The United States is composed of numerous ethnic communities given the constant influx of immigrants across its borders. Often, a considerable number of these immigrants happen to hold undocumented residential status. As a result, many of these undocumented individuals struggle to obtain healthcare. Currently, there are roughly 49,100 African immigrants residing in the Philadelphia area, accounting for roughly 0.8 % of the Metro-area population, with Liberians and Nigerians having the highest uninsurance coverage rates.[1] The inability of these communities to obtain healthcare could have profound consequences for the entire US Healthcare Delivery System. Lack of access to healthcare leads to the development of chronic and/or acute conditions, including but not limited to diabetes, hypertension, and obesity that when managed at late stages within the continuum of care, entail greater cost and suboptimal medical outcomes. For this reason, the Mercy Health Promoter Model (MHPM) was designed by the Mercy Catholic Medical Center (MCMC) in collaboration with the Institute of Clinical Bioethics (ICB) at Saint Joseph’s University (SJU) to aid immigrants struggling with access to healthcare. Over the last eight years, the MHP Model has successfully helped selected African communities in Philadelphia to deal with these aforementioned conditions through wellness, education, and basic primary care access. The success of the program has necessitated an expansion to another local African community. Hence, this paper will discuss the objectives and procedures of the MHPM, including the recent addition of new services. We hope this model can serve as a paradigm for other healthcare systems across the country to aid these vulnerable and underserved immigrant populations.
This paper examines the spatial pattern of heart disease death rates in the general population in West Virginia between 1999 and 2012. METHODS: Tertiles of low, medium, and high rates are derived for heart disease death rates for the counties and choropleth maps are created to depict the changes in the spatial distribution of counties with low, medium, and high rates over the study period. Correlation analyses are performed to explore the association between the outcome variable and selected socio-economic variables. RESULTS: Overall, the heart disease death rates declined over time in the state. While the number of counties with high death rates decreased during the study period, the counties with low rates increased in number. The analyses show that the heart disease death rates are significantly associated with educational attainment, household income, and lack of health insurance. CONCLUSION: The between-county differences in the heart disease death rates suggest that the underlying factors and the associated mortality burden have varying impact on West Virginia communities. While the correlation results indicate the significance of the county level socio-economic environment, research is needed to investigate this association at the individual level in the state.
Heroin is a synthetic opioid drug that is becoming the drug of choice among many opioid drug abusers. The recreational use of heroin has become a problem resulting in nearly two thousands deaths a year and costing the United States about $22 billion each year due to medical costs, lost productivity, social welfare, and crime. This issue will only deteriorate further as the supply of heroin from south of the border continues to increase and as more individuals continue to become addicted to the drug. In an effort to address the problem, numerous overdose education and prevention programs have been launched around the country. Some of these nearly 200 programs also distribute a drug that can prevent heroin overdoses. This drug, naloxone, is an opioid antagonist that can reverse an opioid overdose by acting on the central nervous system and is used as a harm reduction agent. The U.S. Food and Drug Administration (FDA) approved a naloxone auto-injector, Evzio, to be available effective April 3, 2014 by prescription to those who may experience or witness an overdose. Opinion is divided, medically, legally, and ethically, as to whether this nationwide distribution of naloxone is providing a service or disservice to heroin users, as well as whether or not this distribution is a wise use of taxpayers’ money.
Research Question: To find out the prevalence of opiate abuse in a rural area of Punjab. Objectives: To assess the prevalence of opiate abuse in a rural area of Punjab. Study Design: Community based cross-sectional study. Setting: The field practice area of Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana (i.e. Rural Health Training Center (RHTC) located at village Pohir, Block Dehlon, District Ludhiana, Punjab). Participants: One thousand Seven hundred and thirty two study subjects, fifteen years and above were interviewed . Materials and Methods: The study subjects were interviewed personally in local language by predesigned proforma and ASSIST V3, selected from sample frame of 15 villages by probability proportion to sampling size technique. Number of subjects (15 years and above) were 1732 interviewed in the present study. Statistical analysis: The statistical analysis was performed by using Microsoft excel 2003 and Epi Info version 3.5.1. Results: Study 7.62% individuals of the total population surveyed (1732) had used opiates during the past 12 months. Conclusions: Age at first opiate use was 15-45 years. This study reflects the need to intensify efforts at the community level to protect productive age group from the evil of opiates abuse.
Objective: Epidemiological studies on factors implicated in pathogenesis of breast cancer reveal international variations. The aim of this study was to identify the actual risk factors among Greek women in Macedonia. Design: A cross-sectional case-control study among women with or without breast cancer was prospectively conducted in outpatient breast department of two surgical clinics of Thessaloniki. Materials and Method: Fifty three histopathologically confirmed breast cancer cases were included. The control group consisted of 131 women. Data were collected by a face to face interview using a questionnaire consisting of 33 questions. Statistical adjustment was rendered more efficient by matching cases and controls in groups, choosing a control group (n=75) with an age distribution similar to that of the cases (n=53). Statistical comparisons were performed using logistic regression analysis, to compute the odds ratios (ORs) for the variables of interest. Results: Differences in distribution of age at first live birth were found between cases (Median age: 25 years, Range: 22 years) and controls (Median age: 22 years, Range: 35 years), p=0,021, Odds ratio= 1,086. All of the rest key risk factors were interestingly found to have no significant effect in breast cancer risk. Conclusion: We did not find any statistical relationship between key risk factors and development of breast cancer, except for age at first live birth. Our miscellaneous results may be due to specific characteristics of our study population. Further studies are required to test the consistency of our findings in larger sample sizes and hopefully in other study populations.
Aim To predict pre-eclampsia and eclampsia of pregnancy much before its detection Clinically. Methodology This study included 42 patients who attended OPD of Obstetrics and Gynaecology, GSVM Medical College Kanpur. Out of these patients 11 normal pregnant women were having no disease, constitued control group and 31 having preeclampsia & eclampsia were kept in test group. Their blood was collected for estimation of malonaldehyde and for assessment of levels of superoxide dismutase and catalase. Study was conducted in collaboration with the Department of Biochemistry, King Georges Medical College, Lucknow. Recent research implicates free radical in the pathophysiology of preeclampsia, as oxidative stress is a mediator of endothelial cell dysfunction and this contributes to the cardiovascular complication of pre eclampsia. (1) Result The frequency of PIH in primigravida patient was more (70.96%) than that in 2005 multipara patients (29.03%). The mean systolic and diastolic blood pressure in test group was found to be higher in comparison to mean systolic and diastolic B.P. of control group, the difference is highly significant (P<.001) with preeclampsia and eclampsia was found to be higher (8.48±0.96 Nmoles/ml of plasma) as compared to control group in which mean MDA level was found 4.88±10.35 Nmoles/ml of plasma (Control Vs test P<.001).The mean value of enzymes SOD in control group is much higher (0.704±0.109 unit/mg of protein) than test group (0.347±0.069 u/mg of Protein).The mean value of enzyme catalase in control group is significantly higher (0.304±0.089) than test group (0.112±0.02). Conclusion These findings support notion that increased oxidative stress in the pre-eclamptic placenta may contribute to the patho physiology of this disease-
Human sex variation has been attributed to cultural practices, seasonal variation, small-family size policy and sex selective technology. Information on secondary sex ratio in Southern Nigeria is limited. Therefore our aim for this study was analyzed human sex ratio at birth from a sample of the Niger-Delta population in a Southsouth Nigerian Teaching Hospital, in-order to know the trend of male/female sex ratio at birth and to compare the findings with those of previous reports. Data were collected from Niger-Delta University Teaching hospital (NDUTH) at Yenagoa, Bayelsa state; the data consisted of 1856 single births recorded between April 2007 and March 2012. Each set of data was analyzed to determine the sex ratio by year and month. Chi-square analysis was used to determine the significance of differences between male and female birth from the average value. The annual average male to female sex ratios were 1.24, 1.89, 1.3 and 1.34 for 2008, 2009, 2010, and 2011 respectively. When pooled together, the average ratio was 120:100. This shows some bias for male births and the difference shown to be statistically insignificant at («2=9.13, p=0.10). Data also indicates less male birth in the peak period of rainy season and the highest male to female ratio in harmattan season, suggesting a seasonal variation of sex ratio. These findings are representative of a sample of populations in a Teaching Hospital in South- South Nigeria, and their male female sex ratio is higher when compared to those of southwest Nigeria or other regions in Nigeria as well as other populations of African origin.
Background/aims: To assess the retinal arterial tortuosity and the association between tortuosity and certain health indices in healthy young to middle aged Indians. Methods: This cross-sectional study included 80 fundus (right and left eyes) of 40 healthy adults aged 18 to 45 years, (18 M, 22 F; mean age 35.1yrs) who were characterized by determination of retinal arterial tortuosity using a three-level grading scale (straight, wavy, tortuous),after screening for arterial blood pressure and diabetes. Results: Higher grades of tortuosity were common among the study subjects, 20 (25 %) had straight retinal arteries, 24 (30 %) had wavy arteries and 36(45%) had tortuous arteries when reported as the average of right and left eyes because the correspondence between right and left eyes was high. Increasing values of mean arterial blood pressure were associated with decreasing levels of retinal arterial tortuosity even in pre-hypertensive individuals while age, sex and gender did not significantly contribute towards dimorphism. Conclusion: Considerable variations in retinal vasculature in terms of tortuosity can be observed among young healthy subjects. Determinants of disparities in retinal arterial layout are mainly associated with blood pressure levels while age, gender and right vs left laterality do not appear to much affect the wavy patterns of vessels in this study population. Assessment of retinal vascular tortuosity can provide a means of monitoring systemic health to recognize what determines how retinal vessels are laid out early in life, before systemic risk factors and clinical disease have developed.
BackgroundProper feeding practices are essential for complete physical, mental and psychological growth of the child. It takes care of two elements, malnutrition and infections. This study was conducted to study feeding practices like exclusive breast feeding, prelacteal feeds in young infants. Methods-This Community based cross sectional study was conducted among 150 mothers having children between 0-9months age group and data was collected using pre-tested questionnaire on breastfeeding practices in The Military Area, Patiala District, Punjab, India . Results: Only 40.6% of the women practiced exclusive breast feeding(EBF). Prelacteal feeds were given in 54.7% of the infants. Education has got no effect on exclusive breast feeding practices and administration of prelacteal feeds, may be these are influenced by family traditions. In maximum cases(36%) initiation of breast feeding was within 1-4 hours. Conclusions: Undesirable cultural practices such as giving pre-lacteal feeds, and late initiation of breast feeding are still prevalent among the mothers and these should be discouraged by proper IEC activities. . The study emphasizes need for breastfeeding intervention programmes
HIV/AIDS prevalence is highest among young people between the ages of 20 and 24. Over 60% of new HIV infections in Nigeria are in the 15-24 year age range. The study done in at a tertiary Institution in Nigeria, examined the pattern of risk factors for HIV infection, knowledge of HIV/AIDS, sexual behavior, life style, stigma and discrimination among the undergraduates, whose VCT uptake has been evaluated and reported. It was a cross-sectional study. A semi-structured, self-administered, pre-tested questionnaire was used among undergraduate students. Student size was estimated using sample size formula. Hostels selected by ballot method while room was selected by abridge table of random sample. Data was summarised into simple frequencies, and percentages. Cross tabulations were made, further analysis done, using Microsoft-Excel 2007 Version for Pearsons product correlation coefficients. A total of 378 students were recruited. Most participants were single 366(96.83%), with male to female ratio at 1:1.33 a nd 63.49% were within the 20 �24 years of age. Data showed persistence of risk behaviors among undergraduates dsespite sound knowledge of HIV route of transmission and preventive measures. Newly emanating social risk behavior such as sharing of hair dressing needles was discovered among the studied participants. Further-analysis revealed that independent frequencies of self Perception of contracting HIV infection correlate to those who have multiple sexual partners and inconsistent use of barrier contraceptive such as condom at correlation co-efficient of (p=0.9965 and 0.4487) respectively. Pre and post-counseling sessions with emphasis on abstinence might influence risk behaviors among these vulnerable age group that was studied.
Prevalence of cardiovascular disease in Africa has increased in recent years. Studies suggest that cardiovascular disease will soon be the most important cause of morbidity and mortality in Africa. The objective of this study was to determine the prevalence of cardiovascular risk factors in patients presenting to the cardiac clinic of the Department of Medicine, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Medical records of 432 patients were selected from the cardiac clinic, using simple random sampling. The demographic characteristics of the patients together with the prevalence of cardiovascular disease risk factors were examined. The patients were aged between 13 - 97 years with the mean age (+/-standard deviation) of 55.35 (+/-19) years. There were more females 229 (53 %) than males 203 (47 %). The main cardiovascular risk factors seen included: hypertension (48.4 %), overweight and obesity (46.3 %), dyslipidaemia (43 %), Electrocardiographic left ventricular hypertrophy (ECG LVH) (41.6 %) and diabetes mellitus (7.9 %). Conclusion: Cardiovascular risk factors are highly prevalent in patients attending cardiac clinic at KATH, Kumasi, Ghana
Medical tourism is a vastly growing medical phenomenon in which patients from around the world travel internationally in search of inexpensive and quick, medical procedures. These economically driven treatments can be as different as plastic cosmetic surgery to fertility treatments. The one aspect that they have in common is the poor quality of treatment and care some hospitals and clinics offer to patients. Medical tourism is risky at best with many aspects of the process lacking monitoring or standardization. The surgical procedures are often medically unsafe, illegal and could be considered unethical. Without a doubt, medical tourism is a growing and very critical public health concern. Despite the many risks, however, medical tourism is a thriving industry: 6 million US citizens alone continue to travel globally into the medical tourism phenomenon. India has become the center for medical tourism over the last 5 years. India is specifically known in field for its specialties in cardiovascular, neurology/spine, orthopedic, oncology and weight loss surgeries. Due to the income it has accumulated from the paying tourists, India is not only expanding in medical tourism, but other countries are imitating their medical entrepreneurship, adding to the growing medical tourism business. Medical Tourism is being promoted as a viable solution to the financial dilemma regarding the costs of medical and surgical procedures that often result in a medical disaster for the patient. The guidelines being proposed in this paper seek to protect the health and life of patients by making sure they are fully informed of the medical and legal risks and benefits of any proposed treatments and procedures they may seek in a foreign country. The only hope is that with appropriate guidelines and standards, medical tourism can be rendered medically, legally and ethically more acceptable and be in the best interest of patients, physicians and society as a whole.
BackgroundSkin diseases are associated with environmental factors, and a public health approach is particularly important .The present study was conducted to determine the prevalence of skin disorder, to analyze the age and sex distribution and to deworm the cases which had Pityriasis alba. MethodsA cross sectional study was conducted in 988 children of a higher primary school for 3 weeks duration in Kalkunte Agrahara which is the field practice area of Dept. of Community Medicine, Vydehi institute of medical sciences and research centre,Bangalore. Students were clinically examined for the presence of skin disorders and details noted down in pre-tested structured questionnaires individually. Results -In this study, among 988 children, 24 skin disorders were prevalent .Pityriasis Alba was the most common skin disorder accounting for 46.76%, followed by others like Keratosis Pilaris (13.03%), Seborrhea (10.92%), Icthyosis (8.09%), Acne (5.2%), Pediculosis (3.35%) and Impetigo (4.14%). In all ages pityriasis alba was the most common followed by keratosis pilaris. Impetigo was found among all but in more in higher primary. Seborrhea and pediculosis was seen more in higher primary. Folliculitis was seen more among lower primary. ConclusionHealth education among school children to be made as a curriculum and deworming of all school children to be taken as a regular health care scheme .
BACKGROUND: The Pro Children Eating Habits Questionnaire has been evaluated as a valid and reliable tool in Europe to measure determinants of fruit and vegetable intake for children; however, it has not been validation for United States populations.The purpose of this study was to (1) assess the reliability and discrimination validity of fruit and vegetable correlates for the Pro Children Eating Habits Questionnaire; (2) investigate the predictive validity of determinants of fruit and vegetable consumption for multi-ethnic elementary school children; and, (3) to assess the association of social determinants with fruit and vegetable consumption.METHODS: One hundred and thirty elementary school students from the 3 rd and 5 th grades completed this cross-sectional study.RESULTS: Fruit and vegetable determinants, had satisfactory internal consistencies.No differences were found between the test and the retest for the individual questions with the exception of the question for mean perceived vegetable intake.The discriminatory validity indicated the questionnaire could show differences across grade and gender levels for barriers of fruit and vegetables but not for other factors.Grade together with gender explained barriers to eating fruit and vegetables.Greater availability of fruit in the home and school was associated with higher frequency of consumption.CONCLUSIONS: The results of this study indicate the Pro-Children Eating Habits Questionnaire may be a reliable and valid tool for assessing fruit and vegetable consumption of children in the United States.
Public health officials are grappling with a new wave of heroin abuse across the New York Region. “During the first six months of 2009, 25 people in Nassau County died of heroin overdoses—more than from homicide and drunk driving combined; in 2008, 46 people fatally overdosed on heroin, up from 27 in 2007, according to Nassau officials. In New York City, recent drug raids of so-called heroin mills yielded hundreds of thousands of bags of drugs at a time, up from several hundred bags a year.” One of the most alarming aspects of this increase in heroin use is that it is occurring among teens and people in their early 20s; and many come from upper or middle-class suburban families. Another alarming aspect is that the heroin that is available in the Northeast is purer and more lethal than the kind that ravaged New York City in the 1970s. Dealers often mark bags of heroin with words like “Red Bull,” “Lexus,” “Kiss of Death,” “R.I.P” or skull and crossbones. This spike in heroin use is attributed to its widespread availability and low cost. A bag of heroin can sell for $5 to $25 and induce a sixto -eight hour high. Cocaine, by comparison, can cost $40 to $60 for a 30-minute high while prescription pain killers like Vicodin or OxyContin sell more than $40 a pill on the street.[ii] New York Public Health officials have made the availability of heroin and heroin addiction a major focus, but a comprehensive strategy is lacking. BACKGROUND AND REVIEW Public health officials are grappling with a new wave of heroin abuse across the New York Region. “During the first six months of 2009, 25 people in Nassau County died of heroin overdoses—more than from homicide and drunk driving combined; in 2008, 46 people fatally overdosed on heroin, up from 27 in 2007, according to Nassau officials. In New York City, recent drug raids of so-called heroin mills yielded hundreds of thousands of bags of drugs at a time, up from several hundred bags a year.” 1 One of the most alarming aspects of this increase in heroin use is that it is occurring among teens and people in their early 20s; and many come from upper or middle-class suburban families. Another alarming aspect is that the heroin that is available in the Northeast is purer and more lethal than the kind that ravaged New York City in the 1970s. Dealers often mark bags of heroin with words like “Red Bull,” “Lexus,” “Kiss of Death,” “R.I.P” or skull and crossbones. This spike in heroin use is attributed to its widespread availability and low cost. A bag of heroin can sell for $5 to $25 and induce a sixto -eight hour high. Cocaine, by comparison, can cost $40 to $60 for a 30-minute high while prescription pain killers like Vicodin or OxyContin sell more than $40 a pill on the street. 2 New York Public Health officials have made the availability of heroin and heroin addiction a major focus, but a comprehensive strategy is lacking. Heroin, also known as diamophorine, is a semi-synthetic opioid drug of the opium poppy. Heroin usually appears as a brown or white powder or a black sticky substance known as “black tar heroin.” 3 As with other opioids, heroin is used as both a pain-killer and a recreational drug and has a high potential for abuse. Heroin can be injected, snorted/sniffed, or smoked, routes of administration that rapidly deliver the drug to the brain. “Heroin enters the brain, where it is converted to morphine and binds to receptors known as opioid receptors. These receptors are located in many areas of the brain (and in the body), especially those involved in perception of pain and in reward. Opioid receptors are also located in the brain stem—important for automatic processes critical for life, such as breathing (respiration), blood pressure, and arousal. Heroin overdoses frequently involve suppression of respiration.” 4 Heroin acts as a pro-drug that allows rapid and complete central nervous system absorption; this accounts for the drug’s euphoric and toxic effects. 5 Regular heroin users develop a tolerance in which the user’s physiological and psychological response to the Heroin Addiction: An Ethical Evaluation of New York City’s Heroin Manual 2 of 9 drug decreases, and additional heroin is needed to achieve the same intensity of effect. Heroin users are at a high risk for addiction. It is estimated that about 23% of individuals who use heroin become dependent on it. 6 A range of treatments exist for heroin addiction, including medications and behavioral therapies. Treatment usually begins with medically assisted detoxification to help patients withdraw from the drug safely. Medications such as clonidine and buprenorphine can be used to help minimize symptoms of withdrawal. The most effective treatment is behavioral treatment in combination with medication. These are usually delivered in residential or outpatient settings. 7 Heroin use and addition is a major problem both internationally and nationally. The United Nations estimates that there are more than 50 million users of heroin, cocaine and synthetic drugs. Global users of heroin are estimated at between 15.16 million and 21.13 million people ages 15-64. 8 According to the 2008 National Survey on Drug Use and Health (NSDUH), approximately 3.8 million Americans aged 12 or older reported trying heroin at least once representing 1.5% of the population aged 12 or older. Approximately 453,000 (0.2%) reported using heroin within the past year and 213,000 (0.1%) reported using it in the past month. The number of current (past month) heroin users aged 12 or older in the United States increased from 153,000 in 2007 to 213,000 in 2008. There were 114,000 first-time users of heroin aged 12 or older in 2008. 9 In New York City, accidental heroin overdoses is the fourth leading cause of early adult death, claiming more than 600 lives each year. 10 In addition, heroin use, particularly in those who inject the drug, is also responsible for spreading needle-related infectious diseases such as hepatitis and HIV/AIDS. To address the critical problem of heroin overdoses and the increased spread of hepatitis and HIV/AIDS, the New York City Department of Health and Mental Hygiene in 2007 prepared a 16-page guidebook called Take Charge, Take Care: Ten Tips For Safer Use (NYC.gov website). The purpose of this guidebook, according to representatives of the Department of Health and Mental Hygiene, is “to help people who are injecting drugs reduce the harm associated with this type of drug use until they are able to get into treatment and recovery.” 11 Approximately 70,000 copies of the pamphlet have been produced and distributed at a cost to New York City taxpayers of slightly more than $32,000. 12 Proponents argue that this guidebook can help heroin users avoid health issues and potential inflammation, infection and other problems. More importantly, it could possibly save lives and prevent the spread of needle-related infectious diseases. Opponents argue that the 10-step guidebook could encourage the use of heroin, could deceive users into believing there is a safe way to inject heroin, and could be considered a gross misuse of taxpayers’ money. The purpose of this article is threefold: first, to present the facts presented in Take Charge, Take Care; second, to examine the arguments for and against the guidebook; and third, to give an ethical analysis of this guidebook as a harmreduction approach to lessen the negative consequences of heroin use. TAKE CHARE, TAKE CARE The New York City Department of Health and Mental Hygiene produced and distributed Take Charge, Take Care as part of a long-term comprehensive strategy to prevent heroin overdoses and decrease the spread of infectious diseases like hepatitis and HIV/AIDS. In addition to this informational guidebook, the comprehensive plan includes face-to-face community outreach initiatives, expansion of drug abuse treatment facilities and 47 state-authorized needle exchange programs throughout New York City’s five boroughs. 13 The guidebook is part of a harm-reduction model that could lessen the negative consequences of illegal drug use. Harm reduction can be seen as a set of principles and strategies about human behavior, which, when incorporated into a prevention or treatment program, seek to reduce the negative consequences of high-risk behaviors such as alcohol and drug use and unprotected sex. This approach is also known as damage limitation, casualty reduction and harm minimization. 14 Harm reduction operates on a set of principles and assumptions about how individuals make changes. These principles include recognizing that the desire for change must reside within the individual that long-term change begins with small, realistic and attainable steps; that low-threshold strategies wherein the individual need not commit to abstinence can be effective in bringing about desired change. Harm reduction also affirms individuals as the primary agents in reducing the harm from their at-risk behavior and establishes the quality of individual and community life and well being, not simply cessation of all high-risk behavior, as a criterion for successful interventions. 15 The basic tenet of harm reduction is that there has never been, is not now, and never will be a drug-free society. The aim of the Take Charge, Take Care is to lessen the harm of heroin in New York City through education, prevention and treatment. It is a realistic policy that is based on the fact that a certain number of heroin users Heroin Addiction: An Ethical Evaluation of New York City’s Heroin Manual 3 of 9 will continue to use drugs and some action must be taken to help these individuals and those indirectly affected by their drug use. The goal of this policy is similar to many standard harm-reduction strategies. It is to “move the individual along the continuum toward abstinence, thereby reducing the harmful consequences of the behavior. The continuum model accepts abstinence as the ideal risk-reduction strategy; however, a
Objective: 1.To study the prevalence of contraceptive utilization with its socio-demographic variables in a rural area of Haryana.Study Design: Cross-sectional.Setting: Agroha village Participants: 260 eligible couples Methodology: The minimum sample size to be covered was derived on the basis of current contraceptive prevalence rate of rural Haryana ie.62% (as per National Family Health Survey III -2005-06).For the purpose of the study, 260 eligible couples were selected by simple random sampling.Complete data was collected in a pre-designed, pre-tested quesionnaire.Statistical Analysis: The data collected were analyzed by using percentages and chi-square test.Result: Out of 260 couples selected for the study, 10 couples were non willing.Out of 250 eligible couples, 59.2% were current users of contraception (terminal methods users 46% & spacing method users 13.2%).Contraceptive prevalence increased significantly (p <0.001) with increasing age and also with the literacy status of the women ( 38.5% in illiterate women to 65.0% in women educated to high school & above).Caste-wise, the highest current contraceptive prevalence was found among the Other castes (74.6%) followed by OBCs (46.5%) and SCs (46.0%)(p < 0.001).Current contraceptive prevalence among women of nuclear families was higher (87.0%) than women in joint families (40.7%) & the difference was statistically significant (p <0.001).Current contraceptive prevalence was found to decrease with the increase of socio-economic status as the prevalence was 72.6% in class V (Lower Class) and progressively declined to 47.6% in the class I (Upper Class) (p <0.05).Conclusion: Preference of terminal sterilization methods over spacing methods observed in the present study as a family planning approach needs special attention and there is a need to shift women centric approach to couple centric approach for family planning.Extensive mass awareness campaign at regional level about types, advantages, availability and use of spacing methods is required and locally field workers need to apply Behavior Change Communication (BCC) methods to motivate the couples to accept the spacing methods for better maternal and child health.
Objective: To assess the knowledge, attitude regarding family planning and the practice of contraceptives among eligible couples of rural Haryana.Study Design: Cross-sectional.Setting: Agroha village.Participants: 250 eligible couples.Methodology: The primary tool in this study was predesigned and pretested questionnaire for recording of individual informations.Result:The knowledge about one or more methods of contraception, particularly modern contraceptive methods was 95.0%, being 95.6% among males and 94.4% among females.The knowledge about traditional methods of contraception was 72.0% in males and 46.4% in females.The most common source of knowledge for all couples in general was the "Exposure to family planning messages" (72.0%) followed by discussion with doctors and other health care workers (42.6%).Sex-wise, the most common source of knowledge for males as well as females was "Exposure to family planning messages" (75.2% and 68.8% respectively).Of 250 interviewed couples, 148 (59.2%) were practicing different contraceptive methods.Completion of family was found to be the most common reason for using contraception (81.1%).Fertility related reasons (45.1%) followed by husband's opposition (28.4%) were the common reasons for not using contraception.Positive attitude for contraception was shown by 198 (79.2%) females and 158 (63.2%) males.Conclusion: The study reveals good knowledge and favourable attitude of rural couples towards contraception.The study also highlights that awareness does not always lead to the use of contraceptives.A lot of educational and motivational activities and improvement in family planning services are needed to promote the use of contraceptives and reduce the high fertility rate.
Research Question: To find out the extent and reasons of unmet need for Family Planing among rural women of reproductive age group and its association with some demogaphic factors.Objectives: (a) To estimate the magnitude of unmet need for family planing among women of reproductive age group.(b) To find out the association of socio-demographic factors with the unmet need for family planning and contraceptive users.(c) To explore common reasons for unmet need for family planning.Study Design: Community based cross-sectional study.Setting: Primary Health Training Centre (PHTC), Agroha (Hisar).Participants: Four hundred and eighty three willing women of reproductive age group.Materials and Methods: The primary tool in this study was predesigned and pretested questionnaire for recording of individual informations.Statistical analysis: Proportions & Univariate analysis (Chi Square test).Results : The extent of unmet need for family planning was 41.61%, of which 25.46% were limiters and 16.15% were spacers.Only 45.55% women were contraceptive users.Contraceptive use rate increased significantly X2(4, N = 483) = 11.00,p = .026with the advancement of age.Limiters increased significantly X2(4, N = 201) = 15.67,p = .003with advancement of age with proportionate decrease of spacers.Women's education exert a powerful influence on unmet need X2(4, N = 483) = 14.56, p = .005.With increasing level of literacy, significant X2 (3, N = 201) = 28.59,p = <.001increase in the prevalence of spacers with reciprocal decrease in the limiters were noticed.Neither the type of family nor the number of living children was significantly associated with the unmet need for family planning.However the prevalence of spacers had significantly decreased and limiters increased with increase in numbers of living children.The major reasons for unmet need were opposition from husband & family members (34.83%) and lack of information regarding the different methods of family planning (29.35%).Conclusions: Prevalence of unmet need was higher in more fertile age group (i.e.<30 years), therefore family planning program should focus more on this age group along with targetting illiterate people in rural areas.
