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.

Impact of social factors on health practices of the elderly: an analytical study in rural Surendranagar

Introduction: Increased attention to health promotion and disease prevention are important for the appropriate care of the elderly. With the increasing life expectancy, a focus on preventive measures to decrease morbidity and improve quality of life in old age has also developed. To that end, health behavior and lifestyle have become important areas of concern over the last 20 years. Social factors lay a significant impact on the health practices. This study was therefore taken up to study the above factor and draw conclusions.Aims and objectives: 1. To study the various health practices of the elderly. 2. To find out association between the socio demographic features and the prevailing health practices.Methods: A Cross sectional analytical study was carried out. All the subjects were interviewed personally to know the details and were treated with due respect after a consent. Out of all the talukas in rural Surendranagar, Sayla was selected randomly after which Sayla village was selected in a similar manner from all the villages in the talukas.Results: The mean age of the subjects was 68±7.5. Majority of the subjects were unemployed and illiterate (58%). Social factors like Social class, staying with children and staying in joint family were significantly associated with good health practices.Conclusions: The Health practices of the elderly can be improved upon by large scale health education programmes which can be targeted on the age group. Patient compliance improvement can be achieved by explaining them about the disease and treatment protocol in detail at the time of their health visit.

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

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

Evaluation of immunization coverage among children aged 12-23 months in Surendranagar city

Background: Infectious diseases are a major cause of morbidity & mortality in children. One of the most cost effective & easy methods for child survival is immunization. In May 1974, the World Health Organization (WHO) officially launched a global immunization programme known as Expanded Programme of immunization (EPI) to protect all the children of the world against 6 Vaccine Preventable Diseases by the year 2000. It was later redesignated as Universal Immunization Programme (UIP) since 1985. The objectives of this study were to assess the dropout rate and primary immunization coverage of children aged 12-23 months in Surendranagar city and to know the various reasons for partially or not immunizing the child.Methods: A community-based cross-sectional study. Thirty clusters were selected out of a total of 282 blocks of Surendranagar using the cluster sampling method. Cluster sampling method was used for sample selection and the proforma designed by UNICEF was used as a study tool. Sample size was 210 children (7 Children from each cluster) of aged 12-23 months. The obtained data were analyzed using appropriate statistical tests like Z test and X2 test. Results: Out Of the 210 surveyed children, 121(57.62%) were males and 89(42.38%) were females. Immunization card was available for 69.52% of children and fully immunized were 70.47%. Coverage was highest for BCG (95.71%) followed by OPV3 (82.85%), DPT3 (79.52%) and lowest for measles (75.23%). As far as the dropout rate is concerned, it was 21.39%, 10.21%, and 9.37% for BCG to measles, DPT1 to DPT3, and OPV1 to OPV3, respectively. Amongst the various reasons main reasons for dropout or unimmunization of children were ignorance in about 64% and lack of information regarding time, place and schedule (21%).Conclusions: Improvement should focus on reducing the dropout rate from DPT2/OPV2 to DPT3/OPV3 and improving coverage of measles and also Vitamin A

A study on the effect of occupational stress on job performance in the nursing staff of a tertiary care teaching hospital in Surendranagar district

Introduction: Occupational stress is a health hazard to the individual worker both physically and psychologically. Research for the past years shows that, signs of occupational stress appear to be rising amongst nursing profession. The ability of nurses to appropriately handle stress while on duty may have a significant impact on individual outcomes, especially job performance. Objective: This study was conducted to measure the work-related stress and its association with the job performance among nurses. Methods: A pilot study was done and  prevalence of  work related stress was 13 % on the basis of which sample size was calculated which was 102 (in open epi).  The 102 nurses were selected randomly from  a tertiary care teaching hospital of Surendranagar district. The data was collected using a structured self-administered questionnaire which included questionnaires on demographic variables, level of work stress and job performance. Results: The findings of the study revealed that moderate and severe level of work stress was present in  53% and 45% of nurses respectively. The mean job stress score was found to be higher among younger  nurses than those of more than 40 years. There was a negative relationship between job stress and job performance (r = −0.01) among staff nurses. Conclusion: Based on study findings, it was concluded that all the nurses were suffering from mild to severe level of work stress. and it was negatively correlated with the job performance of the nurses. Hence, it is recommended that corrective measures may be planned by the authority to reduce the work stress of nurses to improve the job performance

Serum 25-hydroxyvitamin D₃ levels are elevated in South Indian patients with ischemic heart disease

Several lines of evidence point to a possible relationship between vitamin D and cardiovascular disease. Animal experiments and observational studies in humans suggest vitamin D to be arteriotoxic and an association of high intake of vitamin D with increased incidence of ischemic heart disease (IHD). The major source of vitamin D in adults is vitamin D synthesized in the skin through exposure to the sun. In tropical environment there is a possibility of high level of solar exposure and enhanced serum levels of vitamin D in the population. We explored the relation between serum level of 25-hydroxyvitamin D3 and IHD in a case-control study involving 143 patients with either angiographic evidence of coronary artery disease or patients with acute myocardial infarction and 70 controls, all men in the age group of 45–65 years. Fasting blood samples were collected, serum separated and serum levels of 25-hydroxyvitamin D3 was measured by protein binding radioligand assay. Serum levels of cholesterol, triglyceride, calcium, magnesium and inorganic phosphate were also determined. Prevalences of diabetes, hypertension and smoking history were noted. Statistical comparisons of variables between cases and controls were done using χ2-tests. Multivariate logistic regression analysis was done to examine the association of IHD with serum levels of 25-hydroxyvitamin D3 controlling for selected variables. Serum levels of 25-hydroxyvitamin D3, calcium, inorganic phosphate, total cholesterol, low density lipoprotein and triglycerides were elevated in a higher proportion of patients, compared to controls. Serum levels of 25-OH-D3 above 222.5 nmol/l (89 ng/ml) was observed in 59.4% of cases compared to 22.1% in controls (p < 0.001; unadjusted odds ratio (OR): 5.17; 95% confidence interval (CI): 2.62–10.21). When controlled for age and selected variables using the multivariate logistic regression, the adjusted OR relating elevated serum 25-hydroxyvitamin D3 levels ( ≥222.5 nmol/l, ≥89 ng/ml) and IHD is 3.18 (95% CI: 1.31–7.73). Given the evidences for the arteriotoxicity of vitamin D, further investigations are warranted to probe whether the elevated serum levels of 25-hydroxyvitamin D3 observed in patients with IHD in a tropical environment has any pathogenic significance