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   2018| January-March  | Volume 43 | Issue 1  
    Online since February 13, 2018

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How multipurpose health workers spend time during work? results from a time-and-motion study from Puducherry
Nirmala Saravanan Narayanasamy, Subitha Lakshminarayanan, S Ganesh Kumar, Sitanshu Sekar Kar, Kalaiselvi Selvaraj
January-March 2018, 43(1):5-9
DOI:10.4103/ijcm.IJCM_276_16  PMID:29531430
Background: A multipurpose health worker (MPHW) is the key functionary and the first contact person in a subcenter. This study explores the workload of MPHWs in the multifarious domains of their activities and also assesses their time utilization pattern. Methods: A time and motion study was conducted among 19 auxiliary nurse midwives (ANMs) and 10 HWs male (M) from six selected primary health centers of Puducherry. Participants self-reported their daily activities on a time measurement sheet for 6 days in a week. Data were entered in EpiData software and analyzed using Excel. Calculations are based on a total of 646 and 340 person-hours of observation by ANMs and HWs (M), respectively. Results: Time utilization pattern revealed that ANMs spent half of their time on maternal and child health activities. HWs (M) utilized 45% of their time for vector control programs and 11% for other programs. Documentation constituted nearly 16% and 10% time spent by ANMs and HWs (M), respectively. Other activities that constituted multipurpose workers' time utilization include traveling (8–10%), patient education (5-10%) and personal activities (6–12% ). The proportion of time spent in community activities was around 54% by HWs (M) and 32% by ANMs. Observations on self-reporting were comparable with that of participant observations. Conclusions: This study reflects the workload in different domains of MPHWs' activities and the “multipurpose” nature of their work, relevance of their job responsibilities in the context of national programs, and changing profile of their job.
  11,156 440 1
A comparative study of health status and quality of life of elderly people living in old age homes and within family setup in Raigad District, Maharashtra
Priyanka Amonkar, Madhavi Jogesh Mankar, Pandurang Thatkar, Pradeep Sawardekar, Rajesh Goel, Seema Anjenaya
January-March 2018, 43(1):10-13
DOI:10.4103/ijcm.IJCM_301_16  PMID:29531431
Background: The traditional concept of family in India to provide support to the elderly is changing soon with disintegration of joint families. In this scenario the concept of old age homes (OAHs) is gaining momentum and the number of people seeking OAH care is rapidly increasing. However, not much is known about the quality of life (QOL) of Indian elderly staying in the OAH setup. Objectives: To assess and compare the Health status, Quality of Life and Depression in elderly people living in OAHs & within family using WHOQOL –OLD questionnaire & Geriatric Depression Scale Methods: A cross sectional study was conducted in elderly aged above 60 years of age. After taking a written consent and matching for age and sex & socioeconomic status, 60 elderly from OAHs & 120 elderly living within family setup were selected randomly. The WHOQOL-OLD standard questionnaire & GDS were used to assess quality of life & depression in elderly. Result: The QOL of elderly in domains of autonomy, past present & future activities, social participation and intimacy was better in family setup (60.62, 70.62, 66.14 and 58.43) as compared to OAHs (51.35, 62.91, 59.47and 41.16) (p<0.05). There was statistically significant difference in mean geriatric depression scores of both the group (3.96 within family setup and 5.76 in OAH's). Conclusion: Quality of life of elderly within family setup was better as compared to elderly in OAHs.
  7,457 627 4
Detect–Treat–Prevent–Build: Strategy for TB elimination in India by 2025
Anil Jacob Purty
January-March 2018, 43(1):1-4
DOI:10.4103/ijcm.IJCM_321_17  PMID:29531429
  5,839 518 5
An analysis of integrated child development scheme performance in contributing to alleviation of malnutrition in two economically resurgent states
Aparna Ruia, Rajul Kumar Gupta, Gargi Bandyopadhyay, Rajshree R Gupta
January-March 2018, 43(1):44-48
DOI:10.4103/ijcm.IJCM_47_17  PMID:29531439
Background: Good economic growth is considered synonymous with good nutrition. In recent past, some states (like Bihar and Gujarat) have seen unprecedented economic growth. Despite this and introducing plethora of programs (including integrated child development scheme [ICDS]) to reduce malnutrition, one state might be performing well in reducing malnutrition whereas other with equally high economic growth rate might lag behind. Is mere economic growth good enough to alleviate malnutrition? Objectives: The aim of the article is to document a critical comparative analysis of malnutrition with special emphasis on ICDS (with respect to finances, infrastructure, training, performance) in the two economically resurgent states of Gujarat and Bihar. Material and Methods: An exploratory study using secondary data sources (for ICDS performance) to critically analyze malnutrition status in Bihar and Gujarat. Results: Gujarat, which was criticized for placing excessive emphasis on economic growth, has shown sharp improvement in combating malnutrition. Undernourished children declined from 73.04% in 2007 to 25.09% in 2013, with just 1.6% being severely malnourished. On the other hand, Bihar too exhibited an impressive economic growth but still languishes at bottom with malnutrition rate of 82%. Conclusion: A high economic growth does not have automatic immediate positive gains on malnutrition alleviation.
  4,317 256 -
A step toward healthy newborn: An assessment of 2 years' admission pattern and treatment outcomes of neonates admitted in special newborn care units of Gujarat
Harsh Dilipkumar Shah, Bonny Shah, Paresh V Dave, Janak B Katariya, Khyati P Vats
January-March 2018, 43(1):14-18
DOI:10.4103/ijcm.IJCM_305_16  PMID:29531432
Context: Facility Based Newborn Care (FBNC) is a key strategy to improve child survival, especially in newborn care where neonatal mortality rate (NMR) is stagnant in declining. Gujarat has achieved considerable amount of reduction in child deaths, but neonatal health requires attention. The study was aimed to assess the admission pattern of Special Newborn Care Units (SNCUs) which supports decision-making. Settings and Design: A cross-sectional descriptive analysis was done from secondary data of the SNCU reports on the aspects of admission patterns, morbidity, and mortality pattern. The reports had been analyzed on various critical variables. Results: In 2015–2016, Gujarat has operationalized forty SNCUs by saturating each district with at least one SNCU. The study found near proportions of (53%) inborn – (47%) outborn admission and 44% admission of female. Out of 69,662 admissions, 67% were discharged, 16% died, 10% leaving against medical advice, and 7% referred to higher centers. Major reasons for admission were respiratory distress syndrome (RDS) (22%) and infection (21%). Similar pattern in mortality found as final diagnosis of deaths was RDS (23%) and infection (21%). The proportion of neonatal deaths in outborn was high compared to inborn. Conclusion: Strengthening of FBNC is essential to address neonatal mortality. NMR is of prime focus because the health interventions needed to tackle NMR differ from those needed for infant mortality rate and under-five mortality rate. This accentuates the need for focused attention on facility- and community-based child health interventions along with quality maternal health services and robust referral mechanisms to all delivery points.
  3,791 240 2
Factors affecting compliance to antihypertensive treatment among adults in a tertiary care hospital in Mumbai
Ayushi Jayesh Shah, Vijaykumar Singh, Subita P Patil, Mithila R Gadkari, Varun Ramchandani, Karan Janak Doshi
January-March 2018, 43(1):53-55
DOI:10.4103/ijcm.IJCM_40_17  PMID:29531441
Background: Compliance to antihypertensive therapy reduces the risk of complications. It is important to understand the factors affecting compliance in patients so that the goal of successful treatment is not jeopardized. Objectives: To determine the proportion of participants' compliant to treatment and various factors associated with compliance of antihypertensive treatment. Settings and Design: A cross-sectional study of 330 hypertensive patients on treatment attending the outpatient department of a tertiary care hospital in Mumbai. Subjects and Methods: It was conducted over 8 weeks using a validated, pretested questionnaire including information on the individual's sociodemographic profile, compliance to antihypertensive therapy and lifestyle advice assessed using a 4-point Likert scale. Statistical Analysis: Data were entered into MS Excel 2007 and analyzed using SPSS 20. Results: Participants' mean age was 55.2 ± 12.6 years. 39.4% were compliant to their treatment. Common reasons for frequently skipping the dose – forgetfulness (41.2%) and discontinued the medication when feeling well (30.3%). Factors positively associated with compliance were gender and illiteracy. The proportion of noncompliance among smokers and alcoholics was statistically significant. Conclusion: Forgetfulness and subjective feeling of wellness were the prevalent reasons for noncompliance. Controlling habits such as smoking and alcohol may prove as key factors for compliance.
  3,801 198 2
Dietary diversity and stunting among infants and young children: A cross-sectional study in Aligarh
Istiyaq Ahmad, Najam Khalique, Salman Khalil, Urfi , Mohd Maroof
January-March 2018, 43(1):34-36
DOI:10.4103/ijcm.IJCM_382_16  PMID:29531436
Context: Child undernutrition is a public health problem in a developing country like India. Dietary diversity is an important immediate determinant of undernutrition. Aims: The aim of this study is to find the prevalence of stunting among infants and young children aged 6–23 months and its association with dietary diversity. Settings and Design: This study was community-based cross-sectional study. It was carried out in the registered families of the Urban Health Training Centre and Rural Health Training Centre, Department of Community Medicine, Jawaharlal Nehru Medical College, AMU, Aligarh. Methods: A total of 326 children aged 6–23 months were included in the study. Study tools were predesigned and pretested questionnaire, modified infant and young child feeding practices questionnaire, and infantometer. Systematic random sampling with probability proportionate to size technique was utilized to drawn necessary sample size. Statistical analysis: Wald's statistics, Z-scores, and bivariate and multivariate logistic regression (LR) (stepwise backward LR) were used. Results: The prevalence of stunting in study population was 45.7% (95% CI - 40.1%, 51.1%); moderate stunting was 33.7% (95% CI - 28.8%, 39%); and severe stunting was 12% (95% CI - 8.8%, 16%). The prevalence of stunting was significantly associated with dietary diversity (OR - 0.17, 95% CI - 0.10–0.29) Conclusions: The study concludes that dietary diversity is a significant predictor of stunting. Therefore, interventions aimed at improving dietary diversity should be taken to reduce the burden of stunting among infants and young children.
  3,527 288 6
Assessment of perception and effectiveness of concept mapping in learning epidemiology
Urvish Joshi, Sheetal Vyas
January-March 2018, 43(1):37-39
DOI:10.4103/ijcm.IJCM_375_16  PMID:29531437
Background and Objectives: Current programs in medical education technology concentrate mainly upon “how-to-teach.” The focus is needed on learner's memory retention too. An innovative strategy like concept mapping might be a way forward. The study was carried out to assess its effectiveness and to know students' perceptions. Materials and Methods: During community medicine classes, a student-group was sensitized on how to make and use concept maps out of taught contents. At the end of epidemiology exercises sessions, this group was given additional minutes to prepare concept maps, interact, and brainstorm followed by quick QA session. Others were taught same contents in conventional way. Performances of both groups were assessed in one immediate (term-ending) and one distant (preliminary) exam. Feedback was also taken from study group. Results: Study group consistently scored higher in both exams. Difference in scored mean marks was highly significant in term-ending-examination (P < 0.0001, t = 5.754, df = 121.9). Largely positive feedback was received on utility of concept maps in memorizing, confidence-boosting, and understanding subject. Felt need for innovations in conventional teaching-learning (T-L) was palpable. Conclusion: Time has come to start focusing on enhancing students' learning. Performance-enhancing utility of concept maps is proven and should be integrated in regular T-L.
  3,130 217 2
Metabolic syndrome among adults of surendranagar District of Saurashtra, Gujarat: A cross-sectional Study
Chaitanya Gopalrao Chinawale, Dipak V Parmar, Parth Kavathia, Twinkle Rangnani, Jainy Thakkar, Girija Kartha
January-March 2018, 43(1):24-28
DOI:10.4103/ijcm.IJCM_339_16  PMID:29531434
Background: The metabolic syndrome (MetS) is a complex disorder and a major health concern in developing countries. Data on MetS in Indian population show multiplicity. There are no published reports about the prevalence of MetS in population of Saurashtra region, Gujarat. The aim of this study is to assess the prevalence of MetS and its components in adult population of this region. Methods: This cross-sectional observational study was carried out among 473 participants who attended free health checkup camps. Demographics, personal details along with anthropometric, clinical, and biochemical data were recorded. The MetS was diagnosed as per the definition provided by Joint Interim Statement 2009. Results: The overall prevalence of MetS among studied population was found to be 41.01% (females 44.21% and males 37.91%). Abdominal obesity (66.38%), low high-density lipoprotein-cholesterol (64.69%), and high blood pressure (40.59%) appeared as the most prevalent components. MetS showed a significant association with age, body mass index, total cholesterol, habit of chewing tobacco, and history of hypertension and hyperglycemia. Conclusion: The high prevalence of MetS shows that population of Saurashtra is at an increased risk of cardiovascular disease (CVD) and diabetes. This highlights the need for extensive diabetes and CVD prevention and control program in this region.
  3,007 250 2
Analysis of medical students perception for community medicine as career option and subject
Geetu Singh, Vishal Agarwal, SK Misra
January-March 2018, 43(1):56-57
DOI:10.4103/ijcm.IJCM_86_17  PMID:29531442
  2,910 263 -
An alternative approach for supportive supervision and skill measurements of health workers for integrated management of neonatal and childhood illnesses program in 10 districts of Haryana
Arun K Aggarwal, Rakesh Gupta, Dhritiman Das, Anar S Dhakar, Gourav Sharma, Himani Anand, Kamalpreet Kaur, Kiran Sheoran, Suresh Dalpath, Jaidev Khatri, Madhu Gupta
January-March 2018, 43(1):40-43
DOI:10.4103/ijcm.IJCM_402_16  PMID:29531438
Context: “Integrated Management of Neonatal and Childhood Illnesses” (IMNCI) needs regular supportive supervision (SS). Aims: The aim of this study was to find suitable SS model for implementing IMNCI. Settings and Design: This was a prospective interventional study in 10 high-focus districts of Haryana. Subjects and Methods: Two methods of SS were used: (a) visit to subcenters and home visits (model 1) and (b) organization of IMNCI clinics/camps at primary health center (PHC) and community health center (CHC) (model 2). Skill scores were measured at different time points. Routine IMNCI data from study block and randomly selected control block of each district were retrieved for 4 months before and after the training and supervision. Statistical Analysis Used: Change in percentage mean skill score difference and percentage difference in median number of children were assessed in two areas. Results: Mean skill scores increased significantly from 2.1 (pretest) to 7.0 (posttest 1). Supportive supervisory visits sustained and improved skill scores. While model 2 of SS could positively involve health system officials, model 1 was not well received. Outcome indicator in terms of number of children assessed showed a significant improvement in intervention areas. Conclusions: SS in IMNCI clinics/camps at PHC/CHC level and innovative skill scoring method is a promising approach.
  3,009 144 -
Capacity assessment of district health system in india on services for prevention and management of infertility
Sanjay Chauhan, Sayeed Unisa, Beena Joshi, Ragini Kulkarni, Amarjeet Singh, Thilakavathi Subramanian, Ramendra Narayan Chaudhuri, AC Baishya, Shalini Bharat, Anushree Patil, Achhelal Pasi, Dinesh Agarwal
January-March 2018, 43(1):19-23
DOI:10.4103/ijcm.IJCM_306_16  PMID:29531433
Background: Infertility is a neglected service component in the public health-care system in India. Objectives: This study aims to assess the availability and practices on prevention and management services for infertility in the district health system. Methodology: A cross-sectional survey of selected health facilities and the staff from 12 district hospitals (DHs), 24 community health centers (CHCs), 48 primary health centers (PHCs), and 48 subcenters was conducted using qualitative and quantitative methods. Interviewed staff included 26 gynecologists; 91 medical officers; 91 auxiliary nurse midwife; 67 laboratory technicians; and 84 accredited social health activist workers. Results: The findings indicate that adequate staff was in place at more than 70% of health facilities, but none of the staff had received any in-service training on infertility management. Most of the DHs had basic infrastructural and diagnostic facilities. However, the majority of the CHCs and PHCs had inadequate physical and diagnostic facilities related to infertility management. Semen examination service was not available at 94% of PHCs and 79% of CHCs. Advanced laboratory services were available in <42% at DHs and 8% at CHCs. Diagnostic laparoscopy and hysteroscopy were available in 25% and 8% of DHs, respectively. Ovulation induction with clomiphene was practiced at 83% and with gonadotropins at 33% of DHs. Conclusion: The district health infrastructure in India has a potential to provide basic services for infertility. With some policy decisions, resource inputs and capacity strengthening, it is possible to provide advanced services for infertility in the district health system.
  2,882 184 -
Depression effects on hospital cost of heart failure patients in California: An analysis by ethnicity and gender
Baqar A Husaini, Deborah Taira, Keith Norris, S Vivek Adhish, Majaz Moonis, Robert Levine
January-March 2018, 43(1):49-52
DOI:10.4103/ijcm.IJCM_151_17  PMID:29531440
Background: Depression often interferes with self-management and treatment of medical conditions. This may result in serious medical complications and escalated health-care cost. Objectives: Study distribution of heart failure (HF) cases estimates the prevalence of depression and its effects on HF-related hospital costs by ethnicity and gender. Methods: Secondary data files of California Hospital Discharge System for he year 2010 were examined. For patients with a HF diagnosis, details regarding depression, demographics, comorbid conditions, and hospital costs were studied. Age-adjusted HF rates and depression were examined for whites, blacks, Hispanics, and Asians/Pacific Islanders (AP) by comparing HF patients with depression (HF +D) versus HF without depression (HFND). Results: HF cases (n = 62,685; average age: 73) included nearly an equal number of males and females. HF rates were higher (P < 0.001) among blacks compared to Hispanics, AP, and whites and higher among males than females. One-fifth of HF patients had depression, higher among females and whites compared to males and other ethnic groups. Further, HF hospital costs for blacks and AP were higher (P < 0.001) compared to other groups. The cost for HF +D was 22% higher compared to HFND, across all gender and ethnic groups, largely due to higher comorbidities, more admissions, and longer hospitalization. Conclusion: Depression, ethnicity, and gender are all associated with increased hospital costs of HF patients. The higher HF and HF +D costs among blacks, AP, and males reflect additional burden of comorbidities (hypertension and diabetes). Prospective studies to assess if selective screening and treating depression among HF patients can reduce hospital costs are warranted.
  2,750 107 4
Epidemiology and management for health care
Purushottam A Giri
January-March 2018, 43(1):60-60
  2,678 170 -
Final leprosy push: Out of society
Pugazhenthan Thangaraju, Sajitha Venkatesan, MK Showkath Ali
January-March 2018, 43(1):58-59
DOI:10.4103/ijcm.IJCM_155_17  PMID:29531443
  2,551 127 6
The tolerability and efficacy of oral isotonic solution versus plain water in dengue patients: A randomized clinical trial
Leonard Nainggolan, Saptawati Bardosono, Ermita I Ibrahim Ilyas
January-March 2018, 43(1):29-33
DOI:10.4103/ijcm.IJCM_377_16  PMID:29531435
Background: Plasma leakage plays an important role in dengue infection, and this condition can lead to hemoconcentration, hypovolemia, and shock. Fluid replacement is the main treatment for dengue. There is a lack of evidence to support certain oral fluid therapy as a treatment for dengue patients. Objectives: The objective of this study is to evaluate tolerability and efficacy of oral isotonic solution (OIS) compared to plain water as a fluid replacement in dengue patients. Materials and Methods: A randomized, clinical trial with single-blinded groups was conducted to compare tolerability and efficacy of OIS and plain water in dengue patients. We evaluated gastrointestinal disturbances (nausea, vomiting, and bloating), body temperature, mean arterial pressure (MAP), fluid balance, hematocrit, Na+, and K+ levels. Data were analyzed with SPSS 20.0, and figures were made with GraphPad Prism version 5.01. Results: Twenty four subjects were included and divided equally into two groups. Our results showed that there are no significant differences but indicate several noteworthy trends. The intervention group (OIS) experienced less nausea, less vomiting, had positive fluid balance and higher MAP, and became afebrile faster compared to the control group (plain water). Conclusion: Although not statistically significant, this study shows the trend that OIS is well-tolerated and effective for dengue patients compared to plain water.
  1,755 180 2
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  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007