WHO South-East Asia Journal of Public Health
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   2012| April-June  | Volume 1 | Issue 2  
    Online since May 24, 2017

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Nipah virus outbreaks in Bangladesh: a deadly infectious disease
Mahmudur Rahman, Apurba Chakraborty
April-June 2012, 1(2):208-212
DOI:10.4103/2224-3151.206933  PMID:28612796
During 2001-2011, multidisciplinary teams from the Institute of Epidemiology, Disease Control and Research (IEDCR) and International Centre for Diarrhoeal Disease Research, Bangladesh(icddr,b) identified sporadic cases and 11 outbreaks of Nipah encephalitis. Three outbreaks were detected through sentinel surveillance; others were identified through event-based surveillance. A total of 196 cases of Nipah encephalitis, in outbreaks, clusters and as isolated cases were detected from 20 districts of Bangladesh; out of them 150 (77%) cases died. Drinking raw date palm sap and contact with a case were identified as the major risk factors for acquiring the disease. Combination of surveillance systems and multidisciplinary outbreak investigations can be an effective strategy not only for detection of emerging infectious diseases but also for identification of novel characteristics and risk factors for these diseases in resource-poor settings.
  6,897 420 11
Injection practices in India
Narendra K Arora
April-June 2012, 1(2):189-200
DOI:10.4103/2224-3151.206931  PMID:28612794
Background: About 16 billion injections are administered each year worldwide, and at least half of them are unsafe. India contributes 25% to 30% of the global injection load. A majority of curative injections are unnecessary. The present study was undertaken to assess the burden of injections and prevalent injection practices in India. Methods: A nationwide population-based cluster survey (1200 clusters; 24 021 subjects) at household level; along with observations, interview of prescribers (2402), and exit interview of the patients (12 012) at health facility level in the selected clusters was carried out -using probability proportionate to size (PPS) technique. Observations at health facility included generic observation (3592), observation of injection process (17 844), and observation of prescriber-client interaction (24 030). Results: The frequency of injections was 2.9 (95%CI: 2.8-3.2) per person/year. Of the total injections, 62.9% (95%CI: 60.7-65.0) were unsafe. Injections administered for curative purpose constituted 82.5% and a large majorly of these were prescribed for common symptoms like fever/cough/diarrhoea. Use of glass syringes was consistently associated with potential risk of blood-borne viral transmission. Satisfactory disposal of injection waste was observed at 61.3% (95%CI: 58.2-64.3) of the health facilities, and at 50.9% (95%CI: 46.7-55.2) of the immunization clinics. Significant differences were observed in the injection prescription pattern in public and private facilities, and in rural and urban areas. Conclusions: Three billion injections were estimated to be administered annually in India; of them 1.89 billion were unsafe. Evidence suggests that the micro-level leadership for reducing injection overuse and making injections safer lies with the prescriber.
  3,064 169 16
Initiating tobacco cessation services in India: challenges and opportunities
Cherian Varghese, Jagdish Kaur, Nimesh G Desai, Pratima Murthy, Savita Malhotra, DK Subbakrishna, Vinayak M Prasad, Vineet G Munish
April-June 2012, 1(2):159-168
DOI:10.4103/2224-3151.206929  PMID:28612792
Background: Tobacco use contributes significantly to the diseases burden in India. Very few tobacco users spontaneously quit. Therefore, beginning 2002, a network of 19 tobacco cessation clinics (TCCs) was set up over a period of time to study the feasibility of establishing tobacco cessation services. Methods: Review of the process and operational aspects of setting up TCCs was carried out by evaluation of the records of TCCs in India. Baseline and follow-up information was recorded on a pre-designed form. Results: During a five-year period, 34 741 subjects attended the TCCs. Baseline information was recorded in 23 320 cases. The clients were predominantly (92.5%) above 20 years, married (74.1%) and males (92.2%). All of them received simple tips for quitting tobacco; 68.9% received behavioural counselling for relapse prevention and 31% were prescribed adjunct medication. At six-week follow-up, 3255 (14%) of the tobacco users had quit and 5187 (22%) had reduced tobacco use by more than 50%. Data for three, three-monthly follow-ups was available for 12 813 patients. In this group, 26% had either quit or significantly reduced tobacco use at first follow-up (three-months), 21% at the second (six-months) and 18% at the third follow-up (nine-months) had done so. Conclusions: It is feasible to set up effective tobacco cessation clinics in developing countries. Integration of these services into the health care delivery system still remains a challenge.
  2,251 241 12
Antibiogram of S. enterica serovar Typhi and S. enterica serovar Paratyphi A: a multi-centre study from India
Sangeeta Joshi
April-June 2012, 1(2):182-188
DOI:10.4103/2224-3151.206930  PMID:28612793
Background: Enteric fever continues to be a public health problem in many countries including India. Emergence of the multidrug resistant strains of S. enterica serovar Typhi may render treatment with antibiotics ineffective. A multi-centre surveillance study was, therefore, conducted in India to monitor the time trends in antibiotic susceptibility patterns of S. enterica serovar Typhi and S. enterica serovar Paratyphi A in India. Methods: All S. enterica serovar Typhi and S. enterica serovar Paratyphi A strains isolated from January 2008 to December 2010 in the 15 participating centres were included in the study. Each centre compiled their data in a predefined template which included data of the antimicrobial susceptibility pattern, location of the patient and specimen type. The data in the submitted templates was collated and analysed using a common protocol. Results: A total of 3275 isolates of Salmonellae causing enteric fever were included in the study. There were 2511 S. enterica serovar Typhi and 764 S. enterica serovar Paratyphi A strains during the three-year study period. Resistance to nalidixic acid was seen in 83% of the S. enterica serovar Typhi and 93% of S. enterica serovar Paratyphi A strains. Majority of the strains were susceptible to third generation cephalosporins. Conclusions: Enteric fever in India is caused by S. enterica serovar Typhi and S. enterica serovar Paratyphi A. Nalidixic acid resistance is high among both S. enterica serovar Typhi and S. enterica serovar Paratyphi A. Susceptibility to ampicillin, chloramphenicol and cotrimoxazole is high. Third generation cephalosporins continue to remain susceptible.
  1,947 164 15
Funding health promotion and disease prevention programmes: an innovative financing experience from Thailand
Supreda Adulyanon
April-June 2012, 1(2):201-207
DOI:10.4103/2224-3151.206932  PMID:28612795
Sustainable sources of funding for health programmes have been explored by many countries. In Thailand, the Health Promotion Foundation (ThaiHealth) was established in 2001 as an innovative state agency for funding health promotion from the 2% surcharge on alcohol and tobacco excise tax. ThaiHealth is governed by a Board chaired by the Prime Minister. It is not part of the conventional health services. ThaiHealth explicitly pursues a “socio-cultural” rather than a “biomedical model” of health. It has fostered strategic partnerships with government, private sector, nongovernmental organizations, and communities to implement health promotion plans. In 2010, its budget was 3700 million bahts (119 million US dollars). Since ThaiHealth plays a catalytic, coordinating, empowering and enabling role, its impact can only be assessed “collectively” with all partner organizations. ThaiHealth contributed to development of several policies that led to enactment of laws and building the capacity of organizations, communities and individuals in planning and carrying out health promotion activities. The “Collective impact” includes decline in smoking among the more-than-15-year-olds from 25.47% in 2001 to 20.7% in 2009; harmful alcohol drinkers from 9.1% in 2004 to 7.3% in 2009; death rate from vehicle accidents from 22.9 per 100 000 in 2003 to 16.82 per 100 000 in 2010. The main factors leading to achievements of ThaiHealth are: flexibility, financial security and effective strategy. However, inadequate understanding among public and stakeholders about the philosophy, governance and operation of ThaiHealth is reckoned as a huge challenge.
  1,486 179 6
Abuse against women in pregnancy: a population-based study from Eastern India
Bontha V Babu, Shantanu K Kar
April-June 2012, 1(2):133-143
DOI:10.4103/2224-3151.206926  PMID:28612789
Background: Violence against women is widely recognized as an important public health problem. However, the magnitude of the problem among pregnant women is not well known in several parts of India. Hence, the prevalence and characteristics associated with various forms of domestic violence against women in pregnancy were studied in Eastern India. Methods: A population-based cross-sectional sample survey covering married women with a history of at least one full-term pregnancy (n 1525) was carried out in the Orissa, West Bengal and Jharkhand states of India. Interviews were conducted using a pre-piloted structured questionnaire to inquire about physical, psychological and sexual domestic violence. Data on socioeconomic characteristics and behaviours were also collected. The association of independent variables with domestic violence were examined by using logistic regression models. Results: The prevalence of physical, psychological and sexual domestic violence during a recent pregnancy was found to be 7.1%, 30.6% and 10.4% respectively, and the lifetime prevalence during all pregnancies was 8.3%, 33.4% and 12.6% respectively. Urban living, higher maternal age and husbands’ alcoholism were the factors associated with domestic violence in pregnancy. Women belonging to lower social groups were less likely to have physical domestic violence. Factors such as higher prevalence of undesirable behaviours like denying adequate rest and diet, demand for more sex, not providing antenatal care and pressure for male child were also associated with domestic violence in pregnancy. Conclusions: Considerable proportions of women experience some type of domestic violence during pregnancy. Health-care providers should be able to recognize and respond to pregnant women’s victimization and refer them for appropriate support and care.
  1,402 127 12
Prognostic indicators in patients with snakebite: analysis of two-year data from a township hospital in central Myanmar
Myo-Khin , Theingi-Nyunt , Nyan-Tun-Oo , Ye-Hla
April-June 2012, 1(2):144-150
DOI:10.4103/2224-3151.206927  PMID:28612790
Background: Rural people seek medical treatment for snakebite at peripheral health care facilities. Hence, identification of the characteristics, which can be used at peripheral levels of health care as reliable predictors of mortality, are required. Methods: Hospital records of 101 patients (70 males and 31 females) with age ranging from 3 to 80 years, admitted to Nahtogyi township hospital in central Myanmar during January 2005 to December 2006 were reviewed retrospectively. Binary logistic regression was used for estimating odds ratio (OR) and 95% Confidence Interval (CI) for various prognostic indicators of mortality. Results: Almost all snakebites were on extremities; more in legs (62%) than hands (37%). Most (52.5%) bites occurred in the morning (4 am to noon). Mean (SD) time for bite-to-hospital and bite-to-injection of anti-snake venom (ASV) was 134.6 (78.6) and 167 (187.8) minutes respectively. Eleven cases (10.9%) had died. Case fatality ratio (CFR) was significantly higher in 39 patients with un-clotted blood as compared to 62 patients with clotted blood (25.6% vs 1.6%, p <0.0005). Significantly higher CFR was observed in 49 patients who received ASV in >2 hours after the bite compared to 52 cases who received ASV within two hours (9.9% vs 0.9%, p <0.0001). Odds ratio of fatality were higher among those who had urine output of <400 ml in the first 24 hours (OR 26.4; 95% CI 2.4 to 288.3), un-clotted blood (OR 4.6; 95% CI 0.3 to 66.7), bite-to-injection time of >2 hours (OR 4; 95% CI 0.1 to 219.8) bite-to-hospital time of >2 hours (OR 3.1; 95%CI 0.1 to 136.3) and bites in the morning (OR 2; 95% CI 0.3 to 16.0). Conclusions: Clinical parameters could be used by healthcare providers to identify snakebite patients for referral, who may have fatal outcome.
  1,319 155 4
Performance of cause-specific childhood mortality surveillance by health workers using a short verbal autopsy tool
Rakesh Kumar, Suresh K Kapoor, Anand Krishnan
April-June 2012, 1(2):151-158
DOI:10.4103/2224-3151.206928  PMID:28612791
Background: The routine use of verbal autopsy in health-care delivery settings has been limited. Hence, the performance of neonatal and postneonatal verbal autopsy (VA) tools developed at the Comprehensive Rural Health Services Project (CRHSP), Ballabgarh (India), were assessed. Methods: Short VA tools developed by CRHSP were filled by health workers during their routine house visits while standard VA tools of the International Network of Field Sites with continuous Demographic Evaluation (INDEPTH) were filled by trained research workers for all 143 under-five-children deaths that occurred in 2008. The level of agreement in the cause of death assigned by the two VA tools was assessed by kappa and by comparison of the cause-specific mortality fractions. Results: Among 65 neonatal deaths, the cause specific mortality fraction (CSMF) was 43.1% and 40% for low birthweight, 15.4% and 26.2% for birth asphyxia, and 7.7% and 10.8% for pneumonia by INDEPTH and CRHSP VA tools respectively. In 78 deaths among 29-days to <5-year olds, the CSMF was 29.4% and 26.9% for diarrhoea, and 16.6% each for pneumonia using the INDEPTH and CRHSP VA tools respectively. Kappa for most causes of death was more than 0.8, except for birth asphyxia, which had a kappa of 0.678. Conclusions: Short VA tools have a satisfactory performance in field settings, which can be used routinely by health workers for filling the gaps in the cause-of-death information in places where medical certification of cause of death is deficient.
  1,230 103 5
Early detection of chronic diseases and their risk factors: a women empowerment model from Kerala, India
Safraj Shahul Hameed
April-June 2012, 1(2):213-219
DOI:10.4103/2224-3151.206934  PMID:28612797
Identification of risk factors through screening is an important tool in the fight against chronic diseases. We have used a unique model, named Saantwanam (to console) in Malayalam language, for health screening in Kerala, India. Under the Saantwanam programme, government selects suitable women care-givers who are trained and equipped by a nongovernmental organization through loans from a public sector bank. After training, care-givers deliver screening services by measuring the weight and height, and blood pressure, glucose and cholesterol levels of people concerned in their local communities at a reasonable fee-for-service that provides a source of income to them. All care-givers are trained to counsel on healthy living, i.e. appropriate diet, exercise and unhealthy habits such as tobacco consumption. When cases are detected they are referred to local physicians and later on followed up by care-givers at their residence. In the last five years, the Saantwanam programme has screened more than 300 000 people for various diseases and risk factors. They have been counselled to avail of health-care services. The Saantwanam model does not cause additional expenditure to the government for early detection of chronic diseases and their risk factors. Moreover, it ensures that the care-givers are rewarded for their effort. However, before large-scale implementation of this model, measurement of baseline risk factors in a sample population should be done so that their impact can be measured at a later date. The cost-effectiveness of the model also needs to be determined.
  1,193 79 -
Malaria control in India: has sub-optimal rationing of effective interventions compromised programme efficiency?
Habib H Farooqui, Mohammad A Hussain, Sanjay Zodpey
April-June 2012, 1(2):128-132
DOI:10.4103/2224-3151.206925  PMID:28612788
  1,073 87 1
Role of modern technology in public health: opportunities and challenges
Jai P Narain, Roderico Ofrin
April-June 2012, 1(2):125-127
DOI:10.4103/2224-3151.206924  PMID:28612787
  1,050 76 2
Hospital or home? Scripting a high point in the history of TB care and control
Mukund Uplekar, Mario Raviglione
April-June 2012, 1(2):220-223
DOI:10.4103/2224-3151.206935  PMID:28612798
  974 77 2
Mobile phones for community health workers of Bihar empower adolescent girls
Derek Treatman, Mohini Bhavsar, Vikram Kumar, Neal Lesh
April-June 2012, 1(2):224-225
DOI:10.4103/2224-3151.206936  PMID:28612799
  900 79 1