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Background: National Leprosy Eradication Program (NLEP) was launched in 1983 with the goal of elimination of leprosy as a public health problem. Aim: To evaluate the NLEP performance after integration into general health system from April 2003 to March 2014. Material and Methods: A retrospective record based study was conducted by obtaining data from Rajkot district leprosy center. Prevalence rate (PR), new case detection rate (NCDR), proportion of female cases, child cases, multibacillary (MB) cases, Grade II disability among new cases and release from treatment (RFT) cases were evaluated from April 2003 to March 2014 and analyzed by using Chi-square for trend analysis test. Results: The PR of leprosy per 10,000 populations was significantly declined (P < 0.001) from 0.44 in 2003–2004 to 0.15 during March 2014. Reduction in NCDR trend was statistically significant (P < 0.001). The proportion of female cases among newly detected cases showed fluctuation from 36.23% in 2003–2004 to 37.10% in 2013–2014 (P > 0.05). The proportion of child cases also showed significantly declining trend from 12.08% in 2003–2004 to 6.70% in 2013–2014 (P < 0.05). Significant number of MB cases decreased from 122 (2003–2004) to 69 (2013–2014) (P < 0.001). Grade II disability proportion was 1.45% in the year 2003–2004, increased to 5.2% in 2009–2010 and then again decreased to 3.4% in 2013–2014 (P > 0.05). Proportion of patients RFT showed fluctuation from 66.66% (2003–2004) to 45.68% (2009–2010) and then 64.66% (2013–2014) (P < 0.001). Conclusion: The NLEP is having a favorable impact on the problem of leprosy by maintaining the elimination level of leprosy in Rajkot district over a decade.

Background: Dengue fever (DF) and its severe forms - Dengue haemorrhagic fever (DHF) and Dengue shock syndrome (DSS) have emerged as a notable public health problem in recent decades in terms of the mortality and morbidity associated with it. Methods: A cross-sectional prospective study was conducted at PDU Government Medical College, Rajkot during 1st January to 31st December, 2014. All confirmed Dengue cases were admitted in this institute during 2014 included in the study. The data entry was done in Microsoft Office Excel 2007 and analysis was done using the same software and appropriate tests were applied. Results: This study included 145 patients who were admitted to the institute during the calendar year 2014. 62% were males. 69% were in the age group 15-44 yrs. 59% cases were from rural origin. During September to December, 2014, 80% cases were admitted. 74% cases were consulted by doctor before admission at PDU Government Medical College, Rajkot. Fever was present in all the cases i.e. (100%), followed by myalgia (99%), headache (96%), vomiting (78%) and epistaxis (63%). Majority of the cases presented with Classical Dengue fever i.e. (90%) followed by DHF (10%). Most common complication was bleeding from nose and mouth i.e. (66%). No any death due to Dengue was reported during study period. 93% cases were discharged and 7 % cases were DAMA from PDU Government Medical College, Rajkot. Conclusions: The most common age group for Dengue fever was 15-44 yrs. Most of the patients were male and also from rural origin. Most of the cases occurred during the period of September to December, 2014. Fever was present in all the cases and bleeding from nose and mouth was the commonest complication of Dengue. No any death due to Dengue was reported during study period.

Background: India has the maximum number of diabetic patients in the world and this had given the country the dubious distinction of being the “diabetic capital” of the world. It is evident that the urban poor living in slums and slum like areas adopt a more urbanized lifestyle which places them at a higher risk for non-communicable diseases and have poor access to healthcare, partly related to their poor purchasing ability. Women slum dwellers are particularly vulnerable to negative health outcomes. The study was conducted with objectives to assess prevalence, determine factors and know treatment and control status.Methods: This is a cross sectional study conducted among 405 slum women of age 35 years or more in Rajkot city. Interview, anthropometric measurements and selective clinical examinations i.e., blood sugar estimation were done for all participants.Results: In present study, total 64 (15.80%) women were diagnosed with diabetes. A statistically significant association was found between body mass index, remaining busy in household work, walking, practicing healthy habits, parental history, sibling history and diabetes. Out of 64 women who were diagnosed with diabetes, about half i.e., 36 (56.25%) were aware of their diabetic status. Out of those aware, 29 (80.66%) were on treatment. Among those on treatment, about half i.e., 16 (55.17%) had their blood sugar under control.Conclusions: Studied population high prevalence and inadequate control of diabetes.

Background: Despite significant progress in improvement of Government health care delivery system over past decade, community is reluctant to accept it because of substandard level of quality. “5S” is one of the strategies used to improve the physical quality and work efficiency of organization. 5S stands for five Japanese words which can be translated in English as Sort, Set in order, Shine, Standardize, and Sustain. Rajkot Municipal Corporation has adopted 5S strategy within its health centers with the aim to improve image of public health care facility among community and thereby to increase coverage of health services. This study was conducted to assess 5S implementation status at all Urban Heath Centers under health department of Rajkot Municipal Corporation, Gujarat, India. Methods: “5S” was implemented by the corporation in campaign mode in 18 Urban Health Centers in July 2014. Campaign included training, baseline assessment, and observing 5S week. A cross sectional study was carried out by personal observation and interview to assess the implementation of 5S campaign. Standard audit check list recommended by the State Quality Assurance Cell, Gujarat was used to evaluate. Results: Overall; all five components of 5S showed significant improvement (p

Objective: The primary objective of the following study was to determine and secondarily to compare the clinical and epidemiological characteristics of hospitalized patients with severe and non-severe pandemic influenza A (H1N1) during two waves from September 2009 to January 2011. Materials and Methods: A total of 274 cases were hospitalized during the first wave from September 2009 to March 2010 and from June 2010 to February 2011, 237 cases hospitalized in different hospitals of Rajkot during the second wave. Real-time reverse-transcriptase-polymerase-chain-reaction testing was used to confirm infection. Two wave's comparison was made for factors associated with disease severity. Results: During the first wave 87 (31.8%) patients had severe disease with mortality of 81.6% while during the second wave there were 53 (22.36%) patients having severe disease with higher mortality (94.3%) than the first wave. There were more children up to 15 years of age that required intensive care during the second wave (30.2%) compared to the first wave (20.7%). First wave reported more females and cases from an urban area. Presence of co-existing condition, especially pregnancy was a significant risk factor during the first wave, but not during the second wave. All patients have received antiviral drug oseltamivir during both waves. During the second wave, 39.6% of patients with severe cases received it within 2 days of onset of illness. This was higher than the first wave (19.5%). Conclusion: Higher mortality was reported during the second wave of pandemic influenza A (H1N1) 2009 (H1N1pdm09). There were more cases among the younger age group than adults during the second wave.

Background: Bio medical waste (BMW) collection and proper disposal has become a significant concern for both the medical and general community. Effective management of biomedical waste is not only a legal necessity but also a social responsibility. Objective: To know the knowledge, attitude and practice among health care personnels working in tertiary care centre. Methods: The study was conducted from January 2013 to June 2013. It was a descriptive observational hospital based cross sectional study. Study participants included the resident doctors intern doctors, nursing staff, laboratory technicians, ward boys and sweepers working in the institute who are dealing with BMW. The study was conducted by using pretested, semi-structured proforma. The data was tabulated and interpretation was done by using percentages through Epi Info 3.5.1 software. Results: It included 123 resident doctors and interns, 92 nurses, 13 laboratory technicians, and 54 sanitary staff. Majority of study participants belongs to 21-30 years (61%) age group. More than two third of study participants working in hospital from 1 to 5 years. Only 44.3% study participants received training for bio medical waste management. HIV (74.47%) and Hepatitis B (56.03%) were the main infectious diseases transmitted by the bio medical waste. Conclusion: The importance of training regarding bio medical waste management cannnot be overemphasized, lack of proper and complete knowledge about bio medical waste management impacts practices of appropriate waste disposal.

Background The first case of 2009 pandemic influenza A or H1N1 virus infection in India was reported in May 2009 and in the Saurashtra region in August 2009. We describe the two waves clinicoepidemiological characteristics of children who were hospitalized with 2009 influenza A infection in the Saurashtra region. Methods From September 2009 to February 2011, we treated 117 children infected with 2009 influenza A virus who were admitted in different hospitals in Rajkot city. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) test was used to confirm infection, and the clinico-epidemiological features of the disease were closely monitored. Results In the 117 patients, with a median age of 2 years, 59.8% were male. The median time from onset of the disease to influenza A diagnosis was 5 days, and that from onset of the disease to hospitalization was 7 days. The admitted patients took oseltamivir, but only 11.1% of them took it within 2 days after onset of the disease. More than one fourth (29.1%) of the admitted patients died. The most common symptoms of the patients were cough (98.3%), fever (94.0%), sore throat and shortness of breathing. Pneumonia was detected by chest radiography in 80.2% of the patients. Conclusions In children with infection-related illness, the survival rate was about 71% after oseltamivir treatment. The median time for virus detection with real-time RT-PCR is 5 days. Early diagnosis and treatment may reduce the severity of the disease.

Background: The Integrated Child Development Services (ICDS) scheme has been operational for more than three decades in India. Objective: To evaluate the various aspects of the ICDS program in terms of inputs, process and outcome (coverage), utilization, and issues related to the ICDS program. Methods: A total of 130 Anganwadi centers (AWCs) were selected including 95 AWCs from rural areas and 35 AWCs from urban areas from April 2012 to March 2015, from 12 districts of Gujarat and the union territory of Diu. Information was collected for infrastructure, baseline characteristics of AWWs, provision, coverage and utilization of various ICDS services, and various issues related to program operation. Results: A majority of pregnant (94.7%) and lactating (74.4%) mothers, and adolescent girls (86.6%) were availing ICDS services. In 96.9% of the AWCs, a growth chart was available and 92.3% AWWs were using it accurately. A total of 14.9% children were underweight including 13.5% moderately and 1.4% severely malnourished children. Two-third (66.2%) children were covered by supplementary nutrition (SN). Only 14.6% of the AWCs reported 100% preschool education (PSE) coverage among children. More than half (55.4%) of the AWCs reported an interruption in supply during the last 6 months. Various issues were reported by AWWs related to the ICDS. Conclusion: The study has reported gaps in terms of infrastructure facility, different trainings, coverage, supply, and provision of SN, status of PSE activities in AWCs, and provision of different services to the beneficiaries.

Background: The first case of 2009 pandemic influenza A (H1N1) virus infection in India was reported in May, 2009 and in Saurashtra region in August, 2009. We describe the clinico-epidemiological characteristics of patients who were hospitalized with 2009 influenza A (H1N1) infection in Saurashtra region. Materials and Methods: From September, 2009 to February, 2010, we observed 274 persons infected with 2009 influenza A (H1N1) virus who were admitted in different hospitals in Rajkot city. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection; the clinico-epidemiological features of the disease were closely monitored. Results: Of 274 patients, median age was 29.5 years, and 51.5% were males. Only 1.1% patients had recent travel history to infected region. Median time of five days was observed from onset of illness to influenza A (H1N1) diagnosis, while median time of six days reported for hospital stay. All admitted patients received oseltamivir drug, but only 16.1% received it within two days of onset of illness. One fourth of admitted patients were expired. The most common symptoms were cough (96.7%), fever (92%), sore throat and shortness of breathing, and coexisting conditions including diabetes mellitus (9.9%), hypertension (8.8%), chronic pulmonary diseases (5.5%) and pregnancy (5.5%) (P

Introduction: This study investigated the clinico-epidemiological characteristics of patients who were hospitalized with 2009 pandemic H1N1 influenza virus infection and seasonal influenza in the Saurashtra region of India. Methodology: From September 2009 to February 2010, a total of 773 patients with influenza virus attending different hospitals in Rajkot city were studied. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection; the clinico-epidemiological features of the disease were closely monitored. Results: Of the 733 patients, 35.4% (274/773) were cases of 2009 pandemic H1N1 influenza and 64.6% (499/773) were cases of seasonal influenza. Of the 274 patients with 2009 pandemic H1N1 influenza, the median age was 29.5 years, and 51.5% were males. Only 1.1% positive patients had recent travel history to an infected region. A median time of five days was observed from onset of illness to influenza A (H1N1) diagnosis, and a median time of six days was reported for hospital stay. All admitted influenza A (H1N1) patients received Oseltamivir drug, but only 16.1% received it within two days of onset of illness. One fourth of the admitted positive patients died. The most common symptoms were cough, fever, sore throat, and shortness of breath. The coexisting conditions were diabetes mellitus, hypertension, chronic pulmonary diseases, and pregnancy (p = 0.001). Chest radiography revealed 93% of the positive patients had pneumonia. Conclusion: The clinical course and outcomes of the 2009 pandemic (H1N1) influenza virus are comparable to those of the currently circulating seasonal influenza, with high mortality in influenza A (H1N1) patients.

Background: Tobacco which is most common legally available hazardous substance, most of the new users in India's is school children. For prevention and control of tobacco consumption, legislation lies at the very heart of any effective tobacco control programme. To assess knowledge regarding harmful effects and legislation of tobacco consumption among undergraduate studentsMethods: A cross sectional study carried out among 2000 students in 20 colleges of different streams of Rajkot and Morbi districts during February-March 2016 using self-administered questionnaire. Proportion of male: female was kept 3:1.Results: Knowledge regarding harmful effects of tobacco was present in 95.8% participants. 92.8% students believed that cancer is the harmful effect of tobacco consumption.77.3% students had knowledge that tobacco consumption is the leading cause of death in India. Television was the commonest source of knowledge of harmful effect of tobacco (71.9%). Only 15.9% students had knowledge regarding the penalty for violation of rules of tobacco consumption prohibition.Conclusion: Knowledge regarding harmful effects of tobacco consumption was present in majority of students but it had no association with tobacco consumption habit. Knowledge regarding legislation of tobacco consumption was poor among students.

To evaluate Integrated Child Development Services (ICDS) program in terms of infrastructure of Anganwadi centers, inputs, process, coverage and utilization of services, and issues related to program operation in twelve districts of Gujarat, India. Facility (Anganwadi) based study. Twelve districts of Gujarat, India (April 1, 2012 to March 31, 2013). ICDS service providers (60 Anganwadi workers from 46 rural and 14 urban Anganwadi centers) and their beneficiaries. Coverage of supplementary nutrition, pre-school education, immunization and referral services. Supplementary nutrition coverage was reported in 48.3% in children. Interruption in supply of supplementary nutrition during last six months was reported in 61.7% Anganwadi centers. Only 20% centers reported 100% pre-school education coverage among children. Immunization of all children was recorded in only 10% Anganwadi centers, while in 76.7% centers, no such records were available. Regular health checkup of beneficiaries was done in 30% centers. Referral slips were available in 18.3% Anganwadi centers and referral of sick children was done from only 8.3% centers. There are program gaps in coverage of supplementary nutrition in children, its regular supply to the beneficiaries, in pre-school activities coverage, recording of immunization, and regular health check-up of beneficiaries and referral of sick children.

Background: The Integrated Child Development Service (ICDS) program aims at enhancing survival and development of children from the vulnerable sections of the society. Aim: The present study was conducted to assess various nutritional activities at anganwadi centers (AWCs) in different districts of Gujarat state. Settings and Design: AWCs, cross-sectional study. Materials and Methods: A total of 130 AWCs were selected including 95 from rural and 35 from urban area from April 2012 to March 2015 including 12 districts of Gujarat and union territory, Diu. Five AWCs were selected from one district randomly. Detailed information about various nutritional activities including growth monitoring, preschool education (PSE) and nutrition and health education (NHED), coverage for supplementary nutrition (SN), type of food provided under SN, and its issues at AWCs was collected. Statistical Analysis: Percentages, proportions, Chi-square/Fischer's exact test. Results: Growth chart was available in 96.9% AWCs. The malnutrition was reported among 14.9% children. PSE received by all children was only in 14.6% AWCs. NHED meeting was conducted in 73.8% AWCs. High coverage of receiving SN among enrolled was reported in pregnant and lactating mothers (84.6%) and adolescents (79.2%). SN was fully acceptable in 91.5% AWCs. Interruption in SN supply during last 6 months was reported in 55.4% AWCs. Conclusion: Regular workshops should be conducted for ICDS staff to sensitize them about the importance of and practices on PSE. Interruption in supply of SN should be corrected by regular and adequate provision of SN foods to the beneficiaries.

To compare prevalence of goitre in primary school children; to determine median urinary iodine concentration in children; and, to assess level of salt iodization at retail trader level.30 cluster survey study.Primary schools of Kutch district, Gujarat, India.Total 70 students including five boys and five girls from 1st to 7th standard, present in class on the day of visit were selected randomly for Goitre examination (n=2100). Urine sample was collected from one boy and one girl from each standard in each cluster. From the community, 28 children, including two boys and two girls from each standard in the same age group were examined, and salt samples were tested from their households. From each village, one retail shop was visited and various salts available were purchased and tested for iodine on the spot with spot kit.Goitre prevalence of 11.2% was found among primary school children (grade 1- 8.6% and grade 2-2.6%). As the age increased, the Goitre prevalence also increased except in age group of 8 years. Median urinary iodine excretion level was 110 µg/L. Iodine level more than 15 ppm was found in 92.3% salts samples tested at the household level.Present study showed mild goitre prevalence in primary school children in Kutch district of Gujarat.

Background: Even after more than 3 decades of implementation, the success of integrated child development services (ICDS) program in tackling maternal and childhood problems still remain a matter of concern. The present study was conducted to assess issues related to Anganwadi worker (AWW) and Anganwadi center (AWC) including infrastructure facilities. Materials and Methods: A total of 60 AWCs were selected including 46 AWCs from a rural area and 14 AWCs from an urban area during April 2012 to March 2013 from 12 districts of Gujarat. Five AWCs were selected from one district. Information on AWWs background characteristics, along with infrastructure and other services delivered at AWCs were observed and recorded. Results: Majority (66.7%) AWCs building were owned by state and 73.3% AWCs having pucca type of building. Almost two-third (65%) AWWs had >10 years of experience. Induction training was given to only 1 AWW (7.1%) in an urban area. Poor findings were reported for regular health checkups (30%), immunization (10.0%), referral slips availability (18.3%), and referral of sick children (8.3%). Significant number of 6 months to 3 years age group and 3 to 6 years in rural areas received services from Anganwadi. Similarly, significant number of pregnant mothers (P < 0.00), lactating mothers (P < 0.00) and adolescent girls (P < 0.00) in rural areas compared to urban areas received Anganwadi services. Nutrition and health education day was observed in 81.7% AWCs. Conclusion: The performance of AWCs and maternal and child health services delivered by AWCs still needs improvement. Coordinated steps catering to different services provided at the centers are needed to optimize the functioning of the ICDS scheme.

Background: In India, the first case of 2009 pandemic influenza A (H1N1) virus infection was reported in May 2009 and the same in Saurashtra region in August 2009. We describe the epidemiology and factors associated with severe and non-severe cases of 2009 influenza A (H1N1) infection reported in the Saurashtra region. Materials and Methods: From September 2009 to January 2011, we reported 511 patients who were infected with 2009 influenza A (H1N1) virus and admitted in different hospitals of Rajkot city. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) testing was used to confirm infection. Factors associated with severe cases were determined by comparing with non-severe cases. Results: Out of 511 patients, 140 had severe disease (requiring intensive care or died) and 371 non-severe diseases (admitted in wards and survived). Median age of 30 years; median time of 5 days from onset of illness to diagnosis, and 4 days median time was reported for hospital stay among severe disease patients. More than half (60.7%) were females. Out of the patients with severe disease, 52.1% patients residing in urban area (OR = 1.68, CI = 1.13-2.49). Significant association was reported among severe disease patients for delayed referral from general practitioner/physician after initial treatment. All patients received antiviral drug, however, only 27.1% received within 2 days of illness. Presence of coexisting condition (pregnancy (OR = 0.19, CI = 0.08-0.48) was strongly associated with severe disease. Conclusion: Delayed referral from general practitioner/physician, duration of antiviral treatment, presence of coexisting condition (i.e., pregnancy) were responsible for intensive care or mortality among severe influenza A (H1N1) illness.

Objective: To study and compare clinical and epidemiological characteristics of pediatric patients hospitalized with 2009 pandemic Influenza A (H1N1) infection during two waves. Materials and Methods: From September 2009 to February 2011, 62 children were admitted in pediatric ward of the hospitals during 1 st wave and 55 during 2 nd wave, infected with 2009 Influenza A (H1N1) virus in Rajkot city. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection. The clinico-epidemiological features of the disease were closely compared and monitored. Results: First wave reported median age of 2.5 years, which was 2 years during second wave in positive cases. The median duration of diagnosis of infection was reported 5 days after onset of illness, and 7-day median time for hospital stay in both the waves. Majority of patients reported with cough and fever. Total 16.1% patients during 1 st wave and 27.3% in 2 nd wave reported some underlying condition. All admitted patients received oseltamivir drug, but only 9.7% (1 st season) and 12.7% (2 nd season) cases received it within 2 days of onset of illness. In both seasons, more than one-fourth (29.0%) of admitted patients expired. Pneumonia was reported in 97.1% patients (1 st wave) and in 60.0% (2 nd wave) with chest radiography. Conclusion: Influenza A (H1N1)-related illness affects children, including infants with survival of about 71% patients during both waves. The median time from the onset of illness to diagnosis was 5 days. Delayed referral, presence of any coexisting condition, pneumonia and receiving corticosteroid treatment were associated with severe Influenza A (H1N1).

Objective: To study and compare clinical and epidemiological characteristics of patients who were hospitalized with influenza A (H1N1) infection for two waves in Saurashtra region. Materials and Methods: Total 274 patients admitted during the first wave from September 2009 to March 2010 and 237 during the second wave from June 2010 to February 2011 with 2009 influenza A (H1N1) virus were admitted in different hospitals in Rajkot city. Real-time reverse-transcriptase-polymerase-chain-reaction (RRRT-PCR) testing was used to confirm infection; the clinical and epidemiological features of the disease were closely monitored. Results: The median age of positive cases reported was 27 years in the first wave and 29 years in the second wave, respectively. The median duration of diagnosis of infection was reported five days after onset of illness in both the waves. Majority of patients were reported with cough and fever. Total 160 patients were reported with at least one underlying condition. Hypertension and diabetes mellitus either alone or together was mainly reported as the underlying condition during both season, followed by chronic pulmonary diseases and pregnancy. More number of pregnant women were reported with a range of 5 to 9 months of amenorrhea during first wave (5.5%) compare to second wave (3.0%). Conclusion: We have demonstrated that during two waves, infection-related illness affects both children including infants and adults with survival of 77.2% patients in second wave. Pregnancy was found as a significant ( P < 0.05) risk factor for severe disease. Significant number of patients with severe influenza A (H1N1) received antiviral treatment within two days of onset of illness.