Background: Data on timing and probable causes of infant deaths are very important for the design of intervention to reduce mortality because of very limited study in the state. This study was undertaken to determine the timing and causes of infant deaths in our state using verbal autopsy. The suggestions and recommendations can be used to strengthen and improve the existing facilities and services for the better outcome of life in the early childhood.Methods: A cross sectional study was conducted in 180 selected clusters by WHO cluster sampling method, using validated verbal autopsy tool for timing and causes of infant deaths.Results: Verbal autopsy was done for 45 infant deaths. 37.8% infant deaths were early neonatal, 15.5% in late neonatal and 46.7% in post neonatal period with mean age of 5.79±6.35 days in neonatal period while it was 5.07±3.38 months in post neonatal period. Of all the infants 57.78% were females. The major causes of death were severe infection (15.5%) in neonates, pneumonia (13.3%) in post neonates followed by LBW with prematurity (11.1%) and diarrhea (11.1%). No specific cause could be determined in 13.3% cases.Conclusions: The major causes of infant deaths are preventable. It emphasizes for the robust reporting mechanism to determine the exact causes of all infant mortality, strengthening of comprehensive health care delivery and ensuring the accessibility to the health care services to have a healthy infanthood.
Hepatitis B virus (HBV) has several genotypes. In the Indian population, genotypes A and D are the most frequent. HBV infection is hyper-endemic in the Lahaul and Spiti district in Himachal Pradesh; however, the virus genotype in this area is not known. We sequenced a 398-nucleotide segment of HBV genome that included parts of pre-S1/S2 and polymerase genes from 17 specimens from this district, and assigned a viral genotype to these. Of the 17 specimens studied, 13 (76% [95% confidence interval = 50-92%]) showed the presence of genotype C HBV; the remaining four were genotype D (n = 4; 24%) HBV. Prevalence of genotype C HBV was much higher in the district than in other parts of India. This may reflect the historical mixing of this population with that in China. Since genotype C has a higher risk of chronicity and mother-to-child transmission, prevention of HBV infection may need particular emphasis in this area.
Background: Viral hepatitis B is a systemic infection affecting predominantly the liver, caused by hepatitis B virus. The similarity of hilly tribal’s in spiti and the Tibetans with documented high prevalence of HBsAg encouraged us to explore the burden of the hepatitis B infection in them as well. So the study was designed to document the prevalence of the chronic hepatitis B infection for timely intervention with the required prevention and control measures.Methods: 30 cluster villages from the 82 inhabitated villages were taken with 37 samples from each cluster village. Data was collected using interview schedule. Serum samples were taken and subjected to sandwich ELISA for the detection of HBsAg and positive samples were tested for the HBeAg then after.Results: The study included 1110 participants with 424 males. 99.7% of them were Buddhist and 98.5% belonged to Scheduled Tribe category. 60.1% were educated up to the middle and18% were illiterates. The prevalence of HBsAg was 21.9% (CI 19.6-24.6) with 22.6% in females and 20.9% in males. HBeAg was positive in 24.4% of HBsAg positive cases, higher in the 15-24 years age group and 30.5% in the reproductive females.Conclusions: The current study has reported hyper endemic (21.9%) sero-prevalence of HBsAg with infectivity rate of 24.4%, more in the young and reproductive population. The infection is homogenously distributed among the Buddhist tribal population in the study area.
Background: Industrialization carries with it the seeds of environmental damage and has always entailed some serious population health challenges. Reforms initiated seems to be not sufficient. There was a felt need to identify people’s perspective on industrial pollution and its health hazards in the seriously polluted areas of Himachal Pradesh.Methods: We designed a qualitative study on the perceptions of people towards air and water pollution due to the industrial activities. Eight focus group discussions were convened to extract the public opinion.Results: The narratives of participants formed five broad thematic areas. It emerged that they have experienced the change in the climate of the area and relied more on their senses to assess their exposure and in identifying sources of pollution. It was endorsed that industries pollute mainly during the night hours. They were of opinion that the overpopulation due to immigration leading to overcrowding and unhygienic sanitation practices have also contributed adversely to their health. There is a general understanding that industry contribute more to these problems than individual. The level of health awareness needs to be raised through extensive IEC activities.Conclusions: The contribution of the industries to the environmental degradation has been perceived by the people. Multi sectoral approach is the need of the hour with more stringent laws and accurate monitoring mechanism and due importance to the views of the general public should be given in the policies and planning.
Background: Outdoor air quality has been connected with the prevalence of allergic respiratory infections in children. The impact of industrial pollution on respiratory health during early years of life in school children is a major concern. Pulmonary function tests can be used to assess the impact of air pollution and the degree of airway reactivity.Methods: A cross sectional comparative study was conducted between Primary school children aged 6 to 10 years in the industrial area and non-industrial area. Structured questionnaire based data was recorded from the students regarding respiratory symptoms. Spirometric parameters recorded were Forced Vital Capacity (FVC), Forced Expiratory Volume at one second (FEV1), Maximal Midexpiratory flow (FEF 25-75%) and Peak Expiratory Flow Rate (PEFR).Results: Data from 102 students from each of the two primary schools revealed mean forced expiratory volume in 1 second (FEV1) as 1.01±0.31 L/sec in industrial area and 1.12±0.34 L/sec in non-industrial area (p=0.01). Four or more episodes of allergic rhinitis in the last year were present in 24/84 (28.5%) children in the industrial area as compared to 8/90 (8.8%) in the non-industrial area (p=0.002). Point prevalence of allergic rhinitis was 36 (35.3%) students in industrial area and 22 (21.6%) students in non-industrial area (p=0.03).Conclusions: Industrial air pollution has impact on the lung function tests of school children in the age group of 6 to 10 years with significant difference in spirometric parameters of FEV1, frequency of episodes of allergic rhinitis and point prevalence of allergic rhinitis.
Background: The incidence of gastric cancer varies in different parts of the world and among various ethnic groups. Himachal Pradesh, located in the north of India, has different customs, food habits, life-style and diverse ethnic groups. We undertook this study to analyze the clinical presentations and pathological characteristics of stomach cancer patients in the biggest referral center in the state.Methods: All endoscopic biopsy proven cases of carcinoma stomach attending the OPD or admitted in the general surgery ward between July 2014 to June 2015, went through a thorough clinical examination, routine and diagnostic investigations and endoscopic biopsies for histopathological confirmation.Results: The study included 62 patients of adenocarcinoma stomach with maximum cases between 45 to 65 yrs age, more in males (2:1). Borrmann type II was most common macrocsopic appearance followed by type IV. As per Lauren classification, 36 were of intestinal, 24 diffuse and 2 had mixed type. 10 patients had well differentiated, 28 moderately differentiated and 24 patients had poorly differentiated tumors. Anorexia, abdominal pain, weight loss, nausea and vomiting was the most common symptoms seen in antral lesions (distal) and anemia was the most common sign followed by dehydration, mass abdomen and ascitis.Conclusions: The study has added to the literature of clinical and pathological presentation and relation of signs and symptoms to the site of occurrence of gastric carcinoma from the hilly and rural state of northern India.
Background: Chronic viral hepatitis is a major global public health problem, an important cause of morbidity and mortality. We conducted this study to evaluate the behavioral risk factors of HBV infection and its association with HBsAg positivity among residents of Kaza sub-division of district Lahaul & Spiti in Himachal Pradesh. Material & Methods: The study was carried out by the Gastroenterology, Community Medicine, and Microbiology Department at Indira Gandhi Medical College Shimla at Kaza, a subdivision of Lahaul & Spiti. The cluster sampling technique was used to get the desired sample size of 4000. Forty clusters were chosen using a probability proportionate to size sampling method, and 100 research participants were added to each cluster using a simple random sampling method. The data was gathered using a pre-tested interview plan. A blood sample of 5ml from each study participant was obtained, and its HBsAg content was examined. Results: In our study, 2.7% of the interviewed respondents’ parents were positive for hepatitis B and 3.7% reported one positive family member. Injectable drug use was reported by 1.6 (68/4231). Among these users 8.8% (6/68) shared needles with other IDUs in last 12 months and 35.3% (24/68) used a common container to draw up drug solution. Sexual intercourse was reported to be experienced by 15.5 (655/4231) and 12.2% either did not disclose or were children. Out of those who ever experienced sexual/penetrative intercourse 38.3% (251/655) had reported it with someone else other than a spouse. Majority of these had two partners other than a spouse (30.3%; 76/251). Around 30% (195/655) reported of using a condom in their last intercourse. Body piercings or a tattoo from someone who doesn’t sterilize his or her equipment, including local treatment from lamas, was prevalent among 16.3% of the population (689/4231). Acupuncture was taken as a remedy for any medical condition by 9% of participants. Regression analysis also revealed that one infected family member emerged as an independent factor associated with HBsAg positive test after adjusting for confounders. Conclusion: Our study provided much important information concerning hepatitis B risk factors in this tribal group. Health education about behavioral risk factors among this tribal population should be the main intervention that might help limit the spread of these blood-borne infections.
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