Barman D.,Institute of Health Management Research IIHMR |
Dutta A.,University of Calcutta
Journal of Health, Population and Nutrition | Year: 2013
While many studies attempted to evaluate performance of immunization programmes in developing countries by full coverage, there is a growing awareness about the limitations of such evaluation, irrespective of the overall quality of performance. Availability of human resources, equipment, supporting drugs, and training of personnel are considered to be crucial indicators of the quality of immunization programme. Also, maintenance of time schedule has been considered crucial in the context of the quality of immunization. In addition to overall coverage of vaccination, the coverage of immunization given at right time (month-specific) is to be considered with utmost importance. In this paper, District Level Household and Facility Survey-3 (DLHS-3) 2007-2008 data have been used in exploring the quality of immunization in terms of month-specific vaccine coverage and barriers to access in West Bengal, India. In West Bengal, the month-specific coverage stands badly below 20% but the simple non-month-specific coverage is as high as 75%. Among the demand-side factors, birthplace of the child and religion of the household heads came out as significant predictors while, from the supply-side, availability of male health workers and equipment at the subcentres, were the important determinants for month-specific vaccine coverage. Hence, there should be a vigorous attempt to make more focused planning, keeping in mind the nature of the barriers, for improvement of the month-specific coverage in West Bengal. © International Centre For Diarrhoeal Disease Research, Bangladesh.
Kanjilal B.,Institute of Health Management Research IIHMR |
Mazumdar P.G.,Future Health |
Mukherjee M.,Future Health |
Rahman M.H.,Johns Hopkins University
International Journal for Equity in Health | Year: 2010
Background. Despite recent achievement in economic progress in India, the fruit of development has failed to secure a better nutritional status among all children of the country. Growing evidence suggest there exists a socio-economic gradient of childhood malnutrition in India. The present paper is an attempt to measure the extent of socio-economic inequality in chronic childhood malnutrition across major states of India and to realize the role of household socio-economic status (SES) as the contextual determinant of nutritional status of children. Methods. Using National Family Health Survey-3 data, an attempt is made to estimate socio-economic inequality in childhood stunting at the state level through Concentration Index (CI). Multi-level models; random-coefficient and random-slope are employed to study the impact of SES on long-term nutritional status among children, keeping in view the hierarchical nature of data. Main findings. Across the states, a disproportionate burden of stunting is observed among the children from poor SES, more so in urban areas. The state having lower prevalence of chronic childhood malnutrition shows much higher burden among the poor. Though a negative correlation (r = -0.603, p < .001) is established between Net State Domestic Product (NSDP) and CI values for stunting; the development indicator is not always linearly correlated with intra-state inequality in malnutrition prevalence. Results from multi-level models however show children from highest SES quintile posses 50 percent better nutritional status than those from the poorest quintile. Conclusion. In spite of the declining trend of chronic childhood malnutrition in India, the concerns remain for its disproportionate burden on the poor. The socio-economic gradient of long-term nutritional status among children needs special focus, more so in the states where chronic malnutrition among children apparently demonstrates a lower prevalence. The paper calls for state specific policies which are designed and implemented on a priority basis, keeping in view the nature of inequality in childhood malnutrition in the country and its differential characteristics across the states. © 2010 Kanjilal et al; licensee BioMed Central Ltd.
Shahnawaz M.,Institute of Health Management Research IIHMR |
Singh J.B.,Institute of Health Management Research IIHMR
Epidemiology Biostatistics and Public Health | Year: 2014
Background: India has achieved remarkable economic progress in the last couple of decades but the fruit of progress has failed to assure better nutritional status to our children. The child nutritional situation remains grim for most of the states, especially in the tribal region. This paper is an attempt to measure the extent of under-nutrition in terms of height/length-for-age (stunting), weight-forheight/ length (wasting), and weight-for-age (underweight) for children less than five year of age in predominantly tribal block Jhadol of district Udaipur, Rajasthan, India. Methods: World Health Organization (WHO) child growths standard has been used as reference population to measure the percentage prevalence of stunting, wasting and underweight children from its median. Total of 1286 children (623male and 663female) have been considered for this study. WHO Anthro software has been used for analysis and interpretation of results. Results: The results show severe undernourishment among the children in this part of Rajasthan. About 63% children are moderate to severely stunted (short for age), 46% have been found to be acutely malnourished and the composite index weight-for-age shows that 69% children are moderate to severely underweight. Against the popular facts that girls are more malnourished, boys of Jhadol block reported to be more undernourished. Conclusions: The high prevalence of chronic malnourishment in this part of Rajasthan is a matter of grave concern. This paper calls for a region specific policy based on holistic approach of better healthcare, ensuring food security, access to drinking water, and sanitation.
Shah B.S.,Institute of Health Management Research IIHMR |
Parmar S.A.,JKK Nataraja Dental College and Hospital |
Mahajan S.,H H University |
Mehta A.A.,JKK Nataraja Dental College and Hospital
Current Drug Metabolism | Year: 2012
Platelet activation and aggregation have been established as pivotal elements in the pathogenesis of atherosclerotic and ischemic diseases, including acute coronary syndromes. The difficulty of achieving optimal platelet inhibition remains a major constraint following dual-antiplatelet therapy, which can lead to a diminished response following initiation of clopidogrel therapy. Though the absolute mechanisms underlying clopidogrel resistance are controversial, a variety of responsible factors are recognized. Clopidogrel, being a prodrug, requires conversion to an active metabolite for its activity. This metabolism involves various cytochrome P450 (CYP) enzymes at different steps, and it is hypothesized that competitive inhibition of CYPs may contribute to clopidogrel resistance. Proton pump inhibitors (PPIs) are competitive inhibitors of CYPs that can attenuate the antiplatelet activity of clopidogrel, and this can lead to clopidogrel resistance. Available data from different clinical studies have postulated the possibility of a drug-drug interaction between clopidogrel and PPIs. PPIs differ somewhat in their pharmacokinetic properties like bioavaibility and affinity for CYP2C19. However it is not clear whether the proposed drug interaction of PPI with clopidogrel is same with all PPIs (i.e., a class effect) or it is limited to a subset of PPIs (i.e., a drug effect). This interaction needs further assessment with well designed prospective clinical trials, before any change in clinical practice should be considered. In this review, we attempt to evaluate the available evidence exploring drug interactions with PPIs as the underlying mechanism for the reduced antiplatelet effect of clopidogrel. © 2012 Bentham Science Publishers.
Kothari D.,Institute of Health Management Research IIHMR
Journal of Health Management | Year: 2014
The article aims at formulating a feminist agenda to empower women living in highly patriarchal and traditional surroundings with several obstacles. The 'agenda' is based on the premises that no doubt efficient policing, stringent punishments and legal measures would reduce the incidences of crime against women but these cannot eliminate growing gender inequality in India unless and until the mindset of the society is changed. The article suggests that women-centred reproductive healthcare may alter patriarchal constructs despite strong structural resistance. Ensuring reproductive rights and improving living conditions could be fast track to progress. And this feminist agenda will contribute significantly towards women's empowerment. © 2014 Indian Institute of Health Management Research.
Gupta S.D.,Institute of Health Management Research IIHMR |
Lal V.,Institute of Health Management Research IIHMR |
Vinod Kumar S.V.,Institute of Health Management Research IIHMR
Journal of Health Management | Year: 2012
We conducted this study to ascertain the prescribing behaviour among the private practitioners and to find out the deficiencies therein. A total of 389 outpatient prescriptions were reviewed for standard prescribing norms, therapeutic class and number of drugs prescribed and per day cost of prescription was derived. The prescriptions lacked vital information pertaining to patient's age, sex, diagnosis and dosage. Antibiotics were the most widely prescribed drugs (37 per cent), followed by non-steroidal anti-inflammatory drugs (NSAIDs) and multivitamins. More than 65 per cent of NSAIDs were prescribed in the form of fixed-dose combinations. Polypharmacy (four or more drugs prescribed) was observed in 38.5 per cent prescriptions. None of the prescriptions carried drugs prescribed by unbranded generic names. Median per day cost of prescription was 29.30. The study concluded that the prescribing behaviour was irrational and largely, the prescriptions were incomplete. Implementing guidelines for appropriate prescription writing, standard treatment guidelines, emphasizing the importance of these practices in medical school curricula and continuing medical education programmes are necessary for more rational and safer drug prescribing and efficient drug therapy. © 2012 Indian Institute of Health Management Research.
Mathur A.K.,Institute of Health Management Research IIHMR
Journal of Health Management | Year: 2013
For any intervention in public health, one needs to gather the evidence on the basis of which systematic plans and strategies can be built. In Rajasthan, for HIV and AIDS prevention, care and support activities apex organisation is Rajasthan State AIDS Control Society (RSACS). IIHMR, Jaipur, provided technical support to RSACS in targeted interventions, capacity building, strategic planning and public private partnership. In systematising the intervention with the sex workers living in district Sawai Madhopur, a situational analysis was carried out. The district is internationally known tourist place in Rajasthan and has remarkable mobility pattern among sex workers. It was found that in the district, the risk and vulnerabilities of sex workers has increased because of this mobility and illiteracy. It was reported that majority of sex workers in Sawai Madhopur knew that AIDS is not curable and the rest had either no idea or they thought AIDS could be cured. Amongst those who reported that they had no idea about the cure of HIV/AIDS, most of them were active sex workers. These active sex workers, hence, due to lack of awareness about STI, HIV and AIDS, were very vulnerable against HIV infection. Majority of the sex workers reported that they were not willing to use female condoms. Nearly half of the sex workers in Sawai Madhopur joined this profession as tradition of their families and caste. For HIV prevention and BCC, the better strategy is to use such IEC materials which contains pictures on various issues like condom negotiation, managing violence, sex workers collectives, correct and consistent use of condoms, STI, RTI, HIV and AIDS. Efforts should also be made to integrate the children from sex workers family into formal education process and, simultaneously, a little older children should be imparted skills in alternative trainings for joining other acceptable means of earning livelihood. © 2013 Indian Institute of Health Management Research.