The cost and effective analysis of health care management of very low birth weight babies in rural areas of West Bengal, India

Background: Low birth weight (LBW) is prevalent in low-income countries. Level II neonatal intensive care at SCNUs is cost intensive. Rational use of SCNU services by targeting its utilization for the VLBW neonates and maintenance of community based newborn care is required.  Even though the economic evaluation of interventions to reduce this burden is essential to guide health care policy making for low resource setting, data on low cost outcome study associated with LBW in Indian setup are scarce.  Methods: This study aims to estimate the costs to the health system in the management of LBW in rural setting where affordability of parents for healthcare facility comparatively less. The cost of management was cut off by minimum investigations, more supervision by working health care personnel’s. A prospective observational study was conducted to see outcome of estimate the costs to the health system in the management of LBW or VLBW babies.Results: The mortality and survival rate among the evaluated LBW under this low cost health care setting was 6.66% and 86.6% respectively.Conclusions: Results of this unique cost and effectiveness evaluation of LBW healthcare management in a low resource setting are very relevant in Indian context where healthcare facility is almost out of reach and affordability in majority rural populations. These results are of relevance for similar settings and should serve to promote interventions aimed at improving maternal care in rural settings. Further larger research is required on cost effectiveness of level II neonatal intensive care.

Altered resistin and IL6 in Neonatal sepsis in patients admitted in a tertiary care teaching hospital at Eastern India

Background: Neonatal sepsis is a clinical syndrome followed by bacteraemia in the first month of life and appears to be one of the primary causes of mortality and morbidity worldwide. The study aim was to detect the levels of resistin, IL-6, CRP and hs-CRP in clinically suspected cases of neonatal sepsis and establish its association with the pathogenesis of the disease. Materials & Methods: The case control study consists of 78 neonates of whom 42 were clinically suspected case of sepsis admitted in NICU of Paediatric department and were taken as cases and 36 were normal healthy neonates taken as control subjects in a tertiary care teaching hospital, Durgapur, West Bengal. The cases as well as controls were within 28 days of age. Preterm and term neonates (< 28 days of age) of both sexes showing signs of both early and late onset sepsis and also blood culture positive were included in the study. Two ml of blood was collected without anticoagulant and serum was separated by centrifugation at 3500 rpm for 15-20 mins and was used for measurement of hs-CRP, resistin and IL 6. Serum hs-CRP levels was determined with a high-sensitivity nephelometric method while the serum level of IL-6 and Resistin were measured by immunoassay Kits (Raybiotech, USA). Results: Serum resistin levels were increased in sepsis cases as compared to controls and were statistically significant (38.96 ± 17.15 vs 15.49 ± 8.54 ng/ml; p < 0.0001). It was also observed that serum IL 6 levels were higher in sepsis cases as compared to controls which was statistically significant (58.19 ± 39.97 versus 8.48 ± 3.90 pg/ml; P < 0.0001). However, a weak positive correlation was observed between serum resistin with serum IL 6 level (r = 0.343; P = 0.025) among neonatal sepsis subjects while no correlation was seen in controls (r = 0.141; P = 0.411). Conclusion: The measurement of these sepsis markers is extremely important only in case of neonates with unclear infectious status. We have observed a significant rise in Resistin or IL 6 or hs-CRP which may be suggested as specific marker for the identification of neonatal sepsis.  The combination of Resistin or IL 6 or CRP or hs-CRP could therefore be crucial for the diagnosis and would be better predictors of neonatal sepsis and may be crucial in the pathogenesis of the disease. Keywords: Preterm neonates, neonatal sepsis, mortality and morbidity, serum resistin, interleukin-6 (IL-6), hs-CR

Knowledge, attitudes and practice of adverse drug reaction monitoring among physicians in India

Background: Underreporting of ADRs still remains a major obstacle in the complete success of pharmacovigilance programs. In order to improve ADR monitoring, it is thus imperative to assess the current knowledge, attitude, and practices of doctors. Therefore, the primary objective of this study was to evaluate the knowledge, attitude, and practices (KAP) of the healthcare professionals about pharmacovigilance in various tertiary care government teaching hospital vis-a-vis private clinics in West Bengal.Methods: A cross sectional, questionnaire based survey was conducted among healthcare practitioners in several tertiary care government set-ups and private set-ups in the state of West Bengal (India). The study instrument was a pre-validated structured questionnaire designed to obtain information on the knowledge of the ADRs reporting, the attitudes towards the reporting, and the factors that in practice could hinder the reporting among the doctors.Results: About 89.62% public practitioners correctly spotted the WHO definition for pharmacovigilance, while 77.5% of the private practitioners did the same. Only 19.81% of the public practitioners documented a suspected ADR in any surveillance form, while there were only 3.75% private practitioners who documented it. About 59.43% of the physicians in government hospitals published an ADR case report in any medical journal, while 81.25% private practitioners did no.Conclusions: Study revealed lack of time, incentive less extra work load being major factors responsible for ADR underreporting. In order to improve ADR reporting, continuous medical education, training and proper sensitization of healthcare professionals can help combating the existing scenario and promising an improved tomorrow. The PvPI should be widely publicized in the visual and print media to make health professionals, as well as the general population at large aware of its presence and scope. Pharmacovigilance should be integrated in undergraduate and postgraduate medical courses

Knowledge, awareness and attitude about human papilloma virus infection and its vaccine among medical students in West Bengal

Background: HPV infection is commonly found in the anogenital tract of men and women with and without clinical lesions. The aetiological role of HPV infection among women with cervical cancer is well-established, and there is growing evidence of its central role in other anogenital sites. The key to preventing human papillomavirus (HPV) infection is education and immunization of youth. We investigated the awareness and knowledge of HPV infection/HPV vaccine and potential acceptability to HPV vaccine and explore the acceptability of vaccination among the medical students in West Bengal. Methodology: A cross sectional study was conducted in Jan-Feb 2019 to know the level of knowledge, awareness and attitude about various aspects of HPV infection and vaccine among medical students in two different medical colleges of West Bengal. There were 200 medical students between 18‑25 years who participated in the study, out of which 137 were males and 63 were females. A self-administered questionnaire designed for the study was given to the students. Students were educated on the purpose of the study and contents and completion of questionnaire. Results: Majority of the students were well aware of the viral etiology of cervical cancer. The survey sample consisted of 200 medical students aged between 18‑25 years with a mean age of 21.8 ± 1.57 years. There were 133 (66.5%) males and 67 (33.5%) females studying in second or third year of M.B.B.S and all of them were unmarried. Almost all the students heard about of HPV. Majority of the students (52%) thought lack of access and knowledge was the most important obstacle for receiving HPV vaccination followed by doubt about effectiveness. The most common source of information for our study population was teachers and textbooks (94%) followed by classroom teaching 43.5%. Other sources of information include internet (31%), news papers and television (10.5%) and friends (4.5%). Majority of the study group (99%) like to update their knowledge by experts. About 14.2% of our study participants had been questioned by friends and relatives regarding HPV vaccination. Conclusion: To conclude gaps in knowledge regarding HPV infection and vaccination existed amongst the medical students and a more integrated teaching regarding HPV carcinogenesis, vaccination and cervical cancer needs to be introduced

The cost and effective analysis of health care management of very low birth weight babies in rural areas of West Bengal, India

Background: Low birth weight (LBW) is prevalent in low-income countries. Level II neonatal intensive care at SCNUs is cost intensive. Rational use of SCNU services by targeting its utilization for the VLBW neonates and maintenance of community based newborn care is required. Even though the economic evaluation of interventions to reduce this burden is essential to guide health care policy making for low resource setting, data on low cost outcome study associated with LBW in Indian setup are scarce. Methods: This study aims to estimate the costs to the health system in the management of LBW in rural setting where affordability of parents for healthcare facility comparatively less. The cost of management was cut off by minimum investigations, more supervision by working health care personnel's. A prospective observational study was conducted to see outcome of estimate the costs to the health system in the management of LBW or VLBW babies. Results: The mortality and survival rate among the evaluated LBW under this low cost health care setting was 6.66% and 86.6% respectively. Conclusions: Results of this unique cost and effectiveness evaluation of LBW healthcare management in a low resource setting are very relevant in Indian context where healthcare facility is almost out of reach and affordability in majority rural populations. These results are of relevance for similar settings and should serve to promote interventions aimed at improving maternal care in rural settings. Further larger research is required on cost effectiveness of level II neonatal intensive care. [Int J Res Med Sci 2016; 4(4.000): 1093-1098

Current Recommendations on MMRV combination vaccine in India

Two MMRV vaccines have been available since 2000. ProQuad (Merck & Co., Inc, West Point, PA; Merck) and Priorix-Tetra (GlaxoSmithKline Biologicals, Rixensart, Belgium; GSK). Both have been widely used in USA, Australia, Canada, and many European countries. The MMRV vaccine was developed based on the existing MMR and varicella vaccines 1,2. Licensed ProQuad and Priorix-Tetra have different measles virus strains (Edmonston strain and Schwarz strain, respectively) with the same titer ( > 10 3.0 tissue culture 50% infective dose, TCID50). Mumps virus strain in Priorix-Tetra (RIT 4385 strain, titer > 10 4.4 TCID50) is derived from what is used in ProQuad (Jeryl Lynn strain, titer > 10 4.3 TCID50). ProQuad and Priorix-Tetra have same rubella virus strain (Wistar RA 27/3 strain) and titer (>10 3.0 TCID50). They also have same varicella virus strain (Oka strain), but with different titers (> 10 3.99 and > 10 3.3 plaque-forming units, respectively)