: A total of 403 women were included in the study. Pregnancy registration was done by 88.77% of the women at either government facility or private doctor. Out of total registered women, majority i.e. 54.25% had registered their pregnancy during 2nd trimester. In response to frequency of antenatal visits, study showed that, 59.18% (216) women had availed three or more than three antenatal visits. It was found that 81.92% (299) had taken complete (2 doses) tetanus immunization. About 47% of women had completed full course of iron and folic acid tablets. It was observed that only 46.03% women had availed complete ANC package.Conclusions: Although Antenatal services in India have been created, strengthened and expanded over the years, their output in terms of utilization particularly in rural area is still limited. The present study has brought out many significant socio cultural barriers like caste, women’s literacy, husband’s literacy, occupation of women, socio-economic class and parity of women affecting the utilization of services

A study to evaluate the effects of nutritional intervention measures on children admitted in the nutritional rehabilitation center (Bal Sanjeevani Kendra) of Surendranagar district

Background:The life cycle dynamics of the causes and consequences of malnutrition demand a holistic and all inclusive approach to prevent and treat under-nutrition and nutritional deficiencies. In response, Government of Gujarat launched “Mission Balam Sukham” in the year 2012 which focuses on both preventive and curative aspects. Curative aspect consist of three tier approach for integrated management of malnutrition at three different levels. Nutritional rehabilitation Center is a unit in a district health facility where children with severe acute malnutrition are admitted and provided with the nutritional & therapeutic care.Methods: Analysis of data of all the children admitted to Nutritional Rehabilitation Centre of Surendranagar district from June-2012 to November 2013. Statistical analysis was done using SPSS.Results: A total of 280 children were included in the study. The overall mean weight at admission was found 8.30 kg with standard deviation of 2.09 kg and the mean weight at the time of discharge was 8.97 kg with standard deviation of 2.16 kg. Average weight gain among 141 boys was 6.63 g/kg/day and among girls was found 7.60 g/kg/day. Out of total 280 children, 103 (36.79%) children had weight gain as per the standard criteria (8 gm/kg/day). Diarrhoea was found to be the associated medical condition in majority of the children. Out of total 184 children without medical complications, 97 (52.72%) children had weight gain as per the standard criteria.Conclusions: Present study reflected that Nutritional Rehabilitation Centers have been playing a key role to cope with malnutrition as demonstrated by high weight gain rate as well as high recovery rate.

Drug price control order: the impact on pharmacoeconomics

Background: The objective of the present study was to analyze the prices of metformin, losartan, atorvastatin, paracetamol and aspirin for the doses which are included in the list of Drug Price Control Order (DPCO) 2013.Methods: Current index medical specialties India, 37th year, April-July 2015 issue was used for analysis. The retail prices of the drugs in INR were tabulated in Microsoft Office Excel 2013. The prices of the above listed drugs were compared with prices of DPCO 2013 for the same doses of drugs. The analysis of drugs costing more than the prices listed in the DPCO with the margin of the difference in percentage was carried out.Results: Out of 25 brands of metformin 500 mg tablet, 11 (44%) brands had price higher than listed in DPCO 2013. Similarly, prices for losartan 25 mg and 50 mg tablets, 8 (25%) out of 32 and 11 (31.42%) out of 35 were higher respectively. For atorvastatin 5 mg and 10 mg tablets, 2 (9.52%) out of 21 and 8 (13.55%) out of 59 brands had higher prices. For paracetamol 500 mg tablet, 12 (63.15%) out of 19 brands were priced higher than DPCO list. For aspirin 100 mg tablet and 325 mg tablet, 3 (100%) out of 3 brands and 1 (100%) out of 1 brand had higher prices.Conclusions: Many of the brand formulations have higher prices than the DPCO 2013 issued by government of India. The clinicians prescribing these drugs should be aware of these brand formulations to reduce the cost of the drug therapy

Utilization pattern of child health care services in the rural area of Surendranagar district: a community based cross sectional study

Background: Infant and child mortality continues to be a major public health problem all over the country. Despite the existence of national programmes for improving child health in India, child mortality and morbidity continue to be high. Utilization of child health care services is poor in the rural areas, causing significant impact on the health causing increased morbidity and mortality.Methods: It was a Community based Cross-sectional study carried out in the rural area of Surendranagar district through oral questionnaire method which was pre-designed and pretested. Data on demography, history of colostrum, initiation of breastfeeding, prelacteal feeds, exclusive breastfeeding, introduction of complementary feeding, immunization, respiratory infections etc. were collected, compiled and analyzed by applying appropriate tests using SPSS.Results: Out of 154 participants, 43.51% were offered breastfeeding within one hour of birth. Association was observed between initiation of breastfeeding, exclusive breastfeeding, time of introduction of complementary foods and duration of breastfeeding and utilization of health education services. Educational level of mothers and immunization status of the children had a significant statistical association. The overall prevalence of ARI was 31.82% & of Diarrhoea was 39.61%.Conclusions: A positive association was observed between nutritional status and utilization of nutritional services. Significant impact of health education services given during the antenatal period was observed on initiation of breastfeeding as well as exclusive breastfeeding. Although child services in India have been created, strengthened and expanded over the years, their performance in terms of utilization particularly in rural area is still limited

Hindi Generation from Interlingua

This paper reports our work on generating Hindi sentences from an interlingua representation called Universal Networking Language (UNL). UNL represents knowledge in semantic net like graphs which contain disambiguated words, binary semantic relations, and speech act like attributes associated with the words. Assisted by a semantically rich lexicon, a priority-matrix of syntax plan, and elaborate morphology synthesis rules, we produce fluent Hindi sentences which also meet the adequacy requirement with respect to the reference sentences, and the faithfulness requirement with respect to the semantic graphs. The system has been tested on agricultural corpora, and the system generated sentences were scored by a team of evaluators. The BLEU scores against the reference sentences have been computed. The results show that our system is able to generate slightly flawed but easy to understand sentences that convey most of the meaning. We observe strong correlation between the fluency scores and the BLEU scores, as well as between fluency and the adequacy scores. Since fluency evaluation does not require reference translation, this correlation facilitates large scale evaluation of our system without translating large number of UNL sentences. This system is a step towards machine translation involving Hindi as the target language. Our approach is also adoptable to the generation of other languages, in particular Indian languages

Violence against women: a study on nature, prevalence and extent

Background: To study the nature, prevalence and extent of domestic violence against women in the study area.Methods: The cross-sectional study was carried out in the urban and rural area of Surendranagar district of Gujarat. Total 600 ever married women of 15-49 years of age were selected for the study purpose. The self-administered questionnaire was used to gather all the information. Steps were taken up to maintain confidentiality.Results: Out of total 600 women, 231 (38.5%) were victims of domestic violence in one form or the other. The analysis based on each form of violence discloses that about 83% were victims of psychological violence, about 54% of the victims had experienced physical violence, about 32% were victims of economical violence and about 24% were victims of sexual violence.Conclusions: Husband was the frequent instigator of domestic violence. Psychological violence is the commonest form of violence experienced by the victims

Remission of Severe, Relapsed, and Refractory TTP after Multiple Cycles of Bortezomib

Acquired thrombotic thrombocytopenic purpura (TTP) is characterized by autoantibodies against a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13). Uncleaved von Willebrand factor (VWF) multimers accumulate and bind to platelets which causes spontaneous microthrombi ultimately causing microangiopathic hemolytic anemia, thrombocytopenia, and end-organ ischemia. Plasma exchange (PEX) with or without steroids constitutes standard first-line therapy with rituximab typically reserved for refractory cases. Therapies beyond rituximab lack strong evidence for routine use. Recently, bortezomib, a proteasome inhibitor used commonly in patients with multiple myeloma, was shown to induce remission in patients with refractory TTP. Here, we report a case of severe, relapsed TTP that was refractory to PEX, steroids, and rituximab that underwent remission following three cycles of bortezomib. We discuss the salient features of our case, the mechanism of action of bortezomib, and the very few other similar reports that exist in the literature. We conclude that bortezomib should be considered for patients with TTP refractory to PEX, steroids, and rituximab due to its efficacy and relatively favorable side effect profile

Experience with NESTROFT for screening for thalassemia trait/ minor: evaluation against CBC and HPLC in a high prevalence region in Saurashtra, Gujarat, India

Background: Hemoglobinopathies pose a significant health burden in India. Prevention programmes can significantly reduce this burden. Although sophisticated methods of screening for β thalassemia trait are available, a cheap and simple method is beneficial for population screening. Although the Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) has been evaluated in many studies, sample sizes were small in some and many earlier studies have not done complete blood count (CBC) and High-Performance Liquid Chromatography (HPLC) in all the cases. We evaluate the suitability of NESTROFT for detection of β-thalassemia trait in a high prevalence region in Saurashtra, Gujarat.Methods: Here, 1000 unrelated individuals were studied. NESTROFT, CBC and estimation of HbA2 and HbF or other hemoglobin variants were done by HPLC.Results: Prevalence of β thalassemia trait was 7.8% in this population. NESTROFT showed an overall sensitivity and specificity of 94.87 and 85.38 respectively for the detection of β thalassaemia trait. Using red cell indices (MCH <27 pg and MCV <80 fl), One β thalassemia trait with normal indices would have been missed. Among twelve individuals with other hemoglobinopathies (HbS, HbD, HbE, δβ thalassemia trait or HPFH), seven had a positive NESTROFT while three had normal MCV & MCH values.Conclusions: NESTROFT is a cost-effective sensitive test which does not require any equipment and can be done in remote areas. It remains a useful first line screening test when large populations have to be screened.

State estimation of chemical engineering systems tending to multiple solutions

A well-evaluated state covariance matrix avoids error propagation due to divergence issues and, thereby, it is crucial for a successful state estimator design. In this paper we investigate the performance of the state covariance matrices used in three unconstrained Extended Kalman Filter (EKF) formulations and one constrained EKF formulation (CEKF). As benchmark case studies we have chosen: a) a batch chemical reactor with reversible reactions whose system model and measurement are such that multiple states satisfy the equilibrium condition and b) a CSTR with exothermic irreversible reactions and cooling jacket energy balance whose nonlinear behavior includes multiple steady-states and limit cycles. The results have shown that CEKF is in general the best choice of EKF formulations (even if they are constrained with an ad hoc clipping strategy which avoids undesired states) for such case studies. Contrary to a clipped EKF formulation, CEKF incorporates constraints into an optimization problem, which minimizes the noise in a least square sense preventing a bad noise distribution. It is also shown that, although the Moving Horizon Estimation (MHE) provides greater robustness to a poor guess of the initial state, converging in less steps to the actual states, it is not justified for our examples due to the high additional computational effort

Putting into Question the Imaginary of Recovery: A Dialectical Reading of the Global Financial Crisis and its Aftermath

In this article we put into question the discourses that emerged during the Global Financial Crisis (GFC) and that coalesced around a particular socio-economic imaginary of ?recovery? over the period 2009-2012. Our reading of these discourses is very much guided by the notion of the dialectic as developed by Fredric Jameson, and as such this paper can be read as attempt to put his theoretical ideas to work. Through our dialectical reading we aim to create a certain estrangement effect that makes the imaginary of recovery seem very odd and unnatural. In order to achieve such an effect we postulate four theses which are deliberately antagonistic: first, that there has been no ?crisis of capitalism?; second, that we must change the valence of the GFC from negative to positive; third, that the relationship between finance capitalism and ?free markets? is deeply contradictory; and fourth, that we must resist the regulation discourse