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   2016| April-June  | Volume 41 | Issue 2  
    Online since February 26, 2016

 
 
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EDITORIAL COMMENTARY
Public health challenges in India: Seizing the opportunities
Jai Prakash Narain
April-June 2016, 41(2):85-88
DOI:10.4103/0970-0218.177507  PMID:27051080
  23,902 567 -
SHORT COMMUNICATIONS
An epidemiological study of overweight and obesity among women in an Urban area of North India
Sangeeta Girdhar, Sarit Sharma, Anurag Chaudhary, Priya Bansal, Mahesh Satija
April-June 2016, 41(2):154-157
DOI:10.4103/0970-0218.173492  PMID:27051092
Background: Obesity is a complex, multi-factorial chronic disease. Overweight and obesity are the fifth leading risk for global deaths. Objectives: To find the prevalence and risk factors for obesity in women aged 20-60 years in Ludhiana city. Methods: The present study is a community based cross sectional study carried out in an urban area of Ludhiana among women aged 20-60 years. Among the study population of 324 women, a pre-designed and pre-tested questionnaire was used to record the socio-demographic and anthropometric profile of women. Chi square test and logistic regression was used to find the association of obesity and hypertension with socio-demographic variables. Results: The prevalence of overweight and obesity was 12.7% and 29.6% respectively. Obesity was found to be more common among middle-aged Punjabi housewives belonging to upper socio-economic strata. There was strong association between overweight/obesity and hypertension.
  3,717 374 -
ORIGINAL ARTICLES
Problem-based learning as an effective learning tool in community medicine: Initiative in a private medical college of a developing country
Nitin Joseph, Sharada Rai, Deepak Madi, Kamalakshi Bhat, Shashidhar M Kotian, Supriya Kantharaju
April-June 2016, 41(2):133-140
DOI:10.4103/0970-0218.177535  PMID:27051088
Background: Knowledge of community medicine is essential for health care professionals to function as efficient primary health care physicians. Medical students learning Community Medicine as a subject are expected to be competent in critical thinking and generic skills so as to analyze community health problems better. However, current teaching by didactic lectures fails to develop these essential skills. Problem-based learning (PBL) could be an effective strategy in this respect. This study was hence done to compare the academic performance of students who were taught Community Medicine by the PBL method with that of students taught by traditional methods, to assess the generic skills of students taught in a PBL environment and to assess the perception of students toward PBL methodology. Materials and Methods: This study was conducted among seventh-semester final-year medical students between June and November 2014. PBL was introduced to a randomly chosen group of students, and their performance in an assessment exam at the end of postings was compared with that of the remaining students. Generic skills and perception toward PBL were also assessed using standardized questionnaires. Results: A total of 77 students took part in the brainstorming session of PBL. The correlation between self-assigned scores of the participants and those assigned by the tutor in the brainstorming session of PBL was significant (r = 0.266, P = 0.05). Out of 54 students who took part in the presentation session, almost all 53 (98.1%) had good perception toward PBL. Demotivational scores were found to be significantly higher among males (P = 0.024). The academic performance of students (P < 0.001) and success rates (P = 0.05) in the examination were higher among students who took part in PBL compared to controls. Conclusion: PBL helped improve knowledge of students in comparison to those exposed only to didactic lectures. As PBL enabled students to identify the gaps in their knowledge and enhanced their group functioning and generic skills, we recommend PBL sessions: They would help optimize the training in Community Medicine at medical schools. Good correlation of tutor and self-assessment scores of participants in the brainstorming session suggests that the role of tutors could be restricted to assessment in presentation sessions alone. Demotivation, which hinders group performance in PBL, needs to be corrected by counselling and timely feedback by the tutors.
  3,205 368 -
Assessment of self-reported emotional and behavioral difficulties among pre-university college students in Bangalore, India
Poornima Bhola, Vidya Sathyanarayanan, Dorothy P Rekha, Sheila Daniel, Tinku Thomas
April-June 2016, 41(2):146-150
DOI:10.4103/0970-0218.177536  PMID:27051090
Background: The understanding of youth mental health needs and development of service delivery models is a national public health challenge. Objectives: The rates and predictors of emotional and behavioral problems among 1087 youth were assessed in a pre-university college in Bangalore, India. Variations in rates of disturbance, identified by using different cut-off points, were also examined. Materials and Methods: The Strengths and Difficulties Questionnaire was used as a self-report screening tool. Results: Results indicated that 10.1% of adolescents had total difficulty levels in the abnormal range, with 9% at risk for emotional symptoms, 13% for conduct problems, 12.6% for hyperactivity/inattention and 9.4% for peer problems. Select gender differences were present. Cut-off scores derived from the sample yielded lower estimates of disturbance than the published cut-offs. Regression analysis identified predictors of total difficulty levels. Conclusions: Implications for assessment of youth mental health and planning targeted services in educational institutions are discussed.
  2,858 357 -
CME
Application of mixed method approach in public health research
Manmeet Kaur
April-June 2016, 41(2):93-97
DOI:10.4103/0970-0218.173495  PMID:27051082
  2,837 339 -
SHORT COMMUNICATIONS
Effectiveness and feasibility of weekly iron and folic acid supplementation to adolescent girls and boys through peer educators at community level in the tribal area of Gujarat
Shobha P Shah, Pankaj Shah, Shrey Desai, Dhiren Modi, Gaytri Desai, Honey Arora
April-June 2016, 41(2):158-161
DOI:10.4103/0970-0218.173498  PMID:27051093
Background: Anemia during adolescence affects growth and development of girls and boys increasing their vulnerability to dropping out-of-school. Hence investing in preventing anemia during adolescence is critical for their survival, growth and development. Objective: To find out the burden of anemia on adolescent age group in the tribal area of Jhagadia block and to assess the change in the hemoglobin level through the weekly Iron and Folic Acid IFA (DOTS) directly observed treatment supplementation under Supervision by Peer Educators at Community level among adolescents. Methods: Community based intervention study conducted with adolescents (117 girls and 127 boys) aged 10-19 years, through supplementation of IFA (DOTS) by trained Peer Educators for 52 weeks in 5 tribal villages of Jhagadia. Hemoglobin level was determined by HemoCue method before and after intervention and sickle cell anemia by Electrophoresis method. Primary data on hemoglobin and number of tablets consumed was collected and statistically analyzed in SPSS 16.0 software by applying paired t-test. Results: The overall findings suggest that the prevalence of anemia reduced from 79.5% to 58% among adolescent girls and from 64% to 39% among boys. Mean rise of hemoglobin seen was 1.5 g/dl among adolescent boys and 1.3 g/dl among girls. A significant association was found in change in hemoglobin before and after intervention (P = 0.000) Conclusion: Prevalence of anemia among girls and boys can be reduced in their adolescent phase of life, through weekly supplementation of iron folic acid tablets under direct supervision and Nutrition Education by Peer Educator at community level.
  2,765 310 -
ORIGINAL ARTICLES
Risk factors for dots treatment default among new HIV-TB coinfected patients in Nalgonda (Dist.) Telangana (State): A case control study
Siva Balaji Reddy Satti, Nagaraj Kondagunta
April-June 2016, 41(2):120-125
DOI:10.4103/0970-0218.177529  PMID:27051086
Background: The therapeutic regimens as recommended by the Revised National TB Control Programme (RNTCP) have been shown to be highly effective for both preventing and treating tuberculosis, but poor adherence to medication is a major barrier to its global control. Aim and Objectives: The study was conducted to assess the influence of patient related factors for DOTS Treatment Default among HIV-TB Co-infected cases. Setting and Design: This was a case control study conducted in Nalgond, Telangana. Materials and Methods: All new HIV-TB coinfected and DOTS-defaulted patients registered under RNTCP for the period from January 2010 to December 2012 were selected. Of the 154 patients, 23 had died and 11 could not be traced, and these were excluded. Thus the total number of available cases were 120 for those age- and sex-matched controls (HIV-TB coinfected patients and those who had completed the DOTS regimen successfully) were selected. Results: The mean age was 36.5 ± 9 years; the majority (23.3%) of patients defaulted during the second month of treatment. Significant risk factors associated with defaulting included unskilled occupation [adjusted odds ratio (AOR: 3.56; 95% confidence interval (CI): 1.1-11.56], lower middle class socioeconomic status (AOR: 17.16; 95% CI: 3.93-74.82), small family size (AOR: 21.3; 95% CI: 6.4-70.91), marital disharmony (AOR: 6.78; 95% CI: 1.93-23.76), not being satisfied with the conduct of health personnel (AOR: 7.38; 95% CI: 2.32-23.39), smoking (AOR: 8.5; 95% CI: 2.31-31.21), and side effects of drugs (AOR: 4.18; 95% CI: 1.35-12.9). Conclusion: Unskilled occupation, marital disharmony, small family size, lower middle class socioeconomic status, not being satisfied with the conduct of health personnel, smoking, and drug side effects were significantly associated with defaulting. Information on the pattern of tuberculosis (TB), the outcome of anti-tuberculosis treatment (ATT), and the factors associated with it will help in planning interventions to improve adherence to DOTS treatment.
  2,406 501 -
Taken to health care provider or not, under-five children die of preventable causes: Findings from cross-sectional survey and social autopsy in Rural India
Vaishali Deshmukh, Chandrakant Lahariya, Sriram Krishnamurthy, Manoj K Das, Ravindra M Pandey, Narendra K Arora
April-June 2016, 41(2):108-119
DOI:10.4103/0970-0218.177527  PMID:27051085
Background: Under-five children in India continue to die from causes that can either be treated or prevented. The data regarding causes of death, community care-seeking practices, and events prior to death are needed to guide and refine health policies for achieving national goals and targets. Materials and Methods: A cross-sectional survey covering rural areas of 16 districts from eight states across India was conducted to understand the causes of deaths and the health-seeking patterns of caregivers prior to the death of such children. Mothers of the deceased children were interviewed. The physician review process was used to assign cause of death. The qualitative data were analyzed as per standard methods, while STATA version 10 was used for analysis of quantitative data. Findings: A total of 1,488 death histories were captured through verbal autopsy. Neonatal etiologies, acute respiratory infection (ARI), and diarrhea accounted for approximately 63.1% of all deaths in the under-five age group. The causes of death in neonates showed that birth asphyxia, prematurity, and neonatal infections contributed to more than 67.5% of all neonatal deaths, while in children aged 29 days to 59 months, ARI and diarrhea accounted for 54.3% of deaths. Care providers of 52.6% of the neonates and 21.7% of infants and under-five children did not seek any medical care before the death of the child. Substantial delays in seeking care occurred at home and during transit. For those who received medical care, there was an apparent amongst in their caregivers toward private health providers. Conclusion: The deaths of neonates and postneonates taken to any health facilities highlight the need for providing equitable and high-quality health services in India. The findings could be used for policy planning and program refinement in India.
  2,395 396 -
VIEW POINT
Controversies continue: Universal supplementation of megadose of vitamin A to young children in India
Neha Sareen, Umesh Kapil
April-June 2016, 41(2):89-92
DOI:10.4103/0970-0218.177515  PMID:27051081
The universal megadose of vitamin A (MDVA) supplementation program was started in the year 1970. The program is presently in continuation for the prevention of nutritional blindness and possibly reduction in under-five mortality rate (U5MR). Presently, blindness due to vitamin A deficiency (VAD) has disappeared and the difference between U5MR and infant mortality rate (IMR) is less than 10 thus MDVA is unlikely to have any impact on mortality. The continuation of universal MDVA needs to be modified based on the current scientific evidence.
  2,350 290 -
SHORT COMMUNICATIONS
Caffeine intake among adolescents in Delhi
Mridul Gera, Swati Kalra, Piyush Gupta
April-June 2016, 41(2):151-153
DOI:10.4103/0970-0218.173501  PMID:27051091
Background: Availability and advertising of caffeinated drinks is on the rise in Indian market. Excess caffeine intake may have deleterious effects on health. Objective: To estimate the daily consumption of caffeine among urban school-going adolescents from Delhi. Materials and Methods: A school-based survey was conducted to determine the amount and pattern of caffeine consumption among students of classes 9-12, using a self-administered questionnaire. Results: Of 300 participants (median age 15 year, 174 boys), 291 (97%) were consuming caffeine [mean (SD): 121.0 (98.2) mg/day]. Nineteen (6%) students were consuming more than 300 mg of caffeine per day. Tea/coffee contributed to more than 50% of the caffeine intake. The rest was derived from cola beverages, chocolates, and energy drinks. Conclusion: Average caffeine consumption among school-going adolescents from Delhi is high. The findings of this preliminary survey need to be confirmed in larger data sets.
  2,252 203 -
ORIGINAL ARTICLES
Burden of ocular motility disorders at a Tertiary Care Institution: A case to enhance secondary level eye care
Rohit Saxena, Digvijay Singh, Shiva Prasad Gantyala, Sneha Aggarwal, Murli Manohar Sachdeva, Pradeep Sharma
April-June 2016, 41(2):103-107
DOI:10.4103/0970-0218.177523  PMID:27051084
Aim: To evaluate the profile of strabismus and amblyopia in patients presenting to a tertiary care institution in order to understand the disease burden. Materials and Methods: A retrospective, prospective hospital-based observational study was conducted at a tertiary level eye care hospital in India. All patients with strabismus or amblyopia who presented over a 1-year period were identified and referred to the squint clinic, where they were evaluated with a detailed clinical history and examination. Results: A total of 24475 patients were evaluated, of which 1950 had strabismus or amblyopia. The overall magnitude of amblyopia and strabismus was 2.0% [95% confidence interval (CI), 1.8-2.2)] and 6.9% (95% CI, 6.6-7.2), respectively. About 20% of those seeking an ophthalmic consultation were children and they constituted over half of the population referred to the squint clinic. Among younger children, the burden of amblyopia and strabismus was 84.4% and 26.6%, respectively. Among the referred patients, strabismus was noted in 84.6% (N = 1649), most of the cases of which was of the comitant subtype (78.1%, N = 1288) with an equal distribution of exotropia and esotropia. Paralytic [12.9% (N = 251)] and restrictive [4.7% (N = 85)] squint constituted the remaining burden of strabismus. Conclusion: Strabismus and amblyopia affect a sizeable proportion of patients presenting to a tertiary care ophthalmology setup. A significantly higher burden is present in the pediatric population. The majority of the cases of strabismus are of a comitant variety, which do not merit tertiary level eye care. There is a need to improve pediatric eye care at a secondary level to reduce the immense burden on tertiary referral centers.
  2,044 251 -
CME
Quality assurance for accuracy of anthropometric measurements in clinical and epidemiological studies [Errare humanum est = to err is human]
Prem K Mony, Sumathi Swaminathan, Jayachitra K Gajendran, Mario Vaz
April-June 2016, 41(2):98-102
DOI:10.4103/0970-0218.173499  PMID:27051083
Anthropometry involves the external measurement of morphologic traits of human beings. High quality anthropometric measurements are fundamental to clinical and epidemiological research. The measurements for each method have inherent variations, either due to biologic variation or due to error in measurement. Errors in measurement cannot be avoided completely but they can be minimized to a large extent. We define methods to estimate measurement error in anthropometry, offer guidelines for acceptable error, and suggest ways to minimize measurement error; thereby improving anthropometry quality in health assessments. We propose that special attention be paid to the following six key parameters for quality assurance of anthropometric measurements: (i) Identification of certified lead anthropometrist and trainer, (ii) manual of standard operating procedures, (iii) choice of robust equipment, (iv) equipment calibration, (v) standardization training and certification, and (vi) measurements resampling.
  2,096 195 -
SHORT COMMUNICATIONS
Empowering the community to manage diabetes better: An integrated partnership-based model
Arun Bamne, Daksha Shah, Sanjivani Palkar, Shweta Uppal, Anurita Majumdar, Rohan Naik
April-June 2016, 41(2):162-164
DOI:10.4103/0970-0218.173497  PMID:27051094
Context : Rising number of diabetes cases in India calls for collaboration between the public and private sectors. Aims: Municipal Corporation of Greater Mumbai (MCGM) partnered with Eli Lilly and Company (India) [Eli Lilly] to strengthen the capacity of their diabetes clinics. Materials and Methods : Medical Officers, dispensaries and Assistant Medical Officers (AMOs) located at attached health posts were trained on an educational tool, Diabetes Conversation Map™ (DCM) by a Master Trainer. This tool was then used to educate patients and caregivers visiting the MCGM diabetes clinics. Results : Twenty-eight centers conducted 168 sessions, and 1616 beneficiaries availed the education over six months. General feedback from health providers was that DCM helps clear misconceptions among patients and caregivers in an interactive way and also improves compliance of patients. Conclusions : This communication highlights a unique public-private partnership where the sincere efforts of public sector organization (MCGM) were complemented by the educational expertise lent by a private firm.
  1,388 208 -
ORIGINAL ARTICLES
Impact evaluation of domains of learning on Universal Work Precautions (UWP) amongst nursing staff in a Tertiary Care Hospital, Western India
Rashmi Sharma, Pradeep Kumar, Brijesh Patel, Sanju Gajjar
April-June 2016, 41(2):141-145
DOI:10.4103/0970-0218.173493  PMID:27051089
Introduction: Second key strategy of National AIDS Control Program (NACP IV) is comprehensive care and support by providing quality services through zero stigma and discrimination. Quality of services can be improved by eliminating stigma and discrimination and making health care provider aware of associated occupational hazards. Nursing staff play crucial role and are more at risk therefore their understanding, perception and skill must be assessed in different domains of learning to improve the contents and methodology of trainings. Material and Methods: Total 85 nursing staff underwent 1 day training in 3 batches focusing on Universal Work Precautions (UWP), Post Exposure Prophylaxis (PEP) and sensitization of the participants towards PLHA (People living with HIV/AIDS). Their learning was evaluated under different domains (cognitive, psychomotor and affective) using structured questionnaire. Results: In pretest evaluation scores showed minor and statistically not significant variations in terms of participant's gender, age, designation work experience and status of having received any similar training in the past. Impact of the training was visible as overall mean scores increased from 10.6 ± 2.7 to 13.8 ± 5.8; gain being statistically highly significant (P value < 0.001). Gain was highest in cognitive (from 58% to 77%) followed by psychomotor (from 48% to 62%) and minimal in affective domain (from 75% to 76%). Conclusions: After undergoing the training, participants were benefitted more in cognitive domain than psychomotor and affective domain. Acquired knowledge, skill and communication skill if evaluated as done in this study will improve the methodology of such trainings making them more effective.
  1,356 205 -
Does awareness of status and risks of human immunodeficiency virus impact risky transmission behavior among infected adolescents? A case study of clients Attending an Antiretroviral Therapy (ART) clinic in Kano, Kano State, Nigeria
Umar Muhammad Lawan, Esther Awazzi Envuladu, Sanusi Abubakar
April-June 2016, 41(2):126-132
DOI:10.4103/0970-0218.177533  PMID:27051087
Background: Human immunodeficiency virus (HIV)-positive adolescents by virtue of their position are prone to dangerous behaviors including risk-taking for HIV transmission. Objective: To determine the awareness of HIV status and risk factors for HIV transmission among HIV-positive adolescents, and how these impact their behavior. Materials and Methods: A case study approach was used to study a random sample of 400 HIV-positive adolescent children attending an antiretroviral (ART) clinic in Kano, Kano State, Nigeria. Data were analyzed using Statistical Package for the Social Sciences (SPSS) 16.0 computer statistical software. Result: The mean age of the adolescents was 14.9 ± 3.15 years. The majority were females (54.8%) from a polygamous family (57.5%). About two-thirds or 251 (62.8%) patients knew their HIV status. The age of 14 years and above (z = 11.36, P = 0.0001) and having at least secondary school level of education (z = 2.78, P = 0.005) were significantly associated with awareness of HIV status on binary logistic regression. Up to 311 (77.8%) patients had good awareness of the risks of HIV transmission. Awareness of risk of HIV transmission was associated with awareness of HIV status (X 2 = 166.2, P = 0.0001). There was a significant variation in the behaviors between those who were aware of their HIV status and those who were not. Paradoxically, the percentage differences in risk-taking were remarkably high in all the variables examined, and were all in the direction of the adolescents who had good knowledge of the risk factors for HIV transmission. Conclusion and Recommendation: Health ministries, development partners working in this field, and behavioral change communication experts should develop formidable strategies for addressing this menace. There is also a dire need for further research in this area.
  1,142 164 -
LETTER TO EDITOR
Why India needs crashworthy vehicles
Chandrashekhar K Thorbole
April-June 2016, 41(2):165-166
DOI:10.4103/0970-0218.177537  PMID:27051095
  1,104 106 -
BOOK REVIEW
Textbook of chronic noncommunicable diseases: The health challenge of the twenty-first century
Shiv Lal
April-June 2016, 41(2):167-167
  635 156 -
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  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007