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Biomedical subjects

K Anand

Publications and source records attributed to K Anand.

69 records · Page 4Linked to original sources
PubMedDate not supplied

Out-of-pocket expenditure on healthcare in a north Indian village.

BACKGROUND: Information on healthcare expenditure at the family or household level is important for the planning and management of health services. It is particularly relevant for health insurance agencies to estimate the amount of premium for initiating a universal health insurance system. METHODS: Of 800 families in a village, 160 were selected by systematic random sampling. Of these, 156 families were followed up for a period of 12 months (September 1998 to August 1999) by making monthly visits. Responses from each family, as given by the head of the family, were recorded with the help of an interview schedule administered in the local language. The interview schedule covered any morbidity among the family members in the past one month and the out-of-pocket expenditure incurred on the same. RESULTS: The private health sector was utilized in 59.4% of total episodes. Utilization of the private sector was directly associated with a higher socioeconomic status (p = 0.002). Of the total expenditure on non-hospitalized cases, 83.6% was incurred in the private sector. The mean per capita annual out-of-pocket expenditure on health was Rs 131. The median expenditure per episode was Rs 15. CONCLUSION: Our study shows that out-of-pocket expenditure is more than the government expenditure on health. There is a need for systems such as health insurance to protect the poor from high medical costs.

Family Characteristics↗
PubMedDate not supplied

HLA associations in P. falciparum malaria patients from Mumbai, western India.

In the present study, HLA associations among the cohort of 171 severe P. falciparum malaria patients were compared with that of 101 normal sex, age and ethnically matched control samples. All these individuals lived in Mumbai in an area of low and seasonal P. falciparum transmission. HLA A, B, DRB1 and DQB1 antigens were serologically (A and B) and molecularly (DRB and DQB) determined using isolated lymphocytes and genomic DNA following the microlymphocytotoxicity assay and PCR-SSP techniques. Significant differences were observed between patients with malaria and controls in the following groups of alleles: A3, B27, B49, DRB1*04, and DRB1*0809 were increased, while A19, A34, B18, B37, and DQB1*0203 were decreased. HLA B49 and DRB1*0809 were found to be positively associated with the complicated severe malaria patients (OR = 13.88; p < 0.0001). HLA A19, B5 and B13 were protective in patients with high parasite index (> 2%). These observations revealed the importance of ethnic background, which has to be taken into consideration while developing an ideal malaria vaccine. Further, when compared to HLA associations of other world populations the present study indicates the relative importance of different HLA alleles that may vary in different populations.

Adolescent↗
PubMedDate not supplied

Declining sex ratio: role of society, technology and government regulation in Faridabad district, Haryana.

BACKGROUND: A declining sex ratio at birth has been documented during censuses in India. The decline is especially more in the northern states of Haryana and Punjab. We attempted to assess the role of society (preference for a male child, awareness and acceptability of the practice of sex determination), technology (availability and affordability) and government regulation in the adverse ratio for girls in the Ballabgarh block of Haryana in northern India. METHODS: The population (about 80 000) in the Ballabgarh block has been under constant demographic surveillance for the past 30 years and the data are stored electronically. This was used to determine the sex ratio at birth in the area since 1990. The data on availability of ultrasound machines was collected from the district authorities, as registration of these machines was made mandatory under the Prenatal Diagnostic Techniques Act, 1994. We interviewed 160 mothers and grandmothers to determine the awareness and acceptability of sex determination methods and practices. RESULTS: The demographic data for the past 10 years showed a declining sex ratio-from 881 in 1990-91 to 833 in 2000-01. The data support the view that in the initial part of this period, ultrasound was used for sex determination of all-order births but subsequently was used more in higher-order births. Our interviews with the mothers and grandmothers of the area showed that the practice of sex determination is prevalent and the attitude of the society is ambivalent. The increased availability of ultrasound machines in the area in the past 10 years corresponded to the decline in sex ratio. When the government made the practice illegal, the sex ratio improved only to fall again as the law was not implemented. Later years saw a more stringent implementation of the law and the sex ratio improved again. CONCLUSION: There is a 'demand' for sex determination technology and, therefore, this would continue to be 'supplied'. At most the 'supply' can be regulated. Social engineering efforts need to be targeted at reducing the demand if the sex ratio is to be improved.

Abortion, Eugenic↗
PubMedDate not supplied

Analysis of admissions to the Arthur Davidson Children's Hospital, Ndola.

The frequency of infectious diseases in 6543 children hospitalised in the year 1974-75 in Arthur Davidson Hospital is analysed. Airborne infections including pneumonias and bronchopneumonias were found in 53.7% of the children and in 79.4% of those who died. Measles was found in 1112 children with a mortality rate of 15.6%. Measles and Malaria were among the top five killer diseases in Arthur Davidson Hospital. Of the airborne infections, measles, tuberculosis, laryngotracheobronchitis and pyogenic meningitis are the worst. Some problems concerning prevention and diagnosis are stressed. Improvement in the diagnosis of infectious diseases will depend on improvement in laboratory facilities.

Child↗
PubMedDate not supplied

Cost of health services provided at a primary health centre.

BACKGROUND: Information on the cost of health services is essential for good planning and management and leads to an efficient use of resources. Very little information on this is available in India. We estimated the distribution of costs incurred on the Primary Health Centre, Chhainsa, Haryana by the type of service provided and their average unit costs. METHODS: We calculated the total costs incurred in running the primary health centre for one year using standard costing methods. This cost was apportioned under different heads on the basis of time and space utilization. The number of activities carried out, between April 1991 and March 1992, was obtained from the monthly reports of the centre maintained by the health assistant and supervised by the medical officer. RESULTS: The total cost incurred for one year was Rs 777,020 (US$ 24,250). Curative care accounted for 32% of the total costs followed by communicable disease control (17%), child care (17%), maternal care (11%) and family welfare (10%). An expenditure of Rs 24 was incurred on each outpatient. The cost of giving full primary immunization to a child was estimated at Rs 131, while Rs 127 was incurred on providing antenatal, natal and postnatal care to each pregnant woman. Tuberculosis-related activities in the community cost Rs 3 per head per year and malaria-related activities Rs 2 per head per year. The cost incurred annually on family welfare services to an eligible couple was Rs 19. CONCLUSIONS: Our findings suggest that the cost estimates from this primary health centre are comparable with the estimates from other developing countries. These cost estimates may be used to determine user fees by health agencies or for premiums for community health insurance schemes.

Capital Expenditures↗
PubMedDate not supplied

Costing of a salt iodine monitoring laboratory in India.

BACKGROUND: Iodine deficiency disorders (IDD) are an important public health problem in India and can be prevented by fortifying common salt with iodine. For the iodation programme to be effective, it is necessary to monitor the iodine content of salt. The National Iodine Deficiency Disorders Control Programme recommends that one salt iodine monitoring laboratory should be set up in each district. We calculated the cost of setting up such a laboratory in the year 1993. METHODS: We estimated that approximately 6000 samples of salt would be sent annually by health workers to the district laboratory as part of the routine report system. We calculated the capital cost of the laboratory to include land, buildings and equipment. The recurrent costs included salaries, chemicals and reagents, and maintenance assuming a uniform discount of 10%. RESULTS: A total of Rs 81,550 would be needed for one such laboratory annually, of which Rs 73,500 (89%) would be recurrent costs. This comes to Rs 13.60 per sample tested or 5 paise per head per year in a district with an average population of 1.7 million. If the building is already available and the staff in position only need to be trained, then Rs 16,040 per year (equipment, chemicals and operating costs) would be required. This comes to 1 paise per head per year. CONCLUSIONS: Setting up a salt iodine monitoring laboratory, a vital component for the salt iodation programme, has modest cost implications, especially if the building and staff already exist. This is likely to be the case in most of the districts.

Costs and Cost Analysis↗
PubMedDate not supplied

Cost analysis of a primary health centre in northern India.

BACKGROUND: Cost data are useful in health planning, budgeting and for assessing the efficiency of services. However, such data are not easily available from developing countries. We therefore estimated the cost incurred for the year 1991-92 on a primary health centre in northern India, which is affiliated to an academic institution. METHODS: The total costs incurred included the capital costs for land, building, furniture, vehicles and equipment as well as the recurrent costs for salaries, drugs and vaccines, diesel and maintenance. Except for land, where the 'opportunity cost' was calculated, the current market rates were considered for all other factors. A discount rate of 10% was used in the study. RESULTS: A total of Rs 777,015 (US $24,282) was incurred on the primary health centre in the study year, 80% being recurrent costs. Salaries constituted 62% of the total costs. A sum of Rs 30 (US $0.94) per head per year on primary health care was being incurred. CONCLUSION: Salaries constitute the bulk of the cost incurred on health. Approximately Rs 28 (40%) of the Rs 69 spent per head per year on health services by the Government of India is incurred on providing primary health care services.

Costs and Cost Analysis↗
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Economic consequences of HIV/AIDS in India.

BACKGROUND: HIV/AIDS is one of the pressing public health problems in India. Available information indicates a rising trend of infection. The impact of HIV/AIDS on the economic front is important as it affects mainly the young, who are in the reproductive age group. We estimated the cost of productivity losses in a lifetime attributable to HIV-related mortality in India in the population of the year 1991 at current HIV infection rates. METHODS: The analysis was done from the societal viewpoint, adopting a discount rate of 5%. To estimate the loss in person-years due to HIV/AIDS, two scenarios were considered. Firstly, the population without HIV/AIDS, and secondly, the population with HIV/AIDS. The difference in person-years lived by the cohort in both populations would provide the person-years lost due to HIV/AIDS. To calculate the person-years lived in each, the life table approach was used. The demographic data from the 1991 Census were used. The population was divided into 15 five-year cohorts and the current age-specific death rates were used. Assumptions regarding HIV incidence rates in urban and rural areas in different age groups were made based on the available data and consensus of experts. The estimate was first done for a cohort of 100,000 population for rural and urban areas and then extrapolated to the population in the different age groups. To convert the person-years lost into monetary terms, minimum wages were estimated to be Rs 14,460 per annum. RESULTS: The total undiscounted life-years lost due to HIV/ AIDS by the present population of India will be 238.4 million years-123.7 million years for urban and 114.7 million years for rural areas. On an average this is 0.4 years lost per person. The life-years lost per case of HIV was 44.4 years. Assuming minimum wages of Rs 14460 as the value of one year, the total economic loss is Rs 3447 billion. The productivity loss per case is Rs 642,024 (US$ 20,710). For an estimated national per capita income of Rs 4252.4 the total economic loss is Rs 1014 billion. If a discount rate of 5% is applied for future losses then the total potential years of life lost will be 23 million-11.3 million for urban and 11.7 million for rural areas. In monetary terms this will be Rs 332.6 billion by minimum wages assumption, and 97.8 billion if the national per capita income is assumed to be the cost of one year. CONCLUSION: HIV/AIDS imposes a significant burden on the economic front. The productivity losses are likely to be an underestimate as the costs of treatment of HIV/AIDS patients, prevention programmes and labour costs have not been taken into account. To decide whether HIV/AIDS needs a high priority int he Indian context, it is necessary to have similar estimates for other important diseases such as tuberculosis and cancer.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Time utilisation pattern of staff of two primary health centres in Ballavgarh, Haryana.

BACKGROUND: All National health programmes are implemented through the Primary Health Centre staff. Targets for the year 2000 A.D. have been fixed for different programmes. Some programmes are getting more emphasis, perhaps at the cost of others. The study area has already achieved most of the targets set for 2000 A.D. Studying the time utilisation pattern of the workers of these PHCs can give valuable information for planning of working of other PHCs. OBJECTIVE: To study the time utilisation pattern of the staff of the two PHCs run by Centre for Community Medicine, AIIMS. METHODS: The multipurpose workers (MPWs) and the health assistants (HAs) were accompanied by investigators and information collected regarding their utilisation of time in the field. The Medical Officers were asked to maintain a diary from which this information was collected RESULTS: The MPWs spend about 3.3 minutes in each house. Child care (immunisation, Vit. A and folifer distribution) is the main activity being carried out by both male as well as female worker. Other important activities for male worker are: family welfare (18%), malaria work (11%) and collection of vital statistics (10%). For the female worker Antenatal care (25%) and family welfare (20%) were other important activities. For the HAs also child care was an important activity. However for the male HA malaria related work was the most important. The Medical Officer spends about 60% of this time in administrative and supervisory work. CONCLUSIONS: Immunisation programme is getting the maximum input from workers, which is reflected in > 90% coverage of all vaccines. Family Welfare and Tuberculosis activity are not getting the emphasis which they deserve. Some rethinking about the strategy is essential if all round progress in achieving the targets for the year 2000 A.D. is to be made.

Adult↗
PubMedDate not supplied

Prevalence of iodine deficiency disorders among school children of Delhi.

BACKGROUND: Iodine deficiency disorders (IDDs) are an important cause of mental handicap and poor educability of children. Though Delhi does not lie in the classical Himalayan goitre belt, it has been shown that IDD was endemic in Delhi. Studies of school children in Delhi reported a total goitre rate of 55% which indicates severe endemicity. The sale of uniodized salt has been banned in Delhi since July 1989. This study was done five years later to assess the impact of this measure on IDD prevalence in Delhi. METHODS: A cross-sectional study was done among class VI students studying in government schools of Delhi. A complete list of government middle schools in Delhi was obtained and 30 were selected on the basis of 'probability proportion to size'. A sample size of 1200 was decided based on an expected prevalence of 50% with 5% error and design effect of three. All children in class VI of each school were clinically examined by a trained doctor for the presence of goitre and casual urine samples were collected in capped plastic tubes. The urinary iodine estimation was done by the wet ashing method. RESULTS: The total goitre rate was 20.5%. If the results were limited to children in the age group of 10-12 years it was 19.7%. The urinary iodine was less than the recommended 100 micrograms/L of urine in 23.6% of the children; 7.6% had no iodine in the urine. It is possible that some children could have substituted water in place of urine. The median urinary iodine level was 198 micrograms/L of urine. CONCLUSION: The study showed that IDD continues to be prevalent in mild endemic proportions. Compared to the results of previous surveys, the IDD rates have declined in the last few years. However, it continues to be an important public health problem in Delhi. It is essential to monitor the iodine content of salt on a regular basis. IDD control activities should be strengthened in Delhi and repeat surveys should be done every 3-5 years to monitor the progress achieved in eliminating IDD.

Child↗
PubMedDate not supplied

Relevance and importance of universal salt iodization in India.

It is well known that iodine and thyroid hormone are essential for normal development of the human brain and body. Lack of iodine in the diet leads to 'visible' and 'invisible' spectrum of iodine deficiency disorders. The prevalence of iodine deficiency can be assessed by estimating the total goitre rate in the population. A large section of the Indian population suffers from iodine deficiency disorders. These are easily preventable as was shown more than 40 years ago in the study conducted in Kangra Valley. Salt is the best medium of iodine supplementation in India. The potential risks of iodine supplementation, including the risk of iodine-induced thyrotoxicosis, are discussed. Finally, we attempt to formulate policy guidelines on iodine supplementation on the basis of presumed risk:benefit ratio for carrying out an iodine supplementation programme. Taking into consideration medical, social, economic and political aspects of universal salt iodization, the benefits far outweigh the potential low risk due to iodine excess in a small segment of the population.

Deficiency Diseases↗
PubMedDate not supplied

Iodine deficiency disorders in Car Nicobar (Andaman and Nicobar Islands).

BACKGROUND: The term 'Iodine deficiency disorders' (IDDs) reflects the spectrum of health effects due to iodine deficiency at all ages. So far, no survey for IDD has been carried out in the Andaman and Nicobar Islands (A&N). Therefore, we aimed to determine the status of IDDs at Car Nicobar Island and to assess the iodine content of salt available for consumption on the island. METHODS: The study population comprised tribal school children between 7 and 18 years of age in government schools of Car Nicobar, A&N. Children were selected from each school by the simple random sampling method using the random number table. The same sampling method was used for each school till completion of the desired sample size for that school. Casual urine samples (in screw-capped plastic bottles for iodine estimation) and blood samples (on No. 3 Whatman filter paper for TSH estimation) were collected from a randomly selected sub-sample of students. Salt samples for iodine estimation were collected from 'captains' (village headman) of each village and the headmasters of the schools and 'canteens' in government retail outlets in the villages. RESULTS: Of the 969 children surveyed, 160 (16.5%) had goitre. The prevalence was significantly more among females (23.6%) than males (9.7%). Analysis of 105 urine samples showed that the median urinary iodine excretion level was 7.0 micrograms/dl. The median TSH values in subjects was 5.7 mU/L. Fifty (82.5%) of the 54 salt samples had adequate iodine (> or = 15 parts per million). CONCLUSIONS: IDDs pose a mild-to-moderate public health problem in Car Nicobar Island. The supply of iodized salt and its iodine content was found to be satisfactory at the time of the study.

Adolescent↗