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    Table of Contents - Current issue
October-December 2020
Volume 45 | Issue 4
Page Nos. 391-568

Online since Wednesday, October 28, 2020

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Prospects of vaccine against COVID-19 Highly accessed article p. 391
Anuj Mundra, Bishan Swaroop Garg
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Leveraging unmanned aerial vehicle technology to improve public health practice: Prospects and barriers Highly accessed article p. 396
Sudip Bhattacharya, Md Mahbub Hossain, Kyle Hoedebecke, Madonna Bacorro, Ozden Gokdemir, Amarjeet Singh
Unmanned aerial vehicle (UAV) is increasingly being used in different sectors, including public health. Common applications of UAVs in public health are delivering logistics in remote areas, transporting biomedical samples, providing community-based health care, and public health surveillance. UAVs have contributed to efficient public health ensuring better health services activities at a lower cost. Across diverse health-care settings, UAVs are used to minimize human labor and physical barriers such as distance or hazards associated with different tasks. This technology has shown notable success in advancing public health in resource-constrained countries. In Rwanda, the use of UAVs has resulted in robust logistic support and improved vaccine coverage. Faster transportation and coordination between points of health services have facilitated the overall health service delivery. Despite these advancements, there are several challenges in using UAVs in public health, which include technical difficulties in operating UAVs, maintenance of devices and systems, regulatory challenges, safety concerns, air traffic congestion, and cost of using UAVs. These challenges should be addressed with empirical research and innovative interventions to leverage UAVs in preventing health-care problems and saving lives around the world.
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Prevalence of Vitamin B12 deficiency and its associated risk factors among pregnant women of rural South India: A community-based cross-sectional study Highly accessed article p. 399
Anitha Mohanraj Barney, Vinod Joseph Abraham, Sumita Danda, Anne George Cherian, S Vanitha
Introduction: Vitamin B12 is essential for the normal functioning of the nervous system and for the formation of red blood cells. Vegetarian diet, low socioeconomic status, and social and religious reasons are known risk factors of its deficiency. Pregnant women, children, and the elderly are vulnerable groups. Indians have the highest prevalence, but the data among pregnant women in the rural setting is lacking. Objectives: The objective of this study is to assess the prevalence of Vitamin B12 deficiency and its associated factors among pregnant women of rural South India. Materials and Methods: A cross-sectional study was conducted to recruit consecutive 120 multigravida women with ≤20 weeks of gestation, attending the mobile doctor run clinic of Kaniyambadi block, Vellore. A structured questionnaire was administered, and blood samples were collected. Results: The prevalence of Vitamin B12 deficiency (<200 pgm/ml) and anemia (Hb ≤10.5 g/dL) was 55% and 17.5%, respectively. Only 11.7% were B12 deficient and anemic. Past history of abortion (odds ratio [OR] = 0.5), fatigue (OR = 0.4), and low B12 intake (OR = 2) was associated only in the bivariate analysis. First trimester (OR = 3.9) and obesity (OR = 9.6) were found to be independent risk factors of Vitamin B12 deficiency. Conclusion: Our study showed a high prevalence of Vitamin B12 deficiency in pregnancy in rural India. Some risk factors were identified. However, studies with a higher sample size will be beneficial to study the associated risk factors better.
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Malnutrition and household food insecurity in children attending anganwadi centres in a district of North East India p. 405
Jyotismita Pathak, Tulika Goswami Mahanta, Priya Arora, Dibyajyoti Kalita, Gurmeet Kaur
Background: Child malnutrition is linked to household food insecurity. Literature reveals mixed results, but most studies were carried out in adults. Aims: The aim of this study is to assess household food insecurity and nutritional status in children attending Anganwadi centers (AWCs) of Dibrugarh district. Materials and Methods: Cross-sectional study among 510 randomly selected children attending AWCs in Dibrugarh was done. Data on nutritional status and food security were collected, and anthropometric measurements were recorded. Statistical Analysis: Data were analyzed using SPSS version 16. Categorical variables presented as percentages and differences between them tested using Chi-square test. Bivariate analysis was performed to find out independent risk factors. Results: The prevalence of stunting, wasting, and underweight was 39.8%, 26.1%, and 39.2%, respectively. Significant associations found between wasting, stunting, or underweight and household food insecurity. Stunting, wasting, and underweight were significantly associated with the literacy status of parents. Underweight and stunting were also associated with socioeconomic class. Conclusions: Malnutrition in all forms is common in the study population. Rates of stunting, wasting, and underweight were higher than the state average. Along-with access to food, an integrated approach that improves the overall socioeconomic well-being of families and parental education is needed.
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Assessment of quality of life of primary caregivers of Egyptian asthmatic children and adolescents p. 410
Hala G Elnady, Lobna S Sherif, Hala D ElGindi, Fatma A Shaaban, Aida M Abdelmohsen, Dina A Salah, Ghada A Abdel-Latif, Reham F Fahmy
Background: Asthma as a serious public health problem worldwide exerts a serious load on children's health-related quality of life (HRQOL) and their families. Objective: We assess the HRQOL of the primary caregivers of Egyptian asthmatic children and adolescents and its relation to HRQOL of their children and asthma severity. Materials and Methods: A cross-sectional study was conducted on 128 pairs of asthmatic children (7–16 years) and their primary caregivers. Pediatric asthma quality of life (QOL) questionnaire, pediatric asthma caregiver's QOL questionnaire, and asthma control questionnaire were used. Results: Uncontrolled asthmatic patients had statistically significantly lower mean caregiver score compared to controlled asthmatic (P < 0.005). There was a statistically significant positive correlation between caregiver's individual and overall QOL scores and their children (individual and overall QOL scores) (P < 0.05). A statistically significant negative correlation between asthma severity and QOL scores of the caregivers of asthmatic children and adolescents was found (P < 0.05). Conclusion: The QOL of the primary caregivers of asthmatic children is significantly adversely affected by their children's illness severity.
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Effect of seasonal variations on infant mortality rate of some selected districts of Jammu Division p. 415
Manjeet Kumar, Vijay Kumar Shivgotra
Background: The infant and child mortality rates are considered as sensitive indicators of living and socioeconomic conditions of a country. The infant mortality rate is regarded as most of the revealing measures of how well a society is meeting the needs of its people. Objective: The purpose of the study is to determine the effect of seasonal variations on the infant mortality in some selected districts of Jammu Division, J&K. Methodology: In the present study, infant mortality data were collected for the 6 consecutive years (2013–2018) from different health centers of four districts of Jammu Division and Jammu Municipal Corporation (JMC), J&K. The seasonal variations of overall infant deaths were analyzed using the monthly mortality data collected for the study period. Poisson regression model was employed to measure the seasonal effects on the overall infant deaths. Data analysis was done using software IBM SPSS 24.0. Results: In this study, a total of 4443 infant deaths were recorded from selected districts of Jammu Division, J&K, from the year 2013–2018. The prevalence of infant deaths was extremely high in the month of January as compared to the reference month June. Furthermore, the parameter estimates for each of the months along with 95% Wald confidence interval were calculated. Conclusions: The present study concludes that seasonal variations significantly affect the infant mortality in Jammu Division, J&K, India. The policymakers must consider the effect of seasons on infant mortality as children in their 1st year of life are more susceptible toward environmental conditions.
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Mid-upper-arm-circumference as a growth parameter and its correlation with body mass index and heights in ashram school students in Nashik district in Maharashtra, India p. 419
Shyam V Ashtekar, Manasi Shekhar Padhyegurjar, Jagdish D Powar, Shekhar Bhikaji Padhyegurjar
Background: Under nutrition is a major problem among Indian schoolchildren. Yet, routine height and weight measurements in schools are nor used for growth monitoring. This study attempts to evaluate mid-upper-arm-circumference (MUAC) as a quick assessment tool against body mass index (BMI) in schoolchildren. Objective: The objective of the study was to evaluate MUAC against BMI, height, and average skin fold thickness (ASFT) parameters and to estimate MUAC values across age, sex, and social categories. Subjects and Methods: The study was conducted in 2017–2018 in four randomly selected Ashram schools and an urban school in Nashik district. Girls (1187) and boys (1083) from age 6–18 were included, and height, weight, skinfold thickness, and MUAC were measured. MUAC was done on the left arm with Shakir's tape and tailor's tape (for MUAC >25 cm). Epi Info 7.1 and Excel were used for the data analysis. Results: MUAC had a consistently high correlation with BMI at all ages for boys (r = 0.8786, P < 0.0001) and girls (r = 0.8586, P < 0.0001). ASFT too was strongly correlated with MUAC (r = 0.5945, P < 0.0001). MUAC had strong but nonlinear correlation with heights in girls (r = 0.7751, P < 0.0001) and boys (r = 0.8267, P < 0.0001). MUAC was higher for girls than boys at all ages. MUAC values for scheduled tribe (ST) children were highly significantly lower than non-ST students. Conclusion: MUAC is a good and quick proxy tool for BMI and can serve as a sensitive nutritional indicator for school ages across socioeconomic categories. However, it is necessary to construct age-wise cutoff points and bandwidths using multicentric studies across income quintiles.
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Prevalence of intestinal parasitosis among under-five children in a rural community of Purba Bardhaman District, West Bengal p. 425
Saptarshi Banerjee, Soumalya Ray, Prabha Shrivastava, Dilip Kumar Das
Context: Intestinal parasitosis (IP), a group of diseases caused by one or more species of protozoa and helminths, is still considered a neglected tropical disease and a public health concern in India. Poor sanitation and unhygienic conditions largely contribute to sustained transmission, primarily among children, adversely affecting health and development. The problem needs area-specific assessment and interventions. Aims: The present study aimed at determining the prevalence of IP and its correlates among under-five children in a rural community of Purba Bardhaman district, West Bengal, India. Settings and Design: A descriptive cross-sectional study was conducted in Bhatar Block of Purba Bardhaman district. Subjects and Methods: Mothers/caregivers of 294 under-five children (selected through multistage sampling) were interviewed for background characteristics at the household level, and stool samples from each child were collected, transported, and examined for ova/parasite/cysts following standard guidelines. Statistical Analysis Used: Statistical analysis of the data obtained was done using SPSS (V20). Results: The overall prevalence of IP was 17.0%. Majority of the intestinal parasites were protozoa (42, 84%), of which the most common was Giardia lamblia (24, 48.0%). Age of the child and practice of defecation showed a significant association with IP on logistic regression. Conclusions: Protozoa, mainly G. lamblia, contributes for majority of intestinal parasitic infections among the study population, and children belonging to the age group of 25–60 completed months and with open-field defecation practice have higher risk of acquiring them.
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Prevalence and factors associated with overweight and obesity among primary school children (9–14 years) in a selected area of Dhaka, Bangladesh: A cross-sectional study p. 429
Md Tarek Hossain, Sharmin Khan Luies, Tuhin Biswas
Introduction: Childhood obesity is a threat worldwide; notably, some Asian nations are experiencing a shift toward obesity at a younger age. The context of overweight/obesity remains unexplored, more among younger age groups in Bangladesh. This study assessed prevalence and factors associated with overweight/obesity among 9–14-year-old school-going children studying in public and private primary schools in a selected area of Dhaka, Bangladesh. Materials and Methods: This descriptive cross-sectional study involved 150 children recruited from four purposively selected primary schools, following simple random sampling technique. Body mass index was assessed to classify children following the Centers for Disease Control and Prevention age and sex-specific cutoff points. Data were analyzed using SPSS, version 20, and Chi-square/Fisher's exact test was done to determine association. Results: A higher prevalence of overweight/obesity was observed among boys (67.1%) compared to girls, and the mean age was 11.6 years. Overweight and obesity were prevalent among girls (35.7% and 17.9%, respectively) in public schools and boys (38.8% and 32.7%, respectively) in private schools. The magnitude was higher (>80.0%) among those not participating in sports at school (P = 0.002) or outside school (P < 0.001). They exposed (97.5%) to sedentary behaviors (P < 0.001) and preferred fast food (60.8%) as regular meals (P = 0.001). Their dietary chart lacked an adequate serving of vegetables and fruits in a week. Conclusions: Overweight/obesity is prevalent among 9–14-year-old school-going children, and behavior factors are major determinants of childhood obesity. Effective public health interventions are required to address this emerging health problem.
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The habitual additional sodium intake among hypertensive patients visiting a tertiary health-care center, Indore, Madhya Pradesh p. 435
Sameer Inamdar, Madhuri Inamdar, Runa Laila, Harshal Gupta, Rajshekhar R Wavare, Ajit R Deshpande
Background: Hypertension prevalence is related to dietary sodium chloride intake. People are consuming much more sodium than is physiologically necessary. The consumption of processed food in urban India has led to a prevalence of 24%–30% of hypertension. The people have a special liking of such type of foods. This study aimed at assessing consumption of sodium among the study subjects to compare habitual additional consumption of sodium among hypertensive and normotensive patients and to find its associate factors impacting hypertension. Materials and Methods: The hospital based, cross-sectional study was conducted on patients attending the outpatient department of general medicine. The sample size was 520 patients. Habitual additional intake of each patient was assessed by a food frequency table. Results: As the age advances, the proportion of hypertensive patients increases (P < 0.05). Among hypertensive patients, 38.65% were not doing exercise (P < 0.05). The body mass index >25 was found among 11.92% normotensives and among 25.38% hypertensives (P < 0.05). There were 23% of hypertensive patients who could not receive dietary advice (P < 0.05). Habitual additional sodium consumption is more among 15–25 years age group (P < 0.05).Habitual additional sodium intake mean for those who were taking a pinch of salt is higher (P < 0.05). Habitual additional sodium intake is found to be significantly impacted by younger age, diagnosis, and lack of dietary advice (P < 0.05, P < 0.05, and P < 0.05). Conclusion: Most of the age groups are consuming more than 2 g habitual additional sodium which is more than the World Health Organization-recommended maximum levels. The dietary advice was given to hypertensives that had a positive impact on habitual additional sodium intake.
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Assessment of nutritional status of mothers of children under 3 years of age and its determinants p. 440
Rajesh Kumar Sinha, Sangna Raybardhan, Nidhi Barnwal, Praveen Kumar, Virender Kumar
Objective: The study was conducted to identify associated factors of severe wasting among mothers. Methodology: A prospective 12 months' study was conducted in 30 randomly selected villages of Khutpani Block of West Singhbhum with a sample of 600 households with children between 0 and 3 years of age using the prevalence of wasting in West Singhbhum district National Family Health Survey, precision of 0.05, design effect of 2 and accounting for error of 10%. Data on socioeconomic status, maternal anthropometry mid-upper arm circumference (MUAC), water, sanitation and hygiene (WASH) practices, gender-based violence, and food security were collected. Data collection was done between July 2017 and June 2018. Results: Wasting and severe wasting prevalence using MUAC criteria among mothers were found to be 60% and 17%, respectively. The study showed higher rate of severe maternal wasting among households facing poverty, food insecurity, poor WASH practices especially related to hand washing and toilet use and women who faced gender-based violence. Conclusion: Nonnutritional interventions addressing poverty, household food insecurity, gender violence, and WASH practices are required to address maternal wasting, in addition to existing nutritional programs.
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Family burden in caregivers of elderly with cognitive impairment residing in rural and tribal population of a district in Western India – A baseline study p. 445
Shobha Misra, Rajat Oswal, Mehul Patel
Study Objectives: The objective was to assess cognitive impairment (CI) in adults older than 59 years, residing in rural and tribal population and to assess family burden of those who had significant CI. Materials and Methods: This cross-sectional study was conducted among adults residing in the rural population of a block in a district located in Western India in 2015. A total of 240 households from 12 villages of the block were selected by multistage and random sampling method. Mini-mental state examination and Zarit Burden Interview tools were used to assess CI and burden. Data were entered in MS Excel 2007 and analyzed with descriptive statistics and Chi-squared test. Results: A total of 212 adults aged over 59 years were studied. The overall prevalence of CI was 42.92%. There was a statistically significant difference seen in CI among females as compared to males. Interview of primary care taker showed that 32 (35.16%) caregivers had little or no burden, 53 (58.24%) had mild-to-moderate burden, and 6 (6.59%) had moderate-to-severe burden, while none had a severe burden. Conclusions: Enabling caregivers to provide at home care for longer periods before hospitalization would decrease the burden of CI.
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Epidemiological determinants of mental well-being and quality of life among homemakers with hypertension: A cross-sectional analysis p. 448
Ashwini Shivakumar Bidnurmath, Chythra Raghavendra Rao, Avinash Shetty, Asha Kamath, Lavya Shetty
Background: Stress is a major contributor to the physiology of hypertension (HTN) and is linked closely to mental well-being and overall quality of life (QoL). Health issues pertaining to women's health have usually focused on reproduction, while mental well-being has largely been neglected. Objectives: The objective of the study was to assess the perceived stress and QoL among homemakers with HTN. Materials and Methods: A community-based cross-sectional study was carried out, among 426 homemakers with HTN residing in Udupi, Karnataka. The sociodemographic and disease characteristics, Cohen's Perceived Stress Scale-10, World Health Organization QoL Brief Questionnaire (WHOQOL-BREF), anthropometry, and vitals were measured. Results: Of the study participants, 245 (57.5%) were aged ≤60 years and 317 (74.4%) had been diagnosed with HTN in the past decade. Low and high perceived stress was seen among 306 (71.8%) and 120 (28.2%) women, respectively. Among the four domains of WHOQOL-BREF, the physical domain had the highest mean (±standard deviation) score of 67.44 (±16.50), whereas the lowest score of 54.49 (±19.75) was observed in the social domain. The odds of high stress among single women and those with a pill burden of >2/day were 1.93 (P=0.004, 95% CI=1.228, 3.054) and 1.77 (P=0.038, 95% CI CI=0.962, 3.270) respectively. The QoL was significantly better among those aged <60 years, married, and literate women. Conclusions: Mental well-being among the hypertensive homemakers was good, with low perceived stress and high mean scores of QOL domains.
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Impact of community defluoridation on a village endemic for hydric fluorosis in rural Karnataka, India p. 454
Arjunan Isaac, S Pruthvish, Radhika Haridas, NS Murthy
Introduction: Excessive intake of fluorides can lead to the development of fluorosis, a serious public health issue in India. The objective of this study was to assess the impact of community defluoridation in preventing fluorosis in Kaiwara village. Methodology: This community interventional trial was conducted in Kaiwara village, Karnataka, after obtaining ethical clearance. The study included 903 participants; preintervention data were collected by recording the required parameters. The postinterventional study was carried out 2 years after installing the reverse osmosis plant. Data from pre- and post-intervention study were compared. Results: Dean's index showed no significant change in the pre- and post-intervention period for its various categories (P = 0.543). However, the mean urine fluoride levels were found to be decreased significantly (Wilcoxon Signed-Rank test, P < 0.001). Conclusion: This study demonstrates the importance of providing defluorinated water to the village population as a potential solution for fluorosis.
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Development and validation of a tool to assess perceptions and practices regarding hypertension and associated comorbidities among primary health care providers of a rural community in India p. 458
Prianka Mukhopadhyay, Indira Dey, Anima Haldar
Background: Primary health-care providers can play a crucial role in the prevention and early detection of non-communicable diseases. Knowledge, attitude, and practice (KAP) survey of primary health-care providers is needed to assess their gaps in knowledge, and identify barriers for effective implementation of the national program. However, such KAP instruments are lacking. Objective: The aim of this study is to develop, validate and assess the reliability of a questionnaire to determine the KAPs of primary health-care providers about hypertension and associated comorbidities Materials and Methods: This study was conducted in the following steps: item construction and psychometric testing, by validity and reliability analysis. Results: The final KAP questionnaire comprised 25 knowledge items, 12 attitude items, and 8 practice items. Exploratory factor analysis using principal axis factoring with varimax rotation revealed four dimensions in the attitude section explaining 35.93% and two dimensions in practice sections explaining 65.96% of the total variance. Cronbach's alpha coefficient for attitude and practice session measured 0.65 and 0.85, respectively. A Kuder Richardson value of 0.70 was obtained for the knowledge section. ICC coefficients were 0.56 (P < 0.00) for knowledge, 0.77 (P < 0.00) for attitude and 0.88 (P < 0.00) for practice sections indicating moderate-to-good correlations. Overall, the instrument developed had acceptable validity and reliability. Conclusion: Overall, the instrument developed had acceptable validity and reliability to assess the perceptions and practices of primary healthcare providers about prevention and control of hypertension and associated comorbidities in the community.
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Risk of fall among older adults and its association with cognitive impairment in a semi-urban community p. 463
Dayana Monachan, Saritha Susan Vargese, Vinny Johny, Elsheba Mathew
Context: Fall in older people is a major public health concern. Two-third of the death due to fall are preventable. Risk assessment in older adults therefore is the first step to identify the high-risk group to plan need-based intervention. Aims: The aim of the study was to determine the prevalence of risk of fall among older adults and its association with cognitive impairment and sociodemographic characteristics. Settings and Design: A cross-sectional study was conducted in the field practice areas of the department of community medicine in a teaching hospital in South Kerala, India. Subjects and Methods: A semi-structured questionnaire was used to collect the data. Berg Balance Scale and Mini-Cog Test were used for measuring risk of fall and cognitive impairment. Statistical Analysis Used: Descriptive statistics and logistic regression were used for the statistical analysis using SPSS. Results: Among the older adults, 45% were at risk of fall, 42.4% in males and 57.6% in females. The risk of fall was found to be significantly associated with cognitive impairment, (odds ratio = 3.89, confidence interval at 95% = 2.06–7.31, P < 0.001). Advanced age, female gender, and unemployed status were significantly associated with the risk of fall. Conclusions: The risk of fall prevalence was high and significantly related to cognitive impairment, advanced age, female gender, and occupational status, with more than half of those currently not working having a higher risk. The study would recommend regular follow-up of risk groups for prevention a good percentage of fall and thereby the related injuries.
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Does the distribution of empanelled hospitals have an impact on the utilization of services under state insurance scheme? p. 467
Sudharshini Subramaniam, TS Selvavinayagam
Context: Tamil Nadu's Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS) aims at reducing inequity by making the health service affordable and available by roping in both the public and private providers. Aims: This study aims to find if there exist any inter-district disparity in the distribution of hospitals empaneled and utilization of services under the CMCHIS scheme. Settings and Design: A secondary data analysis was done using the CMCHIS data on hospitals empanelled and number of claims made in the scheme for the year 2018. Subjects and Methods: The districts were classified into high-developed district (HDD), middle-developed district (MDD), and low-developed district (LDD) based on the Human Development Index. Availability of hospital services was calculated as the number of empanelled hospitals/100,000 families enrolled. Utilization was calculated as the number of claims made by people living in the district per one lakh families enrolled and number of claims made by hospitals under CMCHIS/100,000 enrolled. Statistical Analysis Used: The relationship between enrolment ratio, hospital availability, number of claims made, and Human Development Index across districts was examined using the Pearson's Correlation analysis. Results: Enrolment was highest in the LDDs (22.8%), followed by MDDs (21.9%) and HDDs (18.7%). The number of hospitals per 100,000 families enrolled was the highest in HDDs (8.0) and lowest in LDDs (4.6). The utilization was the highest in HDD followed by MDD and lowest in LDD. Conclusions: The disparity in the hospitals availability and utilization between districts should be addressed by adopting a targeting approach giving priorities to empanelling hospitals in the less-developed districts.
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Development and evaluation of a mobile app for guiding rabies prophylaxis among health-care professionals in India p. 473
Muralidhar Swathi, Sasidharanpillai Sabeena, Jazeel Abdulmajeed, Sarthak Pattanaik, Oliver Dsa, HS Shubha, Muralidhar Varma, Puneet Bhatt, Nagaraja Ravishankar, Govindakarnavar Arunkumar
Background: The majority of dog-mediated human rabies as well as rabies-related human deaths are reported from low-income countries of Asia and Africa where access to appropriate postexposure prophylaxis is limited or nonexistent. At present, India is second in position after China in terms of having the highest number of mobile phone users surpassing the United States. Objective: In this context, we decided to develop a user-friendly, technically less demanding, mobile App for health-care professionals, which is accessible even without Internet facility. Methodology: The current study was conducted in four phases, namely assemblage of informational contents on rabies, development of the software, assessment of the reliability of the questionnaire tool and evaluation of the mobile App. The evaluation of App was conducted among physicians and nursing staffs in a tertiary care referral hospital. Results: The information content was prepared referring national and international guidelines. The App was designed with Hypertext Markup Language 5 for presentation on the World Wide Web and was coined the name of “RabiApp.” This is a hybrid App of the native App and web App, allowing the information to be stored in the local server. The mobile App was assessed using a validated and reliable questionnaire after confirming the internal consistency by means of Cronbach's alpha. The overall Cronbach's alpha for the main scale was 0.788, which was a respectable score. Conclusion: The developed App is a user-friendly, easily accessible platform, which can help health-care professionals in making decisions regarding rabies wound management, treatment, and prophylaxis.
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Plotting Kaplan–Meier curves for survival and time to HIV positivity among high-risk women: A cohort study p. 478
Mamtarani Verma, JK Kosambiya
Introduction: Targeted intervention (TI) project aimed to interrupt HIV transmission among highly vulnerable population and their clients. Aims and Objectives: To compare survival among HIV-positive versus survival among HIV-negative women. Subjects and Methods: Study Design: Prospective cohort with retrospective comparison. Study Setting: Two drop in center clinics. Study Tool and Process of Data Collection: Data were collected for 5 years from 2009 to 2014. Pretested semi-structured questionnaire was used for data collection. Results: The mean age of high-risk women was 32.48 ± 4.67 years. The mean survival among HIV-negative women was 110.62 ± 0.6 months and mean survival among HIV-positive women was 91.09 ± 7.67 months. The mean interval to death among women with sexually transmitted diseases (STDs) was 113.50 ± 1.30, whereas the mean interval to death among women with no STDs was 105.65 ± 0.76. P = 0.00 by log-rank test. Conclusion: Status of high-risk women according to HIV, STDs, typology, category and partner wise were found to have a significant difference in survival experience, whereas PRR positivity for syphilis, literacy, alcohol intake do not have a significant difference.
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Assessment of nutritional status of children between 6 months and 6 years of age in Anganwadi centers of an urban area in Tumkur, Karnataka, India p. 483
Suhitha R Das, Jai Prakash, Chandana Krishna, Krishna Iyengar, P Venkatesh, SS Rajesh
Objectives: Nutritional status is the sensitive indicator of a child's health, and they constitute the most vulnerable segment of any community. Undernutrition causes a great deal of physical, mental, and emotional suffering. Anganwadi is a part of the Integrated Child Development Services program started to combat child hunger and child malnutrition. This study was undertaken to assess the nutritional status of the children (6 months–6 years) in Anganwadis and determine the sociodemographic factors associated with malnutrition and to assess their dietary intake. Materials and Methods: This cross-sectional study was undertaken among 580 children in Anganwadis in the urban field practice area of a Medical college in Tumkur. Results: In this study, the overall prevalence of underweight, stunting, and wasting was found to be 34.14%, 45.52%, and 35.52%, respectively. Age, socioeconomic status, immunization status, religion, and mother's education was associated with undernutrition. The deficient intake of calorie and protein was seen in 90% and 64.8% of the study participants. Conclusion: The present study showed that there is still a high prevalence of undernutrition among the Anganwadi children aged 6–72 months. Socioeconomic factors have a significant role in child nutrition, which manifests itself as poor development.
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Strengthening the use of partograph in high caseload public health facilities in India through an integrated quality improvement approach p. 487
Devina Bajpayee, Enisha Sarin, Saumyadripta Chaudhuri, Sourav Ghosh Dastidar, Anil Gupta, Nitin Bisht, Anurag Joshi, Asif Jeelani, Chitra Rathi, Rakesh Parashar, Geeta Verma, Kaveri Haldar, VS Sridhar, Sachin Gupta, Gunjan Taneja, Rajeev Gera
Background: The effective implementation of evidence-based practices including the use of partograph to improve maternal and newborn outcomes is critical on account of increased institutional delivery. However, despite clear guidelines, partograph use in India is not widely practiced. Materials and Methods: Quality improvement (QI) efforts along with training and mentoring were operationalized in a total of 141 facilities across 26 high priority districts of India. Assessments were conducted across baseline, intervention period, and end line. These included reviewing the availability of partograph and staff competency in filling them at baseline and end line, as well as reviewing monthly data for use and completeness of filling. The monthly data were tabulated quarter wise to study trends. Competency scores were tabulated to show the difference across assessments. Results: An overall upward trend from 29% to 61% was seen in the practice of partograph use. Simultaneously, completeness in filling up the partograph increased from 32% to 81%. Staff competency in filling partograph improved considerably: proportion of staff scoring low decreased over the intervention period from 63% to 2.5% (P < 0.0001), and the proportion scoring high increased from 13% to 72% (P < 0.0001) from baseline to end line. Conclusion: The integrated approach of training, mentoring, and QI can be used in similar settings to strengthen partograph use.
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The perceived stigma of addiction and treatment utilization among cannabis addicts in Thailand p. 492
Suneerat Yangyuen, Manop Kanato, Chatchada Mahaweerawat, Udomsak Mahaweerawat
Context: Amajor social problem among clients with substance use disorders is stigmatization related to health conditions, which contributes to poor mental and physical health circumstances and becomes hazardous to substance abuse treatment. Meanwhile, decreased stigmatization among cannabis users might occur because some people use cannabis without experiencing harm or believe it to be a harmless substance and might not be receiving treatment. Several studies have investigated stigma toward substance use disorder and treatment. However, less is known about how stigmatization influences treatment. Aims: To investigate the association between the perceived stigma of addiction and treatment utilization among cannabis addicts. Materials and Methods: A cross-sectional design was conducted with consecutive sampling techniques among 977 cannabis users recruited from all 7 compulsory drug detention centers in Thailand. The data were collected by standardized interviewers with a structured interviewing questionnaire. Binary logistic regression was applied to determine the effect of perceived stigma of treatment utilization. Results: Most clients were male (84.5%), had a family history of drug problems (54.5%), and had a history of mental health problems (5.1%). Most of them reported moderate-to-high levels of perceived stigma (87.2%) and received treatment (28.9%). Greater perceived stigma was associated with decreased treatment for cannabis abuse Conclusions: The perceived stigma of addiction is a barrier to cannabis abuse treatment utilization. Thus, a better understanding of stigma could reduce its negative impact on seeking and engaging in treatment.
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Identifying the burden and predictors of diabetes distress among adult Type 2 diabetes mellitus patients p. 497
Ratnesh , KS Shivaprasad, Subramanian Kannan, Kranti S Khadilkar, G Venkata Sravani, Reema Raju
Background: Diabetes is a psychologically challenging medical condition. Diabetes distress (DD) refers to the unique, often hidden emotional burdens and worries that the patient experiences when managing diabetes. Objective: The objective of the study was to find the burden and identify the predictors of DD in adult Type 2 diabetes mellitus (T2DM) patients. Materials and Methods: Two hundred and fifty T2DM patients were recruited for this study from the endocrine outpatient department from February to April 2019. DD was measured using the Diabetic Distress Scale. Results: The prevalence of DD was 19.6%. The risk of DD was 4.25 times more in those aged ≤45 years as compared to those aged >45 years. Patients with hemoglobin A1c (HbA1c) >8% had 8.8 times more DD. Patients on insulin had more DD (5.4 times) as compared to patients who were on oral antidiabetic drugs. Patients with a history of treatment interruption had 11 times more risk of DD as compared to patients who did not. Conclusions: DD was found to be high among patients aged ≤45 years, illiterates, patients on insulin, patients with a history of treatment interruption, and those with HbA1c >8%. Patients with high DD were found to have higher HbA1c levels.
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Effect of intimate partner violence on maternal and birth outcomes of pregnancy among antenatal clinic attendees in Delhi: A prospective observational study p. 501
Suneela Garg, Ruchir Rustagi, M Meghachandra Singh, Kajok Engtipi
Context: Violence against women is a major public health problem and a violation of their human rights. Intimate partner violence (IPV) during pregnancy has been linked to various adverse maternal health outcomes and birth outcomes. Aims: The aim of this study is to assess the magnitude of maternal complications and adverse birth outcomes in relation to IPV. Settings and Design: Prospective observational study was conducted from April 2015 to May 2018 in the antenatal clinic of a Tertiary Care Hospital in Delhi. Subjects and Methods: Sample of 1500 pregnant women (≤20 weeks gestation) were recruited and followed up at regular intervals, up to the birth outcome. Statistical Analysis Used: Data were analyzed using the Statistical Package for the Social Sciences version 25. Value of P < 0.05 was considered statistically significant. Results: Prevalence of IPV at baseline was 29.7%. Significantly higher proportion of IPV victims (47.2%) had poor weight gain during the pregnancy. Subjects reporting violence at any of the study contacts had a higher incidence of preterm delivery (12.7%), and a significantly higher incidence of low birth weight in the newborns (32.1% vs 22.3%) (P < 0.05). Conclusions: The findings reveal that IPV during pregnancy is common and significantly associated with adverse maternal and birth outcomes. The findings stress need for research and development of a screening tool to identify violence early in pregnancy and thus prevent its consequences.
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Digital hemoglobinometers as point-of-care testing devices for hemoglobin estimation: A validation study from India p. 506
Kapil Yadav, Shashi Kant, Gomathi Ramaswamy, Farhad Ahamed, Kashish Vohra
Introduction: India has launched Anemia Mukt Bharat (AMB) strategy in 2018, to deal with the high burden of anemia in the country. Point-of-care testing (POCT) of anemia using digital hemoglobinometers and treatment is one of the primary interventions under AMB. This study aimed to determine the diagnostic validity of digital hemoglobinometers (TrueHb and HemoCue 301) for screening of anemia compared to hematology analyzer. Methodology: A hospital-based, cross-sectional study was conducted among pregnant women attending antenatal clinics of a selected primary health center and subdivisional hospital of Haryana, India, during January 2019. Hemoglobin (Hb) levels of the pregnant women were estimated in digital hemoglobinometers using capillary blood samples and hematology analyzer using venous blood samples. Bias, limits of agreement (LOA), and validity of digital hemoglobinometers were assessed against a hematology analyzer. Results: A total of 110 pregnant women were included. Bias (LOA) in Hb values estimated using digital hemoglobinometers was −0.09 g/dL (−1.97 to 1.80 ) for HemoCue301 and −0.04 g/dL (−1.69 to 1.60) for TrueHb compared to the hematology analyzer. HemoCue® 301 (sensitivity: 86% and specificity: 83%) had relatively higher sensitivity and specificity compared to TrueHb (sensitivity: 78.9% and specificity: 81%). Conclusions: Digital hemoglobinometers have high sensitivity and specificity. Thus, these can be a potential POCTs for screening of anemia in peripheral health facilities. Further studies are required to establish the validity of the digital hemoglobinometers at community settings.
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Study to assess birth preparedness and complication readiness to promote safe motherhood among women from a rural area of Western Maharashtra p. 511
Viyusha T Viswanathan, Supriya S Patil, Radhika N Joshi, Prakash M Durgawale
Background: Promotion of maternal health should be an integrated approach comprising adequate planning of pregnancy coupled with the awareness of the available maternal and child health services and its utilization. Objectives: The aim of this study is to determine birth preparedness and complication readiness (BPACR) among antenatal and postnatal women and to assess the factors related to it. Materials and Methods: This hospital-based cross-sectional study was conducted on 400 antenatal and postnatal women attending a tertiary care hospital of Karad. Antenatal women in their third trimester and postnatal women up to Postnatal day-7 were included. Institutional ethical clearance was obtained before the commencement of the study. All the women were interviewed after their informed consent using the appropriately validated and modified BPACR tool developed with respect to the Indian setup. Chi-square and multivariate logistic regression analysis were carried out to determine the various associated factors with BPACR. Results: The study population comprised 55.5% antenatal mothers and 44.5% postnatal mothers. The BPACR index was found to be 59.56, and the maximum had a good BPACR 208 (52%). There was poor knowledge regarding blood transfusion, danger signs, and available community resources. A higher level of education had a statistically significant association with BPACR (46.2%) in women educated above high school). Women belonging to the upper class had two times, and postnatal women had 2.02 times increased chances for a good BPACR. Conclusion: An inclusion of components related to BPACR during pregnancy will improve timely and adequate access to healthcare, better management of complications, and thereby improve both maternal and fetal outcomes.
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Association of obesity and metabolic syndrome among urban dwellers of Rishikesh, Uttarakhand p. 516
Senkadhirdasan Dakshinamurthy, Vartika Saxena, Ranjeeta Kumari, Anissa Atif Mirza, Minakshi Dhar
Background: Noncommunicable diseases include heart disease, stroke, cancer, diabetes, and chronic lung diseases and are collectively responsible for almost 70% of all deaths worldwide. Metabolic syndrome (MetS) predisposes to coronary artery disease irrespective of age, gender, or family history of diabetes. Aim and Objectives: The aims of this study were as follows: (1) to assess the prevalence and its predictors of obesity among the urban population, (2) to analyze the association of obesity with MetS, and (3) to analyze the correlation of obesity with different components of MetS. Materials and Methods: A community-based cross-sectional study was conducted in an urban area of Rishikesh. The World Health Organization STEPS instrument and protocol were used for the assessment of risk factors and measurements. The sample size was calculated to be 478. Data were analyzed using SPSS version 20.0. Appropriate statistical tests for bivariate and multivariate analysis were done. P < 0.05 was considered statistically significant. Results: The prevalence of MetS among obese individuals was significantly higher (57%) according to the National Cholesterol Educational Program Adult Treatment Panel 3 definition (P < 0.001). The prevalence of MetS in male and female obesity was 56.8% and 57.1%, respectively. Body mass index was significantly correlated with systolic blood pressure (BP) (r = 0.238, P = 0.001), diastolic BP (r = 0.281, P = 0.001), Fasting blood glucose (FBG) (r = 0.136, P = 0.003), and triglycerideTriglycerides (TG) (r = 0.12, P = 0.009) and negatively correlated with High Density Lipoproteins (HDL) (r = −0.041, P = 0.37). Whereas, waist–hip ratio was significantly correlated with systolic BP (r = 0.277, P = 0.001), diastolic BP (r = 0.251, P = 0.001), FBG (r = 0.232, P = 0.001), and TG (r = 0.273, P = 0.001) and not with HDL (r = 0.033, P = 0.466). Conclusions: As the prevalence of MetS is higher among obese individuals, health interventions required to reduce the morbidity/mortality and need to be addressed in adult populations.
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Factors affecting mammography screening utilization among educated women in Al Beheira governorate, Egypt p. 522
Basem M M. Salama
Background: Breast cancer (BC) is the leading cancer in women worldwide and is increasing particularly in developing countries where the majority of cases are diagnosed in late stages. Early detection at an early stage by mammography screening leads to better prognosis and improves the survival rate for this malignancy. The aim of the study was to analyze factors that affect mammography screening utilization among educated women. Patients and Methods: A total of 700 educated women aged 40 years and older were included in a community-based cross-sectional interview survey that was conducted in between June 2017 and August 2018 in Al Beheira governorate Egypt. Results: Multivariate logistic regression revealed that lack of knowledge about mammography (odds ratio [OR] = 9.8), education level (OR = 6.0), employment status (OR = 3.5), cancer fatalism (OR = 3.0), residence (OR = 2.8), fear of embarrassment (OR = 2.6, fear of positive result (OR = 2.4), family income (OR = 1.9), and health insurance (OR = 1.8) were significant (P < 0.05) predictors of mammography screening utilization. Conclusion: Mammography utilization screening rate is low. Lack of knowledge about mammography, cultural norms, and socioeconomic factors were barriers to mammography screening.
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Effect of interactive lectures and formative assessment on learning of epidemiology by medical undergraduates – A mixed-methods evaluation p. 526
Vinayagamoorthy Venugopal, Amol R Dongre
Background: Previously, we had a course in epidemiology for medical undergraduates that was based on traditional lecture methods with no formal formative assessment (FA). We found poor uptake of our course in terms of learning and attendance by students. Objective: The objective was to assess the effect of improved course (interactive lectures and formal FA) in epidemiology on student learning and attendance. Materials and Methods: It was a triangulation type of mixed-methods program evaluation, where both quantitative (quasi-experimental design) and qualitative (open-ended responses) analysis was done. This study was carried out in the department of community medicine in a tertiary care teaching hospital, Puducherry. We improved the quality of the course material, interaction in lectures and included formal structured FA in the last course. Kirkpatrick's framework was used for the course evaluation. We compared the performance of three batches to check the effect of our revisions on students' learning and their attendance. Results: Student's learning outcome was measured using end-of-course assessment scores (Level-2). The percentage of students successfully completing the course improved from 39% to 81% and attendance status of ≥90% improved from 50% to 57%. Learner's immediate reactions (Level-1) were captured using open-ended questions, and content analysis was done. Students appreciated the course material, FAs, and in-class activity. Conclusions: Little improvement in a traditional epidemiology course for undergraduates in the form of interactive lectures and formative feedback and providing the student with course material led to significant gains in students' knowledge and attendance.
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Depression among Patients with Pulmonary Tuberculosis at the State Hospital of Makassar p. 531
Andi Alfian Zainuddin, Sri Ramadany, Arif Santoso
Background: Comorbidity of tuberculosis (TB) and depression is common. It is associated with the decrease in function, increasing rate of medical cost, nonadherence to long-term medication and self-care, and upward trend of mortality. This study aims to determine the prevalence and distribution of depression in pulmonary TB patients by age, sex, and marital status. Methods: This study is a descriptive research conducted at the Pulmonary Clinic of the State Hospital of Makassar (RSUD Kota Makassar). Ninety-two of 820 patients were selected using the Slovin sample size formula. The patients of the study were collected from the population of patients with TB using consecutive sampling through an interview. The depression rate was examined using the Beck Depression Inventory-II (BDI-II) questionnaire. Interpretation of the BDI-II was determined by a score of ≤16 indicating no depression and >16 for depression. Results: The study indicates that the percentage of patients with depression constituted 31.5%. The number of female patients with depression was higher than that in males with 38.2% and 27.6%, respectively. The biggest proportion of patients with depression was in senior patients (>45 years old) with 37.5%. The fraction of unmarried/divorced respondents was bigger than coupled respondents, with a percentage of 43.5 and 27.5, respectively. Conclusion: The prevalence of depression in pulmonary TB patients who visited the Pulmonary Clinic of the State Hospital of Makassar reached over one-third of the total patients. Depression was more prevalent among female patients, patients within the age of >45 years, and unmarried/divorced patients, respectively.
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Software intervention in smoking cessation among engineering students in Bhubaneswar city: A randomized controlled trial p. 534
Avinash Jnaneswar, Kunal Jha, Diplina Barman, Arpita Singh, Mona Pathak, Gunjan Kumar
Objectives: The study objective was to test the effectiveness of a photoaging software (APRILAGE©) intervention based on personalized, vivid illustrations of “smoker's face” among smokers aged 18–24 years of age in Bhubaneswar city through a self-structured questionnaire. Materials and Methods: A total of 204 engineering college students were randomized into two groups: intervention and control. A self-structured questionnaire in the form of Google Form was distributed among the participants. The study group participants were photographed using Aprilage® Software. Follow-up data were collected using the same questionnaire at 1-month and 3-month intervals. Statistical Analysis was done using STATA 15 software. Descriptive statistics and the relation between the dependent and independent variables were done using the nonparametric tests of significance. The probability value was kept at 0.05. Results: Significant reduction in nicotine dependency, was seen in 64.36% of the study population (P < 0.0001). There was a shift from severely dependent group to moderately or low dependence group in 33% of the study occupants. Conclusion: Aging software intervention is contemporary, congenial, and admissible and can be espoused to educate youngsters along with the conventional motivational methods. This method successfully delivers smoking cessation advice to young adults. This novel approach can be implemented in motivating young smokers to quit smoking.
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Prevalence of asthma and sleep-related breathing disorder in school-going children p. 540
Rashmi Kaushal, Pankaj Bhardwaj, Akhil Dhanesh Goel, Shashank Shekhar, Prawin Kumar, Jagdish Prasad Goyal
Objective: The main objective of the study was to determine the prevalence of asthma and sleep-related breathing disorder (SRBD) in school-going children. Methods: This school-based, cross-sectional study was conducted among children of age groups of 6–7 and 13–14 years from 31 public and private schools in rural and urban areas of Jodhpur. A pretested and validated questionnaire in Hindi for childhood asthma, International Study of Asthma and Allergies in Childhood questionnaire and 22-item pediatric SRBD scale were used to collect data. Results: A total of 2245 children were screened for asthma and SRBD. The overall prevalence of asthma and SRBD in school children in Jodhpur was 8.0% (95% confidence interval [CI]: 6.9%–9.2%) and 9.5% (95% CI: 8.4–10.8), respectively. Asthma was found to be significantly associated with SRBD in school-going children in Jodhpur (odds ratio: 4.8; 95% CI: 3.3–6.8) on multiple logistic regression analysis.Conclusion: There is a significantly high prevalence of asthma and SRBD with a good association between them in school-going children.
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Assessment of tobacco control policy in India: An evaluation using the World Health Organization MPOWER framework p. 543
Anurag Saxena, Khushbu Sharma, Vidhee Avashia
Background: Tobacco consumption is considered to be one of the most avertable causes of premature mortality and morbidity. In 2004, the World Health Organization (WHO) successfully negotiated the Framework Convention on Tobacco Control to work toward reducing tobacco consumption globally. Being a signatory, India has implemented several programs to control tobacco consumption. Objectives: The objective of this study is to understand the efficacy of tobacco control policies in India between 2013 and 2019 based on the WHO MPOWER measures. Materials and Methods: Secondary data from WHO's reports on the global tobacco epidemic program for the years 2013, 2015, 2017, and 2019 is used. Evaluation of tobacco control policies is done using the MPOWER measures proposed by the WHO in 2008, and a checklist of indicators and scoring system which is widely used in literature. Results: Of the total score of 37, scores for 2013, 2015, 2017, and 2019 are 24, 27, 28, and 29, respectively. The average score for seven years is 27. Conclusions: Tobacco control policies in India have shown an overall improvement. Achievements have been made even though several implementations related challenges requiring urgent attention persist.
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Occupational health of agricultural women workers in India p. 546
J Raja Meenakshi, Sigamani Panneer
Background: Women in Agriculture form a significant portion of the productive work force in Indian economy. Occupational Health is a vital component of nation's infrastructure and it focuses on the physical, mental and social well being of workers. In India, Occupational Heath among agricultural women is a public health issue which needs immediate attention. Objectives: To study the association between health and agriculture, the occupational hazards and health problems faced by agricultural women workers and the related policy provisions in India. Methods: An extensive literature review and data search were done using online search engines, peer reviewed articles and the reports of various departments of Government of India. Results: The result reveals that Occupational health hazards have a direct impact on the physical and mental health of women workers. Conclusion: Implementation of social security and welfare measures by the Government for the agricultural women could enhance the health of women workers.
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Sexual behaviors of HIV-infected men who have sex with men in Jos, Plateau State, North Central Nigeria p. 550
Tolulope Olumide Afolaranmi, Zuwaira Ibrahim Hassan, Zaman Misari, Obinna Joseph Ugwu, Philip Adewale Adeoye, Oluwaleke James Fayenuwo, Eugene Chidi Eugene, Akinyemi Olugbenga David Ofakunrin, Moses Peter Chingle, Ali Ishaq Shugaba
Background: Sub-Saharan Africa region remains heavily plagued by HIV/AIDS with recent information suggesting that sex between men is a significant contributor to the spread of this infection. It was against this backdrop that this study was conducted to examine the sexual behaviors of HIV-infected men who have sex with men (MSM) in Jos, Plateau state, North Central Nigeria. Materials and Methods: A cross-sectional study was conducted among 114 HIV-infected MSM 18 years and above using a quantitative method of data collection. Respondent-driven sampling technique was employed in sampling the study participants, and EpiInfo statistical software version 7 was used for the data analysis. Results: The mean age of the respondents was 26.0 ± 5.4 years with condom use in the last anal sex being 77 (67.5%), while majority (83.3%) of the respondents was adjudged to have been engaged in risky sexual behaviors. Conclusions: This study has brought to light a significant level of risky sexual behaviors among HIV-infected MSM with condom use, multiple same sexual engagement, transactional sex, and bisexual concurrency as areas of possible interventions.
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Prescription audit of treatment of diarrhoea and pneumonia amongst paediatrician in Bhopal p. 554
Devendra Gour, Manju Toppo, Dinesh Kumar Pal, Harshima Sawlani, Shipra Verma, Akhil R Nair, Sudarshan Kushwah
Background: A prescription by a doctor may be taken as a reflection of physician's attitude to the disease. Inappropriate prescription has always been a serious problem in developing countries. Objectives: The objective was to observe the current prescription practices for the management of diarrhea and pneumonia in Bhopal. Settings and Design: This was a cross-sectional study. Materials and Methods: The study was conducted at the clinics and hospitals of Bhopal over 4 months. The prescription of under-5 children with a diagnosis of acute respiratory tract infection and/or acute gastroenteritis attending the outpatient departments was included in the study. Data were recorded and analysis was done. Statistical Analysis Used: Epi Info was used for statistical analysis. Results: A total of 513 prescriptions of pneumonia and 417 of diarrhea were observed under the study. Among pneumonia, signs were mentioned on 15.6%, 74% as cold and cough with 95.5% prescriptions with antimicrobials. Seventy-three percent of diarrhea prescriptions did not mention any signs. Oral rehydration salt and zinc were prescribed in majority of the prescriptions along with around 64% use of antibiotics as well for the treatment of diarrhea. Conclusion: There is a huge need of improvement in prescribing patterns in areas of complete prescriptions with clinical features, follow-up advice along with rational choice of drugs with dose, and duration.
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Knowledge on practice regarding self-defense against sexual harassment among females in Mangalore with a view to providing an informational pamphlet p. 558
Seema Shankarsingh Chavan, Roweena Fern, Shilpa T Augustine, Uma Nayak
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Errors in the use of multivariable logistic regression analysis: An empirical analysis p. 560
Rajeev Kumar Malhotra
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Rapid assessment of diet provided in public health facilities of selected districts of Madhya Pradesh p. 563
Manju Toppo, Dinesh Kumar Pal, Devendra Gour, Akhil R Nair, Shipra Verma, Harshima Sawlani
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Effectiveness of the training material on chronic obstructive pulmonary disease designed for accredited social health activist workers: A quasi-experiment design p. 565
Monica S Barne, Bhushan A Girase, Dhananjay V Pathak, Deesha D Ghorpade, Prakash P Doke, Sundeep S Salvi
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Health workers' approach toward Adverse Events following immunization – An insight from Madhya Pradesh p. 567
Snehal Parmar, Tapasvi Puwar, Deepak Saxena, Santosh Shukla, Apurva Kumar Pandya
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  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007