Background: Estimated cervical cancer screening practice is very low and load of cases very high in India. The studies document that nurses play a crucial role of enlightening community about need and availability of Pap smear. It is important therefore to understand the perceptions and practices of nurses about cervical cancer and screening. Aims & Objective: To evaluate the Knowledge Attitude & Practices (KAP) of the Nurses on cervical cancer and screening. Material and Methods: A self-administered, structured, open ended and pretested questionnaire covering the general characteristics, KAP about cervical cancer and screening (Pap smear) was used to collect responses of nurses in a Teaching Hospital at Surat. The information thus collected was entered and analysed in Epi Info and Microsoft Excel software. Results: Responses from 200 female nurses were recorded and analysed. Majority (88%) were married; most common age of marriage being 21 to 25 years. Nurses linked multiple sexual partners (61%), sex at an early age (44%), Human Papilloma Virus infection (38.6%) and heredity (31%) to cervical cancer. Approximately 70% believed that Ca cervix is preventable, detectable and curable if detected early. Pap smear was recognized as major screening technique by 74% nurses. Major (84%) source of information was health professional. Eighty percent nurses never took cervical screening while 87.5% did not recommend it to others. Conclusion: For successful implementation of cervical screening program, the nurses should be targeted first by education and sensitization so that they can play pivotal role in developing the awareness, confidence and compliance of women.

Caregivers frequently make mistakes when following instructions on discharge medications, and these instructions often contain discrepancies. Minimal literature reflects inpatient discharges. Our objective was to describe failures in caregiver management and understanding of inpatient discharge medications and to test the association of documentation discrepancies and sociodemographic factors with medication-related failures after an inpatient hospitalization. METHODS: This study took place in an urban tertiary care children's hospital that serves a low-income, minority population. English-speaking caregivers of children discharged on an oral prescription medication were surveyed about discharge medication knowledge 48 to 96 hours after discharge. The primary outcome was the proportion of caregivers who failed questions on a 10-item questionnaire (analyzed as individual question responses and as a composite outcome of any discharge medication-related failure). Bivariate tests were used to compare documentation errors, complex dosing, and sociodemographic factors to having any discharge medication-related failure. RESULTS: Of 157 caregivers surveyed, 70% had a discharge medication-related failure, most commonly because of lack of knowledge about side effects (52%), wrong duration (17%), and wrong start time (16%). Additionally, 80% of discharge instructions provided to caregivers lacked integral medication information, such as duration or when the next dose after discharge was due. Twenty five percent of prescriptions contained numerically complex doses. In bivariate testing, only race and/or ethnicity was significantly associated with having any failure (P 5 .03). CONCLUSIONS: The majority of caregivers had a medication-related failure after discharge, and most discharge instructions lacked key medication information. Future work to optimize the discharge process to support caregiver management and understanding of medications is needed.

BackgroundFollowing the World Health Assembly resolution on Elimination of lymphatic filariasis (ELF) as a public health problem by the year 2020, a Global Program (GPELF) was launched in 1997 to help endemic countries to initiate national programs. The current strategy to interrupt transmission of LF, is administration of once-yearly, single-dose, two-drug regimen (Albendazole with Diethylcarbamazine (DEC) to be used in endemic areas with the goal of reaching 65% epidemiological coverage for 4–6 years. We report findings of independent assessment from year 2010 to 2015 for last six rounds, after initial five rounds of Mass Drug Administration (MDA) since 2005 for ELF in endemic area of Gujarat.MethodsIndependent assessment of MDA was performed to find coverage and compliance indicators, reasons for non-coverage and non-compliance in five Implementation Units (IUs). Pre, during and post MDA evaluations were done in three phases. The impact of MDA was measured by microfilaraemia survey. A total of eight sites, four random and four fixed sentinel sites were selected to calculate microfilaria rate (MF) per IUs per year. In years 2010 to 2015, we report results from 125,936 nocturnal blood smears and 17551 population in 120 selected clusters. Four clusters were selected per year in each of the five IUs for assessment of MDA round.ResultPost MDA survey showed drug coverage between 81%-88% and epidemiological coverage 77%-89% across years. Main reasons for non-coverage were drug administrator related (the team did not visit or missed people) while non-compliance was population related (fear of side effects, sickness, people forgot or absent). During MDA findings show that the directly observed consumption is considerably improved from 58% in 2010 to 82% in 2015. The knowledge about benefits of drug provided also increased from 59% to 90% over the years. The current MF rate is less than one in all IUs with an overall 68% percent decrease from baseline year 2005 to year 2015. The average MF rate of Gujarat is 0.44 for year 2015.ConclusionsThe findings show that achieving adequate epidemiological and drug coverage is possible by actual field level operation of the program in large endemic areas. The results and feedback from independent assessment, performed regularly, could guide the policymakers and program managers for mid-term corrections and to frame strategies to enhance program. Monitoring of coverage and impact indicator together informs decisions for reaching end-point of MDA. The impact indicator- microfilaria rate in all IUs of South Gujarat Region has reached and remained less than one percent signaling end-points of MDA. Post MDA stringent monitoring in form of TAS is recommended to keep vigil on maintenance of elimination achieved.

Background: Newborn mortality is one of the world's most neglected health problems. It is estimated that globally four million newborns die before they reach 1 month of age and another four million are stillborn every year. Aims & Objectives:(1) To study the maternal care in terms of Antenatal, Intranatal and Postnatal care practices; (2) To assess newborn care practices in rural areas. Materials and Methods:A cross-sectional study in rural areas of Navsari district, Gujarat, included 243 women who had one child aged 12 to 23 months preceding data collection. Data were analyzed using statistical software Epi Info 6. Results: All the mothers under study had adequate ANC check-ups. All the mothers had received Iron supplements during ANC but 72.8% of them completed it for 3 months. Majority (99.2%) had institutional delivery. Regarding thermal care practices, half of the women reported that the baby was dried and wrapped within 15 minutes of birth. More than one third (37.8%) of babies were bathed in less than 24 hours of birth. Most of the mothers (93.4%) had put substances on the umbilical cord. About 32% of the infants had received pre-lacteals feeds. The colostrum was fed by 90.9% of mothers. Only 56.4% mothers initiated breast-feeding within 1 hour of birth. Conclusion: In majority of cases, correct practices regarding newborn care were observed among mothers and this should be promoted through improved coverage with existing health services.

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Background: Infant feeding practices have a major role in determining the nutritional status of children and are associated with household socioeconomic and demographic factors. Aims & Objectives: (1) To study the socio-demographic profile of mothers; (2) To assess impact of feeding practices on nutritional status of children. Materials and Methods: A cross-sectional study in rural areas of Navsari district, Gujarat, included 243 women, who had one child aged 12 to 23 months preceding data collection. Data were analyzed using statistical software Epi Info 6. Anthropometric analysis was done by using WHO Anthro software (version 3.2.2). Results: Breastfeeding was universal in the study area. Only 56.4 % of mothers initiated breastfeeding within one hour. Only 36.2 % of infants were exclusively breastfed for 6 months and 97.5 % had received complementary feeding at 6-9 months of age. There was 11.5% prevalence of underweight, 15.6% prevalence of stunting and 8.6% prevalence of wasting. There was significant association between underweight with the birth order of the child, birth weight of the child and time of initiation of the breast-feeding to the child. There was significant association between stunting with the sex of the child. There was significant association between time of initiation of breast-feeding with the birth order of the child and type of delivery. Conclusion: Malnutrition was associated with perinatal care practices and infant feeding practices. Efforts are needed to promote early initiation of breastfeeding, exclusive breastfeeding for 6 months and age-appropriate complementary feeding among infants.

BACKGROUND AND OBJECTIVES: The pediatric inpatient discharge medication process is complicated, and caregivers have difficulty managing instructions. Authors of few studies evaluate systematic processes for ensuring quality in these care transitions. We aimed to improve caregiver medication management and understanding of discharge medications by standardizing the discharge medication process. METHODS: An interprofessional team at an urban, tertiary care children’s hospital trialed interventions to improve caregiver medication management and understanding. These included mnemonics to aid in complete medication counseling, electronic medical record enhancements to standardize medication documentation and simplify dose rounding, and housestaff education. The primary outcome measure was the proportion of discharge medication–related failures in each 4-week period. Failure was defined as an incorrect response on ≥1 survey questions. Statistical process control was used to analyze improvement over time. Process measures related to medication documentation and dose rounding were compared by using the χ2 test and process control. RESULTS: Special cause variation occurred in the mean discharge medication–related failure rate, which decreased from 70.1% to 36.1% and was sustained. There were significantly more complete after-visit summaries (21.0% vs 85.1%; P < .001) and more patients with simplified dosing (75.2% vs 95.6%; P < .001) in the intervention period. Special cause variation also occurred for these measures. CONCLUSIONS: A systematic approach to standardizing the discharge medication process led to improved caregiver medication management and understanding after pediatric inpatient discharge. These changes could be adapted by other hospitals to enhance the quality of this care transition.