Dog bites in humans are a major public health problem in India in general and Kashmir in particular. Canine rabies is almost non-existent in developed countries and exists mainly in the poorer, low socioeconomic strata of society in the developing world. The objective of this study was to determine the characteristics, pattern, and burden of dog bite injuries in the Kashmir valley. Data from Anti-Rabies Clinic of a tertiary care hospital in Srinagar, the summer capital of the state of Jammu & Kashmir, was collated and analyzed. Analysis of records of all the patients who had reported between April 2016 and March 2017 was done. A total of 6172 patients had reported to the Anti-Rabies Clinic for management of animal bites from 1 st April 2016 to 31 st March 2017. Most of the patients were young males. Almost half (47.7%) of the patients were bitten in the afternoon. Lower limbs were the most common site of bite (71.7%). Most of the bites were of Category III (57.6%) followed by Category II (42.3%); only one case of Category I was recorded. Almost all (98.0%) cases reported being bitten by dogs. Conclusions: Category III dog bites on lower limbs were the most common type of animal bites presenting to the Anti-Rabies Clinic of a tertiary care hospital. Children have more chances of a bite on head and neck region. Serious and workable efforts have to be made to reduce the incidence and consequences of animal bites.

Background: Blunt abdominal trauma is a frequent cause for presentation of children to the Emergency Department. Children are prone to sustain injuries to intra-abdominal organs after blunt abdominal trauma because of their peculiar body habitus and relatively immature musculoskeletal system. Objectives of this study is to assess the various epidemiological parameters that influences the causation of trauma as well as injury pattern in blunt trauma abdomen in pediatric population.Methods: The present observational hospital based prospective study was carried out in 96 blunt abdominal trauma patients of both sexes aged up to 12 years, over a period of 2 years. The parameters such as age group, sex, mode of trauma, type of injury, and the overall mortality as well as mortality were assessed.Results: The most common mode of injury was road traffic accidents (54.2%) followed by fall from height (41.70%). Splenic injury was the most common in 58.30%, followed by hepatic injuries 34.40% and renal injuries 12.50 %. The accuracy of ultrasonography (USG) was 83.33% while accuracy of computed tomography (CECT) as a diagnostic test was 93.33%. When comparing USG findings with operative findings sensitivity of USG was 88% with positive predictive value (PPV) of 91.66% while as specificity was 60% with negative predictive value (NPV) of 50%. Sensitivity of CT scan was 96.00% with PPV of 96.00% and specificity of CECT scan was 80.00% with NPV of 80.00%.Conclusions: The majority of pediatric injuries are preventable by knowing the epidemiology and pattern of pediatric trauma.

Introduction:Immunization is one of the splendid public health interventions that remarkably reduced child morbidity, mortality, and disability. Despite attaining substantial immunization coverage in Kashmir, assessment of the immunization system is quintessential for sustaining the gains and exploring the gaps. Objective: To assess the gaps in the delivery of routine immunization services in Kashmir Valley. Method: In-depth face-to-face interviews were conducted with thirty-two (32) important stakeholders, who were purposively selected as they play an active role in the planning and implementation of the Immunization Program and devise strategies at different levels of healthcare delivery. At the state level, SEPIO and SMO were interviewed at the District level, DIO/Deputy CMO was interviewed in all ten (10) districts of Kashmir Valley. From all ten Districts, two Medical-Blocks were selected from each District, and one Block Medical Officer and one Medical Officer were interviewed alternatively from each Medical-Block. Results: The thematic qualitative analysis approach was used and the analysis process generated five themes. Each of these themes included many sub-themes. 1. Factors facilitating the implementation of Routine Immunization (RI), 2. Limitations and deficits related to knowledge, attitude, monitoring, 3. Constraints encountered in the implementation of (RI) program, 4. Difficulties in the implementation of RI revealed by respondents, 5. Transformational steps to bridge gaps in the delivery of Immunization (RI) Conclusion: There were visible deficits related to knowledge, attitude, and monitoring among health professionals. Certain constraints encountered in the implementation of the program were financial constraints in the training of health care professionals and human resources constraints. The study showed the need for transformational steps to bridge gaps in the delivery of the Immunization (RI), which included regular monitoring and review meetings, teamwork and peer learning, training, and improvement in cold chain maintenance.

Background: Active acute flaccid paralysis (AFP) cases surveillance in children under 15 years is ongoing till reaching eradication of poliomyelitis in the globe. As there is always a high risk of importation of wild poliovirus (WPV) from the endemic countries, accurate surveillance for AFP cases to detect WPV circulation and to maintain our achievement is thoroughly essential. Objectives: To evaluate the performance of the AFP surveillance system in Kashmir Valley. To identify gaps, if any, in AFP surveillance. Materials and Methods: The Mixed Methods study was conducted in the Kashmir valley from March 2018 to March 2019. An explorative qualitative design using individual, face-to-face interviews with thirty-two (32) different stakeholders from the State, District, Medical Block, and PHC levels. To complement the qualitative study, a quantitative door-to-door survey was done in two Districts, Srinagar and Ganderbal, which consist of five and four Medical Blocks respectively. Results: The thematic qualitative analysis approach was used, and the analysis process resulted in five themes. 1. Stakeholders’ description of AFP surveillance. 2. Perception and awareness, appraisal of AFP Surveillance among stakeholders 3. Barriers in reporting AFP cases 4. Forging stronger linkages, improved planning in the health system to address gaps in AFP surveillance. 5. Enhancement of activities for sensitive AFP surveillance. In door to door survey of households in different sub-centre areas, a total of n = 1304 families were visited in which maximum (n = 647) families had two <15 years’ children. In the survey, only one AFP case was recorded from Sub-Centre Kurag. Conclusion: There is a need for sensitive AFP surveillance by working on various factors, including training, behavioural change of health workers, improving reporting of cases, especially efforts are needed for the formation of effective AFP surveillance system by forging cooperation with different segments of the health system.

Background: Cancer is one of the signicant causes of mortality worldwide. Cancer has been found to increase with acquisition of unhealthy dietary habits, smoking, sedentary life style etc. Objective: (1) To determine the number of cancer deaths in Mattan Block, Anantnag in the ve year period of 2015 -2020. (2)To nd out the prevalence of risk factors of cancer among the studied cases Materials and Methods:It was a descriptive analysis of the cancer related deaths in Mattan area conducted from 2015 to 2020. Whenever a cancer death occurred, a team of health inspector and an ASHAworker went to the family of the deceased where upon socio-demographic details and the details about risk factors were collected. The data was entered and analysed by using Microsoft Word 2010. Results: A total of 197 deaths were recorded. Most of the deaths were in the age group of above 60 years (40%) with male preponderance (65%). Maximum proportion of deaths was due to Gastrointestinal cancers (42%) followed by respiratory cancers (25.4%). About 56% of participants consumed dried vegetables at least twice a week. Salt tea was consumed 3-4 times a day by 35% of subjects, 45.2% of the subjects ate spicy food. About 53% of subjects were smokers. Conclusion: In this study we found that there's high intake of salt tea, dried vegetables and spicy foods among family members of the deceased persons. Smoking is also a menace in the area. Awareness generation among the people in the area needs to be created about the healthy food and life style