KAP Study on Immunization of Children in a City of North India – A 30 Cluster Survey

Background: To determine the knowledge, attitude and practices about immunization among respondents of children aged 12-23 months.\ud Methods: A total of 510 respondents were interviewed in the urban slums of Lucknow district of India, using 30 cluster sampling technique from January 2005 to April 2005. A pre-tested structured questionnaire was used to elicit the information about the knowledge, attitude and practices of the respondents regarding immunization. \ud Results: Knowledge regarding the disease prevented, number of doses and correct age of administration of BCG was highest among all the categories of respondents. The paramedical worker was the main source of information to the respondents of completely (52.0%) and partially immunized (48.5%) children while community leaders for unimmunized children. Those availing private facilities were more completely immunized, as compared to the government facilities. 55.8% of those who took 20 minutes to reach the immunization site were completely immunized as compared to 64.1% of those who took more than 20 minutes.\ud Conclusion: Considering the incomplete knowledge, and inappropriate practices of the people, the policy makers and medical professionals require Herculean efforts to raise the knowledge and to break the old beliefs of the peopl

Application of health economics in medical research and clinical epidemiology

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IMCI approach in Tertiary hospitals, India

Objective: This study was conducted to compare physicians' diagnosis with Integrated Management of Childhood Illness (IMCI) algorithm generated diagnosis in hospitalized children aged 2-59 months. Methods: Recruited were patients aged 2-59 months admitted with one or more IMCI danger signs. IMCI and physician's diagnosis were noted and compared. Results: In 222 included subjects, mean duration of illness was 9.4 (SD: 16.5) days. Among those with cough or difficult breathing, 44 (19.8%) and 66 (29.7%) were diagnosed as either severe pneumonia or mild to moderate pneumonia by physicians and IMCI algorithm, respectively (p= 0.015). Among 146 presenting as fever, 140 (95.9%) were diagnosed as very severe febrile disease by the IMCI algorithm, whereas physicians diagnosed these as either malaria in 10/146 (6.7%), pyogenic meningitis in 47/146 (32.2%), sepsis in 31/146 (21.3%), tuberculous meningitis in 17/146 (11.6%), encephalitis in 5/146 (3.4%), measles in 3/146 (2.1%) or others in 24/146 (16.4%). Conclusion: As there was a low concordance between physician and IMCI algorithmic diagnosis of pneumonia (Kappa value= 0.74, 95% CI: (0.64-0.84)) and since very severe febrile disease is not a diagnosis made by the physicians, the IMCI algorithms have to be refined for appropriate management of these conditions

Determinants of childhood mortality and morbidity in urban slums in India

The large and continuous increase in India's urban population and the concomitant growth of the population residing in slums has resulted in overstraining of infrastructure and deterioration in public health. The link between urbanization, a degraded environment, inaccessibility to healthcare and a deteriorating quality of life is significant and particularly evident in the sharp inequities in IMR if one looks at urban specific studies. It is hence, germane to address the appalling inequalities in the distribution and access to basic amenities and health services with a focus on enhanced service coverage, improved sanitation and water supplies and mobilization of community action for effectively mitigating the childhood death and disease burden in urban slums

Indian pediatrics - Environmental Health Project

The large and continuous increase in India's urban population and the concomitant growth of the population residing in slums has resulted in overstraining of infrastructure and deterioration in public health. The link between urbanization, a degraded environment, inaccessibility to healthcare and a deteriorating quality of life is significant and particularly evident in the sharp inequities in IMR if one looks at urban specific studies. It is hence, germane to address the appalling inequalities in the distribution and access to basic amenities and health services with a focus on enhanced service coverage, improved sanitation and water supplies and mobilization of community action for effectively mitigating the childhood death and disease burden in urban slums

Identification and prioritisation of barriers to quality performance in medical education and patient care in Medical University in India

King George's Medical University (KGMU) is 100 years old and is one of the six medical universities in India. Like most other medical institutions here, there is no formal process of internal evaluation for improvement. This work was done to identify potential barriers to quality performance in medical education and patient care domains and to develop a methodology to prioritize them using qualitative and semi-quantitative techniques. About 30-faculty members identified around 42 barriers in the domains of education and patient care. Majority of the barriers were internal and required changes in systems and behavior. A stakeholder focused KGMU priority-setting matrix was developed to give each barrier a priority score ranging from 8-24. One-thirds (n=14) identified barriers obtained a priority score of ≥ 17 and were subject to external validation, using the same priority setting matrix, on 82 (81.7% males) stakeholders. Limited teacher postgraduate student interaction and less patient-physician interactions were identified as most important barriers in education and patient care domains, respectively, followed by barriers common to both domains (unaesthetic campus, irregular electricity and water supply and poor maintenance of equipment). Thus expedited action in domain specific as well as common priorities would potentially positively impact medical education as well as patient care. KGMU priority setting matrix was found to be a simple instrument, which could capture differences in perspectives of various stakeholders. It can be validated in similar settings elsewhere. There is a need to develop and validate methods of internal assessment and quality assurance within medical institutions in India

Seasonal pattern of morbidities in preschool slum children in Lucknow, North India

Objective: To quantify the burden of common morbidities for each month in one year, in preschool children. Setting: Anganwadi centers under the Integrated Child Development Services Scheme (ICDS) in Lucknow, North India. Design: Prospective cohort study, Methods: From 153 anganwadi centers in urban Lucknow, 32 were selected by random draw. All eligible children registered with the anganwadi worker were enrolled over a period of six months from July 1995 to January 199b. All the subjects were then contacted a second time six months later. Subjects: There were 1061 children (48.3% girls and 51.7% boys) between the ages of 1.5 to 3.5 years. Results: The annual incidence rate (IR) per 100 child-years for respiratory, diarrhea and skin diseases and pneumonia were 167, 79.9, 30.6 and 9.6, respectively. When compared to other seasons, the IR of pneumonia was lowest in the winter months (October to February) while those of diarrhea and skin diseases were the highest in summer (March-June) and monsoon (July to September) months, respectively. Season specific diseases were measles in summer, and fever as the isolated symptom in monsoon. The IR for combined morbidities was the highest in the monsoon as compared to winter months. Conclusions: Season specific intensification of existing health care resources for these morbidities can be considered. Similar studies are needed from other parts of the country

Six-monthly De-worming in infants to study effects on growth

Objective: The study was conducted to assess the effectiveness of six monthly albendazole (ABZ) for improving the weight and height of preschool children when initia ted at 0.5-1 year of age in populations with a high transmission rate of intestinal roundworm,Ascaris lumbricoides. It was a cluster randomized trial in the urban slums of Lucknow, North India.Methods: Control children received 2 ml (1 ml to infants) of Vitamin A every six month whereas those in the ABZ areas received, in addition, 400 mg of ABZ suspension (Zentel, SKB) every six month. Sixty-three and sixty-one slum areas were randomized to albendazole (ABZ) or to control groups, respectively. Children aged 0.5-1 year were recruited in April 1996 and followed up for 1.5 years. Of 1022 children recruited from control and 988 from ABZ areas, the loss to follow-up at 1.5 year was 15.6% and 14.6% respectively. Mean (±SE) weight gain in Kg in control versus ABZ areas was 3.04 (0.03) versus 3.22 (0.03), (p=0.01).Results: After controlling for the presence of weight-for age z-score <-2.00 at enrollment in the ordinary least square's regression model, the extra weight gain in 1.5 years in those who received ABZ plus vitamin A was 0.13 Kg (95% Cl:0.004 to 0.26 Kg., p value=0.043) when compared to those who received only vitamin A; underweight children at enrollment benefiting more than the normal ones.Conclusion: It was concluded that there was an improvement in weight with six monthly ABZ over 1.5 years. However, a much larger trial would be needed to determine whether there is any net effect of improvement in weight on under five mortality rate

Four-country surveillance of intestinal intussusception and diarrhoea in children

Aim: Establishment of baseline epidemiology of intussusception in developing countries has become a necessity with the possibility of reintroduction of rotavirus vaccine. The current study assessed the seasonal trend in cases admitted with intussusceptions and dehydrating acute watery diarrhoea in children aged 2 months to 10 years. Methods: In a prospective surveillance study, teaching and research hospital sites in India (Lucknow and Nagpur), Brazil (Fortazela), Egypt (Ismailia) and Kenya (Nairobi) established a surveillance where a network of hospitals with surgical facilities catered to a reference population of about 1-2 million for reporting of intussusception. One large hospital per site also recruited admitted cases of acute watery diarrhoea. Results: From April 2004 to March 2006, 173 and 2346 cases of intussusception and diarrhoea, respectively, were recruited. Cases of intussusception had no apparent seasonality. Most cases of intussusception (61.3%) (107/173) were in the ≤1 year age group, with males comprising 68.8% (119/173) of all cases. Hospital mortality of intussusception was 4.2% (4/96). Cases of diarrhoea peaked in March, with 56.6% (1328/2346) of admitted cases being males. Majority (83.1%) of cases of diarrhoea had received antibiotics, and the hospital mortality was 0.8% (18/2280). Conclusion: Intussusception in the four participating countries exhibited no seasonal trend. We found that it is feasible to establish a surveillance network for intussusception in developing countries. Future efforts must define population base before the introduction of rotavirus vaccine and continue for some years thereafter. © 2009 Paediatrics and Child Health Division (Royal Australasian College of Physicians)

Helminthic infections

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