1) ALCOHOL MISUSE IN GOA - AMONGST GENERAL PRACTICE ATTENDEES:
A longitudinal Study had been conducted by the Royal Free and College Medical School, ULC Irwin Nazreth & Michael King along with Voluntary Health Association of Goa.
Aims: To determine 1) the prevalence and characteristics of harmful alcohol consumption in general practice attendees; 2) social and psychological association with harmful drinking and 3) recognition of harmful drinking by GPs (General Practitioners).
Methods: A cross-sectional study of ten general practice in Goa. India. A total of 1567 general practice attendees were recruited.
Conclusion: The male pattern of drinking in Goa is one of high rates of abstention coupled with relatively high rates of harmful and dependent drinking in those who consume alcohol. Most women are abstainer. This data provide the first evidence in India on 1) the role of the GP in identification of harmful alcohol use and 2) the contribution of harmful drinking to the perpetration of physical violence from the perspective of the alcohol user.
Paper on Harmful alcohol use in India and its associations with violence: A study in primary care was published.
2) PREDICTORS OF CORONARY HEART DISEASE IN GOA - amongst general practice attendees:
A longitudinal Study has been conducted by the Royal Free and College Medical School, ULC Irwin Nazreth & Michael King along with Voluntary Health Association of Goa.
Objective: To determine the prevalence of coronary heart disease (CHD); risk factors for CHD in primary care attendees without existing CHD and the identification and management of CHD and its risk factors by primary care practitioners
Design: Cross sectional study.
Setting: nine private primary care practices in Goa.
Participants: 626 men and 930 women attending primary care.
Conclusion: There is a high prevalence of CHD in primary care attendees in Goa with greater levels of the disease detected in women rather than men. Additionally, people without the disease were at high risk of CHD. Primary care doctors are unaware of the extent of the problem and seldom provide primary or secondary prevention. The Framingham risk score has limited application for early detection of CHD in India. There is an urgent need to increase awareness of CHD prevention in India primary care.
FOLLOW UP STUDY ON CORONARY HEART DISEASE
VHAG in association with University College, London conducted a longitudinal cohort based follow up study on ‘Risk factors for Coronary Heart Disease’. This was a follow up of a study done in 2004.
Total number of respondents for follow-up is 1556.
Total no. Of people interviewed 342 respondents.
North Goa (Calangute, Mapusa areas) – 45
South Goa (Vasco area) – 108
Panaji - 9
Betul – 180
We stopped taking interviews in Betul due to no good response.
VHAG has also published a patient information booklet on Coronary Heart Disease.
3) SURVEYS ON PRESCRIPTION ERRORS:
A) A survey was carried out of all prescriptions dispensed at a busy pharmacy in the state of Goa, over a seven consecutive day period.
Aim: - to describe the quality of prescriptions by medical practitioners, including both the layout of the prescription and the type and number of drugs prescribed.
No. of prescriptions collected: - 990 prescriptions were collected randomly.
Findings: - The majority (83.9%) was from private practitioners. The quality of the layout of prescriptions was unsatisfactory. Thus, information to identify the practitioner was incomplete in more than a third of prescriptions and information to identify the patient was incomplete in more than half. Clarity of written instructions on how to take the medicines was unsatisfactory in the majority of prescriptions. Polypharmacy was the norm with more than half (52.7%) of prescriptions containing at least 3 medicines. 40% of prescriptions included a vitamin or tonic and a quarter included an antibiotic and an analgesic. Over 90% of prescriptions contained only branded medicines. Private practitioners prescribed significantly greater number of medicines, more likely to prescribe vitamins and antibiotics, more likely to use branded medicines.
VHAG is finalizing Prescription Guidelines – has already arranged 2 round table discussions involving all stakeholders. We hope to finalize and publish them shortly.
B) VHAG conducted a small medicine survey. One prescription for 21 Voveran tablets & 10 Valium tablets was taken on the letterhead of an authorised, Registered Medical Practitioner, and visited 5 pharmacies in Margao, and 5 pharmacies in Panaji with the same prescription. Each of the 10 pharmacies dispensed the prescribed medication. Therefore we ended up with around 200 tablets of Voveran and 100 tablets of Valium, which is a dangerous amount to have with a patient. Later we got another prescription scribbled by a non-medical person, on a blank sheet of paper, for 10 tablets of Alprazolam (Restyl), and visited 5 pharmacies in Panjim with the same prescription. We ended up with 50 tablets of Restyl. This was done to reveal carelessness in dispensing process of chemists in Goa today. Letter was send to the Director of FDA with all the above details and some remedial measures were also suggested.
MANAS (Manushati Sudhar Shodh) Project
VHAG in collaboration with Sangath successfully conducted MANAS (Manushati Sudhar Shodh) project. It is a cluster randomized controlled trial study in Primary health care settings in Goa.
Approximately 1000 patients were interviewed who visited private clinics/ General Practitioners clinics for Common Mental Disorders such as Stress, Depression, Anxiety, Phobia etc. using standardized and validated interview instruments such and CISR, WHO_DAS.
The main Study OF MANAS started in April 2007, and this year i.e. March 2010 we saw the end of the phase. VHAG was involved in reviewing treatment follow-ups and outcome of patients recruited in the study.
In phase 1 (PHC) the total no. of cases recruited was 1648. From which we completed 1437 cases in the 1st review with 87.2% completion rate. In the 2nd review 1416 cases completed with 85.9% completion rate and in the 3rd review 1386 cases completed with 84.1% completion rate.
In the GP Phase (Phase II) started in July 2008 and ended in January 2009. In Phase 2 (GP) the total no. of cases recruited were 1148 wherein in the 1st review we completed 1054 cases with 91.8% completion rate. In 2nd review they completed 1013 cases with 88.2% completion rate & in the 3rd review they completed 981 cases with 85.5% completion rate
HEALTH CARE AND RIGHTS OF PATIENTS
A book titled “Health Care and Rights of Patients” has been authored by members of VHAG and been published by Voluntary Health Association of India in June 2007 & the book is also translated in many languages including Konkani and Marathi.
BREASTFEEDING PROMOTION INITIATIVE:
Breastfeeding Promotion Program
VHAG had initiated a breastfeeding awareness counselling program in association with the Goa Medical College & Hospital, wherein VHAG’s nutritionist/health counsellors conduct individual & group counselling sessions on the significance of breastfeeding at the Gynaecology OPD as well as wards, on weekly basis. The program was initiated in July 2008 and VHAG has counselled more than 580 pregnant women & mothers plus family members during this year.
VHAG has also initiated Breastfeeding awareness sessions at various District hospitals – Asilo Hospital, Mapusa and Cottage Hospital, Chicalim – Vasco & Hospicio hospital - Margao in association with the Directorate of Health Services, Goa in August 2008. The program had been well received by the Medical Officers, nurses as well as patients, which has encouraged us now to make it a regular, weekly feature. VHAG used the following methods to conduct the session:
Individual Counselling (case work)
Counselling in small groups (3-4)
Flip chart usage
Pre test (preliminary evaluation) and post test (follow-up session)
Films on breastfeeding promotion by UNICEF
VHAG has initiated a breastfeeding promotion counselling program in association with the Directorate of Health Services from Dec 7 2009 in 2 district hospitals to assist both the Hospitals (Asilo & Hospicio) in Implementing the 10 steps / guidelines of UNICEF to become a Baby Friendly Hospital at the OPD as well as wards, on weekly basis in Asilo- Mapusa and Hospicio hospital- Margao.
Workshop was conducted for Breastfeeding Week at Cortalim primary health centre. Wherein Doctor Surlekar, asked VHAG Health Counsellor to give a talk on importance of breastfeeding. VHAG Counsellor discussed about the exclusive breastfeeding for six month without any other food supplements. Than after six month they have to give home made food like rice and dhal water, ragi, Porridge etc.