Directorate of Health Services

Hyderabad andhra Pradesh, India

Directorate of Health Services

Hyderabad andhra Pradesh, India
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Sarkar J.,Directorate of Health Services | Murhekar M.V.,National Institute of Epidemiology
Indian Journal of Tuberculosis | Year: 2011

New sputum negative (NSN) tuberculosis case detection in Jalpaiguri district has been consistently low. Availability and accessibility of health facilities with chet x-rays is key for the diagnosis of NSN cases. To identify factors associated with utilisation of x-ray facilities in the district, we interviewed 4,875 chest symptomatics who were sputum negative on two occasions with an antibiotics course in between. Chest radiography was available in only three public health facilities in the district. Low income, long distance from the public health facilities with chest radiography and high cost of x-rays at private hospitals were key factors associated with symptomatics not undergoing X-ray. It is necessary to increase facilities for radiological diagnosis and provide mobility support for the symptomatics in Jalpaiguri.


Jaikrishan G.,Bhabha Atomic Research Center | Sudheer K.R.,Bhabha Atomic Research Center | Andrews V.J.,Bhabha Atomic Research Center | Koya P.K.M.,Bhabha Atomic Research Center | And 3 more authors.
Journal of Community Genetics | Year: 2013

Monitoring newborns for adverse outcomes like stillbirth and major congenital anomalies (MCA) is being carried out in government hospitals since 1995 in and around high-level natural radiation areas, a narrow strip of land on the southwest coast of Kerala, India. Natural deposits of monazite sand containing thorium and its daughter products account for elevated levels of natural radiation. Among 141,540 newborns [140,558 deliveries: 139,589 singleton, 957 twins (6.81 ‰), 11 triplets (0.078 ‰), and one quadruplet] screened, 615 (4.35 ‰) were stillbirth and MCA were seen in 1,370 (9.68 ‰) newborns. Clubfoot (404, 2.85 ‰) was the most frequent MCA followed by hypospadias (152, 2.10 ‰ among male newborns), congenital heart disease (168, 1.19 ‰), cleft lip/palate (149, 1.05 ‰), Down syndrome (104, 0.73 ‰), and neural tube defects (72, 0.51 ‰). Newborns with MCA among stillbirths were about 20-fold higher at 190.24 ‰ (117/615) compared to 8.89 ‰ (1,253/140,925) among live births (P <.001). Logistic regression was carried out to compare stillbirth, overall, and specific MCA among newborns from areas with dose levels of ≤1.5, 1.51-3.0, 3.01-6.0 and >6 mGy/year after controlling for maternal age at birth, gravida, consanguinity, ethnicity, and gender of the baby. Clubfoot showed higher prevalence of 3.26 ‰ at dose level of 1.51-3.0 mGy/year compared to 2.33 ‰ at ≤1.5 mGy/year (OR = 1.39; 95 % CI, 1.12-1.72), without indication of any clear dose-response. Prevalences of stillbirth, overall MCA, and other specific MCA were similar across different dose levels and were relatively lower than that reported elsewhere in India, probably due to better literacy, health awareness, and practices in the study population. © 2012 Springer-Verlag.


Shriram A.N.,Medical Port | Krishnamoorthy K.,Vector Control Research Center Indian Council of Medical Research | Sivan A.,Medical Port | Saha B.P.,Directorate of Health Services | And 2 more authors.
Acta Tropica | Year: 2014

Mass Drug Administration is being carried out in Andaman and Nicobar Islands, India since 2004. Cross sectional microfilaria (Mf) survey was conducted in Nancowry group of islands, the lone foci of diurnally sub periodic form of bancroftian filariasis in Nicobar district, to examine its eligibility for Transmission Assessment Survey (TAS). A total of 2561 individuals (coverage: 23.9%) were screened from five islands. The overall Mf prevalence was 3.28%. Except one island, all other islands recorded Mf prevalence >1%, ranging from 2.5% to 5.3%, indicating persistence of infection despite six annual rounds of MDA. Mf prevalence was age dependent and was higher among males, but not significantly different between genders. Age and gender specific analysis showed a significant reduction in all the age classes among females vis a vis pre-MDA prevalence while the reduction was significant only in 21-30 and 41-50 age classes in males. Exposure to day biting and forest dwelling Downsiomyia nivea can be attributed for the persistent infection besides non-compliance for MDA. Based on fits of modified negative binomial distribution, true prevalence of Mf carriers in the community was estimated to be 4.74%, which is markedly higher (about 24%) than the observed prevalence of 3.28%. Follow up of cohorts showed evidence of continued persistence of infection and acquisition of new infections post six rounds of MDA. As the Mf prevalence was above >1% in four of the five islands, this area is not eligible for TAS, warranting continuation of MDA. Mass DEC fortified salt is suggested as an adjunct to hasten elimination of infection. © 2014 Elsevier B.V.


Thompson D.,University of Bath | Batterham A.M.,University of Teesside | Peacock O.J.,University of Bath | Western M.J.,University of Bath | Booso R.,Directorate of Health Services
Preventive Medicine | Year: 2016

Wearable devices to self-monitor physical activity have become popular with individuals and healthcare practitioners as a route to the prevention of chronic disease. It is not currently possible to reconcile feedback from these devices with activity recommendations because the guidelines refer to the amount of activity required on top of normal lifestyle activities (e.g., 150 minutes of moderate-to-vigorous intensity activity per week over-and-above normal moderate-to-vigorous lifestyle activities). The aim of this study was to recalibrate the feedback from self-monitoring. We pooled data from four studies conducted between 2006 and 2014 in patients and volunteers from the community that included both sophisticated measures of physical activity and 10-year risk for cardiovascular disease and type 2 diabetes (n = 305). We determined the amount of moderate-to-vigorous intensity activity that corresponded to FAO/WHO/UNU guidance for a required PAL of 1.75 (Total Energy Expenditure/Basal Metabolic Rate). Our results show that, at the UK median PAL, total moderate-to-vigorous intensity physical activity will be around 735 minutes per week (~ 11% of waking time). We estimate that a 4% increase in moderate-to-vigorous intensity activity will achieve standardised guidance from FAO/WHO/UNU and will require ~ 1000 minutes of moderate-to-vigorous intensity activity per week. This study demonstrates that feedback from sophisticated wearable devices is incompatible with current physical activity recommendations. Without adjustment, people will erroneously form the view that they are exceeding recommendations by several fold. A more appropriate target from self-monitoring that accounts for normal moderate-to-vigorous lifestyle activities is ~ 1000 minutes per week, which represents ~ 15% of waking time. © 2016 The Authors


Nayak P.,World Health Organization | Kumar A.M.V.,International Union Against Tuberculosis and Lung Disease | Agrawal T.K.,Directorate of Health Services | Chandraker S.,Intermediate Reference Laboratory | Nair S.A.,World Health Organization
International Journal of Tuberculosis and Lung Disease | Year: 2014

SETTING: Three medical college hospitals using light-emitting diode fluorescence microscopy (LED-FM) for diagnosing tuberculosis (TB) in Chhattisgarh, India. OBJECTIVES: To assess and compare the proportion of sputum smear-positive TB patients diagnosed through same-day microscopy (spot-spot) strategy or with the conventional (spot-morning) strategy. METHODS: During November 2012 - March 2013, all consecutively enrolled presumptive TB patients (aged ≥18 years) were requested to provide three specimens: two spot specimens collected 1 h apart on the first day and one early morning specimen the next day; these were stained using auramine-O and examined using LED-FM. RESULTS: Of 1716 (93% of total 1845) presumptive TB patients who provided all three specimens, 218 (13%) were smear-positive: 200 (11.7%) by same-day microscopy and 217 (12.7%) by the conventional method (McNemar's χ2 13.5, df 1, P = 0.0002). Eighteen (8.3%) cases were missed by the same-day method. CONCLUSION: Although LED-FM is more sensitive to paucibacillary samples, 8% of smear-positive cases were missed using the same-day method. These findings indicate the need to revisit the global applicability of the current World Health Organization recommendation of switching to same-day diagnosis from the conventional policy. © 2014 The Union.


Anyait A.,Makerere University | Mukanga D.,Makerere University | Oundo G.B.,Directorate of Health Services | Nuwaha F.,Makerere University
BMC Pregnancy and Childbirth | Year: 2012

Background: Among the factors contributing to the high maternal morbidity and mortality in Uganda is the high proportion of pregnant women who do not deliver under supervision in health facilities. This study aimed to identify the independent predictors of health facility delivery in Busia a rural district in Uganda with a view of suggesting measures for remedial action.Methods: In a cross sectional survey, 500 women who had a delivery in the past two years (from November 16 2005 to November 15 2007) were interviewed regarding place of delivery, demographic characteristics, reproductive history, attendance for antenatal care, accessibility of health services, preferred delivery positions, preference for disposal of placenta and mother's autonomy in decision making. In addition the household socio economic status was assessed. The independent predictors of health facility delivery were identified by comparing women who delivered in health facilities to those who did not, using bivariate and binary logistic regression analysis.Results: Eight independent predictors that favoured delivery in a health facility include: being of high socio-economic status (adjusted odds ratio [AOR] 2.8 95% Confidence interval [95% CI]1.2-6.3), previous difficult delivery (AOR 4.2, 95% CI 3.0-8.0), parity less than four (AOR 2.9, 95% CI 1.6-5.6), preference of supine position for second stage of labour (AOR 5.9, 95% CI 3.5-11.1) preferring health workers to dispose the placenta (AOR 12.1, 95% CI 4.3-34.1), not having difficulty with transport (AOR 2.0, 95% CI 1.2-3.5), being autonomous in decision to attend antenatal care (AOR 1.9, 95% CI 1.1-3.4) and depending on other people (e.g. spouse) in making a decision of where to deliver from (AOR 2.4, 95% CI 1.4-4.6). A model with these 8 variables had an overall correct classification of 81.4% (chi square = 230.3, P < 0.001).Conclusions: These data suggest that in order to increase health facility deliveries there is need for reaching women of low social economic status and of higher parity with suitable interventions aimed at reducing barriers that make women less likely to deliver in health units such as ensuring availability of transport and involving spouses in the birth plan. © 2012 Anyait et al.; licensee BioMed Central Ltd.


De Silva V.A.,University of Colombo | Jayasekera N.E.L.W.,Directorate of Health Services | Hanwella R.,University of Colombo
Annals of General Psychiatry | Year: 2013

Background: Medically unexplained symptoms have been reported among both civilians and military personnel exposed to combat. A large number of military personnel deployed to the Gulf War in 1991 reported non-specific symptoms. These symptoms did not constitute a clearly defined syndrome. Post-traumatic stress disorder (PTSD) and to a lesser degree exposure to combat are associated with physical symptoms.Methods: This is a cross-sectional study of representative samples of Sri Lanka Navy Special Forces and regular forces deployed in combat areas continuously during a 1-year period. Multiple physical symptoms were elicited using a checklist of 53 symptoms. Cases were defined as individuals with ten or more symptoms. Symptoms of common mental disorder were identified using the General Health Questionnaire 12 (GHQ-12). PTSD was diagnosed using the 17-item National Centre for PTSD checklist civilian version.Results: Prevalence of multiple physical symptoms was 10.4% (95% CI 8.11-12.75). Prevalence was significantly less in the Special Forces (5.79%) than in the regular forces (13.35%). The mean number of symptoms reported by those who met the criteria for PTSD was 12.19 (SD 10.58), GHQ caseness 7.87 (SD 7.57) and those without these conditions 2.84 (SD 3.63). After adjusting for socio-demographic and service variables, 'thought I might be killed' , 'coming under small arms fire' , and 'coming under mortar, missile and artillery fire' remained significant. Multiple physical symptoms were associated with functional impairment and poor perceived general health.Conclusions: Prevalence of multiple physical symptoms was significantly lower in the Special Forces despite high exposure to potentially traumatic events. More multiple physical symptoms were reported by personnel with PTSD and common mental disorders. Multiple physical symptoms were associated with functional impairment. © 2013 de Silva et al.; licensee BioMed Central Ltd.


Mahdi S.S.,Directorate of Health Services | Habib O.S.,University of Basrah
Eastern Mediterranean Health Journal | Year: 2010

This was a cross-sectional study in Basra, and involved 353 women who had recently given birth drawn from health care institutions. The main objective was to determine the factors that helped determine the women's choice of place of delivery: Hospital or home. Only 16.1% delivered at home, while 83.9% delivered in hospital. The main reasons for choosing hospital delivery were safety and security (96.6% of the women), better hygiene (66.6%) and because of medical advice (63.2%). The main reasons for the choice of home delivery were social support and privacy (98.2%). The women were consistent in their choice of delivery place across different pregnancies (previous, present and future).


Vijayakumar K.,Government Medical College | Sudheesh Kumar T.K.,Government Medical College | Nujum Z.T.,Government Medical College | Umarul F.,Directorate of Health Services | Kuriakose A.,Government Medical College
Journal of Vector Borne Diseases | Year: 2014

Background & objectives: The district of Thiruvananthapuram reports the maximum number of cases of dengue in the state of Kerala. To determine the larval diversity, density and breeding site preferences of Aedes mosquitoes, during pre-monsoon and monsoon periods in urban and rural areas of Thiruvananthapuram district. Methods: Based on the daily reports of dengue cases, 70 clusters were identified in Thiruvananthapuram district. A cross-sectional larval survey was done in the domestic and peri-domestic areas of 1750 houses, using the WHO standard techniques. The larval indices were calculated, and the larvae were identified by using taxonomic keys. Urban and rural differences and the variations during pre-monsoon and monsoon seasons were also studied. Results: In the surveyed houses, 15% had mosquito breeding, with 88% having Aedes larvae. The house index, container index and the breteau index were 13.08, 13.28 and 16.57%, respectively. About 86% of the clusters were found positive for Aedes albopictus and 11% for Ae. aegypti. Aedes albopictus was distributed almost equally in rural and urban clusters, whereas the distribution of Ae. aegypti was significantly higher in urban areas (p = 0.03). The most common water holding containers found (outdoor) were of plastic, followed by coconut shells. The breeding preference ratio was highest for tyres. Significantly lesser positivity was found for containers during monsoon period when compared to pre-monsoon period. Conclusion: The geographical distribution of Ae. albopictus is significantly high in peri-domestic areas and, therefore, its epidemiological role in the widespread disease occurrence needs to be studied. The discarded tyres being the most preferred breeding sites, where IEC activities will help in source reduction.


Sufi A.R.,Government Medical College | Singh T.,Government Medical College | Mufti A.A.,Directorate of Health Services | Rather M.H.,Government Medical College
BMC Ophthalmology | Year: 2012

Background: The aim of the study is to compare the outcome of phacoemulsification in patients with and without pseudoexfoliation syndrome in Kashmir. Methods. 200 patients were prospectively evaluated and divided into 2 groups. Group 1 comprised 100 cases with pseudoexfoliation and Group 2 (control) 100 cases without pseudoexfoliation. Phacoemulsification with posterior chamber intraocular lens implantation was performed by 3 surgeons. Intraoperative and postoperative observations were made in both the groups at regular intervals upto 6months. A chi square test was used for statistical analysis. Results: Patients with pseudoexfoliation were significantly older (P=0.000), had harder cataract(P=0.030) and smaller mean pupil diameter(P=0.000) than the control group. Intraoperative complications were comparable between the 2 groups except the occurrence of zonular dehiscence which was seen in 7% patients of Group 1 compared to 0% in Group 2. Higher postoperative inflammatory response was seen in Group 1(P=0.000). Decrease in intraocular pressure (IOP) at all postoperative measurements was more in Group 1(P=0.000). The visual acuity was better in the control group in the early postoperative period (P=0.029), however the final visual acuity at 6months was comparable between the 2 groups. Conclusions: Phacoemulsification in presence of pseudoexfoliation necessitates appropriate surgical technique to avoid intraoperative complications. Pseudoexfoliation is associated with higher inflammatory response, significant postoperative IOP drop and satisfactory visual outcome. © 2012 Sufi et al.; licensee BioMed Central Ltd.

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