Public Health Facilities In India Research Articles

Complementary feeding at 4 versus 6 months of age for preterm infants born at less than 34 weeks of gestation: a randomised, open-label, multicentre trial.

SummaryBackgroundEvidence on the optimal time to initiation of complementary feeding in preterm infants is scarce. We examined the effect of initiation of complementary feeding at 4 months versus 6 months of corrected age on weight for age at 12 months corrected age in preterm infants less than 34 weeks of gestation.MethodsIn this open-label, randomised trial, we enrolled infants born at less than 34 weeks of gestation with no major malformation from three public health facilities in India. Eligible infants were tracked from birth and randomly assigned (1:1) at 4 months corrected age to receive complementary feeding at 4 months corrected age (4 month group), or continuation of milk feeding and initiation of complementary feeding at 6 months corrected age (6 month group), using computer generated randomisation schedule of variable block size, stratified by gestation (30 weeks or less, and 31–33 weeks). Iron supplementation was provided as standard. Participants and the implementation team could not be masked to group assignment, but outcome assessors were masked. Primary outcome was weight for age Z-score at 12 months corrected age (WAZ12) based on WHO Multicentre Growth Reference Study growth standards. Analyses were by intention to treat. The trial is registered with Clinical Trials Registry of India, number CTRI/2012/11/003149.FindingsBetween March 20, 2013, and April 24, 2015, 403 infants were randomly assigned: 206 to receive complementary feeding from 4 months and 197 to receive complementary feeding from 6 months. 22 infants in the 4 month group (four deaths, two withdrawals, 16 lost to follow-up) and eight infants in the 6 month group (two deaths, six lost to follow-up) were excluded from analysis of primary outcome. There was no difference in WAZ12 between two groups: −1·6 (SD 1·2) in the 4 month group versus −1·6 (SD 1·3) in the 6 month group (mean difference 0·005, 95% CI −0·24 to 0·25; p=0·965). There were more hospital admissions in the 4 month group compared with the 6 month group: 2·5 episodes per 100 infant-months in the 4 month group versus 1·4 episodes per 100 infant-months in the 6 month group (incidence rate ratio 1·8, 95% CI 1·0–3·1, p=0·03). 34 (18%) of 188 infants in the 4 month group required hospital admission, compared with 18 (9%) of 192 infants in the 6 month group.InterpretationAlthough there was no evidence of effect for the primary endpoint of WAZ12, the higher rate of hospital admission in the 4 month group suggests a recommendation to initiate complementary feeding at 6 months over 4 months of corrected age in infants less than 34 weeks of gestation.FundingIndian Council of Medical Research supported the study until Nov 14, 2015. Subsequently, Shuchita Gupta's salary was supported for 2 months by an institute fellowship from All India Institute Of Medical Sciences, and a grant by Wellcome Trust thereafter.

Out of pocket expenditure to deliver at public health facilities in India: a cross sectional analysis.

BackgroundTo expand access to safe deliveries, some developing countries have initiated demand-side financing schemes promoting institutional delivery. In the context of conditional cash incentive scheme and free maternity care in public health facilities in India, studies have highlighted high out of pocket expenditure (OOPE) of Indian families for delivery and maternity care. In this context the study assesses the components of OOPE that women incurred while accessing maternity care in public health facilities in Uttar Pradesh, India. It also assesses the determinants of OOPE and the level of maternal satisfaction while accessing care from these facilities.MethodIt is a cross-sectional analysis of 558 recently delivered women who have delivered at four public health facilities in Uttar Pradesh, India. All OOPE related information was collected through interviews using structured pre-tested questionnaires. Frequencies, Mann-Whitney test and categorical regression were used for data reduction.ResultsThe analysis showed that the median OOPE was INR 700 (US$ 11.48) which varied between INR 680 (US$ 11.15) for normal delivery and INR 970 (US$ 15.9) for complicated cases. Tips for getting services (consisting of gifts and tips for services) with a median value of INR 320 (US$ 5.25) contributed to the major share in OOPE. Women from households with income more than INR 4000 (US$ 65.57) per month, general castes, primi-gravida, complicated delivery and those not accompanied by community health workers incurred higher OOPE. The significant predictors for high OOPE were caste (General Vs. OBC, SC/ST), type of delivery (Complicated Vs. Normal), and presence of ASHA (No Vs. Yes). OOPE while accessing care for delivery was one among the least satisfactory items and 76 % women expressed their dissatisfaction.ConclusionEven though services at the public health facilities in India are supposed to be provided free of cost, it is actually not free, and the women in this study paid almost half of their mandated cash incentives to obtain delivery care.

Cashless childbirth, but at a cost: A grounded theory study on quality of intrapartum care in public health facilities in India

Aimthis study aimed to explore and understand the perceptions and experiences of women regarding quality of care received during childbirth in public health facilities. Designqualitative in-depth interviews were conducted and analysed using the Grounded Theory approach. Participantsthirteen women who had given vaginal birth to a healthy newborn infant. Settingparticipants were interviewed in their homes in one district of Chhattisgarh, India. Data collectionthe interview followed a pre-tested guide comprising one key question: How did the women experience and perceive the care provided during labour and childbirth? Findings'cashless childbirth but at a cost: subordination during childbirth' was identified as the core category. Women chose a public health facility due to their socio-economic limitations, and to have a cashless and safe childbirth. Participants expressed a sense of trust in public health facilities, and verbalised that free food and ambulance services provided by the government were appreciated. Care during normal birth was medicalised, and women lacked control over the process of their labour. Often, the women experienced verbal and physical abuse, which led to passive acceptance of all the services provided to avoid confrontation with the providers. Conclusionsincreasingly higher numbers of women give birth in public health facilities in Chhattisgarh, India, and women who have no alternative place to have a safe and normal birth are the main beneficiaries. The labour rooms are functional, but there is a need for improvement of interpersonal processes, information-sharing, and sensitive treatment of women seeking childbirth services in public health facilities.

Factors influencing the utilization of free delivery care under janani shishu suraksha karyakram in Kamrup district, Assam, India

Background: Janani Shishu Suraksha Karyakram (JSSK) was initiated in 2011 to reduce the out of pocket expenditure incurred by pregnant women and sick neonates accessing public health facilities in India. Aim of the study was to assess the factors influencing utilization of free delivery care under JSSK among beneficiaries in rural areas of kamrup district in Assam, India. Methods: A cross-sectional study with multistage random sampling design was conducted in rural Kamrup from August 2013 to July 2014 among 387 mothers with infants. They were interviewed using a pre-designed and pre-tested semi-structured interview schedule. Statistical analysis used: Chi-square, Odds ratio (OR) and logistic regression. Results: Utilization of free delivery care under JSSK was 83.2% among the beneficiaries. Factors significantly associated with utilization of free delivery, after bivariate logistic regression, were education, age, socioeconomic status, early registration and parity. On multivariate logistic regression, considering all variables, age group below 25 years (OR=2.3; Confidence Interval= 1.33-3.99), Socio-economic class III and below (OR=2.27; CI= 1.32-3.88), early registration (OR=4.3; CI= 2.47-7.56) and single parity (OR=2.08; CI=1.19-3.63) were found to be predictors for utilization of the services. Conclusions: The majority of beneficiary mothers in the rural areas had received ‘free delivery’ care under JSSK available in the public health facilities. However utilization of the benefit was not achieved universally among all the mothers. There should be focussed action at grass-root level to motivate the multipara and older pregnant women in the rural areas to utilize the services to enhance pregnancy outcome.

An Observational Study on the Use of IV Iron Sucrose Among Anaemic Pregnant Women in Government Healthcare Facilities from Two States of India.

In India oral iron tablets for anaemia have been distributed through the health system since many years, but there has been no significant change in the burden of anaemia. The objective of the present study was to capture the existing practices on the use of intravenous iron sucrose (an alternative treatment for anaemia) in the public health system in two states of India (Tamil Nadu and Uttar Pradesh). An observational study in the form of a registry was maintained for 3months at purposively chosen public health facilities in the above-mentioned states of India. Anaemic pregnant women (n=764) who were given intravenous iron sucrose during the antenatal or post-partum period were included in the registry. Information was collected on severity of anaemia at which intravenous iron sucrose therapy was initiated, the dose and schedule given and any adverse events noted during and immediate post-infusion period. 99% of the infusions were given as slow infusion over a mean duration of 30min, diluted with 0.9% sodium chloride. The mean haemoglobin level at the time of start of intravenous therapy was 8.3 gm/dl. In Uttar Pradesh, 46% of women received only one dose of iron sucrose in contrast with 15% in Tamil Nadu. Although intravenous iron sucrose is commonly used in pregnant anaemic women, standard protocols and guidelines for its usage are lacking. These need to be formulated before scaling it up across public health facilities in India.

Factors determining intention to quit tobacco: exploring patient responses visiting public health facilities in India

IntroductionIntention to quit and setting a quit date are key steps in the process towards improving quit rates and are thus an integral part of tobacco cessation efforts. The present study examined various motivating factors of “intention to quit” and “setting a quit date” in patients visiting public health facilities in two states of India.MethodsA total of 1569 tobacco-users visiting public health facilities in 12 districts of the states of Andhra Pradesh and Gujarat were assessed through an interviewer-administered questionnaire. Bivariate and multivariable logistic regression was performed to assess the effect of socio-demographic characteristics, nicotine dependence, previous quit attempts and motivational factors on “intention to quit within 30 days” and “setting a quit date”.ResultsOnly 12% of patients intended to quit tobacco within 30 days and about 11% of them were ready to set a quit date. Respondents aged above 25 years were 53% less likely to quit tobacco within 30 days when compared to those below 25 years (95% Confidence Intervals [CI]: 0.22 to 0.99). Smokeless tobacco users were associated with an odds ratio (OR) of 2.05 (95% CI: 1.15 to 3.65) for “setting a quit date” when compared to smokers. Those with 1 to 5 previous quit attempts (in the past twelve months) were associated with an OR of 2.2 (95% CI: 1.38 to 3.51) for “intention to quit” and 2.46 (95% CI: 1.52 to 3.96) for “setting a quit date”. “Concern for personal health” and “setting an example for children” were associated with ORs of 3.42 (95% CI: 1.35 to 8.65) and 2.5 (95% CI: 1.03 to 6.03) respectively for “setting a quit date”.ConclusionsThis study is amongst the first in India to explore factors associated with the “intention to quit” and “setting a quit date” among patients visiting public health facilities. Our findings suggest that socio-economic and individual-level factors are important factors depicting intention to quit and setting a quit date. We recommend the need for well-defined studies to understand the long term effects of factors influencing tobacco cessation for patients visiting public health facilities in India.

Contradictions of the health-care system in India and a strategy for health-care for all

The contradiction between the socialized nature of the modern health-care system (inclusive of both clinical and social medicine) versus the narrow control over it is obvious in private health-care. However, this contradiction is present to some extent, in its own way, even in the public health facilities in India. To formulate a program for health-care for all in India, it is necessary to grasp these contradictions in both private and public health-care and accordingly conceptualize a strategy to overcome, resolve these contradictions.

Availability of five essential medicines for children in public health facilities in India: A snapshot survey

Objective:To collect information on the availability of five essential children's medicines in the public health facilities of India.Materials and Methods:A snap shot survey of the availability of five essential medicines for children was conducted. Five medicines which are included in the National Rural Health Mission (NRHM) list for subcentres were selected, i.e., vitamin A liquid solution, syrup cotrimoxazole, oral rehydration salt (ORS), syrup paracetamol, and zinc sulphate (oral liquid or tablets). Information about this survey was posted in two e-groups for pharmacologists and pharmacists and volunteers were requested to collect data on the availability of these five medicines and fill up a data sheet which was emailed back to the organizers. Data was collected from February 14 to 21, 2010.Results:Data were collected from 129 public health facilities spanning 17 states, two union territories and NCT Delhi. The overall median availability was 80% (range: 0%-100%). Punjab, Tamilnadu, and Jharkhand showed 100% median availability (range: 40%-100%). Ninety percent of the facilities have ORS, paracetamol, and cotrimoxazole whereas zinc was available in only 36% of the public health facilities. Syrup cotrimoxazole and ORS have 100% availability in all states except in four and paracetamol has nearly 100% availability in all but six states.Conclusion:The availability of essential medicines for children in public health facilities is not satisfactory and needs to be improved.

Occupational exposure to blood and body fluids amongst health care workers in a teaching hospital of the armed forces

Background: Health care workers (HCWs) are at risk of infection with blood-borne viruses in the course of their work. Over 90% of these infections are occurring in low-income countries and most are preventable. However, the situation in the Armed Forces hospitals has always been thought to be much better than the public health facilities in India. The focus of the study was on assessing the exposure frequency amongst HCWs in a teaching hospital in the Armed Forces. Methods: A cross-sectional survey amongst HCWs involved in collecting blood samples and administering injections in all wards of the hospital was conducted. Selection of study participants was by simple random sampling. A pre-tested questionnaire was administered by unlinked, anonymous method. Result: Total sample studied was 70. The proportion of HCWs experiencing exposure to blood body fluid splash (BBF) and needlestick injury (NSI) during last one week was 47.1% and 31.43%, respectively. The incidence density of BBF exposure was 537.14 per 100 person years and that of NSI episodes was 228.57 per 100 person years. The reasons for not using personal protective equipment (PPE) ranged from busy schedule (37.14%, non use of PPE by co-workers (67.14%, emergencies (91.43%) risk that patients may get offended by PPE use by HCWs (27.14% to discomfort while using PPE (24.29%). All components of PPE were available as per only 34.29 percent. Conclusion: The high level of occupational exposure to blood and body fluids and consequent risk of infection amongst a group of HCWs in the Armed Forces highlights the urgent need for interventions to enhance the occupational safety of workers.

Restricted availability of free anti-rabies vaccine in public health facilities in India: unethical and criminal

Restricted availability of free anti-rabies vaccine in public health facilities in India: unethical and criminal