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    Table of Contents - Current issue
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July-September 2020
Volume 45 | Issue 3
Page Nos. 251-390

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EDITORIAL  

Response to COVID-19 pandemic in India: How can we strengthen our response? Highly accessed article p. 251
Satish Kumar, Dandu Chandra Sekhar Reddy
DOI:10.4103/ijcm.IJCM_653_20  
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CME Top

Relevance of community-based participatory research in community medicine training p. 256
Anand Krishnan, Rajesh Tandon, Baridalyne Nongkynrih
DOI:10.4103/ijcm.IJCM_343_19  
Community-based participatory research (CBPR) is an approach in which researchers undertake research in partnership with those affected by the issue being studied, for the purpose of taking action or effecting social change. It can also incorporate those who will use the results to change practice and inform policy. The practice of CBPR is primarily focused on “Knowledge for Change.” Most research projects in such CBPR partnerships are funded through the academic partners. In many situations, academic and professional researcher institutions and researchers find it difficult to share the information and resources or to directly engage with local community and other local stakeholders. In practice, finding an intermediary partner who has good rapport with local community and local government can be very effective. While there are good initiatives in selected medical colleges for community orientation of medical undergraduates and postgraduates in community medicine, these are not immersive enough to cause an attitudinal change. It is time that we exposed our graduates and postgraduates to CBPR concepts and practice.
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VIEW POINTS Top

Replicating the Kerala state's successful COVID-19 containment model: Insights on what worked Highly accessed article p. 261
Asma Ayesha Rahim, Thomas V Chacko
DOI:10.4103/ijcm.IJCM_598_20  
Although Kerala was the first state in India to report COVID cases, it was well prepared drawing on its past experience in managing effectively the Nipah outbreak and Kerala floods. It knew and initiated the measures required for containment because of its prior experience with mobilizing community-based groups, involvement of local-self government in decentralized planning, and participation in the containment and relief measure as well as a system-ready health system and infrastructure. The measures taken to “flatten the curve” that is unique to Kerala and the determinants of success are described in detail as “what worked” using the framework we developed post the Nipah outbreak containment experience. These are being shared with the hope that the insights these measures undertaken by the state provide can be used elsewhere to translate and replicate components that work.
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Human resources for health in India: Need to go beyond numbers p. 266
Sumant Swain, GS Preetha, Satish Kumar, Divya Aggarwal, Rajesh Kumar, Sanjiv Kumar
DOI:10.4103/ijcm.IJCM_247_19  
India's commitment to achieve the goal of Universal Health Coverage is evidenced by the launch of Ayushman Bharat and the transformation of Sub-Centres into Health and Wellness Centre to provide secondary and comprehensive primary healthcare to the vast majority of its population. Successful implementation of these initiatives requires adequate and skilled human resources for health and a conducive work environment. There exists a deficiency of doctors and paramedical professionals in different parts of the country. The vacancies in different categories of health functionaries have increased after 2005 despite the National Rural Health Mission/National Health Mission initiatives to strengthen the health system. The distribution of doctors and paraprofessionals in health is skewed, favoring urban areas. Properly oriented, trained, and skilled health workforce and informed public participation are critical to provide quality services for achieving national health goals. Therefore, it is necessary to establish public health cadre in all states of India and ensure appropriately skilled workforce to meet the functional requirements of health-care delivery system at different levels. This will also help to move forward on the way to reach the Sustainable Development Goals.
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Toward the development of an integrated climate-sensitive disease surveillance in southeast asian countries: A situational analysis p. 270
Sandul Yasobant, Somen Saha, Tapasvi Puwar, Deepak Saxena
DOI:10.4103/ijcm.IJCM_285_19  
Changes in climatic conditions influence the transmission of water and/or vector-borne diseases. It is one of the reasons for the emergence and re-emergence of various infectious diseases. This case study documents the learnings from selected Southeast Asian countries that can be useful for developing integrated disease surveillance and early warning system for selected climate-sensitive diseases. Through informal key-informant interviews and site-visits to Sri Lanka, Bhutan, and Thailand, we studied the disease surveillance, meteorological surveillance and early warning systems. These leanings suggest that an integrated data sharing mechanism is essential for real-time disease prediction. Further, there is immense scope for developing mechanisms on the uniform in data collection, data processing and analysis. There is an urgent need for developing a multi-sectoral collaborative plan for the integration of surveillance for real-time prediction of climate-sensitive diseases.
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Bringing health care closer to people – A review of various telemedicine models under the national health mission in India p. 274
Disha Agarwal, Nobhojit Roy, Vivek Panwar, Ajay Basil, Prashant Mohan Agarwal
DOI:10.4103/ijcm.IJCM_334_19  
Telemedicine is an alliance between technology and medicine. It is a prevalent practice in developed countries; it has been widely used in developing countries to address the issues of access to medical care. India has been experimenting with telemedicine since long to address the issues of access and availability of specialist care and in recent years, with the rapid advancement of information technology, telemedicine has become a popular concept across the country. In this article, we have reviewed the various aspects of different government-funded telemedicine models functional in 12 states across India. We have also attempted to explore the levels of care delivery and services at facilities provided through telemedicine and challenges being faced in the implementation of the models. As a way forward, the health-care community needs to realize the full potential of telemedicine facility and utilize it to their benefit. Telemedicine will work best when it is one component of a well-functioning health system and not as an isolated gap-filling application.
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ORIGINAL ARTICLES Top

Initial viral load of a COVID-19-infected case indicated by its cycle threshold value of polymerase chain reaction could be used as a predictor of its transmissibility - An experience from Gujarat, India Highly accessed article p. 278
Bidisa Sarkar, Rabindra Nath Sinha, Kamalesh Sarkar
DOI:10.4103/ijcm.IJCM_593_20  
Background: Transmission dynamics of the infectious disease Corona Virus Disease - 19 (COVID-19) is yet to be understood fully. The study aimed at exploring whether quantitative viral load of COVID-19-infected case indicated by cycle threshold (Ct) value of real-time reverse transcription polymerase chain reaction could predict about transmission pattern in the community. Materials and Methods: An observational study was conducted involving 1976 individuals, suspected to be suffering from COVID-19 and contacts, of laboratory confirmed cases from selected districts of Gujarat, India. A total of 138 persons were detected to be positive. Weekly positivity showed an overall increasing trend during the studied weeks. It was observed that only 7% had high, 9% as moderate and rest, 84% had low viral load based on Ct values of real-time RT-PCR. Results: Most secondary cases clustered around index cases with high viral load whereas fewer secondary cases clustered around index cases with low viral load. Each index high viral load case transmitted an average of 6.25 secondary cases whereas the same of low viral load transmitted an average of 0.8 case. Conclusion: If cases with higher viral load are selectively isolated on detection from the rest of the community along with contact tracing of all individuals, who came in contact with them during the previous 5 days, the quantum of transmission will reduce subsequently. Moreover, health-care workers often get infected while working, probably due to the fact that they often handle cases with higher viral load. The Ct value of all may be provided along with test report to safeguard everybody's health including health-care workers.
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Quality of life among diabetics: A cross-sectional study in a tertiary care center of Rohtak, Haryana p. 283
Meena Rajput, Yashodha Arivarasan, Aereosonova Khongsit, Rajesh Rajput
DOI:10.4103/ijcm.IJCM_75_19  
Introduction: The most severe health threats dominating the low- and middle-income countries are no longer the dreaded communicable diseases; but, they are everyday diseases due to changes in lifestyle, which are the noncommunicable diseases. Quality of life (QOL) is defined by the World Health Organization as an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. QOL assessment in health system is a multidimensional construct that can be measured by evaluating objective levels of health status filtered by the subjective perceptions and expectations of the individual. Aim and Objective: To assess the QOL among diabetics attending the endocrine outpatient department (OPD) in a tertiary care hospital of Haryana. Materials and Methods: A hospital-based cross-sectional study was conducted at endocrinology OPD of Pt. B. D. Sharma PGIMS Rohtak, Haryana from May 2014 to April 2015. Five hundred diabetics (Type 1 and 2) were recruited for the study. Patients registered on the day of interview were selected using systematic random sampling. A predesigned, pretested, semi-structured schedule which included sociodemographic variables of the study participants along with information about family history of diabetes was filled by interviewing the study subjects in their vernacular language individually. Generic instrument, SF-36 v2 was used to assess the QOL. Results: The mean age of the study participants was 50.41 ± 9.1 years. The mean disease duration was 6.12 ± 5.55 years. Majority of our respondents belonged to Hindu religion (97.4%). The mean scores for the bodily pain domain (79.52 ± 28.15) and social functioning domain (76.47 ± 26.10) of QOL were the highest. Conclusion: The mean scores for the bodily pain domain and social functioning domain of QOL were the highest. Assess the QOL in patients with diabetes by measuring the multiple domains involving physical, psychological and social aspects.
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Profile of women with mental illness admitted in shelter care homes; a co-relational description of changing sociocultural scenario in India p. 287
Febna Moorkath, Mysore Narasimha Vranda, Channaveerachari Naveenkumar
DOI:10.4103/ijcm.IJCM_119_19  
Background: The prevalent explanations of gender and mental illness in the Indian social structure often highlighted in terms of traditions and gender-colored norms which is confirmed with the patriarchal framework. The combination of women and diagnosis of mental illness disturbs the prescribed gender expectations which accelerate the family abandonment, and many women lead their life in shelter care homes after psychiatric hospitalization. The aim of the study is to assess the sociodemographic characteristics of the residents admitted in shelter care homes and understand the co-relational aspects of changing sociocultural scenario. Subjects and Methods: Recruited 50 women residents living in 14 centers both the governmental and nongovernmental shelter care homes in Bengaluru, Karnataka. Utilized sociodemographic datasheet to assess the sociodemographic variables and retrospective file review to elicit commonalities among the sample. Results: The current study reveals that majority (74%) belongs to the nuclear family, lived in a rented house before institutionalization (46%). The reason for stay in shelter care home reported to be family abandonment and rejection (72%) and majority of the residents experiencing chronic homelessness (92%) are unmarried/separated (82%) and majority revealed none of the family members ever visited them in shelter care homes (66%). Conclusion: It is imperative to understand the connection between sociodemographic details of the women admitted in shelter care homes and the rapid changes occurring in the sociocultural structure for comprehensive understanding of mental illness-homelessness-institutionalization nexus.
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Noncompliance to directly observed treatment short course in Mulshi block, Pune district p. 291
Prasad D Pore, Amit Kumar, Iqbal Ahmad Farooqui
DOI:10.4103/ijcm.IJCM_137_19  
Context: Directly observed treatment short course (DOTS) was adopted as the strategy for the provision of treatment to increase treatment completion. Poor adherence to medication has been noted and poses a big challenge even after achieving 70% case detection and 85% cure rate. The focus remains on dealing with important reasons of default and timely retrieval of patients who interrupt the treatment. Aims: The aim of the study was to measure the noncompliance of DOTS and to determine the reason for the same among patients in rural area of Pune. Materials and Methods: An observational cross-sectional study was conducted with a study population comprising the patients who were getting treatment in November 2016 and must have completed at least 1 month of treatment in Mulshi block. The study period was from November 2016 to January 2017. All the patients were interviewed using a pretested questionnaire for their compliance. Results: The total number of patients included in the study was 88. The age was 18–70 years in which 77.3% were male and 22.7% were female. We found 71.6% new cases, and 27.3% were the previously treated patients, whereas 1.1% were multidrug-resistant patients. Among these patients, 25% were tobacco chewers and 31.8% were smokers. We found that 61.4% were compliance patients and 38.6% were noncompliance patients. Reasons given by the patients were side effects, stigma of the society, migration from one place to another, and felt better from symptoms after taking medication. Conclusion: Noncompliance in our study is high. We should take steps regarding this so that people adhere to the medication.
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Depression, sexual dysfunction, and medical comorbidities in young adults having nicotine dependence p. 295
Ranjan Bhattacharyya, Debasish Sanyal, Sumita Bhattacharyya, Kaustav Chakraborty, Rajarshi Neogi, Bejoy Bikram Banerjee
DOI:10.4103/ijcm.IJCM_153_19  
Background: Nicotine dependence, depression, diabetes mellitus, hypertension, and hypothyroidism are risk factors of sexual dysfunction. Aims and Objectives: The present study aims to find the prevalence of sexual dysfunction and the various sexual response cycle domains in individuals with nicotine dependence with and without comorbidities. Materials and Methods: A total of 52 individuals attending the tobacco cessation clinic were included in the study. To assess the primary outcome, Fagerstrom test for nicotine dependence, Arizona Sexual Experiences Scale, and Hamilton's Depression Rating Scale 17had been administered after validation in local vernacular. Results: In the sample, 32 (61.5%) were male and 20 (38.5) were female. The 17 participants (32.7%) met the criteria of low nicotine dependence, 5 (9.6%) participants met low to moderate, 11 participants (21.2%) had moderate dependence, and 19 (36.5%) participants met the criteria of high nicotine dependence. Conclusions: The nicotine dependence is directly related to sexual dysfunction, and it affects various stages of the sexual response cycle. One-quarter of individuals of nicotine dependence also met the threshold criteria of depression. The interventions as primary and primordial preventions with awareness building and health education may be a cost-effective measure to prevent tobacco-related deaths.
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A study on postpartum depression and its association with infant feeding practices and infant nutritional status among mothers attending the anganwadi centers of Valsad district, Gujarat, India p. 299
Trupti Amipara, Hinal Baria, Sunil Nayak
DOI:10.4103/ijcm.IJCM_171_19  
Background: Systematic reviews on postpartum depression (PPD) suggest that PPD mothers are more likely to interrupt exclusive breastfeeding with inappropriate feeding practices resulting malnutrition in child. A community-based study was planned with the objective to find the risk factors associated with PPD and its possible association on infant feeding practices and infant nutritional status. Materials and Methods: This was a cross-sectional study conducted among 116 postpartum mothers attending Anganwadi centers under the Urban Health Training Centre and Rural Health Training Centre of Medical College. A purposive sampling technique was applied. Informed and written consent in local language was taken. Data were collected in predesigned, pretested, and semi-structured pro forma. The mothers were screened for possible PPD using the 10-item well-validated Edinburgh PPD Scale in Gujarati language. The cutoff point is score more than 10.5 based on previous studies. Infant's nutritional status and breastfeeding practices were assessed according to the WHO Growth Chart and Infant and Young Child Feeding guidelines. Results:(1) 6.8% of the prevalence of PPD was reported in the study; (2) sociodemographic factors such as relationship of mothers with in-laws/husbands, help at home in childcare, literacy status, age at marriage and first child, and own desired/in-laws of sex of child are found to be significantly associated with PPD. (3) The Association of PPD and poor nutritional status of child was statistically significant. Conclusions: The study highlights the need of screening for PPD in the community. The potential risk factors for PPD can be taken into consideration during routine antenatal/postnatal care and for planning of preventive strategies.
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Prevalence of food insecurity at household level and its associated factors in rural Puducherry: A cross-sectional study p. 303
Bharathnag Nagappa, Tanveer Rehman, Yamini Marimuthu, Shanthosh Priyan, Gokul Sarveswaran, S Ganesh Kumar
DOI:10.4103/ijcm.IJCM_233_19  
Background: Malnutrition is a consequence of food insecurity. Food insecurity in India became a public health problem due to explosive population growth and widening gap between rich and poor. It also has a detrimental effect on factors related to health and social well-being of the family. Objectives: The study was conducted to determine the prevalence of food insecurity at household level in rural population and factors associated with it. Subjects and Methods: A community-based cross-sectional study was conducted among the households of rural Puducherry. The adult females in the households were interviewed with a pretested semi-structured questionnaire in which, along with sociodemographic factors, food insecurity was assessed using the Household Food Insecurity Access Scale. Univariate and multivariate logistic regression analysis was done to identify the factors associated with food insecurity. Results: Out of 299 households that were assessed for food insecurity, 31.7% (95% confidence interval [CI]: 26.6–37.4) had food insecurity. Out of 95 households with food insecurity, 51 (17%), 37 (13%), and 7 (2%) had severe, moderate, and mild food insecurity, respectively. In univariate analysis, the presence of children in the family, using below poverty line ration card, and socioeconomic status were significantly associated with food insecurity. In multivariate analysis, socioeconomic status was significantly associated with food insecurity (rate ratio: 3.59; P < 0.001 [95% CI: 1.68–7.67]). Conclusions: One in three families experienced the food insecurity, and it was more among households with children. It has to be addressed to prevent nutrition-related disorders in community, particularly in children.
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Diabetes self-care activities: A community-based survey in an urban slum in Hyderabad, India p. 307
Keerthi Chandrika, Biranchi Narayan Das, Saba Syed, Sairam Challa
DOI:10.4103/ijcm.IJCM_236_19  
Background: Diabetes is a chronic illness with silent manifestations, which can be better managed by the individual through self-care behaviors such as diet control, proper exercise, monitoring blood glucose, and adherence to dug. Objective: The present study was conducted to assess the prevalence of existing self-care behaviors among people with diabetes and its associated factors. Methods: It was a community-based, cross-sectional study conducted in an urban slum in Hyderabad. A total of 208 cases of diabetes mellitus were interviewed. The details of diabetes self-care activities were recorded by using the modified Summary Diabetes Self-care Activities Questionnaire. The data were analyzed by applying SPSS US at 24, and the factors associated with good self-care behavior were found. Results: The study revealed that the prevalence of good dietary behavior, good exercise behavior, good monitoring behavior, and good drug adherence was 29.8%, 30.3%, 44.2%, and 56.3%, respectively. Education of secondary class and above (odds ratio [OR] 3.001; 95% confidence interval [CI]: 0.139–6.447) was found to be associated with good dietary behavior, and male gender (OR 3.691; 95% CI: 1.965–6.936) was associated with good exercise behavior. Good monitoring behavior and good drug behavior were found to be associated with higher socioeconomic status (OR 4.540; 95% CI: 2.418–8.522) and age 50 years and above (OR 3.4; 95% CI: 1.731–6.675), respectively. Conclusion: Good dietary and exercise behavior were found poor in comparison to good monitoring behavior and drug adherence. The factors significantly associated were male sex, higher education, higher socioeconomic status, and age above 50 years.
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Pulmonary functions and respiratory symptoms of the women exposed to mine tailings p. 311
Usha G Shenoy, Karthiyanee Kutty
DOI:10.4103/ijcm.IJCM_313_19  
Introduction: Impact of mining on environmental degradation affecting water, soil, and air is established. With the recognition that air pollution is the most important cause for noncommunicable cause for mortality and women as a gender at higher susceptibility to lung dysfunction, it was necessary to make a start to understand the detrimental effect of mine tailing on ambient air pollution almost two decades after closure and its effect on the vulnerable women residents. Materials and Methods: After institutional ethical clearance and informed consent, 258 females between the age of 18 and 60 years living in the gold mining town for over 3 years were selected. Respiratory symptoms were assessed using the American Thoracic Society questionnaire and lung functions of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow rate (PEFR), and FEV1/FVC% using computerized spirometer. Dust samples were analyzed for particulate matter concentration (PM) by gravimetric method. Results: The average PM concentration in the mining area was 1.491±0.737 mg/m. Of the respiratory symptoms, complaints of cough were 34%, breathlessness 31%, phlegm 30%, and asthma 20%. FVC, FEV1, and PEFR were 1.3157 ± 0.487 L/s, 1.2500 ± 0.4850 L/s, and 2.611 ± 1.185 L/s, respectively. FEV/FEV1 was 93.650 ± 9.2733%. Conclusion: Mine tailing contributed to ambient air pollution, which has significantly decreased lung functions in the local women residents and produced the restrictive type of lung abnormality.
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Prevalence and factors influencing diabesity among persons with type 2 diabetes mellitus in urban Puducherry: A cross-sectional analytical study p. 315
Tanveer Rehman, Sathish Rajaa, Gunjan Kumar, R Jayalakshmy
DOI:10.4103/ijcm.IJCM_324_19  
Background: The risk for cardiovascular diseases (CVDs) increase exponentially when type 2 diabetes mellitus (T2DM) and obesity coexist. Objective: To estimate the proportion of people with diabesity and assess the sociodemographic, dietary, and morbidity related factors associated with diabesity. Methods: A hospital-based cross-sectional analytical study was conducted in 2018 among persons with T2DM attending an urban Primary Health Centre in Puducherry using a structured questionnaire. Results: The mean (standard deviation) age of 151 study participants was 58.2 (11.8) years with 66% (n = 100), 77% (n = 116) and 40% (n = 60) being females, sedentary workers and belonging to lower socioeconomic status, respectively. Of total, 71% (n = 107) had hypertension, 66% (n = 99) had uncontrolled fasting blood sugar (FBS) level and 74% (n = 111) did not consume fruits daily. The proportion of diabesity was found to be 66.9% (95% CI 58.8–74.3). After adjusting for other factors, obesity was significantly high among T2DM patients aged 50 years and less (adjusted prevalence ratio– (aPR) 1.4; (95% confidence interval [CI]: 1.07–1.83) compared to >60 years. Having uncontrolled FBS values (aPR 1.28; [95% CI: 1.01–1.64]), deficient in calorie intake (aPR 1.66; [95% CI: 1.25–2.22]), deficient in fruits intake (aPR 1.45; [95% CI: 1.07–1.97]), and high fat consumption (aPR 1.26; [95% CI: 1.02–1.57]) had significant association with diabesity. Conclusion: Considering the rising burden of diabetes associated with obesity, vigilant strategy to reduce modifiable risk factors for CVD needs further emphasis at primary care settings.
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Exploring husband's attitude towards involvement in his wife's antenatal care in urban slum community of Mumbai p. 320
Swati Dahake, Ratnendra Shinde
DOI:10.4103/ijcm.IJCM_344_19  
Background: Developing countries continue to have a high maternal mortality ratio. Antenatal care (ANC) has been termed as one of the “four pillars” of safe motherhood by the World Health Organization. Male involvement has been recognized as having a great impact on women's utilization of maternal health-care service. Objectives: The objective was to assess husband's knowledge and attitude toward their involvement in ANC and to determine factors that influence husband's attitude toward involvement in ANC. Methodology: A community-based observational cross-sectional study on husbands of pregnant women enrolled in an urban health center located in the Malvani slum community of Mumbai with a sample size of 86 was undertaken. Results: The study findings revealed that majority of the husbands 67.4% had a positive attitude, whereas 32.6% had a negative attitude toward involvement in ANC. Knowledge of the husbands regarding early registration of pregnancy, tetanus toxoid, routine blood investigations, and increased dietary requirements were 35%, 45%, 51%, and 65%, respectively. Husband's level of education, their occupation type, distance of health facility from home, length of time spent at health-care facility, and attitude of health-care providers affect the attitude toward involvement in their wife's ANC. Conclusion: Changes in husband's knowledge and attitude about ANC are necessary conditions required to detect pregnancy-related complications at the earliest and for prompt referral.
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“Assessment of nutritional status of rural children (0-18 years) in central India using world health organization (WHO) child growth standards 2007” p. 323
Shruti Atul Prabhu, Nikhil K Shukla, Sai Roshni Mandala
DOI:10.4103/ijcm.IJCM_348_19  
Background: The World Health Organization (WHO) Child Growth Standards (“WHO Standards”) 2007 are the most recent and updated indicators which provide a single international standard that represents the best description of physiological growth for all children. Objectives: The objective of the study was to estimate the prevalence of malnutrition as per anthropometric indicators, namely underweight, stunting, and wasting among rural children in Raipur district, Chhattisgarh, using the WHO Child Growth Standards. Materials and Methods: Nutritional assessment of children was conducted in rural areas using standard anthropometric measurements of height and weight. Totally 10,730 children were screened in 61 schools and 30 Anganwadis belonging to 26 villages across 3 major blocks in Raipur district, Chhattisgarh, during June 2013 to February 2018. Weight-for-age, height-for-age, and body mass index-for-age z-scores were calculated using WHO AnthroPlus software. Results: The prevalence of underweight (≤2 standard deviation) was 45.7% in the children examined. The prevalence of stunting and wasting was 40.4% and 22.0%, respectively. Twenty-two of the 26 villages screened reported malnutrition in more than 30.0% of children, namely every third child lags behind in his or her growth curve despite the Mid-Day Meal Program implemented across the nation including this region since several decades. Conclusion: Malnutrition remains an ongoing health problem in school-going children. WHO AnthroPlus software can be very useful for analysis of state- and national-level data of nutritional status of children and could be used to shape health policies for this age group accordingly.
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Risky riding and its correlates in two-wheeler riding young men: Pillion riders' perspective p. 328
Rajesh Kumar, Seema Mehrotra, Rajeev J Michael, Humera Banu, Paulomi M Sudhir, Manoj K Sharma
DOI:10.4103/ijcm.IJCM_357_19  
Background: Risky riding is one of the major contributing factors in road fatalities. The present study aimed to explore the risky riding behaviors and its correlates in two-wheeler riding young men, as ascertained from pillion riders' perspective. Materials and Methods: A survey that captured perspective of pillion riders about two-wheeler riding young men with whom they used to pillion ride most frequently was administered on 115 subjects. The survey consisted of items pertaining to risky riding, perceived impact of negative emotion on riding, expression of negative emotion on roads in response to frustrating situations, road traffic accidents, and pillions' strategies to reduce anger/stress in their two-wheeler riders. Results: Two-wheeler riders who comprised young men were categorized into two groups: (i) high-risk riding group (n = 54 [48%]) and (ii) low-risk riding group (n = 61 [52%]) based on the subjective report of risky riding behaviors by their pillion riders. The results showed that negative emotions were perceived to have adverse influence on riding in persons with high-risky riding. Pillion riders reported that two-wheeler riding young men with high-risky riding expressed more aggressive behaviors (verbal and nonverbal) while riding in response to frustrating situations and also experienced near misses and minor accidents more frequently than their counterparts. Pillion riders reported utilizing various strategies to regulate emotions and behaviors of two-wheeler riders. Conclusions: The present study highlights assessing risky riding and their correlates from pillion riders' perspective and strengthening their positive influence on two-wheeler riding. It has significant implications in minimizing risky behaviors on roads and enhancing road safety.
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Female sexual dysfunction: Indian perspective and role of Indian gynecologists p. 333
Nilanchali Singh, Pallavi Sharma, Neha Mishra
DOI:10.4103/ijcm.IJCM_365_19  
Background: One rarely finds Indian women talking about their sexuality like this due to sex taboo in our society. This does not mean that sexual dysfunction is uncommon in Indian women. Female sexual dysfunction is widely prevalent. Aim and Objective: Indian women seek less assistance for them, despite undergoing physical and marital problems. Data of prevalence of such problems was collected to understand the scope of these problems and how Indian women deal with it.The objective was to understand prevalence of sexual dysfunction in women attending Gynaecology OPD and their perception about sex. Material and Methods: A questionnaire based prevalence study comprising of 520 patients from January, 2018 to June, 2018 was done. The questionnaire was designed on the basis of prior used ones in various studies and modified according to current patient scenario at the tertiary centre where study was conducted. Results: The data collected showed that sexual problems are not reported even when they were widely prevalent. 64% of women can't talk regarding this to their partners too. 82% patients had some sort of sexual problem. Only 18% patients said that they have no sexual problem and were satisfied with their sexual life. However, none of them consulted or took any form of assistance from any medical personnel. Conclusion: Indian women are reluctant and shy to discuss sexual problem unlike westerners who are more open and demanding when it comes to their needs. Gynecologists need to discuss with the patients about their sexuality and pertaining issues with utmost warmth, care and respect. They need to pull out the problem from within their patients and handle it effectively.
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Study of predictors of quality of life and its association with anxiety and depression in chronic obstructive pulmonary disease in industrial workers p. 338
Akhilesh Jain, Richpal Meena, Rekha Sharma, Neelam Yadav, Anadi Mathur, Garima Jain
DOI:10.4103/ijcm.IJCM_376_19  
Introduction: Chronic diseases such as chronic obstructive pulmonary disease (COPD) have an adverse impact on the quality of life (QOL) of the patient. Anxiety and depression have an association with QOL in COPD. However, this area has not been studied in the Indian subcontinent, especially in reference to the industrial population, which is vulnerable to such chronic disease. The present study aims to assess the prevalence of anxiety and depression and its association with QOL in COPD patients. This study has also examined the other predictive factors associated with QOL in COPD. Materials and Methods: This cross-sectional study involved 50 cases of COPD and an equal number of age- and sex-matched healthy controls. The severity of COPD was classified as per the global initiative for chronic obstructive lung disease recommendation. Participants were assessed for anxiety, depression, and QOL on generalized anxiety disorder 7, Patient Health Questionnaire nine-item and WHOQOL (World Health Organization Quality of Life Instrument)-BREF, respectively. Results: The study sample was predominantly of men (n = 47) with a mean age of 57 years. The mean score of QOL in all domains was significantly lower in COPD cases than control. The prevalence of anxiety and depression was 38% and 44%, respectively, among COPD cases. Odds ratios predicted more risk of developing anxiety and depression in COPD as the OR for depression and anxiety, with 95% confidence intervals were 3.2 (1.2–8.3 and 4.8 (1.8–12.8), respectively. QOL had a strong association with anxiety, depression, chronicity, and the severity of the disease. Conclusion: Anxiety and depression are highly prevalent in COPD and appear to be strong predictors of poor QOL.
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Composite indexing for nutritional status evaluation: A snapshot of malnutrition across India p. 343
Neeraj Agarwal, Neha Chaudhary, Pankaj Kumar Pathak, Avneet Randhawa
DOI:10.4103/ijcm.IJCM_387_19  
Introduction: Data from several sources revealed that huge incongruity persists in nutritional status across the states in India. Thus, this study was undertaken to generate a nutritional index, so that these disparities could be quantified and comparison be done. Materials and Methods: A nutritional index for 21 major states of India has been constructed on the basis of eight important nutrition-related indicators. The scaled value of each indicator for all the states was calculated. Each indicator was assigned an arbitrary weight (Wi) on the basis of its impact on nutritional status. On the basis of the scaled value and weight given to the particular indicator, a composite-weighted index was thus calculated. Results: States were ranked on their nutritional status as per the final composite score they attained. Out of 21 major states, Kerala took the top position followed by Jammu and Kashmir and Himachal Pradesh on the 2nd and 3rd position, respectively, while Uttar Pradesh got the lowest rank followed by Bihar and Jharkhand on the 2nd and 3rd lowest positions. Conclusion: Our study concludes that not taking an account of the burden of malnutrition when disbursing funds leads to ineffective implementation of various nutritional programs. Integrated Child Development Services has already been brought in mission mode under Poshan Abhiyan. Other determinants, i.e., illiteracy, poor sanitation, diseases, and infections, should also be considered and addressed through nutritional programs.
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The hindi version of the breastfeeding self-efficacy scale-short form: Reliability and validity assessment p. 348
Saurav Basu, Suneela Garg, Akashdeep Sharma, Ekta Arora, M Meghachandra Singh
DOI:10.4103/ijcm.IJCM_378_19  
Background: Despite the cultural sanctity and elevation of breastfeeding practices, nearly one in two Indian women nationwide are unable to practice exclusive breastfeeding (EBF). Early identification of mothers at risk of reduced breastfeeding through a suitable instrument can enable targeted interventions for breastfeeding support. Objectives: We conducted this study with the objectives of translation into Hindi and to psychometrically test the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) and to ascertain the sociodemographic and other correlates of breastfeeding self-efficacy. Methods: The BSES-SF was translated into Hindi using a back and forth translation process to ensure linguistic validity. We enrolled a total of 210 married women who were mothers of infants at an urban primary health center in Delhi, India. Results: The Cronbach's alpha for the Hindi translation of the BSES-SF was 0.87 with all except one correlation coefficient <0.3. We conducted an exploratory factor analysis using principal component analysis that revealed a two-component solution, which explained 47.9% and 16.7% of the total variance, respectively. Mothers perceiving higher social support registered significantly higher mean BSES-SF scores, indicating a greater confidence in their breastfeeding abilities (P = 0.01). However, breastfeeding self-efficacy was unrelated to the mother's age, parity, and education. The women planning to breastfeed partially had lower BSES-SF scores compared to the woman adhering to EBF norms (P < 0.001). Conclusion: The Hindi version of the BSES-SF demonstrates good reliability and validity and can also explain previous and planned breastfeeding behavior in mothers of infants.
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A case–control study on food frequency and meal pattern distribution in coronary artery disease patients attending tertiary care teaching hospitals p. 353
Siddharth Bhagvandas Agrawal, Dishant Bhavin Upadhyay, Aparajita Abhinava Shukla
DOI:10.4103/ijcm.IJCM_383_19  
Context: Coronary artery disease (CAD) is the blockage of coronary arteries, usually consequent to atherosclerosis. CAD is a lifestyle disease with an increasing disease burden in society. Evaluation of risk factors for CAD is crucial for its prevention. Lifestyle components like calorie consumption chronology, saturated fatty acid (SAFA) intake, reclining time, nocturnal eating and intermittent fasting were considered. Aims: To correlate calorie distribution, SAFA intake, reclining time, nocturnal eating and intermittent fasting with occurrence of CAD. Study Design/Materials and Methods: A case-control study consisting of 235 cases and 185 controls. Questionnaire was self-designed according to NIN guidelines. Study was ICMR funded and data analysis was done using Microsoft Excel and IBM SPSS. Results: Across case and control groups, total calorie consumption difference was insignificant (P = 0.42). Calories consumed in breakfast slot (P = 0.001) and dinner slot (P = 0.003) were significantly different possibly due to discrepancy among circadian variation in insulin sensitivity and calorie consumption distribution. Reclining time <1 h in afternoon (odds ratio [OR] = 2.24, 95%, 1.481–3.356) and night (OR = 2.05, 95% confidence limit [CL], 1.233–3.410), SAFA consumption (OR = 2.006, 95% CL, 1.214–3.316), intermittent fasting (OR = 1.748, 95% CL, 0.997–3.067) and nocturnal eating (OR = 1.291, 95% CL, 0.779–-2.141) are potential risk factors. Conclusions: Calorie consumption chronology, SAFA intake, Reclining time, Nocturnal eating and intermittent fasting emerged as significant risk factors.
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Obesity prevalence and determinants among young adults, with special focus on normal-weight obesity; a cross-sectional study in Mumbai p. 358
Rujuta Sachin Hadaye, Rukman Mecca Manapurath, Barsha Pathak Gadapani
DOI:10.4103/ijcm.IJCM_408_19  
Background: India has >135 million obese individuals at present. Body mass index (BMI) has been used to assess obesity until recent times. Later, studies have shown that central body fat (BF) measurements as a reliable predictor of metabolic diseases. Hence, normal-weight obesity (NWO) is defined. Those with a normal range of BMI but increased fat percentage are found to be having metabolic syndromes at a very early life. The young adult group is specifically focused on the study with diet and physical activity as potential determinants; as an intervention at the right time can prevent the development of many noncommunicable diseases. Objectives: The aim of this study is to estimate the prevalence of obesity and its determinants with special reference to NWO. Materials and Methods: A cross-sectional study was conducted based on diet, physical activity, and other lifestyle factors on a sample of 269 young adults. Using Harpenden skinfold calipers, BF percentage was calculated based on Jackson and Pollock and Siri's equation. Binary logistic regression was also applied appropriately. Results: The proportion of obesity was 42.01%, and that of NWO was 16.1%. Sex, high protein diet, number of restaurant visits, less homemade tiffin intake, heavy physical activity, alcohol intake were found to be significantly associated with obesity. Intake of fish, physical activity, protein diet, day-time sleep were found to be significantly associated with NWO. Conclusion: The study emphasizes the need for including BF percentage in addition to BMI in regular clinical practice. It may help in preventive and promotive efforts.
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SHORT COMMUNICATIONS Top

Out-of-pocket expenditure and opportunity cost of leptospirosis patients at a tertiary care hospital of Gujarat, India p. 363
Sridhar Ryavanki Prahlad, Rajendra K Baxi, Naresh Godara
DOI:10.4103/ijcm.IJCM_164_19  
Introduction: The study investigates the cost incurred by leptospirosis patients as either out-of-pocket expenditure (OOPE) or opportunity cost (OC) and recommends accordingly for the national program on leptospirosis in India. Objectives: The objective of this study is to determine leptospirosis-related OOPE and OC at a government tertiary care hospital and to disaggregate the total OOPE into contributing cost domains. Materials and Methods: The OOPE data were collected by the personal interview of confirmed leptospirosis cases who took complete treatment at the hospital in year 2009 using a prestructured questionnaire. The patients were interviewed daily until discharge to know daily OOPE. Results: The mean OOPE per patient was Rs. 2157/-, Median: Rs. 1880/-, 25th–75th percentile: Rs. 1446 – Rs 2587.5). The lowest quintile for OOPE was Rs. 1330/- and the highest quintile was Rs. 2874/-. Loss of daily wages was 68% (Rs. 1458.9/-) of the total OOPE. Other major expenditure included cost of drugs Rs. 308.8/- (14%), expenditure on food Rs. 173/- (8%), and travelling expenses Rs. 204.4/- (9%). Conclusions: Rs. 2157/- is significant OOPE, and hence, important factor in understanding health-seeking behavior and compliance of leptospirosis patients. The OC (loss of daily wages) amounts to 68% of total OOPE which has to addressed by the government to realize universal health coverage.
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Population attributable risk of tuberculosis vulnerabilities in Kerala, India p. 367
PS Rakesh, Shibu Balakrishnan, Manu E Mathew, Sunilkumar Mrithunjayan, MS Manu
DOI:10.4103/ijcm.IJCM_336_19  
Background: A robust disaggregated understanding of the determinants of tuberculosis (TB) in each local setting is essential for effective health system and policy action to control TB. Objectives: The objective of the study was to identify population attributable risk (PAR) for TB disease based on the locally available evidences for Kerala, India. Methods: Systematic review was done for risk factors of TB in the state. The second set of searches was done to understand the prevalence of the identified risk factors in general population in Kerala. With all available studies and reports, an expert group consensus was made to finalize state-specific prevalence of risk factors. Population attributable fractions were calculated for identified risk factors. Results: PAR for TB disease in Kerala obtained was 24% for undernutrition, 15% for diabetes, 15% for tobacco use, and 1% for HIV. Conclusion: Kerala state's PAR for TB was comparatively lower for HIV but higher for diabetes mellitus. Similar exercises for summarizing population risk factors need to happen at all states for making plans to effectively combat TB.
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Subclinical vitamin A deficiency and anemia among women and preschool children from Northeast India p. 371
Indrapal I Meshram, B Naveen Kumar, K Venkaiah, T Longvah
DOI:10.4103/ijcm.IJCM_356_19  
Background: Micronutrient deficiencies such as iron, Vitamin A, and iodine are important public health problems in India. Objective: The objective of the study was to assess subclinical Vitamin A deficiency (VAD) and anemia among women and preschool children from Northeast India. Methodology: A community-based cross-sectional study was carried out by adopting systematic sampling in Phek district of Nagaland. Data were collected from women on sociodemographic particulars, and finger prick blood was collected for hemoglobin and free-flowing drop for Vitamin A estimation on Whatman no. 1 filter paper. Results: The overall prevalence of anemia was 27%, 40%, 44%, and 52% among preschool children, nonpregnant nonlactating women, lactating mothers, and pregnant women, respectively, whereas VAD was 37% among preschool children and 24%–32% among adult women. The prevalence of VAD was observed high among those living in kutcha house, illiteracy of head of households, big family size, and low per capita income. Conclusions: Anemia and VAD are important public health problems among tribal population in spite of the rich biodiversity.
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A community-based intervention study to assess the effectiveness of awareness imparted on earthquake preparedness among the residents of South Delhi, India p. 375
Rashmi Agarwalla, Rambha Pathak, Aashiya Siddiqui, Meely Panda, Ekta Gupta, Farzana Islam
DOI:10.4103/ijcm.IJCM_404_19  
Background: New Delhi is located in seismic zone IV, and the occurrence of earthquake is fairly common. Previous disasters have shown that only sustained and timely action to reduce risk can prevent or mitigate the impact of a disaster. Objectives: The objective was to assess the knowledge and preparedness regarding earthquake among the residents of South Delhi and to impart the awareness and assess the effectiveness of the awareness imparted. Methodology: One group pretest–posttest quasi-experimental research was done among 300 respondents on earthquake preparedness. Results: As per the study, 89% of participants felt that earthquake is a concern for Delhi. It was observed that majority of the population are not prepared to handle large scale disaster. Significant association was found between pretest and posttest knowledge assessment scores of the study population. Conclusion: Disasters due to their unpredictable occurrence are difficult to tackle, but awareness and preparedness to face the calamity will help to reduce the burden of disaster.
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LETTERS TO EDITOR Top

Use of artificial intelligence-based computer vision system to practice social distancing in hospitals to prevent transmission of COVID-19 Highly accessed article p. 379
BM Zeeshan Hameed, Vathsala Patil, Dasharathraj K Shetty, Nithesh Naik, Nikhil Nagaraj, Disha Sharma
DOI:10.4103/ijcm.IJCM_366_20  
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Costs, prohibition, and need for responsive public health evidence p. 381
Girish N Rao, Alexander P Philips, Vivek Benegal
DOI:10.4103/ijcm.IJCM_267_19  
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Nurses' knowledge and understanding about autism p. 382
Radhakrishnan Govindan, Rajalakshmi Ramu
DOI:10.4103/ijcm.IJCM_290_19  
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Neonatal tetanus in a nomadic population in South India: A clinicosocial case study p. 384
Gayathri Surendran, Tanveer Rehman, Salin Eliyas, A Kalaiselvy, Sonali Sarkar
DOI:10.4103/ijcm.IJCM_306_19  
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A profile of original research articles published in selected public health journals from India over the last 5 years p. 386
Murali Sharan, Yagnapriya Ammakola, Sitanshu Sekhar Kar
DOI:10.4103/ijcm.IJCM_346_19  
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Self-medication practices: A threat to health care p. 388
Aruna Baskar, Neethu George, ML Sarika, Lakshmi Ramamoorthy
DOI:10.4103/ijcm.IJCM_368_19  
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ERRATUM Top

Determinants of home delivery among mothers in urban and rural Vadodara district, Gujarat, India p. 390

DOI:10.4103/0970-0218.294170  
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  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007