Coverage and Compliance of Mass Drug Administration in Lymphatic Filariasis: A Comparative Analysis in a District of West Bengal, India

Background: Despite several rounds of Mass Drug Administration (MDA) as an elimination strategy of Lymphatic Filariasis (LF) from India, still the coverage is far behind the required level of 85%.Objectives: The present study was carried out with the objectives to assess the coverage and compliance of MDA and their possible determinants. Methods: A cross-sectional community based study was conducted in Paschim Midnapur district of West Bengal, India for consecutive two years following MDA. Study participants were chosen by 30-cluster sampling technique. Data was collected by using pre-tested semi-structured proforma to assess the coverage and compliance of MDA along with possible determinants for non-attaining the expected coverage. Results: In the year 2009, coverage, compliance, coverage compliance gap (CCG) and effective coverage was seen to be 84.1%, 70.5%, 29.5% and 59.3% respectively. In 2010, the results further deteriorated to 78.5%, 66.9%, 33.3% and 57% respectively. The poor coverage and compliance were attributed to improper training of service providers and lack of community awareness regarding MDA.Conclusion: The study emphasized supervised consumption, retraining of service providers before MDA activities, strengthening behaviour change communication strategy for community awareness. Advocacy by the program managers and policy makers towards prioritization of MDA program will make the story of filaria elimination a success

Magnitude and Correlates of Elevated Blood Pressure among Adolescent School Students Aged 15-19 Years in a Block of Murshidabad, West Bengal, India

Background: The prevalence of adolescent hypertension is on the rise due to multiplicity of certain risk factors, like obesity, unhealthy dietary behaviour, physical inactivity, tobacco use, alcohol addiction, and academic stress. The present study aimed to estimate the prevalence of elevated blood pressure and hypertension among adolescent school children and identify the factors influencing it.Methods: The present observational, cross-sectional study was conducted in two higher secondary schools in a block of Murshidabad district, West Bengal, from February to April 2021. The subjects included 15 to 19-year-old school students. Multistage random sampling method was used for selecting a sample size of 183 adolescent school children. Data were obtained by interviewing the study participants, measurement of blood pressure and anthropometric measurements. Chi-squared test and binary logistic regression were used for bivariate and Multivariable data analysis, respectively, with P<0.05 as the level of significance.Results: The mean of Systolic Blood Pressure and Diastolic Blood Pressure were 115.02+10.853 and 71.52+8.484 mm of Hg, respectively. The overall prevalence of elevated blood pressure and adolescent hypertension was 21.3% (95% CI 15.4-27.2). The prevalence was significantly higher among those with paternal education of above middle school (AOR=1.803, P=0.011), high socioeconomic status (AOR=3.16, P=0.02), and high Body Mass Index for their age (AOR=11.474, P<0.0001). Smart phone use (P=0.03) and family history of hypertension (P=0.029) were also found to significantly influence elevated blood pressure among the subjects in bivariate analysis.Conclusions: Measurement of blood pressure, as a part of school health programme, should be given priority with emphasis on physical activity at school, health promotion to avoid unhealthy diet, and restricted smart phone use

Assessment of infrastructure and status of biomedical waste management in primary health-care facilities in a district of West Bengal, India: A mixed method study

Background: The absence of proper waste management, lack of awareness about the health hazards from biomedical wastes, insufficient financial and human resources, and poor control of waste disposal are the most critical problems connected with biomedical waste management (BMWM). Objectives: The objectives of this study were to assess the infrastructure available for BMWM in primary health-care facilities in Murshidabad district of West Bengal and to find out the gaps in the management. Materials and Methods: This descriptive, observational, facility-based mixed method study with cross-sectional design was conducted in primary health-care facilities selected by multistage random sampling technique. In-depth interview was done with important stakeholders related to BMWM at block, subdivision, and district level. Results: The gaps were identified related to infrastructure, logistic supply, and workforce resources in the studied primary health-care facilities. Segregation at source and disposal of biomedical waste were improper. Training on BMWM and posttraining evaluation were also seen deficient. Information, education, and communication materials and proper record keeping were seen to be absent with lack of supervision. Conclusion: Logistics supply with emphasis on the supply chain with proper allocation of the fund at the primary health-care level should be ensured. Filling up of the vacancies of the Group D staff is essential. Training of health workers with supervision and monitoring by block and district officials needs to be strengthened for efficient BMWM

A study on transfusion-transmitted infections and other complications amongst children with beta-thalassaemia major attending a tertiary care institution in Kolkata

Background: Chronic blood disorders such as beta-thalassaemia major require continuous blood transfusions, which results in complications such as transfusion-transmitted infections (TTIs), iron overload, skeletal deformities, endocrinal and cardiac and hepatic disorders. This study aimed at assessing proportion of TTIs, other complications and factors associated with their occurrence amongst children with beta-thalassaemia major. Methods: This cross-sectional study was conducted amongst children with beta-thalassaemia majo attending a tertiary care institution in Kolkata One hundred and ninety two children were selected amongst participants who fulfilled the inclusion criteria. Parents of study participants were interviewed using pre-designed, pre-tested, semi-structured schedule. Results: TTIs were evident in 8.3% of the study participants. Amongst them, hepatitis C, malaria and hepatitis B were present amongst 3.6%, 2.6% and 2.1%, respectively. No cases of human immunodeficiency virus infection and syphilis were found. Elevated serum ferritin levels (53.6%), Chipmunk facies (5.2%), hypothyroidism (2.1%), cardiomyopathy and diabetes mellitus (0.5% each) were noted. A significant association was observed between iron chelation therapy and serum ferritin level amongst these children (P = 0.042). Conclusions: Various transfusion-related complications are still prevalent amongst children suffering from beta-thalassaemia major

Oxytocin administration during cesarean delivery: Randomized controlled trial to compare intravenous bolus with intravenous infusion regimen

Background: Oxytocin is routinely administered during cesarean delivery for uterine contraction. Adverse effects are known to occur after intravenous oxytocin administration, notably tachycardia, hypotension, and electrokardiogram (EKG) changes, which can be deleterious in high-risk patients. Aims and Objectives: To compare the hemodynamic changes and uterotonic effect of equivalent dose of oxytocin administered as an intravenous bolus versus intravenous infusion. Study Design: Randomized, double-blind, active controlled trial. Materials and Methods: Eighty parturients undergoing elective cesarean delivery, under spinal anesthesia, were randomly allocated to receive 3 IU of oxytocin either as a bolus intravenous injection over 15 seconds (group B, n = 40) or as an intravenous infusion over 5 minutes (group I, n = 40). Uterine tone was assessed as adequate or inadequate by an obstetrician. Intraoperative heart rate, non-invasive blood pressure, and EKG changes were recorded. These data were compared between the groups. Any other adverse events like chest pain, nausea, vomiting, and flushing were noted. Results: There was significant rise in heart rate and significant decrease in mean arterial pressure in bolus group compared to infusion group. Three patients in bolus group had EKG changes in the form of ST-T depression and 5 patients complained of chest pain. No such complications were found in infusion group. Conclusion: Bolus oxytocin (at a dose of 3 IU over 15 seconds) and infusion of oxytocin (at a dose of 3 IU over 5 minutes) have comparable uterotonic effect. However, the bolus regime shows significantly more adverse cardiovascular events

Domestic violence among ever married women of reproductive age group in a slum area of Kolkata

Background: Domestic violence has serious impact on women′s health and well-being. A nationwide survey conducted in India observed that 37.2% of women experienced violence after marriage. Objectives: To assess the prevalence of domestic violence among the ever married women in reproductive age group and to find out the types of domestic violence and factors associated with it. Materials and Methods: The study was a community based cross-sectional study, conducted in a slum area of Kolkata. Results and Conclusion: Overall prevalence of domestic violence was 54%, of which 41.9% suffered from both current and lifetime physical and psychological violence. Presence of property, higher per capita income and social support were protective factors against domestic violence, whereas alcohol addiction and multiple sex partners were the important contributory factors for it. The study recommended more social support, awareness and income generation for women in the slum areas

Comparison between general anesthesia and spinal anesthesia in attenuation of stress response in laparoscopic cholecystectomy: A randomized prospective trial

Background: Laparoscopy though minimally invasive produces significant hemodynamic surge and neuroendocrine stress response. Though general anesthesia (GA) is the conventional technique, now-a-days, regional anesthesia has been accepted for laparoscopic diagnostic procedures, and its use is also being extended to laparoscopic surgeries. Objective: The aim was to compare the hemodynamic surge and neuroendocrine stress response during laparoscopic cholecystectomy (LC) under GA and spinal anesthesia (SA) in American Society of Anesthesiologists (ASA) PS 1 patients. Materials and Methods: Thirty ASA physical status I patients, aged 18-65 years were randomly allocated into two equal groups of 15 each. Group A received GA with controlled ventilation. Patients were preoxygenated for 5 min with 100/5 oxygen, premedicated with midazolam 0.03 mg/kg intravenous (i.v), fentanyl 2 mcg/kg i.v; induction was done with thiopentone 3-5 mg/kg i.v; intubation was achieved after muscle relaxation with 0.5 mg/kg atracurium besylate i.v. Anesthesia was maintained with 1-2% sevoflurane and N2O:O2 (60:40) and intermittent i.v injection of atracurium besylate. Group B SA with 0.5% hyperbaric bupivacaine and 25 μg fentanyl along with local anesthetic instillation in the subdiaphragmatic space. Mean arterial pressure, heart rate (HR), oxygen saturation, end tidal carbon-dioxide were recorded. Venous blood was collected for cortisol assay before induction and 30 min after pneumoperitoneum. All data were collected in Microsoft excel sheet and statistically analyzed using SPSS software version 16 (SPSS Inc., Chicago, IL, USA). All numerical data were analyzed using Student′s t-test and paired t-test. Any value <0.05 was taken as significant. Results: Mean arterial pressure and mean HR and postpneumoperitoneum cortisol level were lower in group B than group A though the difference was not statistically significant in hemodynamic parameters but significant in case of cortisol. Conclusion: Spinal anesthesia administered for LC maintained comparable hemodynamics compared to GA and did not produce any ventilatory depression. It also produced less neuroendocrine stress response as seen by reduction in the level of serum cortisol in ASA PS 1 patients put for LC

A study on the role of parental involvement in control of nutritional anemia among children of free primary schools in a rural area of West Bengal

An intervention study was conducted among students of three randomly selected free primary schools in rural West Bengal to assess the effect of health-nutrition education for behavior modification of parents on nutritional anemia of children. Clinically anemic students were school-wise randomized into ′groups of two′ and intervened with anthelminthic, iron-folic acid (IFA) pediatric tablet and health-nutrition education by reoriented teachers. Parents of study group were involved in behavior change processes. Baseline overall prevalence of anemia was 64.4%. After IFA therapy, prevalence of anemia was not found to differ between two groups (χ2 = 2.68, P > 0.05, RR= 0.48, 95% C.I 0.2 < RR < 1.19) while reducing 52.2% of relative risk. Reassessment after six months showed significantly lower prevalence in study group (χ2 = 18.14, P < 0.05, RR = 0.20, 95% C.I. 0.08 < RR < 0.49). Parental involvement for life style and dietary modification may curb childhood anemia

Comparison of hemodynamic response and vasopressor requirement following spinal anaesthesia between normotensive and severe preeclamptic women undergoing caesarean section: A prospective study

Background: Spinal anesthesia is the technique of choice in cesarean sections, but it is not widely accepted in severe pre-eclampsia due to fear of sudden and extensive sympathetic blockade. The aim of the present study was to compare the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), phenyl ephrine requirement, and neonatal outcome between normotensive and severe pre-eclamptic women undergoing cesarean section under spinal anesthesia. Materials and Methods: A total of 30 healthy (group 1) and 30 severe pre-eclamptic (BP > 160/110 mmHg) parturients (group 2) above 18 years of age, meeting inclusion criteria undergoing elective cesarean section, were included in the study. After preloading with 10 ml/kg of ringer lactate solution spinal anesthesia was administered with 12.5 mg of hyper baric bupivacaine. Also, SBP, DBP, MAP, and HR were recorded before spinal anesthesia and then at every 2-min interval after spinal block for the first 30 min and thereafter every 5 min until completion of surgery. Phenylephrine was administered in 50 μg bolus dose when MAP decreased below 30% of base line. Apgar score was noted 1 and 5 min after birth. Results: The minimum SBP, DBP, and MAP recorded were lower in normotensive, and the difference between two groups was statistically significant. The mean phenylephrine requirement in the normotensive group (151.1 ± 70) was significantly greater (P < 0.0001) than that of pre-eclamptic group (48.3 ± 35). Apgar scores at 1 and 5 min after birth were comparable in both the groups. Conclusion: Pre-eclamptics experienced less hypotension following subarachnoid block (SAB) than normotensives and required less phenylephrine with comparable fetal Apgar scores