CP/01(O) EXCLUSIVE BREAST FEEDING: IS IT POSSIBLE AMONG GOVERNMENT
GRADUATE TEACHER MOTHERS?
Ravinder K. Gupta, Ritu Gupta
The Nest “209-A, Gandhinagar, opposite Govt. Qts Jammu , J&K, 180004
drrk_gupta2000@yahoo.com
Objective:To find out the real reasons of the failures of exclusive breast feeding among government
graduate teacher mothers. Design:Prospective Study Setting:Pediatric Clinic Methods: The graduate
teachers mothers who were in government job and were on maternity leave during the study period were
enrolled for the study. All the deliveries had taken place at institution. Mothers will low birth weight and
premature babies were excluded. Mothers and babies with significant illnesses were also excluded. About
100 such graduate teacher mothers were taken up for the study during May 2006 to April 2007. All the
mothers were explained about the benefits of exclusive breast feeding, common problems that may be
faced by them and also about the possible hazards of artificial feeding. They were asked for regular check
ups every fortnightly during the first 2 months and every monthly thereof up to 6 months. Results: There
were 80 graduate teacher mothers who could be followed up for 6 months. Four mothers introduced
artificial milk as early as 10 days of age. About 20 mothers dropped out, after 2 months as they could not
exclusively breast feed their babies. At 4 months of age, there were 24 dropouts. At the end of 6 months,
there were total 48 (60%) mothers who did not breast feed exclusively. Only 32 (40%) mothers
successfully completed 6 months exclusive breastfeeding. The different reasons given for starting artificial
feeding were: Insufficient breast milk 24 (50%), pressure from husbands and elders – 15 (31%), advise
from friends, neighbours and relatives -20 (41.5%), mothers thought they have to go schools, 15(33%),
artificial milk is beneficial for baby 10(23%). The babies who were exclusively breastfed had adequate
weight gain. About 12 (25%) out of 48 babies receiving artificial milk were overweight for their age at 6
months; while (18%) were under weight for their age of 6 months as they were using diluted animal milk /
formula milk. Out of 80 mothers who could be followed in the study, about 20 mothers had knowledge of
exclusive breastfeeding during antenatal period. Conclusion: Exclusive breastfeeding is not seen even in
government graduate teacher mothers despite being on maternity leave. It can be possible only if there will
be proper knowledge and awareness not only among mothers, but also among general public. Explanation,
motivation and reassurance to the mothers and especially family members during antenatal checkups,
immediately following delivery and during follow ups by health professionals can definitely improve the
exclusive breast feeding.
CP/02(P) CHILDHOOD ILLNESSES: WHO ACCOMPANIES
Ritu Gupta, Ravinder K. Gupta
Child Care Centre, 136 Nai Basti, Jammu Cant. J&K -180003
riturgjammu@indiatimes.com
THE
CHILD?
Objective: To study the pattern of accompanying attendants during childhood illness in context
to paternal involvement. Setting: Pediatric Clinic Design: Prospective study Subjects and
Methods: About 4000 children attending Pediatric clinic along with their attendants were enrolled
at random for the study during July 2006 to June 2007.The relationship of attendant accompanying
the children was noted. Family size, its type and nature of job of father was also noted. The
reasons for father being not accompanied during childhood illness were noted. Health education
was imparted to parents. Results: Out of 4000 enrolled children, males were slightly more than
females (1.1:1). The children included toddlers (29%), infants (27.8%), 3-10 age group (19.4%),
neonates (15.8%) and adolescents (8.1%). There was hardly any difference between rural and
urban distribution (1.1:1). About 62% children belonged to joint family. The accompanying
attendants of the children included mother alone (40.8%), mother and father (19.2%), mother and
grand mother (7.4%), mother and other relative (6%), father and grand mother (7.4%), father alone
(5.4%), grand mother alone (5.6%), aunt (1%), neighbor (1%) and self (2.6%).The mothers alone
or with relatives accompanied the child in 73.4% while fathers alone or with other relatives
accompanied the child in 32%. Neither mother nor father did accompany the child in 10.2% cases.
The reasons for father not being accompanied with child were: - being busy in office (13%), out of
station (17%), shopkeeper (23%), thinking that mother is responsible for child’s health (21.4%)
and no reason (25.6%).The reasons for father being accompanied with the child were:- fathers
were of the opinion that both parents should take care of child (23%), male child (21%), neonate
(12.5%), first born (11.3%) and for immunization (especially optional vaccines) (8.4%).The
ailments for which fathers accompanied included seizures, diarrhoeal diseases with dehydration
and respiratory diseases with respiratory distress. Only 12 % fathers showed interest in various
feeding practices. Conclusion: It was observed that mothers were accompanying during childhood
illness most of the times. The paternal involvement is lacking. The father should also accompany
the child and it will definitely help in reduction of morbidity and mortality in children.
CP/03(P) BREASTFEEDING: PATERNAL KNOWLEDGE AND ATTITUDE
Ritu Gupta, Ravinder K. Gupta
Child Care Centre, 136 Nai Basti Jammu Cantt. (J&K)
drrk_gupta2000@yahoo.com
Objective : To asses knowledge and attitude of father towards breastfeeding at the time of birth of first
child.
Design :Prospective study Setting : Pediatric Clinic Methods : About 200 fathers were interviewed using a
pre structured questionnaire within 48 hours of delivery of their first child. The education status,
occupation, type of family type of delivery and details and antenatal care were recorded. The fathers were
asked about the knowledge regarding type of first feed, timing of first feed, frequency of feeds required,
duration of breastfeeding, time of introduction of solid foods and contraindications of breastfeeding.
Results : There were 95 (47.5%) fathers who had education up to matric while 70 (35%) were graduates
and 35 (17.5%) were postgraduates. About 36% fathers belonged to nuclear families. The majority of
mothers (93%) had adequate and regular antenatal check ups and about 84% fathers had accompanied their
wives. About 36% fathers were aware that colostrums should be given to the babies’ immediately after
birth and they tried for it despite resistance from elders. When asked about the knowledge of time of first
feed i.e. within 1st hour of birth, only 41% had correct knowledge. The timing of first feed varied from 2
hours to 3 days. The reasons cited were: mother’s comfort, concept that milk production is delayed or the
baby is unable to suck immediately after birth. About 32% fathers believed in scheduled feeding and 28%
knew about demand feeding while rest did not have any knowledge. Maternal illness was considered to be
a relative contraindication by 27% fathers. Formula milk and diluted animal milk were considered to be
given to babies along with breastfeeding by 27% and 39% fathers respectively. Only 23% fathers had
knowledge that adequacy of breast feeding in judged by weight gain and passage of adequate urine. The
mean duration for breast feeding was 16 months (3m – 30 months) with correct duration of 24 months
revealed by only 31% fathers. Timing of complementary feeds ranged from 4 months to 2 years with only
32% saying that they should start semisolid feeds by 6 months. The knowledge and attitude regarding
breastfeeding and complimentary feeding did not correlate with education, type of family, antenatal
checkup or type of delivery. Conclusion : The father’s knowledge regarding breast feeding in many aspects
and efforts is lacking. They need to improve their knowledge through education and counseling for
successful implementation of exclusive breastfeeding for 6 months and introduction of complimentary
feeding after 6 month. This will definitely go a long way in decreasing malnutrition, morbidity and
mortality in children.
CP/04(P) EPIDEMIOLOGY OF STILL BORN IN BURDWAN DISTRICT.
Nabendu Chaudhuri, Nabamita Chaudhuri
Power House Para, Burdwan -713101
hellomilan_hazra@yahoo.co.in
The still born rate of West Bengal remained 10 per thousand life birth for decades in spite of
extensive improvement and health facilities like 358 ICDS project ,56760 ICDS centre, Pregnancy
Teaching Programme 410786, number of Aganwadi workers 53441 and percentage of antenatal
check up 78.2% and extensive improvement of mass media programme , hospitals and health
centre facilities.
In spite of all measures the hospitals delivery remain 50.5%. The poor
percentage of hospitals delivery is the basic cause of high still born. METHODOLOGY--- The
criteria of conduction of study is – 1)How delivery are conducted by Dhai 2)Mother must have
attend two(2) antenatal visit. --A well design 50 questioaneries were made which will give the
full information
of maternal health status, antenatal care,immunization and conduction of
delivery. An interview was conducted amongst to the mother who has still born Similar interview
was conducted to the husband and also to the Dhai who conducted Delivery. RESULT—50
mothers were interviewed and a focus group discussion amongest the mothers were conducted
The conclusion of this study is –
1)Maternl age is 20-22 years and parental age is2430 years 2)Educational level is up to 4—9th standard 3)Cultivators are 60% and daily warkers
40%, per capita in come 600-700 per
months. Male is the only working personal.
4)Every body know the importance of antenatal check up but do not know the importance of
hospital delivery.5)70% believes in family tradition of home delivery.6)10% labour pain was in
odd hours and non availability of transport 7)20% pointed out that the doctors had told that there
was no problem during antenatal period hence labour was conducted at home. AIM—A well
designed systematic study has been conducted in Burdwan Medical College in the department of
Paediatrics to find out the basic lacunae of the problem CONCLUTION— All the mother should
be motivated for hospital delivery during antenatal Check up. 2)Head of the family member
should be educated regarding the importance of hospital delivery.3)Basic improvement of
education and social status. Is the primary factor for motivation of hospital deliveries. 4) Health
workers should be more vigilance during antenatal checkup and have more contuct with head of
the family member. 5) Dhai should be trained and motivated so long 100% deliveries are
conducted at hospital.
CP/05(P) CHILDREN AND THE INTERNET: CURRENT PERSPECTIVE
J N Goswami
Graded Specialist (Paediatrics),Military Hospital Mhow,MP
jngoswami@rediffmail.com
Introduction: Internet usage is a growing pastime in India. Due to its unique relevance to the
pediatric age group, community pediatrics should study the epidemiology of net surfing by
children in order to regulate its usage accordingly. Aim:To study the current pattern of internet use
amongst children.Material and method: Subjects were children between 7 - 12 years, attending
pediatric OPD in a Military Hospital between July to September 2007.Subjects and their parents
were administered a questionnaire and. results analyzed.Results:78% subjects have surfed internet
more than once. Higher rate of internet use was noticed with higher educational qualifications of
parents and higher per capita income. 94% children did unsupervised surfing. 62% have reported
more than 3 occasions when they have either missed a meal or cut out on sports / studies to
accommodate net surfing. Popular sites in order of popularity were : (a) gaming (b) school projects
(c) chatting among boys and (a) School projects (b) Chatting (c) Online friendship sites among
girls.92% parents were unaware that their children did net-chat sites and made online friends. 96%
of the parents were either unaware of or did not feel the need of child-lock software.88% parents
felt that internet was essential for a child’s development .36% parents felt that their child might
have access to adult sites. 28% parents felt that internet caused harmful effects on a child’s
personality .Perceived dangers included physical problems , rebellious behavior, personality
disorders and exposure to potentially deleterious adult content. Conclusions: (a)There is
considerable internet use among children. (b) Most children surf internet for entertainment (c)
Chatting and online friendship are popular, especially among girls (d) Unattended/unsupervised
internet use is common (e) Most parents are unaware of their children’s internet surfing habits.
CP/06(P) MORBIDITY PATTERN AMONG CHILD LABOURERS IN URBAN AREA OF
MEERUT
Dharmendra Kumar Gupta, Rashmi Gupta, S.P.Goel,Praveen Kumar
Department of pediatrics LLRM Medical College, Meerut-250004
drgupta_pediatrics@rediffmail.com
Aims and objectives: To carry out a comparative study regarding morbidity pattern among child
labourers in different occupations in urban area of Meerut. Material and methods: A total of 400
(344 males, 56 female) 100 children from each group were randomly selected & (i)
hotels/restaurants, (ii) domestic/mess (iii) automobile industry, and (iv) sports industry. were
contacted to assess their health profile and problems. Results: The results of the present study
reveal that poverty(69.0%)and illiteracy (61.5%)especially female illiteracy, were the main
determinants for child labour but other factors like large family size(53.5%),broken homes, family
disharmony, delinquency, bonded labour, desire for more earnings and family involvment.
Females were less(14%) as working children and they were mostly working as Domestic/Mess
servants. Overall their personal hygiene was better. Except for pallor(33.3%) other health
problems were less as compared to males. Except for domestic/mess servants working conditions
and personal hygiene was poor among all groups. Universal immunization was very poor among
all the groups & BCG scar was present only in 11.5%. Most of the children were
malnourished(51.75%) and it is alarming that 10.5% were severely malnourished. The most
common disease among working children was gastrointestinal problems(28.5%), followed by
disease of teeth and gum(27.00%) particularly dental caries, pallor(26.5%), respiratory tract
problems(25.5%), diseases of skin(18.00%), vitamin A deficiency(13.75%) and few children also
had occupational related problems(3.5%) and substance abuse(10.3%). Conclusion: Government
of India is planning to ban child labour in these occupations from 10 October 2006. The child
labour prohibition act is in force for last 10 years without any significant dent hence strong
political will and co-operation from different sections of society is needed for strict
implementation of this law. Beside this, universal compulsory primary education, and
improvement in social-economic status can only eradicate child labour evil.
CP/07(P) KNOWLEDGE AND ATTITUDE OF QUALIFIED V/S UNQUALIFIED
MEDICAL PRACTITIONERS REGARDING IMMUNIZATION AGAINST VACCINE
PREVENTABLE DISEASES IN MEERUT.
Dharmendra Kumar Gupta, S.P Goel, Rashmi Gupta, Praveen Kumar
Department of Pediatrics, L.L.R.M . Medical College and associated S.B.V.P Hospital Meerut,
250004
07dharmendra@gmail.com
Objective - To assess overall knowledge of practitioners in respect to immunization schedule,
diagnosis, management and prevention of vaccine preventable diseases. This is the only study of
this kind conducted in northern India. Method - In urban and rural areas of Meerut, total 210
medical practitioners (85 qualified and 125 unqualified) were interviewed using standard WHO 30
cluster sampling method. Results - Out of 85 qualified practitioners 49% possessed correct
knowledge and 38.5% had partial knowledge about vaccine preventable diseases. In unqualified
group out of 125, 10% had correct knowledge and about 56% had partial knowledge. Qualified
practitioners having knowledge of measles, polio, diphtheria and tuberculosis were 97%, 98.8%,
68% & 97% respectively while among unqualified practitioners this was 21%, 16%, 52%, and
76% respectively. One-third of total practitioners had knowledge regarding routine immunization
in mild illness; about 52.3% had correct knowledge of avoiding immunization in high-grade fever
and infectious diseases and very few knew about immunization in children of cerebral palsy,
convulsion and malnutrition. The knowledge of cold chain among qualified and unqualified was
63.2% and 8.1% respectively. Conclusions – Although the qualified doctors in Meerut district
possessed knowledge and had attitude, it was not up to the mark in regard to immunization against
vaccine preventable diseases. While unqualified practitioners have very little knowledge. Both the
groups do not follow proper guidelines for vaccine preventable diseases and this needs upgrading.
CP/08(P) TRIBAL MOTHER'S VIEWS REGARDING
SOUTHERN RAJASTHAN
D.K. Sharma, Nishtha Sareen, Dharam Singh, Asha Mathur
27-F, New Fatehpura, Udaipur-313 001
madhusareen@yahoo.co.in
INFANT
REARING
IN
SUMMARY: Majority of Indian population resides in rural areas where illiteracy, poverty,
ignorance and poor hygienic conditions are still prevalent. Hence, the infants in tribal population
of Southern Rajasthan are vulnerable to various health hazards. The present study had been
planned to know knowledge and opinion of tribal mothers regarding their infant rearing and
suggest possible measures to improve the knowledge. For this, a cross sectional, randomized door
to door family survey was done covering 200 lactating mothers of infants between 0-1 yr. of age.
After verbal communication with each mother, a pre-tested Hindi performa was filled. The
performa contained various questions regarding infant rearing. After data collection, analysis was
done. It was observed that only 22% of tribal mothers were well aware of proper hygienic
conditions at time of delivery. 29.5% of them offered colostrum to the baby. Majority (88.5%)
were of opinion to offer pre-lacteal feed to newborn. Concept of exclusive breast freeing was
known to 8% mothers only. Premature weaning was offered by 56.5% of them. Only 14.0% were
in favour of starting weaning at 6 month of age. Majority (82.5%) did not believe in bottle feeding
and most of them (78%) were in favour of offering home made eatables to be offered to infant at
time of weaning. Only 17.5% were well aware of concept of vaccination of their children and only
18% were in favour of consulting a specialist for various illnesses of their infant. We must
emphasize upon arranging various programmes for training of TBA in tribal areas and the concept
that older female member of the family assisting in infant rearing should be including in training
for mother craft in tribal areas.
CP/09(O) STREET CHILDREN: EARLY INTERVENTION AND REPATRIATION HOME ALONE
Seth R, Qaiyum Y, Beena B, Singh M, Mishra SK, Alderfer H.
Rockland & VIMHANS Hospitals, Project Concern International, New Delhi
sethrajeev@gmail.com
India has 18 million street children; Delhi alone has over 100,000. Street Children are vulnerable
to exploitation, abuse, HIV/AIDS and substance abuse. The present study involved a new strategy
of early intervention and reunification of these children with their families. Methods: Contact and
identify street children through outreach workers at railway, bus stations and market places in
three different regions of New Delhi. Provide basic services such as education, nutrition,
healthcare, counseling at drop in center (DIC). The Child Development Measurement Tool
(CDMT) was used to assess the life skills and psychological well-being. After ascertaining the
willingness of children for repatriation, then family visit by staff and subsequent home visits are
made followed by reunification of children with their families.Results: 3003 children (age 518year;median 13years) have been contacted over a two-year period. Majority (57%) are migrants
from states of UP and Bihar. The range of years of formal education was 0 to 5 years (median of
one year). 1267 street children (42%) have been brought to DIC for care. CDMT scores revealed
improvement in health and nutrition in more than 50% children. A total of 255 children have been
repatriated. Follow up assessment revealed 20% of repatriated children have again run away and
chosen life on the streets.Conclusions: It is important to solve the root cause of the problem that
made the child leave home. The government should take initiative to provide free primary
education and ensure every child is in school through out our country.
CP/10(O) MISSING GIRLS: INFANTICIDE, FETICIDE AND MADE-TO-ORDER
PREGNANCIES?
Mohit Sahni, Neeraj Verma, D. Narula, Raji Mathew Varghese, V Sreenivas, Jacob M. Puliyel
Department of Neonatology and Pediatrics, St Stephens Hospital, Delhi
puliyel@vsnl.com
Background: It is calculated that there are 44 million missing women in India. Gender bias
favoring males; neglect of girls, infanticides and feticides are said to be responsible but the relative
contribution of each of these is not known. The sex ratio at birth can be used to examine the
influence of ante-natal sex selection on the sex ratio as this figure is not influenced by infanticides
and neglect of girls.Material and Methods: Records from 321,991 deliveries at one hospital over
11 decades were utilized. The middle year in each decade was taken as representative of the
decade. Data from 33,524 deliveries were then analyzed. Sex ratios at birth in each decade were
compared with the overall average sex ratio. Data for each decade was combined with that of
previous decades and compared to the data of subsequent decades to look for any change in the
trend. Sex ratio in the second children born to mothers was also studied. This sex ratio was
examined in mothers whose the first child was a boy and separately in those whose first child was
a girl.Results: The mean sex ratio for the 110 years examined was 910 girls to 1000 boys (95% CI;
891 to 930). The sex ratio in the 1990s was significantly lower [855 (CI: 816 to 895 P<0.04)]
compared to the overall average for the 11 decades. The sex ratio dropped significantly from 935
(CI: 905 to 967) for the period before 1979, to 892 (CI: 868 to 918) during the period after 1980
(P<0.04). The sex ratio in the second child was significantly lower if the first child was a girl [716
(CI: 672 to 762] (P<0.001). On the other hand, there was an excess of girls born to mothers whose
first child was boy [1140 girls per 1000 boys (CI: 1072 to 1212 P <0.001)]. Conclusions: The sex
ratio fell significantly in the 1990s when ultra sound machines for ante-natal sex determination
became available. The sex ratio in second children born to families where the first was a girl was
significantly lower than the overall sex ratio. These circumstances strongly suggest that antenatal
sex determination and sex selective abortions are important factors responsible for the low sex
ratio seen in India. However our data on second children, especially that of an excess of girls born
to mothers who have a previous boy seen even in the decade before the advent of ante-natal ultra
sound machines, suggests that other means of sex selection have been in vogue besides sex
selective abortion, to manipulate the sex composition in families.
CP/11(P) PATCHY IMMUNIZATION: IF THIS IS THE DELHI SCENARIO WHAT
ABOUT THE REST OF INDIA
Mohit Sahni, Charanjeet Kaur, Neeraj Verma, Jacob.M.Puliyal
St Stephen’s Hospital, Delhi
drvermaneeraj@gmail.com
Reported immunization coverage levels for all India ranged from 81% for measles and 96% for
BCG under National Immunization Programme schedule (1) However transmission of disease
continues. The approximate incidences of vaccine preventable diseases in India in 1996 were
103673(2). This house to house survey was done to look at the immunization coverage in 3
clusters of houses in the capital city of Delhi to understand problems with coverage.Methods: We
surveyed three areas Jamuna bazaar, Kuchha Mottar Khan and SIM Colony .from 27/2/07 to
4/2/07. We did a house to house visit to cover all the children up to 5years of age and looked at
their immunization coverage. Immunization record as well as parents recall of immunization were
taken into account. Institutional deliveries, presence of BCG scar and vaccination appropriate for
age were recorded. We excluded OPV being delivered as part of the national immunization days.
Results:The total number of household with eligible couples in the areas was 1480. The total no of
under 5 children were 290. Overall only 25% of the children were completely immunized. 24%
were completely unimmunized. When looked at area by area, in Kuccha Mottar Khan only 11%
were completely unimmunized and 14% in Jamuna bazaar. In contrast to this 61% of the children
in SIM colony area, had not received any immunization. Discussion: Our survey of three areas in
the capital city adjoining 4 major government hospitals (within a 3 km radius) and with numerous
private hospitals in the vicinity there were pockets where majority of children had not received
even one vaccine. The Delhi government immunization programme includes immunization with
newer vaccine like Hepatitis B , MMR , and Typhoid Vaccines. We have enquired only into the
vaccines of the national immunization programme because we felt that these vaccines were an
essential first step before starting more ambitious programmes of vaccination with newer vaccines.
Overall, 51% of the population had received some vaccination but not complete vaccination. This
is far below than the 80% coverage required for herd immunity. The overall immunization rate
hides the fact that there are areas and colonies where immunization penetration is extremely poor.
The higher immunization coverage in ‘good areas’ improve the overall immunization rate but
disease transmission will continue unabated in the pockets of poor immunization. This is
reminiscent of the lesson from polio immunization where high immunization coverage for the
country have been achieved but the transmission has not been stopped because of pockets of poor
immunization. Conclusion:We found that overall immunization coverage was far below
acceptable levels in these areas. Also the overall immunization coverage is not the correct
parameter to look at because of the wide variations of immunization coverage in different areas in
our country. The take home message is that for disease control we need equitable distribution of
the resources and need to concentrate on these pockets of poor coverage.
CP/12(O) A STUDY OF INFLUENCE OF TELEVISION ON SOCIAL, DEVELOPMENT
& LIFE STYLE PROBLEM AMONG CHILDREN
Manju Lata Sharma
Surveillance Medical Officer, II-E-265, J.N.V.Colony, Bikaner – 334003.
smobikaner@npsuindia.org
Television has become “a major socialization factor & dominates the life of children. Television
programme influence the lives of children. AIMS & OBJECTIVES – To study over all impact of
television on development of children. To highlight the influence of television on social
development & life style problems. MATERIAL & METHOD: 100 children of (5 to 15 yrs) with
their parents were interviewed with the help of pre-set questionnaire. Information analysed.
OBSERVATIONS: 100 children of 5-16 Yrs. 70 girls & 30 boys. 40% below 10 yrs. 60% have
one television, 33% have more than one, 8% having personal television.
Reasons to watch & switch off
Entertainment & fun
90%
Everybody else doing same
75%
Nothing to do
40%
For information & education
10%
Parents scolded for watching
50%
Ask to study
60%
For health problem
20%
Programme not fit
10%
Electricity/ cable failure
50%
90% watch everyday, 50% more than an hour & 25% whole day after the school. 75% with their
parents. 25% alone. 50%while studying. 70% while eating. Preference of programme–Popular
serial 30%, Songs 24.5%, Reality shows 40%, Sports 5%, Cinema 9.4%, Cartoons 15%,
Advertisement 10%, News 4%, Others 2.6%. Behavioural problems: Change in behaviour 60%,
become aggressive and violent, change in language. Verbal labelling 10%, anxiety 5%, attention
deficit 5%, lower academic performance 8%, fear and fobias 5%. Impact on Life Style: Out door
activity decreased 40%. Change in eating habit 70%, change in sleeping hours 40%, urge for
smoking & drinking 10%, change in dressing style 10%. Pre-social behaviour: 10% pro-social
behaviour. 10% early sexual behaviour. glamorous side influence, develop various complexes
about their appearance. CONCLUSION: The study clearly bring out that, there is strong influence
& impact of television on the social development of children. it has altered the life style of
children. Change in behaviour, language, anxiety, fear & fobia, poor academic performance are
due to cumulative impact of watching television.
CP/13(O) BURDEN OF BEDWETTING IN URBAN PRIMARY SCHOOL CHILDREN OF
LUCKNOW
K.L.Srivastava, Shitanshu Shrivastava,
Department of Pediatrics Era’s Lucknow Medical College and hospital Lucknow.
dr_shitanshu@yahoo.co.in
Introduction: Bedwetting is a low severity high prevalence disorder causing psychosocial suffering
in children and parents. Objectives: To study details and to asses the burden of bedwetting on
children aged 5-12 yrs and their families Design: Cross-sectional study.Methods: Questionnaires
were distributed in 3000 school going children aged 5-12yrs from primary schools of urban
Lucknow.Data fed in statistical package for social sciences version 12.00 and analyzed. Results:
Prevalence of bedwetting was 6.9%, present as single problem in 4.9% (pvalue<0.001), and
associated with pica ,teeth grinding ,nail biting in 2%. Prevalence was higher in boys. Night time
bedwetting in 57.2% (pvalue<0.001), parental bedwetting in 82 %( pvalue<0.0001), home
conflicts in 42.9% (pvalue<0.001)) were statistically significant variables. 51.4% children were
scolded& 66% were stressed and 41.7% showed poor scholastic performance, 50.3% had nuclear
family, only 26% children
had working mothers. Parental concern was high (77.6%) but
treatment taken only in 32.8%. Conclusion: Burden of bedwetting was high. Problem was found
more in boys Significant relationship found between night time frequency,parental bedwetting
and homeconflicts.Childhood scoldings , stress, poor scholastic performance, nuclear family
were important associated factors . Families did report a high level of concern but the problem was
managed primarily in the family. Awareness needs to be created among parents.
CP/14(O) FUTURE OF STREET CHILDREN A CHALLENGE TO THE COMMUNITY
Devendra Sareen, Nishtha Sareen, Dharam Singh, Abhishek Ojha, K.K. Agarwal
27-F New Fatehpura, Udaipur-313 001
madhusareen@yahoo.co.in
SUMMARY : Street children, still remain an unsolved problem in the developing country like
ours. They lag behind in their socio-cultural, psychological, physical & mental development in
comparison to normal children. Hence, this study has been under taken to find out the sociocultural background, ecological factors & various problems faced by these children. This cross
sectional study conducted in and around Udaipur city included 200 street children chosen
randomly. After obtaining a detailed history regarding their caste, profession of their parents,
family & environmental history, a detailed assessment of child labour was done. Special emphasis
was laid upon child abuse, factors responsible for compelling them to adopt child labour and life
style of these children. All of them were subjected to physical examination and signs of
occupational hazards. Data analysis was done. We observed that they were subjected to child
abuse (30%), were addicted to gutakha (92%) tobacco (65.5%), were working at a remote place
from their house (48%) and were not getting adequate shelter (77%). History of previous
schooling was obtained in minority (21%) and 6% had step parents. Majority of them belonged to
joint families (76%). They were not well entertained (80%), and were not satisfied with behaviour
of their owner (77%). They were exposed to occupational hazards (40%) and majority of them
(93.5%) had ambition to become good citizen of country. So, these street children must be
provided tender care and emotional support and we must empower their educational and cocurricular activities, so that they attain a secure future.
CP/15(P) KNOWLEDGE OF BREAST FEEDING AND BREAST FEEDING PRACTICES
AMONGST MOTHERS DELIVERED AT PDZH, UDAIPUR
Devendra Sareen, Usha Rani Sharma, Ujjawala Jain, Abhishek Ojha, Dharam Singh, Nishtha
Sareen
27-F, New Fatehpura, Udaipur-313 001
madhusareen@yahoo.co.in
SUMMARY:Breast milk is a dream product to feed and immunize every human born on earth. It
is a valuable measure of believes, practices and traditions. The present study was conducted to
determine knowledge of breast feeding and breast feeding practices amongst mothers who
delivered at Panna Dhai Zanana Hospital, Udaipur and to identify the impact of prevailing
educational, socioeconomic and cultural systems on breast feeding. 475 such mothers were
interviewed using a standardized performa regarding knowledge of breast feeding. The performa
contained questions covering various aspects of breast feeding like its initiation, prelacteal feed,
burping and exclusive breast feeding. We observed that majority of the mothers were booked
(69.94%), primipara (66.31%), from urban areas (63.15%), middle class (62.53%), house wives
(68.42%) and living in joint families (61.05%). Most of mothers (61.05%) offered colostrum to
newborn, practiced demand feeding (78.94%) and offered night feed (84.21%). Only a minority
(36.84%) initiated breast feed soon after birth, practiced exclusive breast feeding (22.10%) and
had knowledge regarding burping (41.05%) and had been against practicing prelacteal feed
(22.1%).Sufficient knowledge of breast feeding was observed in booked mothers (75%), from
nuclear families (68%), Hindus (86.82%), Christians (88.88%) and literate mothers (98%). Thus,
we recommend development of training programmes and providing information regarding breast
feeding during antenatal visits to disseminate scientifically proven facts regarding advantages and
essentiality of breast feeding with particular emphasis upon exclusive breast feeding for first six
months of life. We must spread the message of proper breast feeding practices and knowledge
regarding breast feeding during breast feeding week which is celebrated every year from 1st to 7th
Aug.
CP/16(P) CARE SEEKING PATTERN FOR UNDER FIVE CHILDREN IN URBAN
SLUMS OF UDAIPUR
Devendra Sareen, Nilesh Manohar Gothi, Dharam Singh, Nishtha Sareen, Abhishek Ojha
27-F, New Fatehpura, Udaipur-313 001
madhusareen@yahoo.co.in
SUMMARY: Children under five particularly living in urban slums are vulnerable to
communicable diseases. The present study had been aimed to identify the range of providers from
where family seek for under five children, identify cost involved and difference in care seeking
pattern of these children. The study was carried out in 32 urban slum clusters of Udaipur city.
Each slum was visited and families encountered with under five children that had an illness
episode in last one month were interviewed. From each cluster, six families were interviewed
(total 204 families) using a pre-tested questionnaire. The observations were recorded in a printed
protocol and after compilation data analysis was done. We observed that most of the families
sought care from unqualified providers (55%) for illness of their off springs. Only in severe illness
qualified practitioners were consulted (72.72%). Govt. health facilities were utilized infrequently
(24.5%). Cost of care per illness episode being Rs. 126 for an ordinary illness to Rs. 185 for
illness with danger signs. Seeking care from an unqualified practitioner was almost 50% cheaper
from the qualified practitioner. For female off-springs unqualified providers were more consulted
(61%), delay in seeking the care (1.91±1.09 days) and spent less amount for each illness episode
(Rs. 118 ± 0.27) in comparison to male children. p<0.001 highly significant. Poor families and
under privileged caste sought care from an unqualified practitioner more frequently (68.2%) and
spent lesser amount per illness episode. Families did not seek care from Govt. facilities because of
long distance (72%) and fear of high cost entailed (56%).Hence, we must ensure easy availability
and accessibility to Govt. health facilities, enforce schemes of subsidized health care for urban
poor and encourage information education and communication campaigns to improve care
seeking.
CP/17(O) PSYCHOSOCIAL IMPACT ON FAMILY OF CHILDREN LIVING WITH
HIV/AIDS
Kavipriya, Sanjeeva, Sanjeevappa, Sanjay, Pragalatha Kumar, Naveen Benakappa, Govindaraj,
Siddaraju
Regional Pediatric Art Center, Indira Gandhi Institute of Child Health, Bangalore.
kavipriya_k@yahoo.com
Objectives: To study Social issues of HIV/AIDS children. Psychological impact on their family
and their coping styles. Methods:Parents/caregivers of 30children with HIV/AIDS enrolled
between January to August2007 were included.Socio-demographicdatasheet and
interviewschedule used for all caregivers. Results:Male:Female is 1.3:1.70%from urban.53%
were orphans,out of which 12.5% double orphans.Sibling death in 10%.80% were nuclear
families.30% mothers,16.66% fathers were illiterates.Common occupation of fathers was driver
(36.66%),followed by coolie(33.33%).50% mothers were working and rest were house wives.H/o
highrisk behavior available in 66.6%,half having visited sex workers.100% of caregivers were
anxious,96.66% depressed,93.33% worried of future of children,90% had fear of social
stigma,53.33% felt helpless,23.33% showed acceptance,23.33% anger,13.33% felt cheated by
their spouse,30% fathers felt guilty and10% abandoned their family,30% felt financial burden on
the family,13.33% of children had educational difficulties,6.66% denial,12.5% of mothers
attempted suicide.Coping styles like praying(100%),hiding their HIV status(90%),isolating from
relatives(90%),optimistic about cure(6.66%),change of profession(3.33%) were observed.
Summary and Conclusion. Majority from urban nuclear families belonging to lowsocioeconomicstatus with fathers being drivers and 16.66% illiterates 53% were orphans,out of which
12.5% were double orphans H/o highrisk behavior available in66.6%. 100% of caregivers were
anxious more so of the singleorphans,96.66% depressed,93.33% worried about future of children
and sibling death in 10% of families added to that,90% had fear of social stigma.30% of fathers
felt guilty and 10% abandoned family,13.33% children had educational difficulties,30% felt
financial burden on the family,12.5% of mothers attempted suicide. 5. Coping styles like
praying(100%),hiding their HIV status(90%),isolating
themselves from relatives and
neighbors(90%),optimistic about cure(6.66%),change of profession(3.33%)were observed.
CP/18(P) HEALTH AND WELLBEING OF AUSTRALIAN ABORIGINAL CHILDREN
IN FOSTER CARE: A STRENGTHS-BASED APPROACH
Shanti Raman, Anne Piper, Sandra Crothers
Medical Director-Child Protection, Sydney South West Area Health Service, Liverpool, NSW,
Australia 2170
Shanti.Raman@sswahs.nsw.gov.au
Introduction: Several international studies have established that children in foster care (FC) suffer
from a range of physical, developmental and psychosocial disorders. In Australia, Aboriginal
children have significantly worse health outcomes than non-Aboriginal children. In conjunction
with an Aboriginal organisation, a specialised multi-disciplinary culturally appropriate clinic for
Aboriginal children in FC in Sydney was set up in 2005 to provide a pathway to holistic healthcare
for these children. Objectives: We wanted to document the health and wellbeing of Aboriginal
children in FC accessing this specialised clinic, using a strengths-based model. We also wanted to
identify barriers to appropriate care. Methods: We analysed the records of 100 children attending
the clinic in SWS. Information was collected on clinical outcomes and recommendations. Service
providers and foster carers were interviewed about barriers to care by independent evaluators.
Results: A significant proportion of children had health needs identified for the first time including
lack of immunisation (65%), speech delay (60%), developmental delay (40%), dental problems
(46%), and chronic health problems (20%). Despite exposure to abuse and trauma, one quarter of
the children were doing well or had improved with support. Several difficulties and barriers to
appropriate care were identified by health workers and carers. Conclusions: Children attending
this clinic had similar rates of problems identified as other studies. Significant barriers to
appropriate care for these children persist despite having culturally appropriate services.
Characteristics of the children doing well helped identify factors that promote resilience. This
approach may be useful in other disadvantaged child populations.
CP/19(P) ADDRESSING REFUGEE CHILDREN’S HEALTH NEEDS IN AUSTRALIA:
HAVE WE GOT IT RIGHT?
Raman S, Wood N, Webber M, Smith M, Hale K, Taylor K, Isaacs D
Department of Community Paediatrics, Sydney South West Area Health Service, Sydney, NSW,
Shanti.Raman@sswahs.nsw.gov.au
Introduction: Refugee children are known to be at risk of poor health outcomes, poor
immunisation status, and limited access to healthcare. Of the 13,000 refugees accepted to settle
each year in Australia, 50% are children and youth. Objectives: To document the numbers and
health needs of refugee children accessing comprehensive clinical services in New South Wales
(NSW). To match the needs of these children with available services.Methods: We gathered
clinical data on all children <14 years attending refugee specific clinics in NSW in 2005. We
compared these data to the number of refugee children settling in NSW in 2005. Results: NSW
received 1557 refugee children in 2005. One fifth (n=330) was seen in three refugee clinics, most
were asymptomatic or had non specific symptoms. Of these, 224 (65%) were comprehensively
assessed. Of those tested, 25% had anaemia, 27% had schistosomiasis, 16% had evidence of
malaria, 25% were Mantoux positive and 30% had low vitamin D levels. Most needed catch up
immunisation. Other problems included chronic health, developmental and behavioural problems.
Screening tests varied across sites. Follow up was not possible for the majority. Conclusions:
Refugee children arriving in NSW have significant health needs. Only a small proportion of
refugee children have access to comprehensive screening and assessment; follow up is poor. Most
children are asymptomatic. Most of the identified health issues can be prevented or treated
effectively. There needs to be increased resources to provide optimum and culturally competent
assessment and care for this high risk group in Australia.
CP/20(P) EXCLUSIVE BREAST FEEDING (EBF) RATES AMONG INFANTS 0-6
MONTHS IN INDIA
Patel AB, Khadse S, Dibley M, Agho K, Badhoniya N, and the South Asian Infant Feeding
Research Network.
neets_badoniya@yahoo.com
Introduction: The National Family Health Survey (NFHS II, 1999) is a nationally representative,
multi-stage cluster sample survey of households from India. The NFHS II reported the EBF rate
was 48.7%, with more socio-economically privileged groups having lower EBF median duration
than disadvantaged groups. Aims & Objectives: To determine the impact of other potential risk
factors (not included in the NFHS II report) such as antenatal care (ANC), mode of delivery, size
of baby, effect of media on mothers. Material & Methods: Secondary analysis of DHS data using
STATA 10 survey commands to adjust analyses for the sampling design. Results: EBF rates in
mothers with no ANC were 53%,1-2 visits - 47.2%, 3-6 visits - 43.3%, 7+ visits - 37.2% (Trend
OR 0.94, 95% CI:0.92,0.96). EBF in caesarian delivered babies was 37.3% and in vaginal
delivered 41.5%. EBF in small babies was 50.1%, in average size was 47.2% and in large babies
was 36.4% (Trend OR: 0.79, CI: 0.71, 0.88). Those mothers who listened to radio or read
newspapers had lower EBF rates of 38.4% and 43.5% respectively compared to those who did not
(48.6% and 48.3% respectively) (OR 0.66 & 0.82 respectively). Conclusions: Contrary to
expectation the results revealed that more ANC and greater contact with media were associated
with lower EBF indicating the need for improved counseling of health care personnel during
ANC, and, more effective social marketing of appropriate infant feeding. Further multi-variable
analyses are needed to identify those factors most strongly associated with not exclusively breast
feeding.
CP/21(O) COMMUNITY EFFECT OF PRIVATE USE OF H.INFLUENZAE B VACCINE
IN SOUTHERN INDIA.
Verghese VP, Friberg IK, Cherian T, Raghupathy P, Mathew LG, Lalitha MK, Thomas K, John
TJ, Steinhoff MC.
Associate Professor, Department of Child Health, Christian Medical College, Vellore-632004,
valsan@cmcvellore.ac.in
Introduction: Invasive bacterial infection surveillance started in 1994 at the Christian Medical
College (CMC), Vellore. CMC’s pediatric Immunization Clinic provided H.influenzae b (Hib)
vaccine from 1997 when it became commercially available; pneumococcal vaccine was not
provided. Aims & Objectives: To assess trends in hospital admissions for meningitis before and
during introduction and increasing uptake of Hib vaccine at Vellore.Material & Methods: Hospital
surveillance, microbiology and patient records provided data on culture-proven Hib and
pneumococcal meningitis in children under five years admitted to CMC from 1994 to 2005.
Immunization records for the same period were reviewed. Trends in annual numbers of meningitis
cases were evaluated by Chi-square for trend and simple linear regression. Results: Hib vaccine
doses given to children increased from 1498 in 1997 to 14,994 in 2005. More than 4000 children
received three doses of Hib vaccine each year since 2001. A mean of 10.7 Hib meningitis cases
were admitted per year between 1994 and 1996 in comparison with a mean of 3.8 between 2001
and 2005 (p=0.04). During the same periods, there was no significant change in the mean annual
number of pneumococcal meningitis cases admitted (3.0 vs 4.8; p=0.30). From 1994-2005, there
was a significant declining trend of Hib meningitis cases over time (regression slope −0.85,
p<0.0001) while there was no significant temporal trend for pneumococcal meningitis (regression
slope 0.10; p=0.55). Conclusions: Private provision and use of Hib vaccine was statistically
associated with a reduction in Hib meningitis cases admitted to the regional hospital over time,
whereas pneumococcal meningitis numbers did not change, suggesting that purchase and use of
Hib vaccine by individual families can have community-wide effects in India.
CP/22(P) HAND HYGIENE TECHNIQUE IN TERTIARY CARE NEONATAL AND
PEDIATRIC UNIT: AN EYE OPENING”- PROSPECTIVE STUDYNirmal Kumar, Lokesh Kumar Tiwari
4, Rajpur Road,!tr No.B-2, Tis Hazari, Delhi 110 054
Nsk9_2000@yahoo.com
Introduction: The nosocomial infections are responsible for significant morbidity and late
mortality among neonatal intensive care unit. Modifying risk factors for nosocomial infection are
nursery design, adequate staffing, hand washing compliance, minimizing catheter day and trophic
feeding. Our aim of the study is to see the hand hygiene technique a modifying risk factor for
prevention of nosocomial infection among staff (doctor and nurse) handling the babies. Methods
& Results: Prospective observational study in tertiary care nursery, NICU and PICU to see hand
hygiene technique among staff. One person observed all the six steps required for hand hygiene
technique according to W.H.O. and documented correct/incorrect. The right technique observed
among staff nurse was 18% (20/4). Correct technique among doctor observed was 19% (16/3).
This reveals poor compliance for hand hygiene technique. Discussion: Hand hygiene is
considered the most important measure to reduce the transmission of nosocomial pathogen in
health care setting. There is a temporal relationship between hand hygiene practice and reduced
infection rates. It is not only the compliance but correct technique is also important. Barriers to
compliance includes understaffing and poor design of facilities, confusing and impractical
guidelines and polices, failure to apply behavioral change theory fully, and insufficient
commitment and enforcement by infection-control personnel. Conclusion: Poor hand hygiene
compliance among staff (doctor and nurse) treating the babies. Need strict monitoring of hand
hygiene technique, feed back and change of attitude of the staff.
CP/23(P) KNOWLEDGE ABOUT ORS USE AMONG NURSES IN BHUBANESWAR,
ORISSA
Samarendra Mahapatro,Subhranshu Sekhar Kar,Satyabhama Mishra,Renuka Mohanty
Hi-Tech Medical College, Bhubaneswar
samarendramahapatro@yahoo.com
Introduction: ORS has been the backbone of diarrhea management and comprehensive knowledge
about ORS among nursing staff and health workers is necessary for preventing diarrheal deaths in
our country. Methodology: Knowledge about ORS among staff nurses was assessed in
Bhubaneswar , Orissa based on questionnaire [10 points- indication, preparation (large and small
packet), storage, and similarity to glucose drink]. 100 nurses from different departments and
institutions were approached and 96 of them responded, hence included in the study. Result:
Respondents were from pediatrics (15%), medicine (11%), surgery (15%), operation theatre
(22%), ICU (7%) and others (30%). 77 (80.2%) knew about preparation of small packet ORS. 87
(90.6%) said that it is the main treatment for viral diarrhea while 87% of the nurses were aware
that ORS can be used in infants less than 6 months age. Sixty nine (71.8%) of nurses knew that
once prepared, ORS can be used for 24 hours while 10% opined that it must be stored in
refrigerator. 22 (22.9%) nurses said that ORS is similar to Glucon-D and 7 (7.2%) indicated that
sugar can be added to improve taste. 80% of the nurses knew that use of half a packet of ORS is
not ideal. Conclusion: It indicated the lack of appropriate knowledge about ORS use among
nurses, and the need of pre-service and refresher training courses for nurses about common
childhood illnesses.
CP/24(P) ROLE OF FATHER IN CHILD UPBRINGING
K.K.Locham, Baljinder Kaur
Department of Pediatrics Government Medical College and Rajindra Hospital, Patiala
bangabaljinder@yahoo.co.in
Father has a very important role in upbringing of children. Father is not merely a financial
provider for the family but also is a moral pillar & a role model for children. Objective – To study
participation of father in child upbringing. Design - A prospective study. Setting & method – A
hundred children age ranging less than 1 year to 16 years visiting outdoor of Department of
Pediatrics Government Medical College Rajindra Hospital , Patiala were the subjects of study .
For the purpose of study, children were categorized into three groups less than 1 year (infants) , 1
to 5 years (pre-school children) , more than 5 years (school going children) . Study was conducted
for a period of 6 months. Name , age , sex , area ,presence of father during birth , vaccination ,
ailments and participation of father in helping various school and extra curricular activities &and
number of hours spent during day time with chld were recorded on a pre-tested proforma . Data so
obtained was analyzed. Results – Out of 100 children, 52 % were males and 48 % were females.
54 % belonged to urban area and 46 % belonged to rural area. 30 % were having monthly income
of less than Rs 5,000 while 36 % , 20 % , 14 % were having monthly income of more than Rs
5,000, more than Rs 10,000 , more than Rs 20,ooo , respectively . 34 % of children were infants,
36 % were pre-school children, 30 % were school going children. Fathers of 83 % of children
were present at time of birth, of baby. 42 % accompanied mother during vaccination of child while
only 40 % were present during sickness and O.P.D. visits. 10 % changed diapers occasionally. 50
% helped in feeding of infants & pre-school children occasionally. 12 % helped in homework, 10
% helped in extra curricular activities, 12 % attended parent teacher meet. 18 % spent upto 2 hours
during the day with child, 22% spent 1 hour while 60 % spent less than 1 hour. Conclusion – More
participation of father is required in child upbringing.
CP/25(P) SLEEP PATTERN AND PROBLEMS IN HEALTHY TODDLERS AND
PRESCHOOL AGE CHILDREN
KK Locham, Manpreet Sodhi, Harprasad
Deptt. Of Pediatrics, Govt. Medical College / Rajindra Hospital. Patiala.147001
kklocham@hotmail.com
Objective: To study sleep pattern and problems in healthy toddlers and preschool age children
Setting and Methods: 100 children from outdoor as well as indoor of Department of Pediatrics,
Govt. Medical College, Patiala were the subjects of study. Indoor patients with chronic systemic
diseases were excluded. Sleep pattern before onset of sickness was recorded. Age, sex, maternal
education, birth order and sleep details were recorded. Results: 40 children in 1-3 yr age group
(toddlers) and 60 in 3-6 yr age group (preschool) were the subjects of the study. Usual time of
onset of sleep was 9:17 PM ± 00.47 h and 10:04 pm ± 00:35 h in toddlers and preschool children
respectively. Total hours of sleep at night in toddlers and preschool age group was 9.42 ± 1.06 h
and 8.25 ± 00:38 h respectively. The frequency of nighttime awakening was 1.43 ± 0.80 and 0.65
± 0.72 in toddlers and preschool group respectively. Usual time of awakening in morning in
toddler and preschool group was 7.00 AM ± 00:34 h and 6.28 AM ± 00:18 h respectively. Sleep
problems were reported in 5% toddler and 15% preschool age group children. Nightmares were
observed in both groups. In addition, preschool group had night terror, somnambulism, Disorder
of Initiation and Maintenance of Sleep (DIMS) and Obstructive Sleep Apnea Syndrome (OSAS)
Conclusion: Toddler used to sleep earlier and sleep more as compared to preschool group. Sleep
related problems were reported 5% and 15% of toddlers and preschool group respectively.
CP/26(P) PREVALENCE OF ANEMIA IN RURAL SCHOOL CHILDREN OF KOLAR
DISTRICT, KARNATAKA.
Arun Kumar, Ramu D.S, Chandrakala R, Susheela.C.
dr.arun123@rediffmail.com
INTRODUCTION: Anemia is a common nutritional disorder among school children, more so in
rural areas. Its mortality and morbidity can be prevented by cost effective therapeutic
interventions. AIM: To Know the prevalence of anemia in rural school children of Kolar.
METHODS AND MATERIALS: This is a prospective study of 1012 school children between 616 years, studying in 1st-10th standard from both private and government schools of a village near
Kolar. Relevant history and clinical examination was done using a proforma. Children with
chronic diseases, proved hemoglobinopathies and hemorrhagic diseases were excluded. All the
other children underwent hemoglobin (HB) estimation by SAHLI`s method after obtaining the
written consent. Anemia was diagnosed when HB was less than 12 gm% in children of 6-14yrs
and 13 gm% in children 0f more than 14yrs.The statistical analysis was done using SPSS version
11. RESULTS: Of 1012 school children 52% were males and 48% were females. Prevalence of
anemia in them was 26% with 39.2% of girls and 14% of boys being anemic. The prevalence of
anemia was 29.1% and 17.9% in age group 6-14 years and 15-16 years respectively. Prevalence of
anemia was statistically significant (p<0.0001) in girls of government school with 52% and private
school with 30% than boys with 20.8% and 8.1% respectively. Female children had higher
prevalence of anemia with 28.1% and 51.5% in class II and class III socioeconomic status
(p<0.0001) than male children with 9.8% and 18.3%respectively. CONCLUSIONS: Anemia is an
important nutritional disorder in children more so in girls.
CP/27(P) PREVALENCE AND PATTERN OF BREAST FEEDING PRACTICES IN
RURAL WOMEN OF JAMMU
Sanjeev Kumar Digra, Shirin Nomani
Graded Specialist, GMC, Jammu
INTRODUCTION: It is well established fact that mother’s milk is the best food for the newborn
and it has a significant role in reducing morbidity and mortality in infants. AIMS AND
OBJECTIVES: This study was designed to determine the prevalence and pattern of breast feeding
practices in rural mothers in 4 villages in Jammu district. MATERIALS AND METHODS: Five
hundred mothers in the age of 20- 40 years were interviewed between January 2006 and June 2006
and information was obtained regarding their breast feeding practices during the series of medical
camps organized by a local NGO in the 4 villages of the block Bhalwal in Jammu, J&K state.
Detailed breast feeding practices adopted by mothers were recorded on pre-tested proforma.
RESULTS: All the mothers had breast fed their babies. Only 10% mothers started breast feeding
their babies within first hour after delivery. 37.6% mothers did so between 1 to 6 hours and 52.4%
6 hours after delivery. 70.2% mothers gave prelacteal feeds to their babies, honey being the most
common (40%) followed by jaggery (20%). 32% , 19.6% , 10% & 8% mothers fed prelacteal
feeds with spoon, cotton wick, finger & bottle respectively. Delayed initiation of feeding was
advised by priest in 35%, self decision in 22.2% and by elderly lady in family by 20.4%. Breast
feeding was discontinued before 6 months by 20%, between 6 months and 1 year by 17.5% and
after 2 years by 12.4% mothers. 35% mothers exclusively breast fed their babies for less than 6
months, 31.6% for 6 months and 33.4% for more than 6 months. 22.2% mothers discarded
colostrum believing it to be harmful for baby.CONCLUSION: The present study shows that
though breast feeding was universal but there was a lack of knowledge of proper breast feeding
practices among rural women of this region and efforts are needed to educate them regarding
correct breast feeding practices and its benefits.
CP/28(P) PERSONALITY PROFILE OF STREET CHILDREN THROUGH ART
Shabina Ahmed, Bandana Dutta
Assam Autism Foundation, House No. 5, Dinesh Ojha Path, Rajgarh, Guwahati, Assam
Introduction: Street children form a significant proportion of the child population in India. They
contribute to large number of school dropouts and many of them are involved in use of drugs and
sexual crimes. They urgently need intervention to save the social fabric. In this study art has been
used to expose their personality and assess the impact of their surroundings. Aims & Objectives:
To identify the personality traits of the street children. To see the influence of the environment on
their personality traits To help pediatricians for referral and rehabilitation Material & Methods: 20
children from a stable home environment and 20 street children were given to “Draw a person”
test in a random fashion of the age group 8-15 yrs. Then a comparative study was done on the 10
traits of personality. Home environment was assessed by Mohite’s environmental scale Rating was
done by Likert’s 5 point rating scale. Results: It was observed from their drawing that –
Aggressiveness, Orality, Sexuality and regression were the chief areas that were affected, leading
to vulnerability to drug and sexual experimentation Good parent & child relation does have its
influence on mental development Conclusion: Art is a very simple tool for the pediatrician to
understand the child’s personality and underlying problems. This helps the physicians to treat,
refer to concerned professionals and assist in rehabilitation and counseling of parents.
CP/29(P) DRUG USE PATTERNS IN PEDIATRIC POPULATION OF A NORTH INDIAN
TERTIARY CARE TEACHING HOSPITAL
Srikanta Basu, Dimri S, Tiwari P, Parmar VR
Department of Pediatrics, Government Medical College and Hospital, Sector 32, Chandigarh 160032
srikantab@yahoo.com
Introduction: The pediatric patients form a special group of population and are more vulnerable to
the various adverse events related to use of drugs.There are limited studies addressing drug use
patterns in pediatric population in India. A drug utilization study characterizes the early signals of
irrational drug use. With the help of WHO prescribed drug use indicators and concept of defined
daily doses, it is possible to compare drug utilization patterns between different settings. Aim : To
evaluate the drug utilization in the out patient pediatric setting of a public tertiary care teaching
hospital. Material and Methods:The prospective study was carried out in the pediatric out patient
clinic of a tertiary care teaching hospital in Northern India over a period of three months
(September to November, 2006). The patients attending for vaccination and if referred for
admission to inpatient department or emergency were excluded.The data such as patients’
demographics, diagnosis, dosage, dosage form and route of administration of drugs prescribed
were recorded.The data was analyzed for the WHO recommended prescribing indicators.The
prescribing and utilization pattern of the medicines was carried out with reference to National List
of Essential Medicines (NLEM) India, 2003.The data obtained was represented as Average ± SEM
and percentages, as applicable. Results :The patient and drug information of 254 patients captured
was analyzed for WHO recommended prescribing indicators. The average number of drugs per
prescription was 2.31±0.58 and 45% of medicines was prescribed from National List of Essential
Medicines. The use of injection was low (1.18%); antibiotic prescribed was 29.1% and 5.8%
medicines were prescribed by generic name. Paracetamol was the most frequently prescribed
medicine and amoxicillin was most commonly prescribed antimicrobial(50%). 72% of medicines
were prescribed as syrup followed by tablet..URI was the most common diagnosis followed by
LRTI and anemia. The diagnosis was illegible or not available in 50 cases. Discussion and
conclusion: This study provides early insight into the drug use patterns in a pediatric out patient
department of a tertiary care teaching hospital. The prescribing from NLEM was fair, the use of
injections was low and there is a scope for improvement in case of medicines prescribed by
generic name. Interventions are required in this area to further rationalize drug use in pediatric
This study provides an insight into the drug use
population. Abstract: This study aimed to evaluate drug utilization in pediatric out patient
patterns in pediatric out patients of a north Indian
department of a tertiary care teaching hospital. Interventions are required to improve prescribing
teaching hospital.
by generic name so as to further rationalize drug use in pediatric population. Introduction
The results of this study will help to devise
Methodology Discussion The drug use patterns in pediatric out patient setting was studied. The
interventions, if required to improve the use of
results confirmed that average number of drugs (2.31) is slightly higher than the recommended
medicines in pediatric population.
value of 2.(5) However, this is smaller than earlier Indian reports.(7,8) The average number of
drugs in this study matches that noted in Spain,(9) Jordan,(10) Smolensk (12) and Tanzania (13)
while values under 1.4 have been reported from Sweden, (9) Italy (11) and Barcelona (12). The
appropriate use of antibiotic has been shown to reduce emergence of resistant organisms, in
addition to reducing healthcare cost and risk of side-effects. The antibiotic use was found to be
29%, which is smaller than other Indian reports (7,8) and from Jordan (60.9%). (10) The
prescribing by generic name is known to reduce the cost of drug treatment and rationalizing drug
therapy. This varies from 13.3-93% across the globe. (10, 13, 14) The results of work conducted
in India report this as 73.4% (8) which does not compare very well with the figure of 5.8% found
in this study. This needs further investigation. It should be noted that this study is only a
preliminary one and is ongoing. One of the reasons for poor prescribing by generic name is the
non availability of the pediatric formulations in the hospital pharmacy. Hence, the clinicians often
prefer to prescribe by trade names, with which they are familiar and the patients find it easier to
procure. There was fair prescribing from NLEM but it is less than that reported in a study by
Karande et al.(8) The value of 45% is smaller than that reported from Tanzania,(13) where 93.5%
medicines were prescribed by NLEM. This is another important area with a scope of
improvement. The household administration of liquid dosage form has been identified as one of
the important factor contributing to medication error in pediatric patients, (15); it is very important
to ensure that there is least error of overdosage and underdosage. It has been reported that dosage
prescribed on TSF basis can lead to underdosing because while the quantity defined as ‘a
teaspoonful’ is equivalent to 80 grains or 5.2g of water and the teaspoons available at home vary
in size. (16) Because 72% medications were prescribed as syrups, this is an area of major concern.
Prescribing dosage as ml and use of syringe or graduated caps to measure accurate amount should
be strongly advocated in pediatric setting. Box 1. “What this study adds”. Acknowledgement: The
authors acknowledge the kind support of the Director Principal, Government Medical College and
Hospital, Chandigarh on this work. References: Introduction to drug utilization research. WHO
International Working Group for Drug Statistics Methodology, WHO Collaborating Center for
Drug Statistics Methodology, WHO Collaborating Center for Drug Utilization Research and
Clinical Pharmacological Services; Geneva, Switzerland: WHO; 2003. Anker M, BrudonJacobowicz P, Fresle DA, VHogerzeil H. How to investigate drug use in health facilities: Selected
drug use indicators. Geneva, Switzerland: WHO; 1993. Directorate General of Health Services,
Ministry of Health and Family Welfare. Government of India. National List of Essential
Medicines, 2003. Mathur M, Dandiya PC. Prescribing pattern for outpatients in government
hospitals in Jaipur. Indian J Pharmacol 2004; 36: 383-384. Karande S, Sankhe P, Kulkarni M.
Patterns of prescription and drug dispensing. Indian J Pediatr 2005; 72: 117-121. Sanz EJ,
Bergman U, Dahlstrom M. Pediatric drug prescribing. A comparison of Tenerife (Canary Islands,
Spain) and Sweden. Eur J Clin Pharmacol 1989; 31: 65-68. Otoom S, Batieha A, Hadidi H, Hasan
M, Al-Saudi K. Evaluation of drug use in Jordan using WHO prescribing indicators. East Mediterr
Health J 2002; 8: 537-543. Cazzato T, Pandolfini C, Campi R, Bonati M. Drug prescribing in outpatient children in Southern Italy. Eur J Clin Pharmacol 2001; 57: 611-616. Sanz E, Hernández
MA, Ratchina S, Stratchounsky L, Peiré MA, Lapeyre-Mestre M, et al. Drug utilization in
outpatient children. A comparison among Tenerife, Valencia, and Barcelona (Spain), Toulouse
(France), Sofia (Bulgaria), Bratislava (Slovakia) and Smolensk (Russia). Eur J Clin Pharmacol
2004; 60: 127-134. Nsimba SE. Assessing prescribing and patient care indicators for children
under five years old with malaria and other disease conditions in public primary health care
facilities. Southeast Asian J Trop Med Public Health 2006; 37: 206-214. Nwolisa CE, Erinaugha
EU, Ofoleta SI. Prescribing practices of doctors attending to under fives in a children's outpatient
clinic in Owerri, Nigeria. J Trop Pediatr 2006; 52: 197-200. Walsh KE, Kaushal R, Chessare JB.
How to avoid pediatric medication errors: a user's guide to the literature. Arch Dis Child 2005; 90:
698-702. Hyam E, Brawer M, Herman J, Zvieli S. What's in a teaspoon? Underdosing with
acetaminophen in family practice. Fam Pract 1989; 6: 221-223.
Table I. Profile of prescribing in different age groups
4-8 yrs
8-12 yrs
69(27.2) 97(38.2)
59(23.2)
27(10.6)
Above
12 yr
2(0.79)
2.29
2.42
2.20
2.25
1.5
2.31
39.24
42.52
47.69
65.57
33.33
45
4.4
7.23
6.15
3.27
0
5.8
33.3
32.98
16.99
29.62
50
29.1
0
1.03
3.33
0
0
1.18
0-1 yrs
Number of patients (%)
Average no of drugs per
prescription
% Drugs prescribed from
NLEM
% Drugs prescribed with
generic names
% Encounter with an antibiotic
prescribed
% Encounter with an injection
prescribed
1-4 yrs
Table II. Profile of diagnosis of the patients
Diagnosis
# Male
# Female
TOTAL
Single
118
53
171
Two
20
11
31
Three
2
0
2
Illegible or not available
32
18
50
TOTAL
254(100)
CP/30(P) OVERLOADED SCHOOL CHILDREN
T.M.Ananda Kesavan, K.K.Purushothaman,
Sarada Vihar , Opp.Mathrubhumi, Thrissur - 6800021
dranandiap@gmail.com
Introduction: It is very common to see our children carrying heavy school bags. To an extent it is
due to the overloaded curriculum but may also be due to carelessness of school authorities or
overenthusiastic parents. It is routine to see school children , visiting pediatricians outpatient
department with complaints related to this eg: backache, school phobia, etc. This study was
conducted to see the magnitude of this “school bag syndrome” Subjects and Methods: This
prospective study was conducted in schools of two educational sub-districts of Thrissur district.
Schools were selected on random basis. It included government, private and aided schools with
state/CBSE syllabus. Our team visited the school and weighed the bags . If the bag weight was
more than 10% of the bodyweight of the child, it was considered to be overweight. We also put
forward our suggestions to improve the situation and re-visited the schools. Results: 42 schools
were visited during February 2006 to till date. Majority(35) of them were in private sector.90% of
school children were having overloaded backpacks. It was found to be due to extra tuition books,
water bottle, unwanted books and of course due to the bag itself. In the same class we observed
that students were carrying bags with different weight. The bag weight ranged from 3 kg(L.K.G.)
to 9kg in higher classes. Of the 12 schools we revisited this year, 4(33%) had taken effective
measure to reduce the bag burden. Discussion: Weight of the school bag is really a problem for
our children. It can be reduced by methods like keeping the books in school itself(LP classes), by
making separate books for each term(UP class) and by filing system(high school).Uniform school
bag, simple water bottle, avoiding home work in pre primary classes are other effective measures
. Conclusion: The problems of school bag burden is beyond our imagination. There are simple
and effective methods to reduce the weight of the backpack. The need of the time is support from
teachers, parents and school education committee. There should be necessary steps from the
government to amend the existing laws and to create new laws to improve the situation.
CP/31(P) AWARENESS, ATTITUDE & SOCIAL ISSUES IN HIV
Subhranshu Sekhar Kar, Samarendra Mahapatro, Renuka Mohanty
Hi-tech Medical College, Bhubaneswar
drsskar@yahoo.co.in
AIMS-1.To analyse the socio-cultural issues in HIV. 2. To know the awareness & attitude about
HIV & compare among the lower & upper socio economic group DESIGN-study based on
questionnaire SETTING-Out patient department(OPD) of a private Medical college(category-1)
and OPD of a Government community health centre(CHC) & the Primary health centres under the
CHC(category-2) METHODS-Different categories of parents of children attending two different
types of health institutions were included.Both upper & lower socioeconomic groups comprised
the study population.Questionnaire regarding modes of transmission along with sociocultural
issues like acceptance & attitude towards an HIV positive person were prepared and circulated in
Oriya & English & the result analysed.Out of 450 proforma we actually received 400 (200 in each
group) & hence the sample size became 400. RESULTS-Majority (89%) of category -1 had a good
knowledge about the disease & the mode of transmission but only 57% of category-2 possess the
same.Also,HIV transmission through blood transfusion is known to 70% in category-1 but only
26% knew about it in category-2.Social acceptance was lacking in category-2 where only 28%
were willing to accept an affected person,including a child in their immediate surrounding in
contrast to category-1(77%).Consent for screening was given by 98% in category-1 & 50% in
category-2 but in reality very few(~20% of each category) came for screening on due date.
CONCLUSION-In low socioeconomic group,the knowledge, attitude & acceptance is alarmingly
poor. Literacy & publicity through media is the cornerstone in creating awareness among people
in low socioeconomic strata.Focus should be on educating people regarding all the modes of
transmission of HIV and special counseling centers along with volunteers & social workers
should be employed in underpriviledged areas with poor literacy rate.