Comprehensive Rural Health Services Project Research Articles

Community practices in COVID-19 outbreak in rural Ballabgarh, Haryana - A mixed methods study.

More than 43 million cases and 5.2 lakhs death have occurred due to COVID-19 in India. Approximately 1 lakh people (cumulative) have been infected by COVID-19 in Faridabad district alone as of 4 April 2022. To understand the effects of COVID-19 on community practices this study was conducted. A community-based cross-sectional study was conducted in Intensive Field Practice Area of Comprehensive Rural health Services Project (CRHSP), Ballabgarh, Haryana. Five hundred participants (≥18 years) were selected by using simple random sampling from Health Management Information System (HMIS) maintained at Centre for Community Medicine, AIIMS, New Delhi. Participants were informed regarding study and consent was taken. A semi-structured interview schedule was administered. Study participants included 500 adults (52.2% Male). Mean age (S.D.) of participants were 39.1 (14.9) years. Almost all participants started practicing hand sanitisation (496, 99.2%), avoiding crowd (488, 97.6%), and covering face with cloth/handkerchief (459, 91.8%). More than 80% (428, 85.6%) started using mask, and following cough etiquettes (405, 81.0%). More than three-fourth (389, 77.8%) participants were very unsatisfied with lockdown. Majority faced financial difficulties (322, 64.4%), followed by difficulty in their entertainment/recreational activity (158, 31.6%), difficulty in acquiring ration/food items (87, 17.4%) and mental stress (46, 9.2%) during lockdown. Rural community of Ballabgarh showed positive practices with respect to prevention of COVID-19. Financial distress and job loss due to lockdown were widely reported from the rural community. Majority of the community was displeased with lockdown as intervention for COVID-19.

Prevalence of iodine deficiency among adult population residing in Rural Ballabgarh, district Faridabad, Haryana.

Community-based surveys are essential to monitor iodine deficiency disorders (IDD) program at both the state and national levels. There is paucity of information on population iodine nutrition status in Haryana state using standard methods. A cross-sectional study was conducted in villages of Comprehensive Rural Health Services Project (CRHSP), Ballabgarh, Haryana, India. A total of 465 randomly selected individuals were assessed for urinary iodine concentration (UIC) by microplate method and household salt iodine content using iodometric titration. Of the interviewed households, 73% were using adequately iodized salt (≥15 ppm). Iodine nutrition was deficient in 17% respondents (UIC <100 μg/L); 20.2% among males and 13.9% among females. Iodine intake of the study population as measured by UIC was adequate but nearly one-fourth of households in the study population were consuming inadequately iodized salt. The availability and access to adequately iodized salt in the study population should be improved by strengthening regulatory monitoring.

Feasibility of sustainable provision of intradermal post exposure prophylaxis against rabies at primary care level--evidence from rural Haryana.

BackgroundRabies is the most severe and neglected public health problem in India. Management of animal bite with post exposure prophylaxis is the only existent strategy to prevent rabies related deaths. Cost-effective and sustainable programme for provision of post exposure prophylaxis (PEP) is needed in India.MethodsIn this study, we have documented the experience of implementation of intra-dermal anti rabies vaccination in Animal Bite Management (ABM) clinic at Primary Health Centre (PHC). This study facility belonged to Comprehensive Rural Health Services Project, Ballabgarh in Faridabad district of Haryana. Hospital service record of ABM clinic was analyzed and various feasibility issues such as costing of services, vaccine wastage and other operational issues in providing PEP services at PHC level were documented.ResultsA total of 619 patients were treated in the ABM clinic. Service utilization of ABM clinic was increased by 38% in the second year of implementation. Mean age of the patients was 23.9 years (SD: 18.8) and majority (70.4%) were males. Majority (86%) of the patients received the first dose of anti-rabies vaccine within the recommended 48 hours. A total 446 vaccine vials (1 ml) were consumed of which 20.8% was contributed in vaccine wastage. User-fee (350 Indian Rupees) collected from the patients. User-fee was re-used to purchase vaccines, intradermal (ID) syringes and other consumables required to ensure regular availability of ARV services at the PHC.ConclusionsThis study demonstrated the cost-effective and sustainable model of provision of PEP against rabies at primary care level. ID PEP provision at primary care level not only address the unmet need of animal bite management in the community also reduces the out of pocket expenditure of the patients.

The Ballabgarh Health and Demographic Surveillance System (CRHSP-AIIMS)

The Ballabgarh Health and Demographic Surveillance System (HDSS), also known as the Comprehensive Rural Health Services Project (CRHSP) Ballabgarh, is located in north India and was established in 1961 to develop a model for rural health-care practice in India. In addition to demographic surveillance and community-based research, CRHSP Ballabgarh provides preventive, health-promotion, and curative services to its surrounding population. The population served by CRHSP Ballabgarh in 2011 was about 90,000. The system collects data for the entire population through fortnightly visits by health workers (HWs). The system's data base is updated once every month and further updated with missing data and special morbidity surveillance data during the annual census. Since 1961, CRHSP Ballabgarh has collected demographic data, reproductive data, and health data about mothers and their children. More recently, the project began collecting data on diseases such as tuberculosis, and because of changes in life style it recently began collecting data about non-communicable diseases (NCD) and risk factors for NCDs. Nonetheless, an adverse sex ratio, with more boys than girls, and a stagnant neonatal mortality rate, remain major challenges in the population served by CRHSP Ballabgarh. The project shares data with different agencies for health-management purposes, which can be made available to bona fide researchers on receipt of a proposal (enquiries should be directed to: crhsp.ballabgarh@gmail.com); collaboration requests are welcome.

Using Three Delays Model to Understand the Social Factors Responsible for Neonatal Deaths in Rural Haryana, India

To investigate causes of and contributors to newborn deaths in rural Haryana using a three delays audit approach. The study was conducted in 28 villages under the rural field practice area of the Comprehensive Rural Health Services Project, All India Institute of Medical Sciences situated in Ballabgarh, Haryana. Data were collected through house visits and analysed using the three delays model. Of the 50 newborn deaths investigated, 44% occurred within the first 24 h after birth. The leading causes of death were pre-term/low birthweight (32%), birth asphyxia (28%) and neonatal sepsis (14%). Major contributing delays to neonatal death were caretaker's delay in deciding to seek care (44%, 22/50) and delay in reaching a health care facility, i.e. the transport delay (34%, 17/50). Household and transport-related delays were the major contributors to newborn deaths, and efforts to improve newborn survival need to address both concurrently.

Private rural health providers in Haryana, India: profile and practices

Despite a widespread public health system, the private healthcare sector is the major provider of health care in rural India. This study describes the profile and medical practices of private rural health providers (PRHPs) in rural Haryana, India. A cross-sectional study was conducted among PRHPs practicing in the villages of Comprehensive Rural Health Services Project (CRHSP) at Ballabgarh block located in the Faridabad district of Haryana State. The CRHSP is an Intensive Field Practice Area (IFPA) of the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi. Eighty PRHPs participated in this study (response rate 93%). The majority (96%) did not possess a qualification in any formal system of medicine. Half of the PRHPs had a separate space (private area) for the examination of patients. Almost all had stethoscopes, thermometers and blood pressure apparatus. The PRHPs were involved in a wide range of practices, such as dispensing medicines (98.7%), providing injections (98.7%) and intravenous fluids (98.7%), and conducting minor surgery (78.5%). Dumping biomedical waste was a common practice among these practitioners. Some PRHPs (8.7%) were involved in national health programs. Unqualified PRHPs provide substantial outpatient healthcare services in rural Ballabgarh, India. Their biomedical waste disposal practices are inadequate. There is a need for training in waste disposal practices and monitoring of safe injection techniques among PRHPs. Consideration should be given to utilising PRHPs in important public health programs such as disease surveillance.

Role of Cultural Beliefs in Influencing Selected Newborn Care Practices in Rural Haryana

The role of prevalent culturally driven beliefs and practices in influencing home-based newborn care has not been adequately studied, especially in North India. The study was conducted in 28 villages under Comprehensive Rural Health Services Project (CRHSP), All India Institute of Medical Sciences (AIIMS). A total of 415 mothers who had a baby in the second month of life, at the time of the visit for data collection were interviewed using pre-tested questionnaire. Nearly 77% of mothers reported some beliefs/practices with regard to care of the cord. Similarly, 81.0% mothers had beliefs regarding taking the baby out of the house for the first time after birth. Out of all the mothers that were interviewed, around 11% did not prefer their baby to be weighed at frequent intervals because according to them, doing so could lead to slowing of the growth of the baby. Traditional knowledge and practices must be considered before developing neonatal health care intervention strategies.

Dynamic patterns of circulating seasonal and pandemic A(H1N1)pdm09 influenza viruses from 2007-2010 in and around Delhi, India.

Influenza surveillance was carried out in a subset of patients with influenza-like illness (ILI) presenting at an Employee Health Clinic (EHS) at All India Institute of Medical Sciences (AIIMS), New Delhi (urban) and pediatric out patients department of civil hospital at Ballabhgarh (peri-urban), under the Comprehensive Rural Health Services Project (CRHSP) of AIIMS, in Delhi region from January 2007 to December 2010. Of the 3264 samples tested, 541 (17%) were positive for influenza viruses, of which 221 (41%) were pandemic Influenza A(H1N1)pdm09, 168 (31%) were seasonal influenza A, and 152 (28%) were influenza B. While the Influenza viruses were detected year-round, their types/subtypes varied remarkably. While there was an equal distribution of seasonal A(H1N1) and influenza B in 2007, predominance of influenza B was observed in 2008. At the beginning of 2009, circulation of influenza A(H3N2) viruses was observed, followed later by emergence of Influenza A(H1N1)pdm09 with co-circulation of influenza B viruses. Influenza B was dominant subtype in early 2010, with second wave of Influenza A(H1N1)pdm09 in August-September, 2010. With the exception of pandemic H1N1 emergence in 2009, the peaks of influenza activity coincided primarily with monsoon season, followed by minor peak in winter at both urban and rural sites. Age group analysis of influenza positivity revealed that the percent positivity of Influenza A(H1N1)pdm09 influenza virus was highest in >5–18 years age groups (OR 2.5; CI = 1.2–5.0; p = 0.009) when compared to seasonal influenza. Phylogenetic analysis of Influenza A(H1N1)pdm09 from urban and rural sites did not reveal any major divergence from other Indian strains or viruses circulating worldwide. Continued surveillance globally will help define regional differences in influenza seasonality, as well as, to determine optimal periods to implement influenza vaccination programs among priority populations.

Performance of cause-specific childhood mortality surveillance by health workers using a short verbal autopsy tool.

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. 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. 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. 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.

Mothers Knowledge Regarding Danger Signs of Newborn

This descriptive cross-sectional study was undertaken to assess the knowledge of mothers in urban and rural areas about new born danger signs. It included 200 mothers of infants (100 from urban and 100 from rural area), from the Paediatrics OPD and Paediatrics and Maternity Wards, of All India Institute of Medical Sciences (AIIMS), New Delhi, and the Comprehensive Rural Health Services Project (CRHSP), Ballabgarh. The data was collected using self-developed and semi structured interview schedule. The mean knowledge score of mothers regarding newborn danger signs was 39.3 percent. The urban mothers had a mean score of 44.7 percent (graded as ‘average’) as compared to rural mothers whose mean knowledge score was 32.94 percent (graded as ‘poor’). The urban mothers had significantly better knowledge as compared to rural mothers regarding newborn danger signs. Majority of mothers could state at least one symptom of hyperthermia 191 (95.5%), severe jaundice 162 (81%), lethargy150 (75%), respiratory distress 127 (63.5%), and hypothermia 103 (51.5%). Majority of mothers responded that if danger signs are observed in newborns then immediate medical consultation would be necessary. In rural area majority of mothers did not identify hypothermia (64%), convulsions (85%), skin pustules (65%), respiratory distress (54%) and severe dehydration (85%) as danger sign in newborns. The study showed that mothers had inadequate knowledge regarding newborn danger signs and their management. Educational interventions for mothers are needed to make them aware of the newborn danger signs and the need to seek care by qualified health providers for treatment.

Determinants of neonatal mortality in Rural Haryana: A retrospective population based study

To identify the determinants of neonatal mortality. Nested case-control study. 28 villages under the intensive field practice area of Comprehensive Rural Health Services Project, Ballabgarh, Haryana serving a population of 87,016, as on 31st December 2009. The study period was from 2005 to 2009. The data were obtained from Health Management Information System and analyzed using multivariate logistic regression analysis. A hierarchical approach was used to analyze the factors associated with neonatal deaths, using community level factors, socio-economic status and biological determinants. The population attributable fractions were estimated for significant variables. The total live births during the study period were 10392 and neonatal deaths were 248. The infant and neonatal mortality rates during the study period were 45.6 and 23.8 per 1000 live births, respectively. Socio-economic determinants (Low educational status of parents [OR 2.1, 95% CI; 1.4, 3.3]; fathers occupation [OR 1.8, 95% CI; 1.0, 3.0]; Rajput caste [OR 2.0, 95% CI; 1.2, 3.4] appeared to explain a major fraction (45.7%) of neonatal deaths. Community level factors (villages with no health facility [OR 1.5, 95% CI; 1.0, 2.1]; villages with population >6000 [OR 1.7, 95% CI; 1.2, 2.5]) were associated with 27.3% of all neonatal deaths. Proximate determinants (early childbearing age of mother (<20 years) [OR 2.0, 95% CI; 1.2, 3.2]) were least important. All the three level of variables seemed to act independently with little mediation among them. Neonatal mortality is affected by socioeconomic, community level and proximate biological determinants.

Adult mortality surveillance by routine health workers using a short verbal autopsy tool in rural north India

BackgroundMost of the standard verbal autopsy tools are long and are used in a research setting. This study aims to compare a short verbal autopsy (VA) tool developed at Ballabgarh,...

Evaluation of computerized health management information system for primary health care in rural India

BackgroundThe Comprehensive Rural Health Services Project Ballabgarh, run by All India Institute of Medical Sciences (AIIMS), New Delhi has a computerized Health Management Information System (HMIS) since 1988. The HMIS at Ballabgarh has undergone evolution and is currently in its third version which uses generic and open source software. This study was conducted to evaluate the effectiveness of a computerized Health Management Information System in rural health system in India.MethodsThe data for evaluation were collected by in-depth interviews of the stakeholders i.e. program managers (authors) and health workers. Health Workers from AIIMS and Non-AIIMS Primary Health Centers were interviewed to compare the manual with computerized HMIS. A cost comparison between the two methods was carried out based on market costs. The resource utilization for both manual and computerized HMIS was identified based on workers' interviews.ResultsThere have been no major hardware problems in use of computerized HMIS. More than 95% of data was found to be accurate. Health workers acknowledge the usefulness of HMIS in service delivery, data storage, generation of workplans and reports. For program managers, it provides a better tool for monitoring and supervision and data management. The initial cost incurred in computerization of two Primary Health Centers was estimated to be Indian National Rupee (INR) 1674,217 (USD 35,622). Equivalent annual incremental cost of capital items was estimated as INR 198,017 (USD 4213). The annual savings is around INR 894,283 (USD 11,924).ConclusionThe major advantage of computerization has been in saving of time of health workers in record keeping and report generation. The initial capital costs of computerization can be recovered within two years of implementation if the system is fully operational. Computerization has enabled implementation of a good system for service delivery, monitoring and supervision.

Unmet family planning need: Differences and levels of agreement between husband-wife, Haryana, India

Research question:Is there agreement between husbands and wives regarding unmet need of family planning?Hypothesis:The unmet need of family planning is perceived more by women then their husbands.Objective:1) To ascertain the unmet needs of family planning for husbands and wives. 2) To ascertain the level of agreement between husbands and wives regarding unmet needs of family planning.Design:A cross-sectional surveySetting:Dayalpur village in Intensive field practice area of Comprehensive Rural Health Services project (CRHSP), Ballabgarh, Haryana.Study Period:July 2003- June 2005.Participantsincluded 200 married couples selected by simple random sampling.Statistical Analysis:Level of agreement between husbands and wives was analyzed using Kappa statistics.Results:Unmet need for family planning was 11% (22 out of 200) for husbands and 17.5% (35 out of 200) for wives. The difference was seen both in unmet need for spacing (M-3.5% vs. F-6%) as well as limiting family size (M-7.5% vs. F-11.5%). Overall, 93.5% concordance was observed amongst husbands and wives. In all the cases where disagreement was seen (6.5%), wives reported having unmet need for contraception whereas their husbands perceived none. The unadjusted Kappa statistic was 0.73 and prevalence adjusted Kappa was 0.88.Conclusion:Unmet need for family planning was significantly higher for wives compared to husbands. Despite high degrees of agreement amongst the couples, the nature of disconcordance reinforces the need for policy makers to take into account the perspective of men.

Tobacco and alcohol use in rural elderly Indian population.

Background:Tobacco and alcohol use are serious health problems. Studies focusing on problems associated with tobacco and alcohol use in the elderly are limited.Aim:To find out the prevalence of tobacco and alcohol use among rural elderly population.Methods:This cross-sectional study was conducted in the intensive field practice area of the Comprehensive Rural Health Services Project in Ballabgarh in Faridabad, Haryana, a rural field practice area of the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi. The sample was selected using stratified random cluster sampling. The participants were ≥60 years of age at the time of interview. Data on tobacco and alcohol use pattern of 1117 elderly were collected during the interview.Results:The prevalence of smoking was 71.8% in men (n=490) and 41.4% in women (n=497). Among men smokers, 41.5% were light smokers (≤5 beedis/day), 42.9% were moderate smokers (6–20 beedis/day) and 15.6% were heavy smokers (>20 beedis/day). Among women smokers, 71.8% were light smokers, 23.8% were moderate smokers and 4.4% were heavy smokers. Regular alcohol intake was seen in 16.3% of the men compared with 0.8% of the women.Conclusion:The finding of a high prevalence of smoking and alcohol consumption among men in this rural population of India is of serious concern and therefore needs remedial measures.

“Development” is not essential to reduce infant mortality rate in India: experience from the Ballabgarh project

BACKGROUNDIndia aims to reduce the infant mortality rate (IMR) to below 60 per 1000 live births by 2000. IMR is higher in northern India as compared with south Indian states...

Knowledge, attitudes and practice of epilepsy: experience at a comprehensive rural health services project

Beliefs regarding cause and preference of the treatment modality are important factors influencing any epilepsy programme. Patients own attitudes towards the on-going treatment are equally important in ensuring success of any such programme. The study involved interviews of 80 patients with epilepsy attending a comprehensive rural health services project, and was conducted according to a structured questionnaire. The majority of the patients were well informed regarding the cause of epilepsy, but more than half had tried alternative treatment methods. Many patients had misconceptions regarding the goal of the treatment and the consequences of missing a prescribed drug dose. Surprisingly few patients avoided taking medicines on days of religious fast. It was also noted that most patients depended on free medical supplies from the clinic dispensary, and a small number of patients would stop the medicines if these were not given free of cost. We stress the need to understand patients' concepts about the cause and the treatment of epilepsy, the need to educate them and their families regarding principles of modern medical treatment of epilepsy and most importantly, the need to maintain a regular, uninterrupted supply of free medicines, to improve the effectiveness of similar epilepsy management programmes in the setting of rural India and other developing countries.

Knowledge, attitudes and practice of epilepsy: experience at a comprehensive rural health services project

Knowledge, attitudes and practice of epilepsy: experience at a comprehensive rural health services project

Acute Respiratory Infections In Underfives : Experience At Comprehensive Rural Health Services Project Hospital. Ballabgarh

Acute Respiratory Infections In Underfives : Experience At Comprehensive Rural Health Services Project Hospital. Ballabgarh

Effectiveness of ARI control strategy on underfive mortality

A prospective intervention study was conducted in Ballabgarh block of Haryana. The study area has a population of about 30,000 under a state run P.H.C. area. The control area has a population of about 60,000 under Comprehensive Rural Health Services Project of All India Institute of Medical Sciences. ARI control strategies as advocated by WHO was instituted in the study area. Measles and DPT immunization was strengthened. The ARI cases detected or reported to Health Workers were managed as per the standard case management procedure. The underfives mortality, infant and 1-4 years mortality rates were initially higher in study area and differences were statistically significant. After 2 years, the reductions in study area were substantial and differences were not statistically significant. The ARI mortality in underfives, and 1-4 years were higher in study area at the beginning compared to control area. Though they were less than in control area after 2 years of intervention the observed differences were not statistically significant in both periods. The reduction of 37% in underfives mortality and 26% due ARI mortality is substantial. More benefit was attained with measles immunization than with standard case management. ARI control programme is advocated for application on national level vigourously covering with measles immunization and to include the village based private practitioners in the strategy for effective case management.