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    Table of Contents - Current issue
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January-March 2020
Volume 45 | Issue 1
Page Nos. 1-109

Online since Tuesday, January 14, 2020

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EDITORIAL COMMENTARY  

Achieving Universal Health Coverage in India: The Need for Multisectoral Public Health Action Highly accessed article p. 1
Rajesh Kumar
DOI:10.4103/ijcm.IJCM_61_19  
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VIEW POINTS Top

Colombo declaration on epidemiology in Southeast Asia p. 3
Vinod K Srivastava
DOI:10.4103/ijcm.IJCM_526_19  
The Colombo Declaration on Epidemiology in Southeast Asia is based on the deliberations by the delegates of the conference and representatives of the Regional Public Health/Epidemiology Associations held during the Southeast Asia Regional Group Meeting of International Epidemiological Association/College of Community Physicians of Sri Lanka at Colombo, Sri Lanka, on September 19–21, 2019.
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Equity and quality of health-care access: Where do we stand and the way forward? Highly accessed article p. 4
Amitav Banerjee
DOI:10.4103/ijcm.IJCM_183_19  
The development in the country's health status has not kept pace with its economic development. Although India along with most countries of the world was a signatory to the Alma Ata Declaration of 1978, its performance particularly on health equity and quality issues, so far, has been far from satisfactory. There are vast variations in health-care status by states, by ethnic groups, gender, and urban-rural difference. Till recently, government policies and people's perceptions also seemed to be on the wrong track. Our priorities seemed to be all wrong – we seemed to prefer setting up of high-cost tertiary health institutions at the expense of the primary health centers. The recently launched Swachh Bharat and Ayushman Bharat schemes offer hope of addressing these asymmetries. This paper briefly dwells on these issues.
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ORIGINAL ARTICLES Top

Maternal ability to correctly detect significant jaundice in Indian neonates p. 8
Alok Yadav, Amit Devgan, Subhash Chandra Shaw, Puja Dudeja
DOI:10.4103/ijcm.IJCM_379_18  
Background: The ability of mothers to correctly detect jaundice in their newborns is largely unknown. The objective was to ascertain the ability of mother to correctly detect the presence of significant jaundice in her newborn. Materials and Methods: This cross-sectional study was conducted in a tertiary care hospital in eastern India from February 2015 to July 2016. All inborn neonates more than 34 weeks' gestation were included. Congenital malformations, perinatal asphyxia, neonatal sepsis, readmission after discharge, and isoimmunization were excluded. A total of 505 inborn newborns were independently assessed by the mother and the treating pediatrician for significant jaundice every day till discharge. Each newborn underwent total serum bilirubin estimation on suspicion of significant jaundice by either of the two or at discharge, whichever was earlier. Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of maternal detection of significant jaundice was 51.47%, 88.33%, 39.29%, and 92.12%, respectively. Conclusion: Mothers have poor sensitivity and PPV to detect significant neonatal jaundice in the Indian population.
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Major correlates and socioeconomic inequalities in hysterectomy among ever-married women in India p. 12
Shri Kant Singh, Santosh Kumar Sharma, Ankita Siddhanta
DOI:10.4103/ijcm.IJCM_12_19  
Purpose: This article focuses at the prevalence of hysterectomy, its major correlates, and the socioeconomic inequalities in the prevalence of hysterectomy among women in India. Methods: It used data from 527,865 ever-married women interviewed in 2015–2016 National Family Health Survey-4 from 601,000 households across 640 districts in the country. The economic inequalities in the prevalence of hysterectomy have been analyzed using poor–rich ratio and the concentration index (CI) in addition to the adjusted effects of major correlates through multiple logistic regression. Results: Unadjusted (9.3%) and adjusted prevalence of hysterectomy (odds ratio [OR] =7.3; P < 0.001) are significantly higher among women aged 40 and above. Women from rural areas (OR = 1.2; P < 0.001) and those who were formerly married (6%) were more likely to have undergone hysterectomy. Over two-thirds of hysterectomies were conducted in private health-care facilities, where 51% reported that excessive menstrual bleeding was the main reason for hysterectomy. The value of poor–rich ratio (0.79) and CI (0.121) clearly depicts that hysterectomy is more inclined to be concentrated among middle-to-richer class of women in India. Conclusions: Private health-care sector should have standard regulatory practices to deliver more efficient, accountable, and sustainable maternal health-care services.
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Evaluation of maternal health services being provided to the high-risk mothers of Bhavnagar district, Gujarat p. 18
Pooja A Chauhan, Kailesh D Bhalani
DOI:10.4103/ijcm.IJCM_38_19  
Background: Despite substantial progress on maternal and child mortality, neither the Millennium Development Goal 4 nor 5 targets could be met. The global maternal mortality ratio declined by 44% between 1990 and 2015, short of the targeted 75% fall. Objectives: The objective of the study is to evaluate the maternal health services being provided to the high-risk mothers (HRMs) of Bhavnagar district. Methodology: It was a cross-sectional study conducted among the HRMs of Bhavnagar district during the period from March 2017 to August 2018. A total of 90 HRMs were selected and interviewed. Results: All the HRMs were measured for blood pressure and weight; tested for hemoglobin, blood group, and HIV; and examined for pedal edema. None of the HRMs were tested for sickle cell anemia. In the best performing primary health centers (PHCs), all the HRMs were tested for venereal disease research laboratory and hepatitis B surface antigen as against 79.5% of the HRMs from the worst-performing PHCs. About 47.7% of the HRMs from the worst-performing PHCs and 13.3% of the HRMs from the best-performing PHCs made <4 antenatal care (ANC) visits. Conclusions: For most of the ANC services, reason for nonreceipt of the service as given by the HRMs was “service not offered.”
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A study on respiratory morbidities and pulmonary functions among traffic policemen in Bengaluru city p. 23
Giriyanna Gowda, R Thenambigai
DOI:10.4103/ijcm.IJCM_102_19  
Context: Air pollution is a major public health problem in the present Indian cities, due to unplanned urbanization and increased use of vehicles. Traffic policemen, due to the nature of their job and working atmosphere, are more prone to develop respiratory problems such as asthma, chronic obstructive pulmonary disease, rhinitis, recurrent respiratory tract infections, and others. Objectives: The objective was to find out the respiratory morbidities and to assess their pulmonary function using computerized spirometry among traffic policemen in Bengaluru city. Settings and Design: A cross-sectional study was conducted for a period of 6 months (from January 2018 to June 2018) in randomly selected traffic police stations in South Bengaluru, Karnataka. Subjects and Methods: A pretested, semi-structured questionnaire was used to collect information on the demographic profile, duration of exposure, smoking history, allergy/asthma history, and the use of personal protective measures. Pulmonary function test (PFT) was done to assess the lung function using computerized spirometry. Statistical Analysis Used: Data were entered and analyzed using Microsoft Excel 2016 version. Results: A total of 217 traffic policemen were included in the study. The mean duration of working in the traffic department was 5.9 ± 6.6 years (mean ± standard deviation). Among them, 101 (46.5%) used personal protective measures. Allergic rhinitis was reported by 38 (17.5%) individuals, and 28 (12.9%) individuals had chest symptoms (cough and breathing difficulty). Among them, 44 (20.3%) experienced exacerbation of these symptoms at the workplace. Observed mean values of all parameters in the PFT were less than their predicted (expected) values. Conclusions: There was increased burden of respiratory problems and lower lung volumes and flows among traffic policemen.
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Identifying and addressing factors contributing to pretreatment loss to follow-up of tuberculosis patients referred for treatment from medical colleges in Pondicherry: An implementation research p. 27
P Stalin, M Manikandan, Vincent Antony, N Murugan, Zile Singh, King Herald Kisku, Anil Jacob Purty, Kavita Vasudevan, Johnson Cherian, Venkateswara Babu, R Pajanivel, G Kalaiselvan
DOI:10.4103/ijcm.IJCM_118_19  
Background: In India, there is no feedback regarding 34% of tuberculosis (TB) patients diagnosed and referred from medical colleges for treatment to peripheral health institutions (PHIs). Objectives: The aim of this study is to measure the effectiveness of the new intervention package, developed based on qualitative study in reducing pretreatment loss to follow-up (PTLFU) of all TB patients diagnosed and referred for treatment from medical colleges to PHIs. Materials and Methods: An intervention was developed based on the findings of in depth-interviews conducted among different stakeholders such as TB patients who did/did not report, service providers working in four medical colleges in Pondicherry. Intervention consisting of phone calls, home visits, etc., was implemented for a period of 6 months. The baseline and endline proportion of TB patients for whom feedback received was determined from the available records (Revised National TB Control Program State Task Force Quarterly reports). Results: Patient's ignorance, lack of faith in healthcare system, side effects and social stigma, unpleasant experience in hospitals, poor accessibility to directly observed treatment, short-course centers, drugs shortage, poor coordination between program and hospital staff were the risk factors for PTLFU. At baseline, the proportions of feedback received about TB patients referred for treatment from medical colleges to PHIs was 46%. After the initiation of interventions, it increased to 61% and 66% in the first and second quarters of 2017, respectively. Conclusion: Risk factors for PTLFU were multi-factorial related to both patient and health system. Simple, feasible interventions such as phone calls and home visits to TB patients were effective in reducing PTLFU.
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Efficacy of focused group discussion on knowledge and practices related to menstruation among adolescent girls of rural areas of rhtc of a medical college: An interventional study p. 32
Prashant Ramdas Kokiwar, P Nikitha
DOI:10.4103/ijcm.IJCM_134_19  
Context: Learning about menstrual hygiene is vital part of health education for adolescent girls so that they can continue to work and maintain hygienic habits throughout their adult life. Aim: The aim is to study the efficacy of focused group discussion (FGD) in comparison to didactic lecture method (DL) on knowledge and practices related to menstruation among adolescent girls of rural areas. Materials and Methods: Community-based interventional study was carried out among 260 adolescent girls. Knowledge and practice were assessed with the help of questionnaire preintervention. During intervention, 130 girls in DL group were given DL and 130 girls in FGD received FGD. After 2 months, all 260 girls were contacted. Their knowledge and practices were assessed using same questionnaire. Statistical Analysis: Yates corrected Chi-square and Student's t-test was used. Results: Both methods were equally effective in increasing mean knowledge and practices score (P < 0.05). On comparison of mean postintervention scores between the two groups for knowledge, the FGD method was found to be superior (P < 0.05) but not for practices (P > 0.05). Conclusion: FGD was more effective than DL method for knowledge related to menstruation but not for practices.
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Restructuring the modified Faine's criteria for the diagnosis of leptospirosis in monsoon: A study from south Gujarat p. 36
UC Samudyatha, Vipul Chaudhari, Naresh Chauhan, Rahul Damor, JK Kosambiya, Rikita Munshi
DOI:10.4103/ijcm.IJCM_180_19  
Context: Clinical and epidemiological variables in the modified Faine's criteria offered low validity in our study setting. Aims: Restructuring and validating modified Faine's criteria for leptospirosis to better suit health scenario of south Gujarat. Subjects and Methods: Clinical, epidemiological, and laboratory features of derivation cohort (1216 suspected leptospirosis cases) admitted at a tertiary care hospital of south Gujarat (2007–2015) that significantly correlated with confirmed leptospirosis were used in binary logistic regression to derive scoring models and receiver operating characteristic to determine cutoff values. Validity and net reclassification improvement (NRI) were estimated in validation cohort (82 cases, 2016–2017) and algorithm for diagnosis was prepared. Results: Screening model consisted of the presence of conjunctival suffusion, calf tenderness, raised serum creatinine, headache with conjunctival suffusion and/or jaundice, and dyspnea/meningism. Area under curve (AUC) for screening model was 0.590 (standard error [SE] ±0.017) and cutoff score ≥9 gave sensitivity 79.16%, specificity 50%. The confirmatory model consisted of laboratory parameters, namely polymerase chain reaction, immunoglobulin M ELISA, and microscopic agglutination test and gave AUC 0.998 (SE ± 0.001), sensitivity 89.58%, specificity 85.29%, positive predictive value 89.58%, and negative predictive value 85.29% at cutoff score ≥100. Net sensitivity of algorithm was 98.27% at the point of screening (screening model and rapid test) and net specificity 87.89% at the point of confirmation (screening followed by confirmatory model) in validation cohort. Conclusions: Simultaneous use of screening model and rapid test gave NRI 81.25% and sequential use of confirmatory test gave NRI 47.18% compared to corresponding parts of the modified Faine's criteria.
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Spatio-temporal dynamics of tuberculosis clusters in Indonesia p. 43
Dyah Wulan Sumekar Rengganis Wardani, Endro Prasetyo Wahono
DOI:10.4103/ijcm.IJCM_182_19  
Context: Stratification of social determinants leads to clustering of low socioeconomic communities, which then leads to spatio-temporal tuberculosis (TB) clusters. While previous studies have investigated spatio-temporal TB clusters, few have reported on the dynamics of them and the characteristics of social determinants.Aims: To investigate the spatio-temporal dynamics of TB clusters in Bandar Lampung, Indonesia, from 2015 to 2016, and to identify the characteristics of population density and percentage of poverty of the clusters.Settings and Design: A cross-sectional study was performed to analyze the spatio-temporal dynamics of TB clusters. The sample consisted of 705 TB patients (2015) and 1134 TB patients (2016), registered in 30 community health centers in Bandar Lampung, Indonesia Subjects and Methods: Geographical coordinates of the TB patients' residence were collected using Geographical Positioning System. Secondary data, consisting of population density and the percentage of poverty, were obtained from the subdistrict office in the region under investigation.Statistical Analysis: Data were analyzed with space–time permutation model using SaTScan software.Results: Spatio-temporal dynamics of TB clusters were found in 2015 and 2016, including the number of significant clusters, TB cases within the clusters, as well as locations and sizes of the clusters. All the clusters were found to have similar social determinant characteristics: medium–high population density and low–medium percentage of poverty.Conclusions: TB control programs in countries with a high TB burden and low social determinants should consider the spatio-temporal dynamics of the TB cluster and its social determinant characteristics for a better TB's intervention.
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Parental-group interventions for parents of children with mental health problems admitted in a tertiary care center: An experience from India p. 48
N Janardhana, B Manjula
DOI:10.4103/ijcm.IJCM_192_19  
Background: Families play a critical role in their children's development and learning. Parents' understanding of their child's illness has a significant impact on the parent–child relationship and helps them to have realistic expectations. Objectives: The objective of this study is to understand the use of parental-group intervention for making parents understand the problems of the children and to develop skills to deal with the problems. Methods: A six-session parental-group intervention module was developed and tested. Data from the group session were collected for 6 months and have been analyzed. Results: Majority of the parents appreciated the intervention program as it led to skill-building and understanding of the mental health problems among children. Demonstration was liked most of the parents (74) parenting skills and stress management (71 parents); 68 parents liked session on school-related issues; 60 parents liked session on developmental disorders; 54 parents liked session on emotional and behavioral problems. Conclusion: Group-based parenting programs are found to be effective in improving the overall psychosocial health of parents and the emotional and behavioral problems of children and adolescents as a result of better parenting.
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Pregnancy outcome in occupational tobacco exposure: A cohort study from South India p. 54
Rathika Damodara Shenoy, Seema Pavaman Sindgikar, Vijaya Shenoy, Raghuraja Uppoor, Raghavendra Rao, Shalini Singh
DOI:10.4103/ijcm.IJCM_195_19  
Background: Women constitute a significant labor pool in the Indian tobacco industry as bidi (hand-rolled cigarette) rollers. On an average, they roll around 600 bidis/day and are exposed to 120 g of tobacco and 3 g of nicotine. Bidis do not have chemical preservatives or stabilizing agents, and therefore, the rollers are exposed only to nicotine by handling and inhalation. The study objective was to assess pregnancy outcome in these women with occupational tobacco exposure. Materials and Methods: A prospective cohort study of bidi-rollers (n = 177) and women with no tobacco exposure (n = 354), followed up for pregnancy outcome, neonatal anthropometry, and nicotine absorption by cotinine assays. Adjusted risk and adjusted mean differences with a 95% confidence interval were derived. Results: Outcomes included increased adjusted risk for gestational hypertension (3.54 [1.21, 10.31]; P = 0.021) and fetal growth restriction (2.71 [1.39, 5.29]; P = 0.004). Risk for prematurity was not statistically significant (1.81 [0.74, 4.45]; P = 0.194). Lower adjusted mean difference of birth weight (−104 g [−177, −31]; P = 0.005), length (−0.4 cm [−0.8, −0.1]; P = 0.006), and head circumference (−0.4 cm [−0.6, −0.1]; P = 0.002) were seen with increased risk for small for gestational age (1.75 [1.12, 2.73]; P = 0.015). Nicotine absorption was evident in one-third of maternal and cord blood estimations. Conclusion: Occupational passive tobacco exposure results in adverse pregnancy outcome.
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Determinants of sugar-sweetened beverage consumption among indian adults: Findings from the National Family Health Survey-4 p. 60
Manu Raj Mathur, Deepti Nagrath, Jyotsna Malhotra, Vijay Kumar Mishra
DOI:10.4103/ijcm.IJCM_201_19  
Background: Sugar-sweetened beverages (SSBs) are associated with obesity, and various other noncommunicable diseases (NCDs). The aim of the study was to study the patterns of consumption of SSBs and association of SSB consumption with various socioeconomic factors and fried food consumption. Methodology: We used data of the 4th round of National Family Health Survey. We used multiple logistic regression to estimate the extent of the relationship between consumption of aerated drinks and various predictors. Furthermore, generalized structural equation modeling (GSEM) was used to derive a path diagram that showed a significant linkage between aerated drinks and observed variables. Results: Our study showed a clear association between consumption of aerated drinks with socioeconomic variables age, sex, marital status, and wealth index. The consumption of aerated drinks was also significantly associated with watching television and eating fried foods. Conclusion: Aerated drinks are a popular source of added sugar in the Indian diet. Limiting such factors can prove to be beneficial in reducing their consumption and further help in reducing the burden of NCDs.
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To study smoking violations through global positioning system-enabled mobile app, in Bhubaneswar, Odisha p. 66
Devi K Mishra, Nalini K Triathy, Bulu Mahanty, Bhupendra Buda, Manoj K Behera
DOI:10.4103/ijcm.IJCM_202_19  
Introduction: The Government of India has formulated the Cigarettes and Other Tobacco Products Act (COTPA) to implement measures to ensure that effective protection is provided to nonsmokers from involuntary exposure to tobacco smoke. Bhubaneswar is the capital city of Odisha, India, was declared as “Tobacco Smoke Free City” in 2010. For strengthening the implementation of the COTPA Act, an effective regular assessment is needed, and hence, an observational study was planned to assess the current violations of Tobacco Smoking in Bhubaneswar. Materials and Methods: In this observational study, 416 different places were chosen from four different zones of Bhubaneswar. Data were collected with the help of Mobile enabled global positioning system (GPS) technology and pretested structured questionnaire. Results: In this study, 52.88% places were found to be having smoking violations. The study shows maximum violations have occurred in public places (90.89%) followed by transit places (75%). Violations were found to be very low in government buildings, educational, medical institutes, and hotel/restaurants. The average number of smokers in the city was found to be 4.90/place and the average number of smokers was found to be 4.37/public place. Conclusion: In this study, GPS-enabled Mobile App can be used to identify the different locations, where a violation of law occurs. This may help administrators to properly plan and implement the law. Even though Bhubaneswar was declared “Tobacco Smoke free city” in 2010, it is still lacking behind in fulfilling the implementation of law, to reduce Second Hand Smoking.
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Introduction of interactive teaching for undergraduate students in community medicine p. 72
Jarina Begum, Syed Irfan Ali, Manasee Panda
DOI:10.4103/ijcm.IJCM_232_19  
Background: There is lack of interest in the subject of community medicine among undergraduate MBBS students leading to poor understanding of community problems and drastic fall in preventive, promotive component of health care. Aim: To evaluate effectiveness of interactive teaching learning (ITL) over traditional teaching learning (TTL) methods in creating interest in the subject. Objectives: 1. To identify the need of interactive teaching among students. 2. To know the perception of students towards it.3. To know the views and opinion of faculties towards it. Materials and Methods: An interventional study at NRIIMS, Vishakhapatnam. After need assessment survey, under graduate MBBS students were randomly allocated to study (A) and control groups (B). 2 topics were taught using ITL 1& 2 in group A and TTL in group B. After a washout period of 15 days, 2 other topics were taught using ITL3 & 4 in group B and TTL in group A, which was followed by assessment. Feedback from students and faculties were taken at the end of session. Results: 82% of students felt significant need of interaction in classroom. There was an increase in performance of students in the intervention group in terms of better scores (>75% score) which was found to be statistical significant in all the four sessions (P value are 0.0230, 0.0058, 0.0075, 0.0034 for TPS, BS, CBS, PTP respectively). Students were satisfied, so as the faculties with the implementation of ITL module. Conclusions: Student performance was increased. Overall satisfaction was good among students and faculties.
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Pattern of use and determinants of return visits at community or Mohalla clinics of Delhi, India p. 77
Tanisha Agrawal, Shubhro Bhattacharya, Chandrakant Lahariya
DOI:10.4103/ijcm.IJCM_254_19  
Background: Mohalla or Community Clinics of Delhi, India, have made primary care accessible, equitable, and affordable for women, elderly, and children in the underserved areas. Objectives: To understand the population subgroups which use these clinics and to analyze why people use these facilities and the determinants of the return visits for health seeking. Materials and Methods: This was a community-based cross-sectional study, with primary data collection from 25 localities across Delhi. A pretested semi-structured interview schedule was used for data collection. Two regression models were used for data analysis: a linear probability model to understand the factors contributing to the use of these clinics and a probit regression model to understand the determinants of return visits to these facilities. Results: Four hundred ninety-three ever-married women residing in study settings were included. The age of beneficiaries, marital status, distance from the clinics, and awareness about the services were found to be positively associated with the use of Mohalla Clinics. The proximity to households, waiting time at clinics, interaction time with the doctor, perceived performance of doctor, and effectiveness of treatment influenced the decision on a return visit for care seeking. Conclusions: Improved information on service provision, proximity to the facility, assured provision of doctors and laboratory services, and increased patient–doctor interaction time have the potential to increase the use and return visits to these Community or Mohalla Clinics. The lessons from this study can be used to design government primary health-care facilities in urban settings, for increased use by the target populations.
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Prevalence of maternal measles antibody and its associated factors among infants in Coastal Karnataka, India p. 83
S Sathiyanarayanan, Pawan Kumar, Chythra R Rao, Arun Kumar, Asha Kamath, Veena Kamath
DOI:10.4103/ijcm.IJCM_259_19  
Background: The current recommendation in India to commence first dose of measles immunization is at 9 months of age. The effectiveness of measles vaccination is greatly impacted by the level of maternal measles antibody (MMA) during infancy.Objectives: To find the prevalence of MMA and to study the maternal and infant factors associated with persistence of MMA among the infants in a Indian rural community.Methodology: Dried blood spot sample was collected before vaccination among infants aged 9 months and above when they came for first dose of measles vaccine to assess measles-specific maternal IgG antibody titers by enzyme immunoassay. Maternal and child factors influencing persistence of MMA were collected by interviewing the mothers. Association between various factors affecting seropositivity was tested using univariate logistic regression analysis and strength of association is reported as risk ratio with 95% confidence interval.Results: Based on the qualitative estimation among all the recruited children (250) in the study, 4 (1.6%) infants showed the presence of MMA whereas 25 (10%) of children had MMA on quantitative estimation. The effect of maternal factors, child nutrition, and sociodemographic factors on the presence of MMA was not found to be statistically significant.Conclusion: The prevalence of persistent MMA (IgG titer ≥200 mIU/ml) among the infants aged 9–12 months was 10%. The choice of vaccinating infants at the end of 9 months for the first dose of measles vaccine is justified as the remaining (90%) of infants were susceptible for measles infection at this age.
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Prevalence of pet dog ownership in an urban colony of East Delhi and awareness regarding canine zoonotic diseases and responsible pet ownership among dog owners Highly accessed article p. 89
Vinu Cherian, Preeti Dugg, Amir Maroof Khan
DOI:10.4103/ijcm.IJCM_281_19  
Background: India has lowly prioritized pet-associated zoonosis as a public health priority because data regarding the same and the susceptible population involved are sparse. Objective: To find the proportion of pet dog ownership in a settled urban colony of East Delhi and to assess awareness regarding canine zoonotic diseases and responsible pet ownership. Methods: This was a cross-sectional descriptive study of 700 participants in an urban colony of East Delhi. Results: The proportion of pet dog owners was 5.4%. Only one-third (34.2%) of the respondents were aware that pets are a source of disease. A majority of pet owners (86.8%) identified rabies as a disease caused by the bite of only stray dogs. The proportion of responsible pet owners was 39.4%. Only one-tenth of surveyed households had registered their pet with the local municipal authorities, despite such registration being a compulsory requirement by law. Conclusion: This study provides us with a better understanding of the lacunae in awareness of zoonotic diseases and its preventive measures among pet owners. All pet owners have a responsibility to ensure that their pets are healthy and free from disease.
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SHORT COMMUNICATIONS Top

Prevalence of consumption of smokeless tobacco products and exposure to second-hand smoke among women in the reproductive age group in a rural area of Koppal, Karnataka p. 92
BY Yuvaraj, Vijaykumar P Mane, Mallappa Biradar, Virupakshappa Nayaka, Rashmi Sreenivasamurthy
DOI:10.4103/ijcm.IJCM_88_19  
Background: Tobacco use is one of the most important causes of death and disease globally. Nearly one-third of the population in India uses tobacco, and smokeless form is culturally acceptable even among women. Objectives: (1) To estimate the prevalence of consumption of smokeless tobacco (SLT) products among women in the reproductive age group in the study setting. (2) To determine the various factors associated with the consumption of SLT. (3) To estimate the prevalence of exposure to second-hand smoke among the study participants. Materials and Methods: A cross-sectional study was conducted in the field area of primary health center Irkalgad, Koppal in March 2018. A cluster sampling technique was used and a total of 829 women were included. Data were collected using pretested and semi-structured questionnaire and analyzed using the Epi info software version 3.5.4 (Centers for Disease Control and Prevention” (CDC), Atlanta, Georgia, United States of America). Results: The prevalence of consumption of SLT products was 17.85%, and the most common product consumed was tobacco with betel quid. Tobacco consumption was found to be significantly associated with age, literacy, marital, and employment status of the study participants. Conclusion: The present study concludes that SLT consumption is high among women in the reproductive age group in the study setting and identifies multiple determinants for effective planning of interventions.
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A community-based cross-sectional study about the quality of life in postmenopausal women in rural Puducherry p. 96
R Sivapragasam, S Rajini, S Rajalakshmi, K Priyanga, V Rajesh, R Priyadharshini
DOI:10.4103/ijcm.IJCM_91_19  
Background: The aim of this study was to assess the quality of life (QOL) of postmenopausal women, in the rural areas of Puducherry and to find the associated factors. Materials and Methods: A cross-sectional study was done in the rural field practicing area of SLIMS, Puducherry. The sample size was 172 based on the previous study, and simple random sampling technique was used. The women who were receiving hormonal treatment, having chronic illness and those who refused to participate were excluded from the study. The sociodemographic information and menopause-specific QOL questionnaire were used, and data were analyzed using the SPSS 21. Results: In this study, mean age of the postmenopausal women was 61 ± 7.5 years, 42.4% belonged to socioeconomic status (SES) Class IV. The prevalence of one or more symptoms of vasomotor, psychological, and sexual domains were 23.8%, 87%, and 68%, respectively. We found an association between SES and both vasomotor and psychological symptoms. Furthermore, age and psychological symptoms were associated. Conclusion: The menopause-related symptoms had a negative effect on the QOL of postmenopausal women. The study can help in creating awareness and also in helping in educating women for early identification of the frequent menopausal symptoms.
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Perception of doctor–patient relationship in the present time from the viewpoint of doctors: A qualitative study at a tertiary health-care center in Eastern India p. 100
Barun Kumar, Uttam Kumar Paul, Dilip Kumar Pal
DOI:10.4103/ijcm.IJCM_106_19  
Context: Doctor–patient relationship has gone through some troubled times in the recent past. Quality data regarding this is lacking in the Indian setting. Aims: The study aim was to find the perception of doctors regarding doctor–patient relationship. Settings and Design: The study was conducted at a tertiary health-care center in West Bengal. It was a qualitative study including in-depth interviews and focus group discussions (FGDs). Subjects and Methods: The study comprised of in-depth interviews (IDI) of thirty residents and three FGDs, involving 33 residents. Statistical Analysis Used: Data analysis was performed manually by deductive approach. Descriptive “codes” of the text information were done. The consolidated criteria for reporting qualitative research guidelines were followed. Results: Doctor–patient relationship was perceived as of mutual trust and respect. Overburdened doctors, impatient patients, unrealistic expectations from the treatment, and lack of infrastructure were some of the agreed-upon factors for the strained relationship. A combined corrective effort is needed to salvage the current situation. Conclusions: A healthy doctor–patient relationship is instrumental in the holistic picture of health care. Doctors, patients, administration, and media have shared causation to the problem and have equal responsibility for its amendment.
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LETTERS TO EDITOR Top

Fire safety hazards: How safe are our hospitals? p. 104
Rashmi Sharma, Harsh Bakshi, Anupam Banerjee
DOI:10.4103/ijcm.IJCM_182_17  
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School training strategies for prevention and control of dengue p. 106
Swati Alok, Samrun Nessa, Sajeli Begum Ahil
DOI:10.4103/ijcm.IJCM_113_19  
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Physical violence against doctors: A content analysis from online Indian newspapers p. 108
Arulmozhi Madhivanan, Vinayagamoorthy Venugopal, Amol R Dongre
DOI:10.4103/ijcm.IJCM_215_19  
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  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007