SMART city project is being implemented with an objective of developing IT enabled services for the people. With this there is a need to improve the health status of the city dwellers, especially the urban poor. This can be achieved by providing SMART (specific, mobile, affordable, referral linkage and timely) health care in the urban areas.

In 2015, India had 20 percent share of global under-five deaths (1.2 million), highest number of deaths in the world. In the era of Sustainable Development Goal (SDG), to accomplish goal 3, target 3.2 to reduce child mortality to 25 per 1,000 live births, India needs to accelerate to achieve the same. India was taken off from the list of polio endemic countries by World Health Organization in February 2012. In 1997 the National Polio Surveillance Project (NPSP) was established as a joint partnership between the World Health Organization and the Ministry of Health and Family Welfare (MoHFW), Government of India. As in Polio eradication program interaction between the health care providers and Surveillance Medical Officer (SMO), had provided the foundation for successful Acute Flaccid Paralysis (AFP) surveillance, same opportunity can be used for every child death. Each child death reported by reporting unit (RU) needs to be investigated in case investigation form (CIF) and the factors related to continuum of care for maternal, newborn and child health whichever responsible for child death needs to be identified for action. Another aim of this project will be to capture each and every child death occurring in the district and identifying the high risk blocks and accordingly training of health workers and private practitioner can be undertaken for capacity building. The feedback of factors identified for child death can be given to health officers of concerned district and same can be discussed in District Task Force meeting, so appropriate corrective action is initiated; also same can be reviewed at regional, state and national level meetings. National Child Mortality Surveillance Project can take the advantage of network of SMO already available with NPSP along with training modules and forms.

Globally a surge in international travel has been seen. It has led to importation and establishment of disease causing organisms in a previously naive area resulting in onset of epidemics and increase in size of the endemic area. Vaccines are available for some diseases and are considered as one of the best method to prevent diseases. There are vaccines which are routinely recommended for all irrespective of travel and few vaccines e.g., Yellow fever, Meningococcal and OPV are mandatory for travellers as part of International Health Regulation. Vaccination of travellers provides benefit in two ways i.e. protection of individuals and thereby protecting the population of entire country.

Background: Kangaroo mother care is an efficacious intervention in preventing mortality in low birth weight babies. With increasing focus on providing home based newborn care in India, it is pertinent to train the frontline healthcare workers in necessary skills for care of low birth weight babies. Objective: The current review was undertaken to evaluate the content of training manuals of frontline health workers in context of care of low birth weight (LBW) babies and Kangaroo Mother Care (KMC). Methods: A systematic extensive internet search was performed to identify training manuals available in public domain, and a targeted search was also done in the websites of Ministry of Health and Family Welfare, Government of India, National Institute of Health and Family Welfare, and National Health System Resource Centre. Manuals published in or after the year 2000 and those in the English language were included in the review. A quality assessment tool was devised and the manuals were finally classified as “poor”, “fair”, “good” quality. Results: The initial search yielded 107 potentially eligible documents, however, a total of eight training manuals were finally found to be eligible for content evaluation. The mean average score for all the eight manuals was 17.0 (out of a total score of 48) and thus they were “fair” quality (aggregated per cent score of 35.4). Out of the eight training manuals, six had separate section on care of the LBW babies, though content on breastfeeding and skin-to-skin contact was variable. None of the manuals provided case studies/ scenarios or introduced challenges to effective initiation and continuation of KMC. Conclusion: Current training manuals lack quality content on care of LBW babies and KMC and need to be upgraded with evidence-based information.

Background: The state of Tamil Nadu in India is one of the states with better health indicators in the country. With an ambition to provide still better health care to the residents of the state, the possibilities of the journey towards UHC are analyzed. Objectives: To explore the possibilities of using the existing Chief Minister's Comprehensive Health Insurance Scheme (CMCHISTN) as base to reach Universal Health Coverage (UHC) in Tamil Nadu. Methods: The various dimensions of UHC namely people, benefit, and financial protection are analyzed considering the present status in the state particularly the Chief Minister's Comprehensive Health Insurance Scheme and matched with future needs to reach UHC in Tamil Nadu. This provides the vital indications in success towards UHC. Results and conclusion: The gap between the existing modalities under CMCHSITN and requirements for UHC are within the reachable level. With additional resources and effort, it is possible to reach UHC in Tamil Nadu in the near future. CMCHISTN is one of the best available options for reaching UHC in Tamil Nadu.

Iron deficiency anemia is the most prevalent nutritional deficiency disorder in India. Diagnosis of iron deficiency can sometime be quite tricky due to discordant biochemical results obtained in presence of other chronic disorders or due to biological variations. There is certainly a need of newer markers which could help in the early identification of iron deficient states particularly in resource limited set up. Technological advancements have made it possible with the availability of new red cell parameters along with the traditional CBC parameters, which when fully utilized can aid in the screening & diagnosis of iron deficiency anemia.

Community based medical education (CBME) is described as education that focuses on both population groups and individual persons and take into account the health needs of the community concerned. Now a days health professionals need to be more responsive to needs of the populations they serve, rather than the hospitals they serve, which requires medical students and doctors to imbibe abilities and perspectives consistent with the updated medical knowledge and capacity to promote health. In Community Based Medical Education, the majority of the clinical training of the students happens in the community setting in contrast to campus based teaching hospital in traditional teaching. CBME is a broad concept, providing students with opportunities to interact with people from a wide range of social, cultural, economic and ethnic back-grounds. It is often directed towards priority health needs of specific populations, and requires an amalgamation of clinical skills, command on subject, capabilities and inclination towards the community. Health is highly influenced by social and cultural factors such as socioeconomic status, race, gender roles, migration, poverty, social support, and environment. Community based education will make the graduates familiar how these factors influence health and give them the ability to act appropriately. CBME will go a long way to address the increasing demand on health care, as well as making the medical graduates more empathic, flexible and passionate for providing health to all.

Background: Open field defecation is a major public health problem. In India, majority of rural population defecate in the open due to absence of proper sanitation facilities. Studies on latrine coverage and its usage in coastal regions of India is limited. Objectives: To estimate the proportion of households with latrine, proportion of people using latrine and to identify the factors related to non-usage of latrine Methods: A community based cross sectional study by house-to-house survey was conducted in the three coastal villages of Tamil Nadu. Data on availability and usage of latrine was collected. Proportion of hosueholds having and using latrine were calculated. We also calculated prevalence ratios to identify socio-demographic characteristics associated with usage of latrine. Results: Of 593 houses surveyed, 444 houses (75%) had latrine. The most common reason for not having latrine was the lack of money. Of 2480 individuals residing in 593 surveyed houses, 1032 (41.5 %) resorted to open-air defecation at least once in last 12 months. The most common reason was that they are habituated to open field defecation. Among the 1861 people who had latrine in their houses, only 1448 (78 %) were using it. Conclusions: One-fourth of the households didn't have a latrine facility and only three-fourths of the households having latrines are using it. Efforts in the form of Health education are needed to improve the availability and better usage of latrine facilities.

Background: Sedentary life style is a major risk factor for non-communicable diseases. There has been increasing reports of reduced physical activity among adolescents in recent times. There is a need to clinically assess levels of physical activity among adolescents. Objective: To develop a short three item scale for measuring physical activity among adolescents and check its validity and reliability. Methods: A cross sectional study was conducted on a sample of 200 students aged 13-16 years, selected from a school in Chennai using a random sampling method stratified by sex and class of study. A short three item questionnaire covering the domains of transportation to school, physically active playing during leisure time and time spent in sleep was developed with a Likert type response format based on frequency of the activity. The short physical activity questionnaire and the General Physical Activity Questionnaire (GPAQ) were administered to the adolescents. The same questionnaires were administered to the adolescents after 2 weeks. Intra class Correlation was assessed to check reliability of the measure and Pearson's Correlation to check for validity of the short physical activity scale compared to GPAQ. Results: The students had a mean score of 9.57 (SD 2.39) out of a maximum score of 15 in the short physical activity scale. The short physical activity score showed good reliability with intra class correlation of 0.770 (95% CI 0.686 – 0.831). There was a statistically significant correlation between the short physical activity scale score and the METS calculated from the GPAQ with a Pearson's correlation of 0.232 (p = 0.002). Conclusions: The short physical activity scale has an acceptable validity and good reliability in measuring physical activity level among adolescent students.

Background: Nearly one-third (31%) of the Indian population live in urban areas. It is estimated that about 40% of the total Indian population will be urbanized by 2030. Urban population and the urban poor are far from being homogenous and comprise of several sub-groups that differ socially, economically, and geographically. NHM seeks to improve the health status of the urban population particularly slum dwellers and other vulnerable sections by facilitating their access to quality health care. The health care utilization and health care spending among urban poor is drastically different from other section and needs to be addressed. Methods: A cross-sectional study was conducted in health camps from April to August 2015. Exit interview of patients attending all Health Camps under Urban Health Mission was conducted during this period. Results: Majority of the patients (55.8%) attending the health camp reported that they go to public health facilities for their routine illness followed by private health facilities (27.6%) or both 8.3%. Few patients reported going to others (unqualified practitioners, drug stores) for their routine illness. Among patients (73%) who reported any illness in the past 3 months, 64.1% had utilized public health facilities for seeking health care, 25.6% reported private and 10.2% reported seeking health care from unqualified practitioners/ drug stores. Conclusion: This study highlights that health camps are usually attended by people belonging to low- income or lower middle-income groups and most of them prefer to use public health care facilities for their routine health care issues.

Background: Vacant posts of medical officers at primary health care level leads to overburdening at secondary and tertiary care levels, compromising the quality of health care delivered. Objective: The following study aims to find out whether a single point approach for patients at secondary and tertiary care levels will be successful in treating as well as satisfying the patients. Methods: All patients registered at general OPD of the hospital between 10am-11am were included in the study based on the inclusion and exclusion criteria. They were treated by the junior residents posted in the department of community medicine under supervision of a faculty member which involved examination, investigation and treatment of the patient by the junior resident himself after requisite training. Patient feedback was taken at different points and the total time involved per patient was noted and analysed. Results were analysed based on patients' feedback, time involved in treating, number of patients returning for follow-up and their willingness to return to the same hospital for future health problems. Results: 2531 patients were seen in the general OPD. 69.7% returned for follow-up and of these, 69.9% were successfully treated by the junior residents. Referrals were required in only 30.1% of the patients. 67.6% of the total patients expressed satisfaction with the health care services given by the junior residents. Conclusion: Provision of single point health care by junior residents is a successful and satisfactory approach for community health services.

Introduction: According to GLOBOCAN 2012, breast cancer is the second most prevalent cancer in world and the most frequent among women. In India, around 80,000 cases are estimated to occur annually. Survival from breast cancer depends on two main factors, early detection and optimal treatment. There are virtually no population-based breast cancer screening programs in developing countries. This community based study was carried out for creating awareness about Breast Self-Examination (BSE), the easiest method for early diagnosis and to assess the impact of interventional measures on acceptance of BSE. Objectives: To assess the awareness about breast cancer and BSE among 20 – 49 years women and to create awareness about breast cancer and BSE among 20 – 49 years women. Methods: It was an interventional study, conducted in the field practice area of a Medical College. Total of 310 women were assessed on Self-administered questionnaire filled by women in pre and post intervention for awareness of Breast cancer and BSE. Results: 3% women were aware of BSE at baseline which increased to 89.68% at end line. (p=0.001, p<0.05). There was statistically significant difference in attitude towards BSE (p=0.0001, p<0.05) at end-line and 92.90% women started performing BSE on regular basis. Conclusion: From selective review on practice and effectiveness of BSE, only 0% to 52% of women practice Breast Self-Examination on regular basis and there is no evidence of performing the procedure correctly. It is evident that BSE functions as an effective preventive health action.

Background: Bihar government has implemented a total alcohol prohibition in state since April 2016. Alcohol de-addiction centre had been started in each district to tackle the problem of alcohol withdrawal. However it seems that number of expected people did not turn up at these de-addiction centres. Apart from it, there is reporting of alcohol availability in state despite ban. Objectives: This study was conducted to estimate the alcohol users after ban, to describe type of alcohol being consumed and place of availability of alcohol. Methods: A cross sectional study was conducted in three blocks relatives of identified alcohol user were interviewed by trained field investigators in two weeks of data collection period (25^th July to 10^th August 2016). Data was collected by trained investigators using predesigned semi structured questionnaire. Results: Majority of drinkers (64%) stopped taking alcohol after the ban and above 25% people shifted to other substance like Toddy, Ganja (Marijuana) etc. Majority of drinkers are still getting alcohol illegally from nearby locality or neighbouring district. Most common available type of alcohol is country made (Local, Desi) alcohol. Female / spouse of male were very happy after this ban as male gives their quality time and money for wellbeing of homes. Conclusion: About 30% known alcoholics still consuming alcohol. Most of them getting it illegally from nearby villages and districts. Above one fourth of the alcoholics have shifted to other substance abuse after ban to satisfy their desire.

Background: Disorders during pregnancy, birth and post-birth are leading causes of morbidity and mortality during reproductive age in developing countries. It is imperative that disorders are prevented, if not prevented, recognised, managed timely and appropriately. Since there is limitation to prevention of many disorders, it is essential that women are made aware of disorders, action needed so that they take action. Lack of awareness leads to delay in seeking care. Present article is based on information collected from women of low resource settings. Objective: To assess the awareness among women regarding disorders which can occur during pregnancy, birth and postbirth. Methods: Fifteen hundred women(750 rural,750 urban), who presented to prenatal clinic for the first time and who were not sick, were randomly interviewed through predesigned questionnaire in local language, by the social worker who was briefed about the objective of the study. Results: Very few rural as well as urban women were aware of disorders like anaemia, pre-eclampsia, eclampsia, antepartum haemorrhage, preterm labour, prelabour rupture of membranes, abnormal presentations, obstructed labour, fetal distress, postpartum haemorrhage, which are responsible for most of the maternal and perinatal deaths. Only 67(8.9%) rural, 74(9.9%) urban women had some knowledge of one or other disorder. Most commonly known disorder was anaemia. Health providers were the source of knowledge. Conclusion: In low resource settings, there is lack of awareness amongst women regarding disorders which can be life threatening to mothers and newborns. Action is needed.

Background: Prevention of Yellow Fever (YF) in travellers to Yellow Fever endemic zone can be done with YF 17D vaccine which is a live attenuated vaccine and can be given only up to one hour after reconstitution. The objective of this study was to study the demographic and travelling pattern of clients who got vaccinated at newly established Yellow Fever Vaccination Centre (YFVC) at AIIMS Patna and to assess the vaccine wastage by initiating online and telephonic registration system. Methods: We developed a web based portal to register the name of passengers who wanted to take YF vaccine at AIIMS Patna from August to December 2016. General demographic characteristics of travellers and their travelling pattern was also obtained. Results: Total 428 doses used and 409 persons were vaccinated from August to December 2016 with vaccine wastage of less than 5%. Most of them have taken vaccine for travelling to the African endemic countries (81.9%) and the main purpose of their visit was for doing job (85.5%). Conclusion: By using online registration system and twenty four hour accessibility on mobile phone, we have achieved a remarkable achievement in terms of keeping vaccine wastage below 5% level.

Background: In India oral cancer is an important public health problem accounting for country's 30% cancer burden. The objective of this study was to describe the socio-demographic profile, food habits and substance use pattern of oral cancer patients and to elicit their relation with stage of oral cancer. Methods: It was a hospital based cross-sectional study. Study included histopathological diagnosed oral cancer patients attending General Surgery outpatient department (OPD) of GSVM hospital, Kanpur, Uttar Pradesh. Study period was from August 2011 to July 2014. Pre-tested semi-structured interview schedule was administered to capture socio-demographic factors, food habits and substance use pattern. Results: The male female ratio in this study was 5.2:1. Maximum number of the participants in the study were from the age group of 41 to 50 years (32.2%). Buccal mucosa was the most frequently involved site, accounting for 45.7% cases. Personal habit revealed that most of the participants were tobacco chewers (72.9%). Almost one third of the participants with oral cancer each were in stage 4 (34.2%) and stage 3 (30.7%) of TNM staging. Conclusion: We found a relatively younger population with male predominance presented in the health facility. Later stage of disease presentation is also a matter of concern.

Stroke in young is now a major health concern in developing countries along with coronary artery disease (CAD), according to various Indian studies, its prevalence is 25-34%. Among the undetermined etiological factors thrombophilic disorders constitute 60% cases of stroke. A 19 year old young male presented with symptoms of left middle cerebral artery (MCA) thrombosis, on evaluation homocysteinemia is noticed. In this case homocysteinemia seems to be the only risk factor responsible for stroke.

It is important to emphasize that the presence of intrahepatic or extrahepatic biliary stenotic foci in an HIV-positive patient with low CD4 count suggests a possibility of AIDS-associated cholangiopathy, which may be an indicator of progression of the disease. It presents with a clinical variable presentation, although right upper quadrant pain and fever accompanied by an elevated serum alkaline phosphatase (ALP) level are the most common manifestations. We present a case of a young female patient diagnosed with AIDS cholangiopathy as evidenced by clinical features, altered liver function profile indicating obstructive jaundice, classical imaging features on USG, MRI and MRCP, and very low CD4 count.