Browsing by Author "Lakshmi, P V M"
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Item Association of air pollution and mortality in the Ludhiana city of India: A time-series study.(2010-04) Kumar, Rajesh; Sharma, Suresh K; Thakur, J S; Lakshmi, P V M; Sharma, M K; Singh, TBackground : With rapid industrialization, the quality of the air is being compromised in several Indian cities. Hence, the effect of air pollution on mortality was studied in the Ludhiana city of Punjab in northern India. Materials and Methods: Air quality and meteorological and mortality data were obtained for 2002-2004. Punjab Pollution Control Board monitored air quality on specific week days at different sites. Respirable suspended particulate matter (RSPM) (equivalent of PM 10 ) was measured by the gravimetric method and NOx and SO 2 by chemical method. The estimation of the daily average RSPM level was attempted by combining 24-h average of the monitoring stations working on a particular day. Sahnewal Airport records temperature, dew point, and relative humidity at 8.30 am, 11.30 am, and 5.30 pm. Visibility of fixed landmarks is observed manually every hour from 6.30 am to 6.30 pm. Daily death records were obtained from the civil registration system. The association between visibility as proxy for RSPM and mortality was established using the generalized additive model (GAM) with natural spline smoothers at 6, 3, 3 df in R software with deaths (excluding accidents) as a dependent variable. Smoothers for day of the week, temperature, and relative humidity were also included in the model. Results: Air quality monitoring days for different monitoring stations ranged from 86 to 138 per year. The annual mean RSPM ranged from 226.7 to 269 μg/m 3 , SO 2 from 11.6 to 20.9 μg/m 3 , and NOx from 32.2 to 46.3 μg/m 3 . The mean (SD) temperature was 25.6 (7.9)°C, relative humidity was 58.1 (19.3)%, and visibility was 3398 (1418) m. Overall 28,007 deaths were registered, with an average of 25.4 deaths (SD 5.8) per day. The association between air quality as indicated by visibility (haze) and daily mortality was found to be statistically significant. For every 1 km decrease in visibility at midday, mortality due to natural causes increased by 2.4%. Conclusions: In Ludhiana, air pollution levels were quite high. The air quality (as measured by visibility) was significantly associated with mortality.Item Effectiveness of Muskaan Ek Abhiyan (The Smile Campaign) for Strengthening Routine Immunization in Bihar, India.(2012-02) Goel, Sonu; Dogra, Vishal; Gupta, Satish Kumar; Lakshmi, P V M; Varkey, Sherin; Pradhan, Narottam; Krishna, Gopal; Kumar, RajeshBackground: In Bihar State, proportion of fully immunized children was only 19% in Coverage Evaluation Survey of 2005. In October 2007, a special campaign called Muskaan Ek Abhiyan (The Smile Campaign) was launched under National Rural Health Mission to give a fillip to the immunization program. Objectives: To evaluate improvement in the performance and coverage of the Routine Immunization Program consequent to the launch of Muskaan Ek Abhiyan Intervention: The main strategies of the Muskaan campaign were reviewing and strengthening immunization micro-plans, enhanced inter-sectoral coordination between the Departments of Health, and Women and Child Development, increased involvement of women groups in awareness generation, enhanced political commitment and budgetary support, strengthening of monitoring and supervision mechanisms, and provision of performance based incentive to service providers. Methods: Immunization Coverage Evaluation Surveys conducted in various states of India during 2005 and 2009 were used for evaluation of the effect of Muskaan campaign by measuring the increase in immunization coverage in Bihar in comparison to other Empowered Action Group (EAG) states using the difference-indifference method. Interviews of the key stakeholders were also done to substantiate the findings. Results: The proportion of fully immunized 12-23 month old children in Bihar has increased significantly from 19% in 2005 to 49% in 2009. The coverage of BCG also increased significantly from 52.8% to 82.3%, DPT-3 from 36.5 to 59.3%, OPV-3 from 27.1% to 61.6% and measles from 28.4 to 58.2%. In comparison to other states, the coverage of fully immunized children increased significantly from 16 to 26% in Bihar. Conclusions: There was a marked improvement in immunization coverage after the launch of the Campaign in Bihar. Therefore, best practices of the Campaign may be replicated in other areas where full immunization coverage is low.Item Health care seeking behavior of adolescents: comparative study of two service delivery models.(2008-09-06) Kumar, Rajesh; Prinja, Shankar; Lakshmi, P V MOBJECTIVES: To assess the perceived health problems and help seeking behaviour and utilization pattern of adolescent health clinics. METHODS: A pre-tested, semi-structured questionnaire was administered to 360 school going adolescents who were selected by stratified random sampling from two sectors of Chandigarh where services were being provided by a school-based and dispensary-based adolescent health clinic. RESULTS: Majority (81%) of the adolescents reported having some health problem during last three months prior to the survey; predominant (60%) problems were psychological and behavioural in nature. To resolve these problems boys consulted mainly friends/peers (48%) while girls consulted their mothers (63%). Compared to the dispensary-based adolescent health clinic, utilisation was significantly higher in a school-based clinic where proportion of psychological or behavioural problems reported was also significantly higher (P<0.01). CONCLUSION: Adolescents have greater counselling needs for psychosocial problems than for medical problems. School-based adolescent health clinic was utilized more often than the dispensary-based clinic particularly for psychosocial problems.Item Psychosocial predictors of adolescent sexual behavior.(2007-10-06) Lakshmi, P V M; Gupta, Nitin; Kumar, RajeshOBJECTIVE: To find out the psychosocial factors associated with adolescent sexual behavior. METHODS: A cross sectional study was carried out in Chandigarh Union Territory of India by enrolling 11 th class students from six randomly selected schools. A pre-tested questionnaire containing 83 items was administered after ensuring privacy and confidentiality. Socio-economic status, residence, gender, grade in the class, religion, acculturation level, self esteem, social support and coping behavior were considered as independent explanatory variables and physical sexual contact (which included kissing, hugging and sexual intercourse) was taken as dependent variable. RESULTS: Two hundred and fifty seven students enrolled for the study had mean age of 17 yr. The prevalence of sexual activity was 20% (95% CI: 13.6%-28.1%) among males and 6% (95% CI: 1.3%-18.8%) among females. Four percent of males and 1% of females reported sexual intercourse. The main reason for not having sexual physical contact was societal norms. After adjusting for confounders in multivariate analysis, male gender (OR: 3.5; 95%CI: 1.5-8.1) and modern attitudes (OR: 0.77; 95%CI: 0.6-0.98) were found to be the risk factors for initiation of sexual activity in adolescence. CONCLUSION: Cultural norms rather than the individual/psychological factors tend to govern adolescent sexual behavior in Indian society.Item Utility of Prevention of Parent-to-Child Transmission (PPTCT) Programme data for HIV surveillance in general population.(2010-09) Kumar, Rajesh; Virdi, Navkiran Kaur; Lakshmi, P V M; Garg, Renu; Bhattacharya, Madhulekha; Khera, AjayBackground & objective: HIV sentinel surveillance (HSS) among antenatal clinic (ANC) attendees is used to monitor HIV trends in general population. Recently, information on HIV infection has also become available from prevention of parent-to-child transmission (PPTCT) programmes. Systematic appraisal of routinely collected programme data is needed for choosing a scientific, cost-effective, and ethical surveillance strategy. In this study HIV prevalence estimates obtained from PPTCT programme and HSS were compared to find out the utility of PPTCT programme data for HIV surveillance. Methods: The data of HSS and PPTCT programme were obtained from National AIDS Control Organization, New Delhi. A list of PPTCT programme sites where ANC HSS was also conducted during 2005 to 2007 was prepared. HIV prevalence and 95 per cent confidence interval (CI) were estimated from antenatal attendees in PPTCT and HSS. Correlation coefficient of HIV prevalence in PPTCT and HSS was also examined according to the level of HIV test acceptance in PPTCT programme. Pregnant women presenting directly for labour in PPTCT centers were not included in the analyses. Results: In 2007, HIV test acceptance ranged from 8 to 100 per cent (average 76%) in 372 sites where both PPTCT and HSS were carried out. HIV prevalence was similar in the PPTCT (0.68%, 95% CI 0.66%, 0.70%) as compared to the HSS (0.61%, 95% CI 0.58%, 0.66%). Overall the correlation of HIV prevalence between PPTCT and HSS was quite high at state level (r = 0.9) but low at district or site level (r = 0.6). Interpretation & conclusions: HIV prevalence estimates among pregnant women in PPTCT program were similar to that of ANC HSS. Routinely collected PPTCT program data therefore has potential for providing reliable HIV time trends in various states of India.