Background: Vaccination being one of the cheapest and safest methods of primary prevention, indicators of maternal and child healthcare are crucial. Multi-indicator cluster survey was planned to check these objectives as set up in reproductive child health (RCH)-II and National Rural Health Mission (NRHM) plan. This study was initiated to determine the vaccination coverage among the children in tribal district in Gujarat and to determine factors associated with partial immunization and non-immunization.Methods: A community based cross-sectional study was done in tribal district Narmada in Gujarat for a period of four months from May 2011 to August 2011. The study population consisted of all children aged between 12-23 months. After using cluster sampling method, assessment of vaccination programme was obtained from 346 out of total 352 children scattered across 30 clusters. A pre-tested semi-structured questionnaire was administered by interview technique.Results: Highest coverage was seen in the first dose of diphtheria, pertussis, and tetanus (DPT) 95.7% (CI 92.3-99) followed by Bacillus Calmette-Guérin (BCG) 95.4% (CI 92-98.7) and first dose of oral poliovirus vaccines (OPV) 95.4% (CI 92-98.7). The proportion of fully immunized children was 77.7% (CI 69.4-86.1), whereas 2.9% (CI 0.0-6.1) children were not vaccinated at all. The drop-out rate was 8.76% from DPT1 to DPT3 and 16% for DPT1 to measles.Conclusions: Vaccination coverage was highest for DPT first dose followed by BCG. The drop- out rate was 8.76% from DPT1 to DPT3 and 16% for DPT1 to measles. Non-awareness regarding subsequent doses of vaccines was most common reason for partial or non-vaccination.
Medication is an important part of a patient's treatment by clinicians and is one of the measures taken by them during the entire period of treatment. This descriptive cross-sectional study aims to assess patients’ understanding about prescribed medication obtained after consultation with clinicians at the outdoor patient department of a tertiary care hospital in central Gujarat, India. 184 patients from different clinical departments were interviewed after their consultation with the clinician. Majority of the subjects (45.5%) were 25-44 years of age, while the rest ranged from 45-54 years of age group. Furthermore, 55.5% of the subjects were female, 20.4% were Illiterate people, and 32.5% were educated up to primary level. The results showed that 84.3% of the patients were informed about proposed treatment duration, while 13.9% were informed about diet relation. Therefore, the patients had fair knowledge about the disease they were suffering from and proposed duration of treatment, but they were not aware of about the line of treatment. In conclusion, patients need to be educated about the correct use of medications by clinicians.
In 1986 the report Bridges over Troubled Waters (NHS Health Advisory Service, 1986) stated quite categorically that patients under the age of 16 should not be treated in adult psychiatric wards. The National Association for Children in Hospital has also worked tirelessly against children and adolescents being treated in adult hospital wards, although this has mainly concerned the paediatric, medical and surgical fields. However few guidelines were laid down about the function of psychiatric units for children and adolescents when the majority of such units were first being established in the late 1960s and early 1970s. Indeed in the circular from the Ministry of Health (1964) about the need for such units it was stated that some adolescent patients could suitably be treated in adult wards. However no age limits were specified in the circular. There have been no specific guidelines issued subsequently by the Department of Health about the use of adult psychiatric beds for adolescents.
Aims Catheter associated blood stream infection (CABSI) is a serious complication of central vessel catheterisation (CVC). During 2010 a series of policy changes were introduced including the use of multi-lumen umbilical venous catheters (UVC). Our aims were to assess whether these changes reduced the rate of CABSI or peripheral line use, and whether the CABSI rate varied by CVC type. Methods CVCs inserted during 2009 and 2012 were identified using the electronic patient record (EPR). Line type, duration of catheterisation and patient demographics were collected from the EPR and cross referenced with the blood culture results. CABSI was defined using standard criteria. Results In 2009 657 CVCs were placed in 311 babies providing 3992 catheter days (cd). In 2012, 682 lines were placed in 292 babies, providing 3792 cd. There were no significant differences in patient demographics. During 2009, the highest CABSI rate was seen during days with multiple CVCs in situ (39/1000 cd), in days of care with a single CVC the rate was higher in long lines (25/1000 cd) than in UVCs (17.5/1000 cd). Between 2009 and 2012: CABSI rate fell from 22.4/1000 cd to 6.1/1000 cd. The proportion of babies with a CVC who developed CABSI fell from 23% to 7.5% (p < 0.0001). There was a reduction in the proportion of CVC days provided by long lines from 51% to 45% (p < 0.01) and an increase in UVC days from 24% to 33% (p < 0.01). The number of peripheral lines used in babies with CVCs fell by 21% (from 1557 to 1228). The proportion of babies with a CVC who never required a peripheral line rose from 38/311 (12%) to 51/292 (17.5%) (P = 0.01). Conclusion We have seen a significant reduction in CABSI since the introduction of our new policies. Some of this reduction can be attributed to the increased usage of multi-lumen UVCs however the magnitude of the effect suggests the whole care bundle has contributed. There has also been a reduction in the use of peripheral venous cannulation.
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