Block-wise comprehensive health index in Gadchiroli: A tribal district in Maharashtra

Background: The National Health Mission expects bottom-up approach for preparing Project Implementation Plan and also expects special attention toward tribal areas. Some district-level health information is available from national health surveys, but subdistrict-level information is mostly not available. Gadchiroli is the farthest district from the state capital. There are 12 blocks in the district. It is a notified tribal district having 8.61%–81.50% tribal population in different blocks and block-wise urbanization varies from 0.00% to 37.10%. Objectives: The objective was to assess community health status at block level in Gadchiroli district and then develop comprehensive health index for ranking the blocks. Methods: The author has used available secondary data sources including Census, Survey of Cause of Death scheme, health management information system, Directorate of Economics and Statistics, and Maharashtra Medical Council. Ten indicators were selected after discussion with public health specialists to evolve comprehensive health index. Blocks having best statistic in each indicator were given 100 marks and other blocks were given proportionate marks. Thus, the highest possible score for any block was 1000. Results: The range of block-wise score was from 424 to 781. The highest scoring block was Gadchiroli and was an outlier. The comprehensive score was having correlation with urbanization, r = 0.63 (95% confidence limits, 0.09–0.88). After principal component analysis, the extracted three components were responsible for most of the variations. Conclusions: Reasonably reliable and valid block-wise data are available to carry out community health assessment and develop comprehensive health index. The index is useful for comparison among blocks

Gender Issues in Health Sector

Gender wise analysis of data brings out biological, behavioural and social variables which indicate inequality in the health parameters in male and female sex. There is discrimination against women. Right to birth is denied by sex selective elimination, right to survival is denied by the neglect of girl child resulting in declining trend of child sex ratio which has reached an alarming low level of 914 in 2011 in spite of the fact that the female sex is biologically stronger. The mortality and morbidity indicators are unfavourable to the females. Maternal mortality in developing countries including India is unacceptably high. There is a failure of achievement of Millennium Development Goals in relation to maternal mortality and gender equality and empowerment of women. Crime against women is increasing. Violence is domestic or at workplace or occurring in public places. Social factors like male dominance and subordinate status of women make them vulnerable to unfair treatment, discrimination, denial of basic human rights to survival, education, health, inheritance, etc. The preventive measures in the form of education of masses for effective change in behaviour against gender discrimination, provision of facilities for achieving gender equality, and legislative measures for controlling violence against women at domestic and public level need intensification to achieve social justice of gender equality

Comprehensive index for community health assessment of typical district administrative units in Maharashtra State, India

Background: Health administrators require status of health of different administrative units under them. Use of large number of indicators may create confusion and uncertainty about health status. Availability of a comprehensive index is certainly useful.Objective: To evolve one comprehensive health index for a district as unit and measure district wise disparity.Materials and Methods: Ten indicators from categories of health outcomes, health system, determinants of health, and utilization of services were considered. Data for districts in Maharashtra State were obtained from different sources.For each indicator the best performing district was given score of 100 and other districts were given marks proportionately.Results: The comprehensive index for the state was 0.52. The district scoring lowest value of 0.36 was a tribal district and scoring highest value of 0.66 was a nontribal district.Conclusion: Computing such index of districts for monitoring and allocation of resources may be useful managerial tool

Chronic respiratory diseases: A rapidly emerging public health menace

Chronic respiratory diseases, especially the common chronic obstructive pulmonary disease (COPD) and asthma, are increasing at a swift pace. Although smoking is the most typical risk factor globally, indoor and outdoor air pollution is more important in India. Deaths due to COPD have been next to coronary heart disease since 2014. It causes about 64 deaths per lakh population. It is a chronic and progressive disease having many exacerbations. Mostly senior males are affected. Often, the exacerbation needs intensive care, which may be taxing to the limited intensive care units and may deprive other more warranting patients. The diagnosis requires spirometry, which is available only in private or government tertiary care hospitals. The mainstay of treating both diseases is the inhalation of bronchodilators with or without steroids. The diagnosis and treatment are costly, and treatment is required lifelong. Reduction in risk factors is a challenging and long journey. It requires behavioral change communication. The government in the health sector has critical options. On the one hand, the disease is increasing for various reasons; on the other hand, resources are enormously required for prevention and management. The ASHA system and health and wellness centers, which have not been given due importance, can screen, diagnose, and manage majorly patients. Public health specialists should forcefully advocate for resources required for training and equipment

Life Time Risk of Maternal Death in districts of Maharashtra State, India: Mathematical Estimation Using Proxy Indicators

Background: Maternal Mortality Ratio, Maternal Mortality Rate, Life Time Risk of Maternal Death are used to describe maternal mortality. First is most commonly quoted indicator. The Life Time Risk is most comprehensive. Three simple methods of calculations of Life Time Risk are documented. The calculations require Maternal Mortality Ratio and Total Fertility Rate; Maternal Mortality Rate and Reproductive Age Group Span. Reliable district wise data of these indicators is unavailable. Aim & Objectives: To calculate district wise life time risk of maternal deaths. Material & Methods: The proportion of non-institutional deliveries was used as proxy for Maternal Mortality Ratio and the proportion of couples not using any family planning method was used as proxy for the Total Fertility Rate. The correlation and regression equation between estimated Life Time Risk using standard method and using proxies was calculated. District wise Life Time Risk for Maharashtra state was calculated using the regression equation. Results: Good correlation was observed using proxies (r=0.97) and regression equation was: y=0.09+1.71x. For Maharashtra state the estimated of Life Time Risk was found to be 0.14% which exactly matched the estimate using conventional method. Conclusion: Using proxies reliable estimates of Life Time Risk for districts can be calculated

Developing Block Wise Composite Health Index in Yavatmal District, Maharashtra State, India: An Analysis of Available Data

Introduction: Numerous health indicators from different domains and comprehensive systems for describing health of community at state or district level are in vogue. Some sub-district information is also available from Health Management Information System but the numbers of indicators are many. Here composite health index of sub-district level is calculated similar to documented procedure. Objective: To develop block wise composite health index in an average district, Yavatmal district using available data. Methods: We grouped health indicators in following four categories; health outcomes, health system, other determinants and utilization of services. From these categories we selected four, three, two and one indicator respectively. Almost all the information is collected from already available data. There are 16 blocks in Yavatmal district. Block wise information of all indicators was first compiled. The block having best value was given 100 marks and remaining blocks were given proportionately less marks. The block wise total marks were calculated. The total score was converted into index by dividing by 1,000. Results: The composite health index ranged from 0.369 to 0.794. The median was 0.425 and interquartile range was 0.126. Out of ten, nine health indicators had normal distribution. We observed positive correlation between urbanization and composite health index. The Yavatmal block obtained highest composite index 0.794 and was an outlier. Principal component analysis extracted four components which contributed 82.06% to total variance. Conclusion: Using only ten indicators and simple method blocks composite health index can be developed which may be used to compare blocks or even districts

A clinico-epidemiological study of chikungunya outbreak in Maharashtra state, India

The year 2006 witnessed an extensive outbreak of Chikungunya fever in Maharashtra state. Out of 6467 sera of suspected patients sent to National Institute of Virology, Pune, 804 were serologically confirmed. This retrospective study was carried out by interrogating all those patients for their sickness experience. Adult females from rural area were more affected than males. In 68.2% families, there were multiple cases. Fever and multiple joint involvement were almost invariable. In 36.5% patients, there was history of recurrence. Along with pain, slight swelling was noticed in 55% patients. The commonest joints involved were wrist, inter-phalangeal, elbow, knee and ankle, in that order. The pain and swelling persisted for more than a month. After health education during outbreak, there was positive improvement in behavior pertaining to source reduction of vector. Inter-personal communication was best remembered. In health education, the role of paramedical workers and government doctors was prominent

Determinants and perception of postpartum intrauterine contraceptive device services in Maharashtra, India

Undesired and unintended pregnancies increase unwanted births or induced abortions, consequently increasing maternal morbidity and mortality. Postpartum insertion of the Intra Uterine Contraceptive Device (PPIUCD) is an effective method for population control. The authors conducted the study to assess the determinants of PPIUCD services by identifying beneficiaries and healthcare workers' perceptions. We conducted this study in Maharashtra State, India having five geographical divisions and 36 districts. The authors visited 10 Primary Health Centers and three Community Health Centers from five districts, randomly selecting one from each division. We interviewed 45 women who had undergone insertion one day to one year prior and 17 health care workers. About one-third of women received counseling during pregnancy. The medical officers obtained the consents mostly during delivery. They inserted about 85% of devices within one hour of delivery. About 38% of women had at least one complication. Lower abdominal pain (22.22%), irregular bleeding (20.00%), the expulsion of CuT (13.33%), pain during periods (13.33%) were common. The removal rate was 6.67%. The complication rates observed in the present study are comparable to the hospital studies. Thus, the study reassures that the services in small institutions are very safe, and governments can fearlessly implement the program.Keywords: ComplicationsCounselingExpulsionHealth center Quality Removal