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    Table of Contents - Current issue
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July-September 2018
Volume 43 | Issue 3
Page Nos. 141-249

Online since Thursday, September 20, 2018

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EDITORIAL COMMENTARY  

Challenges to healthcare in India - The five A's Highly accessed article p. 141
Arvind Kasthuri
DOI:10.4103/ijcm.IJCM_194_18  PMID:30294075
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VIEWPOINT Top

Capacity building of private sector workforce for public health services in India: Scope and challenges p. 144
Sembagamuthu Sembiah, Bobby Paul, Aparajita Dasgupta, Lina Bandyopadhyay
DOI:10.4103/ijcm.IJCM_316_17  PMID:30294076
Indian health sector is a complex admixture of public and private providers, but several lacunae of public health service delivery system in terms of human resource, access, and quality have resulted in unprecedented growth of private sector. Although seamless delivery of services at rural and urban areas, timely approach, and improved information technology system are the strength of the private sector, this package comes at the cost of high out-of-pocket expenditure. Mobilization of private sector health workforce by their capacity building in terms of orientation toward public health services is one of the available solutions to move toward wider coverage of public health services. However, numerous challenges need to be addressed before realization of this vision.
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ORIGINAL ARTICLES Top

Assessment of functioning of village health nutrition and sanitation committees in a District in Maharashtra Highly accessed article p. 148
Raviraj Uttamrao Kamble, Bishan S Garg, Abhishek V Raut, Madhukar S Bharambe
DOI:10.4103/ijcm.IJCM_171_17  PMID:30294077
Background: Community participation is one of the core principles of primary healthcare. The village health nutrition and sanitation committee (VHNSC), one of the elements in implementation of the National Health Mission (NHM), is an example of community participation. There are not many studies conducted to assess the actual participation of VHNSC in health-care delivery at the village level. Objective: The objective of the study is to develop a VHNSC Maturity Index (VMI) and pilot it to assess the institutional maturity of VHNSC. Materials and Methods: This community-based, cross-sectional study was conducted in 83 villages under four Primary Health Centres (PHCs) of the Wardha Community Development block. VMI was developed, Through several discussion sessions with VHNSC members and staff of the DCM; observations of VHND; attending VHNSC monthly meetings; the VMI was finalized after piloting it in all the four PHC areas. Results: All the 83 VHNSCs were constituted as per norms led down under NHM. Forty-eight (57.8%) VHNSCs had developed an annual Village Health Action Plan, 72 (86.7%) VHNSCs had ≥4 meetings held in the past 6 months, and ≥70% attendance in the past 6 months was observed in 40 (48.2%) VHNSCs. A majority of 82 (98.8%) VHNSCs helped in organizing the village health and nutrition day, 59 (71.1%) VHNSCs monitored the implementation of national health programs. The entire untied fund received in the previous year was utilized by 68 (81.9%) VHNSCs. Conclusion: The study shows that VMI can be used for continuous monitoring and assessment tool for VHNSC to evaluate and plan different health activities.
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India has reached on the descending limb of tobacco epidemic p. 153
Rohini Ruhil
DOI:10.4103/ijcm.IJCM_213_17  PMID:30294078
Introduction: Till 2016, India was the second largest consumer of tobacco in the world, second only to China. However, in June 2017, the factsheet release of Global Adult Tobacco Survey-2 showed a 6% point decline in the prevalence of tobacco use among adults (>15 years) in the country. Materials and Methods: This is a form of ecological study where trends in aggregate prevalence of tobacco use at country level (using secondary data) were studied in relation to corresponding policy actions over a period of two decades. Results: The results have shown that initial policy actions since the cigarettes act of 1975 till prevention of food adulteration Amendment act of 1995 were largely targeting cigarettes, and so smoking prevalence among men was constantly declining. On the other hand, smokeless tobacco use was increasing among both men and women and reached a peak in 2009–2010. After that, the government took strict policy actions including Food Safety and Standards Authority of India Gutka ban in 2011. There were other persistent efforts, which are discussed in this paper. As a result, a transition has occurred in relation to tobacco epidemic in India. Conclusion: The paper has been concluded with a note that there is no room for complacence and we have a noncommunicable disease action goal to further decline the prevalence of tobacco use in the country to <24.22% by the year 2025.
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An epidemiological study of blood pressure and its relation with anthropometric measurements among schoolboys of Burdwan Municipal Area, West Bengal p. 157
Kaushik Nag, Nabarun Karmakar, Indranil Saha, Samir Dasgupta, Bijay Prasad Mukhopadhyay, Md Rafiul Islam Mondal
DOI:10.4103/ijcm.IJCM_232_17  PMID:30294079
Background: High blood pressure (BP) is often an underdiagnosed problem, because of the asymptomatic nature in early phases of onset during adolescence. This increases the chances of developing complications later during adult life. Objective: The objective of this study was to find the relationship of BP with anthropometric measurements among school-going adolescent boys. Materials and Methods: It was a cross-sectional study conducted among 894 adolescent schoolboys aged 13 to 18 years from July 2013 to October 2014 in schools of Burdwan Municipal area, West Bengal. The required number of students from each school was determined by proportional probability sampling. Then, the required number of students from each school was selected by systematic random sampling technique. BP and anthropometric measurements such as weight, height, and waist circumference were done using standard guidelines. Results: The mean systolic and mean diastolic BP in the study participants was significantly higher with an increase in weight, height, waist circumference, and body mass index (BMI) (P < 0.05). BP was found to be positively correlated with different anthropometric measurements such as weight, height, waist circumference, and BMI, which were statistically significant. Conclusion: Early detection of high BP and application of lifestyle modification among adolescents will be helpful in reducing the burden of high BP in adult life.
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Relationships between positive deviant behaviors and children of normal growth pattern in poorly resourced rural communities p. 161
Chitrarpita Saha, Vanisha S Nambiar
DOI:10.4103/ijcm.IJCM_236_17  PMID:30294080
Background: Promotion of positive deviant behaviors (PDBs) can be crucial to bring sustainable change as these behaviors are likely to be affordable and acceptable by the wider community. Objectives: The objective of this study was to assess if any PDBs exist among poorly resourced rural mothers with young children near Vadodara. Materials and Methods: Mothers of children <5 years (n = 160) were enrolled from four rural clusters near Vadodara based on their current growth status (weight-for-age) and were categorized as PD (n = 65) and negative deviant (ND; n = 95), as per the WHO Anthro Software. Personal interviews were conducted through household (HH) visits using a semistructured questionnaire. Data were elicited on HH socioeconomic status, infant and young child feeding practices, diet pattern, and hygiene–sanitation practices. HH dietary diversity score was calculated individually after collecting data through food frequency questionnaire. Results: Mothers had several significant PDBs (P < 0.05), PD group vs. ND group, less use prelacteals to children (53% vs. 71%) and had more exclusive breastfeeding rates (44% vs. 26%), provided cleaner clothing to children (52% vs. 28%), had sufficient intra-HH food distribution (30% vs. 18%), and scored better in dietary diversity at HH level (52% vs. 28%). Conclusions: PDBs and normal growth patterns do exist in poorly resourced areas, and these mothers can be used as “change agents” by the practicing pediatricians of rural communities for improving child health and nutrition.
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Association of physical problems and depression with elder abuse in an urban community of North India p. 165
Shashi Mawar, Pity Koul, Smita Das, Sanjay Gupta
DOI:10.4103/ijcm.IJCM_249_17  PMID:30294081
Context: Elder abuse is a serious problem that has adverse consequence on health. Still, research on elder abuse is sparse in India. Aims: This study aimed to find the nature, prevalence, and factors such as depression and physical problems associated with elder abuse in an urban North Indian community. Materials and Methods: A cross-sectional study was conducted with 222 elders with 97 males, aged 60 years or older residing in an urban community of Delhi. Elders were assessed for abuse by modified Vulnerability to Abuse Screening Scale questionnaire, Geriatric Depression Scale, and self-reported questions on health problems. Results: Mean age of the study population was 66.3 ± 4.2 years. The overall prevalence of any type of elder abuse was 24.3%. Psychological abuse was the most common type (22.9%) followed by financial abuse (5.8%), physical abuse (1.4%), and anti-constitutional abuse (nil). Among the abused, nearly 20% experienced more than one type of abuse. Thirty-seven women (30%) and 17 men (18%) reported elder abuse. Low income (Conclusion: Elder abuse is common in urban North India and is underreported. Appropriate interventions are required to ameliorate the problem.
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Ambiguity about selection of cardiovascular risk stratification tools: Evidence from a North Indian rural population p. 170
Tarundeep Singh, Manju Pilania, Gopal Singh Jat, Rajesh Kumar
DOI:10.4103/ijcm.IJCM_255_17  PMID:30294082
Background: Several nonlaboratory based cardiovascular disease (CVD) risk scoring tools are available for resource-limited settings, but the performance of these tools remains to be established in Indian population. This study aimed to assess and compare the performance of the World Health Organization (WHO)/International Society for Hypertension (ISH) risk prediction chart and the Framingham Risk Score (FRS) calculator in an Indian setting. Materials and Methods: This cross-sectional study was carried out among 283 participants aged 30–74 years who attended screening camps in the rural area of Punjab from October to December 2015. Nonlaboratory-based WHO/ISH risk prediction chart for South-East Asia Region and FRS calculator was used to assess the 10-year risk of cardiovascular event. Chi-square test for trend and quadratic weighted kappa were used for analysis. Results: Of total participants, 67.1% were female. Mean age of the study participants was 52.1 (standard deviation ± 11.6) years. Using the WHO/ISH risk prediction chart, 11.3% and 4.9% of the participants were found to have high and very high risk, respectively, whereas, FRS calculator predicted high risk in 13.8% and very high risk in 12.0% for developing CVD in next 10 years. Agreement level between two risk prediction tools was good (67.8%). Conclusion: Although the good agreement was seen between WHO/ISH risk prediction chart and FRS calculator, the proportions of participants having a high and very high risk of CVD identified by these risk prediction tools are significantly different. In resource constraint setting like India, CVD risk prediction tools should be validated for local population by prospective cohort studies to ensure judicious use of resources.
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Knowledge and skills of ayurvedic and homeopathic practitioners to provide skilled birth attendance in India: An observational study p. 175
Nomita Chandhiok, Shalini Singh, Nayanjeet Chaudhury, Aparna Shrotri
DOI:10.4103/ijcm.IJCM_280_17  PMID:30294083
Background: To overcome the dearth of trained skilled birth attendants, mainstreaming of doctors from the alternative systems of medicine has been adopted by some states in India. Objectives: The objectives of the study were to explore the adequacy of knowledge and clinical skills of AYUSH practitioners (APs) (ayurvedic and homeopathic) engaged by the state governments to provide maternity care services, with a view to identify gaps if any, and to suggest measures for improvement. Materials and Methods: A cross-sectional observational study was conducted in three states of India (Maharashtra, Rajasthan, and Odisha). The APs were assessed for (a) knowledge of essential obstetric care and identification and management of complications of pregnancy and (b) clinical skills during provision of antenatal and postnatal care (PNC) and during the conduct of deliveries. Adequate knowledge or skill demonstration was defined as a score of 70% or more. Results: A total of 109 APs engaged in 37 peripheral level facilities were assessed. Nearly 76% of APs had adequate theoretical knowledge of essential obstetric care and identification and management of complications of pregnancy. Most APs demonstrated adequate skills while providing antenatal care but were deficient in taking past history and counseling pregnant women for danger signs during pregnancy and childbirth. APs in Maharashtra and Rajasthan had adequate skills for conducting vaginal deliveries but performed poorly in Odisha. Skills for resuscitation of newborn were deficient. Skills for providing PNC were adequate only among APs in Maharashtra. Conclusion: Through provision of appropriate in-service training and an enabling environment, APs may be a useful human resource for providing maternity care in the primary health-care settings in India.
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A comparative study on social media usage and health status among students studying in pre-university colleges of urban Bengaluru p. 180
NR Ramesh Masthi, S Pruthvi, MS Phaneendra
DOI:10.4103/ijcm.IJCM_285_17  PMID:30294084
Introduction: Social Media usage is a “global consumer phenomenon” with an exponential rise within the past few years. The use of social media websites is among the common activity for today's adolescents, they are sometimes overused/misused, which may lead to social media addiction. Objectives: The objective of this study was to assess and compare the prevalence of social media addiction between Government and Private Pre-University (PU) college study subjects, to assess the health problems related to social media usage among the study subjects, and to assess the various factors associated with social media addiction. Materials and Methods: This cross-sectional study was conducted in Government and Private PU colleges situated in a selected ward of urban Bengaluru city through multistage sampling. A total of 1870 study subjects were recruited. A scale was developed to assess social media addiction. Results: The prevalence of social media addiction was 36.9% among users, distributed equally among private and Government PUs. The most common health problem identified was strain on eyes (38.4%), anger (25.5%), and sleep disturbance (26.1%). Being a male, the habit of smoking, alcohol, and tobacco, consumption of junk food, having ringxiety and selfitis were found to be significant risk factors for social media addiction. Conclusion: Social media addiction was found in over one-thirds of subjects and majority had mild addiction.
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Assessment of tuberculosis prevalence in newly diagnosed human immunodeficiency virus-infected adults attending care and treatment center in Gujarat, India Highly accessed article p. 185
Dixitkumar Jayantibhai Kapadiya, Paresh V Dave, Bhavin Vadera, Pranav Govindbhai Patel, Sudhir Chawla, Deepak Saxena
DOI:10.4103/ijcm.IJCM_291_17  PMID:30294085
Background: Tuberculosis (TB) is first opportunistic infection and leading cause of death among human immunodeficiency virus (HIV)/AIDS. Certainly, the prevalence of TB is expected to differ between general population and HIV-infected persons. This study was conducted to determine the prevalence of TB among newly diagnosed HIV-infected adults attending antiretroviral therapy (ART) center in the state of Gujarat, India. Materials and Methods: Cross-sectional study was carried out among newly diagnosed HIV-infected persons attending ART center from July 2012 to September 2012. Screening of TB symptoms and chest X-ray was done for those who consented. Sputum samples were collected for microscopy with Ziehl–Neelsen method for all presumptive TB cases and those diagnosed as pulmonary TB, culture, and drug susceptibility test was done. Blood samples were collected for CD4+ T-cells count and hemoglobin. Results: Out of 2021 eligible HIV-infected persons, 63.5% were males and 68.2% were in the age group of 26–45 years. The prevalence of TB was 17.8%. Among 360 patients with TB, 102 (28%) had smear positive TB, 86 (24%) had smear-negative TB, and 172 (48%) were diagnosed as extrapulmonary TB. Two hundred and thirty-eight (27%) TB patients with CD4+ T-Cell count below 200 compared to 122 (11%) patients above 200. Conclusion: A high prevalence of TB was found among newly diagnosed HIV-infected adults attending ART center for care and treatment. The prevalence of pulmonary and extrapulmonary TB was almost equal. Chances of TB disease were more with depletion of CD4 counts. The study highlights urgent need of intensive case finding as well as periodic screening of newly diagnosed HIV-infected individuals.
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Comparison between weight-for-height Z-Score and mid upper arm circumference to diagnose children with acute malnutrition in five Districts in India p. 190
Praveen Kumar, Vasundhara Bijalwan, Narendra Patil, Abner Daniel, Rajesh Sinha, Richa Dua, Anju Seth
DOI:10.4103/ijcm.IJCM_310_17  PMID:30294086
Background: The World Health Organization recommends weight-for-height Z-score (WHZ) or mid-upper arm circumference (MUAC) and bilateral pitting edema to diagnose acute malnutrition among children aged 6–59 months. WHZ and MUAC identify different sets of children with acute malnutrition, and overlap between their prevalence varies greatly among countries. Objective: The objective of the study was to determine the degree of overlap and agreement between WHZ and MUAC to diagnose children with acute malnutrition in India. Methods: Five nutrition surveys using Standardized Monitoring and Assessment of Relief and Transitions methodology were conducted in four Indian states. A total of 2127 children aged 6–59 months were analyzed. All anthropometric indices were calculated using emergency nutrition assessment software and analyzed in Epi-Info 3.5.4. Results: Of total global acute malnutrition (GAM) cases, 96% and 28.4% cases were diagnosed with WHZ and MUAC, respectively. Similarly, of total severe acute malnutrition (SAM) cases, 95.1% were identified using WHZ and 30% using MUAC. The proportion of overlap between the two criteria for GAM and SAM cases was 24.5% and 25.2%, respectively. The analysis showed that MUAC was comparatively more sensitive to identify acute malnutrition among 6–23-month aged children and females. Conclusion: One-fourth of GAM and SAM cases were identified with both criteria. MUAC identified approximately 30% of the total SAM cases which was lower than other countries. MUAC identified more number of females and younger children, who may have higher mortality risk and would result significantly smaller caseload (68% smaller) that requires intervention compared to when using WHZ.
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Devadasi and their intimate partners: Dynamics of relationship p. 195
Janardhana Navaneetham, Manjula Basavarju, Mutharaju Arelingiah
DOI:10.4103/ijcm.IJCM_311_17  PMID:30294087
Background: Devadasi practice is still prevalent in some parts of North Karnataka; most of the Devadasis get into sex work for their survival. During sex work, devadasis would get close to their customer, as they feel secure and emotionally satisfied. Objectives: The present study aims at understanding the Devadasi sex worker (DSW) and their intimate partners' (IPs) relationship and knowing the reasons for continuing the relationship even though they experience violence and abuse from their IP. Methods: Exploratory research design was adopted. Purposive sampling was used for the field visits. Data were gathered through personal interviews during field visits along with the counselors who were capacitated to deal with the relationship issues of DSWs and their IPs. Modified thematic analysis was used to analyze twenty field visit reports. Results: This study analyzed the quality and dynamics of the relationship between DSWs and their IP. DSWs and their IP define their relationship as “like marriage” without legal recognition. DSWs accept the violence from their IP as a symbol of love. Violence was identified as a key concern for the sex workers and is often acceptable in their relationship. Conclusion: The relationship between DSWs and their IPs needs to be understood before arriving at the care plan to deal with the relationship issues. There is an urgent need for developing an interventional model for the counselors and equip them to deal with the relationship issues of DSWs.
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Spatio-Temporal risk-analysis of cancer endemicity in Sulthan Bathery Taluk of Wayanad District of Kerala-A geo-informatics approach p. 199
Elmy Gory, Rajesh Kumar Sinha, Dola Saha, TR Vinod, NR Crips, Preetam Ashok Gaikwad
DOI:10.4103/ijcm.IJCM_52_18  PMID:30294088
Context: Asian countries have to confront with the global burden of cancer and various environmental factors predisposing the incidence. Geoinformatics can assist in spatial autocorrelation and statistical analysis in determining environmental and demographic correspondence to endemicity. What is of prime importance is the availability of the spatial datasets of cancer cases. Aims: The aim of this study was to reveal the distribution pattern of cancer and its magnitude in the eight panchayats of Sulthan Bathery Taluk of Wayanad district. The present study also attempted to develop and implement a data frame facilitating better data collection. Settings and Design: This was a taluk-level cross-sectional retrospective analysis and interventional study. Subjects and Methods: A retrospective survey created a geodatabase with 547 cancer cases registered along the timeline of 2015–2016. Input datasets were geocoded using Google Earth Pro software. Statistical Analysis Used: The analysis was performed using ArcMap-10.2 version. Results: Registration revealed the high breast cancer incidences and temporal increment mainly in town areas. The incidence depicted male predominance and prevalence along the age group of 30–69 years. The pattern showed cancer incidence at a proximity to state borders and forest regions (Noolpuzha) which are high population density regions, instantiated relation of geographic variables, and cancer incidences. The implementation of data frame ensured structured data collection. Conclusions: This study concluded the spatial association of cancer incidence demonstrating the high-risk regions with male predominance and role spatial risk analysis in cancer database management.
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Prediction model of tuberculosis transmission based on its risk factors and socioeconomic position in Indonesia p. 204
Dyah Wulan Sumekar Rengganis Wardani, Endro Prasetyo Wahono
DOI:10.4103/ijcm.IJCM_60_18  PMID:30294089
Context: The current evidence shows that people in low-socioeconomic positions tend to be at high risk for tuberculosis (TB) transmission. Aims: The aim of this study is to identify the significance of socioeconomic position and TB risk factors to TB transmission, particularly in Bandar Lampung, Indonesia. Settings and Design: This cross-sectional study, conducting in January–November 2017, included 166 samples of smear-positive TB patients collected from 30 community health centers across the city that had implemented DOTS strategy. Subjects and Methods: The latent variables consisted of the following: socioeconomic position, housing, nutritional, healthcare access, and TB transmission, which was measured through corresponding indicators. The data were collected through in-depth interviews. Statistical Analysis Used: Data analyzed using the partial least square method. Results: Determinants of socioeconomic position through housing determinants significantly influence TB transmission with R2of 42.3%. They also show that education, housing density index, and internal house transmission are the strongest indicators in explaining their associated latent variables. Conclusions: TB control program should be integrated with education improvement, a reduction of housing density index, and strengthened examinations of internal house contacts. These programs should be supported by health institutions and other related institutions. The findings will improve TB control programs, especially in low- and middle-income countries with high-socioeconomic disparity.
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District level analysis of routine immunization in Haryana State: Implications for mission indradhanush under universal immunization programme p. 209
Shankar Prinja, Divya Monga, Saroj Kumar Rana, Atul Sharma, Suresh Dalpath, Pankaj Bahuguna, Rakesh Gupta, Arun Kumar Aggarwal
DOI:10.4103/ijcm.IJCM_306_17  PMID:30294090
Background: The immunization coverage in India is far away from satisfactory with full immunization coverage being only 62% at national level. Targeting the intensive efforts to poor performing areas and addressing the determinants of nonimmunization and dropouts offers a quick solution. In this paper, we assess the inter-district variations in Haryana state, and the association of social determinants with partial and no immunization. Methodology: This analysis is based on data collected as part of a large household survey undertaken in the state of Haryana to measure the extent of Universal Health Coverage. A multistage stratified random sampling design was used to select primary sampling units (i.e., subcenters), villages, and households. A total of 11,594 mothers with a child between 12 and 23 months were interviewed on receipt of immunization services. Determinants of nonimmunization and partial immunization were assessed using multiple logistic regression. Results: About 21% of children aged 12–23 months were partially immunized, while 4.3% children aged 12–23 months had received “no immunization.” While the coverage of full immunization was 74.7% at the state level, it varied from 95% in best performing district to 38% in poorest performing district. Odds of a partially immunized child were significantly higher in urban area (odds ratio [OR] = 1.23; 95% confidence interval [CI] = 1.1–1.38), among Muslim household (OR = 3.52; 95% CI = 3.03–4.11), children of illiterate parents (OR = 1.58; 95% CI = 1.22–2.05), and poorest quintile (OR = 1.61; 95% CI = 1.36–1.89). Conclusions: Wide interdistrict variations call for a need to consider changes in resource allocation and strengthening of the government initiatives to improve routine immunization in these districts.
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Analysis of out-of-pocket expenditure in utilization of maternity care services in urban slums of Rajkot City, Gujarat p. 215
Sandeep Sharma, Pramod B Verma, Ankit P Viramgami, Mayur C Vala, Kaushik K Lodhiya
DOI:10.4103/ijcm.IJCM_47_18  PMID:30294091
Background: India contributes 20% global maternal deaths every year. An important reason of such maternal mortality is due to cost of maternity services which makes it in accessible to the poor. Knowledge of maternity-related expense and its determinants is useful for health authorities to focus public resources and target financial assistance or exemption guidelines toward the “neediest.” Methodology: It was a cross-sectional descriptive study conducted amongst 180 women living in urban slums and who had delivered a baby within 1 year of the interview date. Results: The mean cost of delivery was around Rs. 8880. The average delivery cost of private institutions was significantly higher than that of government hospitals or home delivery. Around 75% of women delivered in private institution had health expenditure of more than 10% of total annual family income – catastrophic expenditure. Conclusion: In spite of significantly higher maternity care-related costs in private institutes than government hospitals, majority of mothers had utilized services from private clinics and had suffered catastrophic expenditures during utilization of maternity care services. This study highlights the need for birth preparedness counseling as well as effective implementation of maternity benefit schemes to prevent families from pushing downward to the poverty line.
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Nicotine dependence, its risk indicators, and exhaled carbon monoxide levels among the smokers in Bengaluru, India p. 220
P Sugavanesh, K Pushpanjali
DOI:10.4103/ijcm.IJCM_98_18  PMID:30294092
Background: Tobacco is the significant cause of preventable death worldwide. The prevalence of smoking in India is 13.3%. Among the chemical constituents in the cigarette, nicotine is the one most often associated with dependence resulting in increased consumption of them. Studies have proven the dose-dependent relationship of cigarette smoking with lung and oropharyngeal cancer. Hence, assessment of nicotine dependence among the smokers is essential as it influences the tailor-made intervention. Objectives: The objectives of this study were to assess the nicotine dependence and exhaled carbon monoxide (CO) levels among the smokers in Bengaluru. Materials and Methods: A cross-sectional survey was conducted among 396 smokers selected using probability proportional to size sampling technique. Fagerstrom Test for Nicotine Dependence was used to assess the levels of nicotine dependence. Exhaled CO levels were measured using the Smokerlyzer to indicate the nicotine dependence. Results: About 23.7% of the participants had the very low dependence on nicotine. Nearly 26% and 22.5% of the participants had the high and very high dependence on nicotine correspondingly. The number of years of smoking was found as a significant risk indicator for nicotine dependence. Exhaled CO levels were significantly correlated with the nicotine dependence (P = 0.000) indicating it as a marker for nicotine dependence. Conclusion: The high nicotine dependence among the participants warrants effective public health policies to prevent tobacco-related diseases. Considering the risk indicator, the number of years of smoking, smoking cessation programs should target the participants with the habit of continuous smoking with tailor-made interventions to prevent the relapse among them.
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Quality of free delivery care among poor mothers in Gujarat, India: A community-based study p. 224
Kranti S Vora, Shahin L Saiyed, Dileep V Mavalankar
DOI:10.4103/ijcm.IJCM_51_18  PMID:30294093
Background: Government of Gujarat introduced a public–private partnership scheme called the Chiranjeevi Yojana (CY) in 2005, to improve access to delivery care for poor women. Till date, more than 1 million deliveries have been conducted under CY. Although CY has been evaluated, this is the only study using primary data to evaluate the quality of care. Objective: The objective of this study was to (i) determine the quality of free delivery care and (ii) examine the differences in the quality of care between public sector facilities and accredited private sector facilities. Methodology: The community-based survey was conducted in three districts of Indian state of Gujarat. Trained data collectors used pretested questionnaire in vernacular language between 7th and 10th days of delivery. Overall surveyed mothers were 3858 in the prospective study; analytic sample was 1616 mothers. Statistical analysis includes Chi-square test using IBM SPSS version 20. Results: Quality of care was perceived to be good in both public sector and accredited private sector. When free delivery care was compared between two sectors, private sector was perceived to have better quality of care. This difference was statistically significant for indicators, such as infrastructure, allowed to eat/change positions, application of pressure on abdomen, and weighing of baby. Conclusion: The study highlights the need for engaging private sector to improve access to delivery care for poor women. Quality assurance programs in Gujarat need to address respectful care issues in the public sector. Future research should include qualitative study to understand the drivers of quality delivery care.
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Morbidity pattern and role of community health workers in urban slums of durg and Bhilai City of Chhattisgarh p. 229
Kishu Waghela, Nagma Nigar Shah, Somen Saha
DOI:10.4103/ijcm.IJCM_53_18  PMID:30294094
Introduction: In 2002, the Government of Chhattisgarh initiated a Community Health Worker program called the Mitanin Program, to strengthen the health system of Chhattisgarh. The current study was conducted with the twin objectives to assess morbidity pattern and health-seeking behavior in urban slums of Durg and Bhilai to understand the role of Mitanins in health seeking of their slum population. Methods: Ten urban slums, five each from Durg and Bhilai were selected through simple random sampling for the study. Household survey was done using prestructured questionnaire. A total of 1025 households representing 4997 family members were surveyed. Results: The study found that diseases which were most prevalent in the urban slums of Durg and Bhilai are blood pressure and diabetes mellitus. Diseases such as diarrhea, typhoid, hepatitis, tuberculosis, leprosy, and filariasis which have strong association with safe drinking water and sanitation are prevalent. For chronic communicable disease and reproductive and child health (RCH), people from both cities prefer going to public health-care facilities. About a fourth of the population came in contact with the Mitanins to seek health care mostly in relation to chronic communicable diseases and RCH. Conclusion: The study shows an increase in the prevalence of chronic lifestyle diseases among the slum population. There is a case for inclusion of chronic conditions, as specified under Comprehensive Primary Health Care. There is a need to reprioritize Mitanin's role in early diagnosis through point-of-care diagnostics and ensuring prompt referrals and follow-up.
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Journey to death: Are health systems failing mothers? p. 233
Kranti Suresh Vora, Shahin L Saiyed, Sandul Yasobant, Saanchi V Shah, Dileep V Mavalankar
DOI:10.4103/ijcm.IJCM_57_18  PMID:30294095
Background: Annually, about 44,000 maternal deaths occur in India, which is 20% of the global burden. Despite persistent efforts, India failed to meet the fifth millennium development goal by 2015. Lack of reliable data on maternal mortality demands utilization of tools for counting maternal deaths which is vital to implement preventative actions. Objectives: Our study aims to determine health system-related issues of maternal mortality using the WHO validated tool – Maternal Death Review and demonstrates usefulness of maternal death surveillance and review as a monitoring tool. Methods: Fourteen maternal deaths were evaluated through community based and facility-based audits from July 2013 to June 2014 in three districts of Gujarat. Pathways to death were traced through Global Positioning System (GPS). Factors contributing to the three delays were analyzed. Results: Type III delay, that is, delay in receiving adequate care was frequently observed in our review including weak referral linkages, lack of blood banking services, inadequate surgical facilities. and staff shortages. Mothers succumbed, not because they did not seek treatment or reach facilities in time but because facilities were incapable of providing appropriate medical care. Conclusion: Scaling up of maternal death audits and subsequent use of these findings will help to reduce maternal mortality in India. As we continue to push for institutional deliveries, we need to reevaluate if our health system is prepared to manage an increasing number of facility births and obstetric complications.
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SHORT COMMUNICATION Top

Sexual and reproductive health concerns of adolescents living with perinatally infected HIV in India p. 239
Mysore Narasimha Vranda, Doddaballapura K Subbakrishna, Jayashreee Ramakrishna, Hukunda Gundaiah Veena
DOI:10.4103/ijcm.IJCM_5_18  PMID:30294096
Background: With improved access to highly active antiretrieval treatment, many children with perintally acquired HIV are now able live longer. These children are now reaching into adolescence and sexually active. This qualitative, explorative study examines the sexual and reproductive health (SRH) needs and concerns of adolescents living with HIV (ALHIV) in India. Materials and Methods: We used qualitative research design to collect the data. Twenty participants were recruited from two nongovernmental organizations which provide shelter care, education, and emotional and social support to HIV/AIDS orphan children located in Bengaluru District of Karnataka State using purposive sampling. In-depth interview guide was prepared and used to elicit the adolescents' concerns, knowledge, and perspective related to sexuality, marriage, child bearing, and barriers in availing SRH services in the context of HIV. Results: Totally, four themes were emerged from that qualitative data based on thematic analysis, which are as follows: “Perceived challenges in relation to romantic relationship;” “Confusion regarding whether to marry person with HIV positive or HIV negative;” “Aspiration to have children,” and “Perspective of ALHIV in relation to SRH needs and concerns.” Conclusion: The findings of the research brought out the need for policies and guidelines specifically targeting the SRH needs and concerns of ALHIV.
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LETTERS TO EDITOR Top

Maternal mortality audit in Delhi: Further perspectives p. 243
Saurav Basu
DOI:10.4103/ijcm.IJCM_258_17  PMID:30294097
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Response from the Authors (Singla et al)[1] p. 243
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Effect of counseling on newly diagnosed Type 2 diabetes mellitus patients visiting a tertiary care hospital: A randomized control trial p. 244
Varun S Parmar, Sangita V Patel, Charoo C Iyer
DOI:10.4103/ijcm.IJCM_61_18  PMID:30294099
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Open defecation-free India by 2019: How villages are progressing? p. 246
Jay Patwa, Niraj Pandit
DOI:10.4103/ijcm.IJCM_83_18  PMID:30294100
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Health-Care services utilization among diabetes patients enrolled in tertiary care hospital of East Delhi p. 248
Archana Thakur, Tapas Kumar Ray, Manish Kumar Goel
DOI:10.4103/ijcm.IJCM_121_18  PMID:30294101
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  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007