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Background: Maternal determinants influence the outcome of pregnancy and child’s health in early years. Rashtriya Bal Swasthya Karyakram (RBSK) deals with the 4 D (birth defects, chronic diseases, deficiency disorders and developmental delays) among children (from birth till 18th years). Objectives were to determine and document the association between maternal determinants especially antenatal care (ANC) and 4 Ds and suggest preventive measures. Methods: Out of 302 children with 4 D’s registered during April 2018-March 2020, 102 children were selected using probability proportionate to sample size (PPS) sampling for each category of 4D. Information of socio demographic details and maternal determinants was gathered on a semi structured questionnaire by interviewing mothers/caretaker. Results: Relevant information could be gathered from 96 mothers. Mean maternal age was 26.4±4.1 years. Congenital defects were significantly associated with higher maternal age (p

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Background: Major illness requiring hospitalization in poor family makes the family poorer with further tragic outcomes. In that view, Rashtriya Swasthya Bima Yojna (RSBY) by GOI and Mukhyamantri Amrutam (MA) Yojna by Gujarat Government were launched for Below Poverty Line families. Aims & Objectives: To assess knowledge and utilization regarding these two schemes amongst the registered families. Material & Methods: A community-based survey was carried out in a block of Gandhinagar using 30 clusters sampling. Sample size was calculated taking RSBY utilization rate 2.0%. Results: 98.4% had RSBY card & 83.7% had MA card. Common reasons for not having card were either “card not issued/people did not go to collect card” or “were unaware about the schemes/ card”. Only 1.5% families had valid RSBY cards. Knowledge regarding both the schemes (when & where to use, benefit amount etc.) was very poor (20- 25%). RSBY & MA utilization among valid card holders for last 1 year was 1.2% & 0.2% per enrolled member respectively in last 1 year. In both RSBY & MA, 30 – 40% beneficiaries had out of pocket expenditure, mainly towards transport & food. Few had towards medicines and/or investigations. However, most were satisfied with the services. Conclusion: Looking to the poor knowledge, it is important to carry out IEC activities to make people aware about the schemes which will help increase the utilization.

Background: Drug resistant tuberculosis (DR-TB), is usually associated with adverse socioeconomic and psychological outcomes. Such patients with co-morbid depression have lower treatment adherence and poor outcomes. Programmatic management of drug resistant tuberculosis (PMDT) guidelines recommend screening of DR-TB patients for mental illnesses at baseline and Follow-up (FU). The objectives were to explore perceptions and experiences of service providers about depression amongst MDR TB cases, review current strategies for screening for depression at Tuberculosis units (TUs) and recommend measures to address depression among MDR TB cases.Methods:This qualitative study was conducted across all TUs of Ahmedabad Municipal Corporation wherein 26 Key informant interviews (KIIs) were conducted using thematic guidelines and subsequently categorized in to subtheme for thematic analysis.Results: MOs had mixed experiences about encountering depression among MDR-TB cases, ranging from 1%-50%. Long duration and side effects of treatment, financial burden due to unemployment and societal stigma were contributory factors. Ensuring compliance was a major challenge. Counselling is an effective intervention for this but lack of counsellors in the program was another challenge. MOs stated that pre-treatment screening for depression is done at DR TB centre, but there is no structured, process. However, most of them don’t do subsequent follow up for depression.Conclusions:More counsellors need to be included in the program and a structured method needs to be devised for screening of depression among MDR TB patients. Both MO TUs and Counsellors need to be sensitized and trained for screening and monitoring depression amongst MDR TB in a systematic way.

Light microscopy of blood smears for diagnosis of malaria in the field has several limitations, notably delays in diagnosis. This study in Ahmedabad in Gujarat State, India, evaluated the diagnostic performance of a rapid diagnostic test for malaria (SD Bioline Malaria Ag P.f/Pan) versus blood smear examination as the gold standard. All fever cases presenting at 13 urban health centres were subjected to rapid diagnostic testing and thick and thin blood smears. A total of 677 cases with fever were examined; 135 (20.0%) tested positive by rapid diagnostic test and 86 (12.7%) by blood smear. The sensitivity of the rapid diagnostic test for malaria was 98.8%, specificity was 91.5%, positive predictive value 63.0% and negative predictive value 99.8%. For detection of Plasmodium falciparum the sensitivity of rapid diagnostic test was 100% and specificity was 97.3%. The results show the acceptability of the rapid test as an alternative to light microscopy in the field setting.

This study compared the validity of the haemoglobin colour scale (HCS) and clinical signs in diagnosing anaemia against Sahli's haemoglobinometer method as the gold standard, and assessed the reliability of HCS. The sample comprised 129 pregnant women recruited from 6 urban health centres in Ahmedabad. The prevalence of anaemia was 69.8% by Sahli's method, 78.3% by HCS and 89.9% by clinical signs; there was no statistically significant difference between Sahli's method and HCS whereas there was between Sahlis method and clinical signs. The mean haemoglobin level by Sahli's method and HCS differed significantly. The sensitivity, specificity, positive predictive value and negative predictive value of HCS was 83.3%, 33.3%, 74.3% and 46.4% respectively and that of clinical signs was 91.1%, 12.8%, 70.7% and 38.5% respectively. Interobserver agreement for HCS was moderate (K = 0.43). Clinical signs are better than HCS for diagnosing anaemia. HCS can be used in the field provided assessors are adequately trained.

The present study was carried out to have understanding of characterisation including symptoms, signs and laboratory parameters which are associated with fatality of malaria cases on arrival to hospital which may lead to early recognition and improved management. Information about deaths due to Malaria, as reported to malaria Department of Ahmedabad Municipal Corporation by municipal corporation hospitals and civil hospital from January 07 to December 07, was used to locate details of those deaths in respective hospitals by obtaining indoor case papers and death reports of those cases from Medical Record Section of respective hospitals and were analyzed by using appropriate statistical software. Total 57 malaria deaths occurred in the above mentioned 4 hospitals. Overall Case Fatality Rate was 3.03% for indoor malaria cases. Complete information could be obtained about 42 cases. Mean age of cases was 36.50 years. 45.23% of patients falling in the age group= 40 yrs. There were 57.1% males and 42.9% females. 55 cases were positive for P. falciparum, 1 case for P. vivax and 1 case was having mixed infection. Average duration of Hospital stay was 2.87 days and average total duration of illness was 6.82 days. The most common presenting symptom was intermittent fever with vomitingaltered sensorium in 38.88%most common complication was Acute Renal Failure in 45.2% of cases. Paired t-test was applied on the investigations carried out on the day of admission and those carried out on the day or before a day of death and found significant for the levels of Haemoglobin, Blood UreaSerum Billirubin. Malaria still remains one of the important causes of admission and mortality. In view of changes in anti-malarial drug policy and introduction of costly artemisinin combination therapy accurate, rapid diagnostic tools are necessary to target treatment to people in need.

The emergence of resistance to anti-tuberculosis drugs in general and Multi Drug Resistan Tuberculosis (MDR-TB) in particular, has become a significant public health problem and an obstacle to effective TB control. Baseline and adequate information on epidemiological factors and their interaction are prerequisites for its effective control.To study socio-demographic profile, housing environment, health-seeking behaviour, present and past history regarding treatment of tuberculosis, drug resistance pattern and the preventive practice adopted by the patients.A cross-sectional study was carried out on 81 MDR-TB patients registered under RNTCP of Ahmedabad city during July 2007-June 2008. To accomplish the objectives, information was collected by personal interviews using pre-designed, pre-tested proforma. Data, so collected, was analyzed and tabulated using appropriate statistical software.More than 2/3rd were males and majority were in age group 16-45 years, educated up to primary level, living in overcrowded and ill-ventilated houses. Initially almost all had pulmonary TB. At the start of category II, maximum number of patients were defaulters, the prime cause being financial crunch. The mean number of Anti Tubercular Treatment (ATT) taken before start of category IV was 2.85. More than 90% experienced side-effects of drugs. Although indiscriminate spitting was less, other methods of sputum disposal were also unsafe. Resistance to all four drugs (H, R, SE) was found in more than 2/3rd of cases. Smear and culture conversion rate at three month follow up was 62.0% and 58.7% respectively. Only one patient (1.2%) was reactive for HIV in the study. Most of the patients perceived some degree of improvement in their condition following treatment.Most of the MDR cases were living in poor environmental conditions, had previous history of TB and defaulter of treatment regimen prescribed. Motivation of private practitioners for increasing referrals, use of incentives and enablers, enhancing contact tracing and increasing awareness regarding sputum disposal practices and measures to prevent the spread are necessary for effective control of tuberculosis.