UTILIZATION OF SUBCENTER OPD SERVICES UNDER SANKHALI PRIMARY HEALTH CENTER

Introduction

At present one Primary health centre covers about 30,000 or more population. With Primary functions of preventive, promotive and curative health service delivery to the community through its subcentres. The most peripheral institutional facility is the subcentre, which is run by one male and female multipurpose worker. In most places there is one subcentre for about 5000 population. (1)

Each subcentre is visited by medical officer from Primary Health centre on fixed week days for fixed hours for providing clinical services and supervision of National programs.

Primary Health Centre Sankhali is situated in the Bicholim Taluka of North Goa, which covers approximately 40,000 populations. There are seven sub-centres under PHC Sankhali, Karapur, Amona, Harwalem, Surla, Velgem, Pali and Sankhali-Virdi. Each subcentre serves approximately 5000- 6000 population. There are specific week days allotted to each subcentre to be visited by PHC doctor to provide clinical services and to supervise implementation of various health programs e.g.  Amona Subcentre will be visited by doctor on every Thursday except on public holidays.

Aim:

To Study the utilization of the clinical services at Subcentre.

Methodology:

In this study only clinical service provided by doctor at 2 of the 7 sub centres  has been evaluated, other services has not taken into consideration. Data regarding age, sex and provisional diagnosis of individuals treated at subcentre, Karapur and Harwalem was collected from November 2012 and Jan 2013. Data was entered in Excel sheet and analysed with SPSS software.

Result:

Harwalem subcentre is visited on every Tuesday and Karapur on every Friday except on Public Holidays. Total of 13 visits were available for each subcentre from November 2012 to January 2013. Of this 9 (69%) visits were made to Harwalem Subcentre, two visit missed due to Public holidays and two because of some official work. At Karapur all 13 visits were made.

There were total 447 visits by patients at both the centres, of which majority were females 337(75.4%). Of the total females, most i.e. 219 (64.99%) were from Karapur centre. Also male OPD attendance at Karapur subcentre was 73 (66.36%) compare to Harwalem centre 33.64%. On an Average 17 and 22 patients visit Harwalem and Karapur Sub-centre every week days respectively. Children below 10 years visiting from both the subcentre were 14.1% and 55.7% of patients were from age group of 31- 60 years. Only 19.5% of patients were above 60 years of age.

Of the total visits, 139(31.1%) were for ARI and 114(25.5%) for Hypertension, Bodyache and Backache were 10.7 %( 48), 4.7% (21) were COPD patients. Most of the bodyache and backache i.e. 40 patients were female, 34.53% of ARI cases were among children less than 10 years old.It has been also observe that there is no card system at Subcentre and patient clinical details are maintain in OPD register.

Discussion:

Both the subcentre are 3-4km from primary health centre, still OPD attendance at subcentre is an average 17-22 patients. It has also been found that maximum 40 patient had visited the Karapur subcentre. Most of the patients who are visiting subcentre are residing in and around subcentre within 500m-1km radius. Each subcentre covers approximately 5000 population, but clinical services utilisation from subcentre is by villagers staying near subcentre. This may be because:

1.       Doctor visits once a week, only clinical and limited investigation facility available.

2.       Most patients visiting subcentre are women probably because men go to work.

3.       Old patients who cannot afford to go to the Primary Health Centre come to the subcentre.

In our study 19.5% of patients were above 60 years utilising subcentre OPD services, whereas in survey conducted by ICMR among the population aged 60 years and above 11.3% were utilising Subcentre health services(2).

Important finding of this study is that the Subcentre facility is mostly underutilised and utilisers are mostly women and elderly who are residing in immediate vicinity of the subcentre.

Recommendation:

Since the OPD services are under utilise, this can be further improved by applying the following:

1.       OPD card system can be introduced with provision of monthly medication to Hypertension, DM and COPD patients.

2.       Provision of monthly blood collection facility at subcentre- Those patient requiring monthly or routine monitoring of blood profile like FBSL, lipid profile, renal function test and others can be provided to patients by collecting blood at subcentre on monthly basis and sending for analysis at Govt. Lab at PHC.

3.       Improve IEC activities to increase utilisation of services at Sub centre especially by patients with chronic illness like diabetes and hypertension, this would also decrease patient load at PHC.

4.       Location of subcentre should be at strategic point, so that maximum patients can avail services.

Acknowledgement: I gratefully acknowledge help provided by Subcentre ANM staff Ms. Bharati Betkikar, Mrs. Diksha Parsekar, Ms. Poonam Palkar and Mrs. Pratima Gaonkar.

Bibliography

          1.  Kishore, J. National Health Programs. 6th. ed : Century Publication, 2006.

          2. Indian Council of Medical Research. http://icmr.nic.in/final/hcra_1.html [Cited: february 14, 2013.].

Dr.Swapnil Salelkar MBBS DPH PDCR

Medical Officer-Sankhali-Goa PHC

nil3483@gmail.com

Dr.Saroj Salelkar MBBS DPH PDCR

Insurance Medical Officer- ESI Dispensary

Bicholim-Goa

Table 1. Patient visit at Subcentre

Table 2. Patient visit to subcentre by Age and  sex

Patient visit to subcentre by Age and Gender

Nutritional Status Of Anganwadi Children

Preliminary report on analysis of data from Anganwadi children examination from age group of 3-6 years from Sankhali -Goa. Data was analyse with WHO Anthro software. 

Weight for Height

A REPORT: ANEMIA AND BLOOD GROUP DETECTION CAMP

India has probably the highest prevalence of nutritional anemia in women and children. About half of the non pregnant women and young children are estimated to suffer from anemia.60-70% of pregnant women are anemic. 20-40% of maternal deaths are attributed to anemia. By far, the most frequent cause of nutritional anemia is iron deficiency and less frequent cause is folic acid and vitamin B12 deficiency¹. Anemia is defined as a condition in which the hemoglobin concentration in the body is below the normal values (12 gm% for females & 13gm% for males).

It is preferable that every individual should know his/her blood group so that no time is wasted during emergency for determining blood group prior to blood transfusion. With these aspects in mind, an anemia and blood group detection camp was held in ESI dispensary Bicholim on 5^th March 2013 on occasion of ESI day celebrations; for the ESI beneficiaries (Insured person and family members). A health talk on anemia was given by the chief guest of the function, Dr Laxmi Narayan a practicing gynecologist. The causes, treatment and preventive aspects of the same were highlighted.

 Hemoglobin testing was done using Sahli's method and blood typing done using monoclonal blood typing antibodies for slide test. Hemoglobin results were classified as “normal', “mild anemia”, “moderate anemia” and “severe anemia” based on WHO reference values². Blood grouping was done on basis of ABO and Rh typing i.e. A+, A-, B+, B-, AB+, AB-, O+ and O-.

A total of 51 people participated in camp, of which male were 25 (49.02%) and 26 were females. Most of the patients i.e. 47% were between 31-50years and 9.8% were above 60 years. The Prevalance of mild and moderate anemia were 37.25% and 13.73% respectively, with moderate anemia were detected in only female patients.There was no individual with severe anemia.

With respect to blood group, 31.37% individuals were B+; 25.48% were O+; 21.57% A+; 3.92% who were B- and 1.96% was A-. There were no individuals with O- blood type.

References

1. Parks Textbook of Preventive and Social Medicine, 19^th edition, page 622.

2. Hemoglobin Concentration for the diagnosis of anemia and assessment of severity. WHO/NMH/MNM/11.1

Dr Saroj S. Salelkar

Insurance Medical Officer

ESI Dispensary

Bicholim-Goa

Utilization of Anganwadi Services (ICDS)

TO assess the utilization of Integrated Child Development Services (ICDS) in 1-6 year old children at a subcentre area in rural Goa

Dr. Saroj Salelkar  MBBS, DPH, PDCR

Insurance Medical Officer- Goa

email: saroj_18183@yahoo.com, saroj18183@gmail.com

contact Dr. Saroj Salelkar for full article.

ABSTRACT

A cross-sectional study was carried out at Sub center Mandur area for 1-6 year old children with the following aims (1) To assess the utilization of Integrated Child Development Services (2)To identify the reasons for non-utilization if any (3)To evaluate the nutritional status of the utilizer in comparison with the non-utilizer of ICDS scheme. It was observed that 47.1% of the children under study were utilizing whereas 52.9% were not-utilizing the scheme. Of the non-utilizers, 43% availed services of the nursery school and 48.5% of the children did not utilize the services because the distance of the anganwadi centers was more than 1 kilometer. There was no significant difference between the nutritional status of the utilizer and non utilizer of the ICDS scheme. The reasons for this could be multifactorial ranging from higher socioeconomic status to higher literacy rates in the state of Goa.

Prevalance Of Anemia In pregnancy

Prevalence of anemia during pregnancy: Results of laboratory data analysis from a Primary Health center of Goa

Abstract:

Introduction: Globally anemia affects 1.62 billion people which correspond to 24.8% of the population. It is more prevalent in pregnant women and young children. ^[1]

Objective: Study was conducted to know the status of anemia in the antenatal cases registered at the Primary health Center.

Methods:  Anaemia was diagnosed by estimating the haemoglobin concentration in the blood with the use of the indirect cyanmethemoglobin method, data generated at laboratory was collected and analyzed.

Results: During study period 649 Antenatal cases laboratory data were available, of this 37.6% were mild anemic, 7.4% having moderate anemia, overall prevalence of anemia was 45.10%% in Antenatal cases.

Conclusion: Present study aims at only to find prevalence of anemia among antenatal cases, which was 45.10% slightly higher than NFHS III data, which was 36.9% among pregnant women. ^[2] Further detail assessment of the various factors involved in anemia need to be study among antenatal women.

Key words: Anemia, antenatal cases, pregnancy.

Introduction: Anemia is a global public health problem affecting about 1.62 billion people which corresponds to 24.8% of the population, from both developing and developed countries with major consequences for human health as well as social and economic development. It is more prevalent in pregnant women; over 80% of the countries have a moderate or severe public health problem.^[1]  In the low socio-economic groups 50-60 per cent of women are anemic in the last trimester of pregnancy. Anemia is associated with high incidence of premature births, postpartum haemorrhage, puerperal sepsis and thromboembolic phenomena. ^[3]

Objectives: To study the prevalence of anemia in antenatal cases.

Methodology:  This study was conducted at Sankhalim Primary Health Center of the North Goa. The area under primary health center mostly comprise of rural areas, catering approximately 40,000 populations with more than 70% population belongs to low and middle socio-economic class. Primary Health Center is the nearest government health facility available to this people. Average 64 new antenatal cases (ANC) are registered per month to this PHC. All the Antenatal cases were provided with iron and folic acid supplementation from 13^th week onward.

During their first visit, hemoglobin estimation is done by only laboratory technician by cyanmethemoglobin method. Data which was generated in the laboratory was compiled and analyzed for the prevalence of anemia.

Data was collected for the period of 10 months from January 2010 to October 2010 and analyze for prevalence.

Anemia in pregnant women is defined as hemoglobin level below 11gm%.^[4] and further classified as mild ( 9-10.9 gm%), moderate (7-8.9 gm%) and severe anemia (less than 7 gm%).

Results and Discussions

During study period 649 Antenatal cases data were available at the Primary health Center of which, 88.9% Antenatal cases were Hindu and 10.9% Muslim. Of the 649 Antenatal cases, 86.5% Antenatal cases belongs to 20 to 30 years of age group and only 2.0% was less than 20years of age. Mean hemoglobin was 10.7gm% (SD of 1.37gm %) and mean age was 25.5 years (SD of 4.5yrs)

Total prevalence of anemia among ANC was 45.10%, with mild anemia in 37.6% cases and 7.4% had moderate anemia. In age group of 20-25 years, 45.5% of the 358 Antenatal cases were anemic and 47.3% were having anemia in the age group 26-30years.Anemia in less than 20 years were 53.9% of 13 Antenatal cases (P 0.778).

As per Family Welfare statistics of India 2009, for North Goa, anemia among ever married women aged 15-49 yrs were 38.9% (NFHS III) and 36.4% (NFHS II).Pregnant women age 15-49 who are anaemic are 36.9% NFHS III ( urban-43.3% and rural-26.1%), NFHS II-35%.^[2]   Total 577 Hindu Antenatal cases registered at PHC, of which 44.7% were anemic and 33% of the 71 Muslim Antenatal cases were anemic.(P 0.925)

Prevalence of anemia in Valencia study was 34.44%, and of which 1.8% had severe anemia. ^[5]  Similarly in Tanzania study 23 % of pregnant women had Hemoglobin less than 11gm%. ^[6]

G.S. Toteja et al study shows that the prevalence of anaemia among the 6,923 pregnant women from the 16 districts was 84.9% and overall prevalence of moderate and mild anaemia in pregnant women was 60.1% and 11.8% respectively. ^[7]   Prevalence of anaemia in this study was more than NFHS III.

Present study had only assessed the prevalence of anaemia in antenatal cases at a point of time, further follow up and pregnancy outcome with impact on newborn require to be studied. 

 Age wise distribution of anemia in Antenatal cases

              

                   

References

1.   Worldwide prevalence of anemia 1993-2005, WHO Global Database on Anemia. Edited by Bruno de Benoist, Erin McLean, Ines Egli and Mary Cogswell.

2.   Family welfare statistics in India 2009; Ministry of Health and Family Welfare, Government of India.

3.   K. Park. Preventive Medicine in Obstetrics Paediatrics and Geriatrics. Park’s Textbook of Preventive and Social medicine, 17^th edition. Jabalpur, M/s Banarsidas Bhanot Publishers, 2002; 363.

4.   Iron Deficiency Anaemia, Assessment Prevention and Control, A guide for Programme managers; WHO/NHD 01.3.

5.   Arturo Marti-carvajal, Guiomar Peña-Martí, Gabriela Comunian, Sergio Muñoz et al Prevalence of anemia during pregnancy : Results of Valencia (Venezuela) anemia during pregnancy study. ALAN 2002; v.52n.1Caracas mar.

6.    S.G Hinderaker, B. E. Olsen, Per Bergsjo, Rolv T Lie, Peter Gasheka and Gunnar Kvale. Anaemia in pregnancy in the highlands of Tanzania. Acta Obstet Gynecol Scand 2001; 80: 18–26.

7.   G. S. Toteja, Padam Singh, B. S. Dhillon, B. N. Saxena, F. U. Ahmed, Lt. R. P. Singh et al. Prevalence of anemia in pregnant women and adolescent girls in 16 districts of India. Food and Nutrition Bulletin 2006; vol.27:311-15.